Tammy Baldwin on Health Care Democratic Representative (WI-2)

We need to build upon the Affordable Care Act

Hovde: I'm the one who was against Big Pharma. It's your Wall Street partner who invests in Big Pharma. You oversee it and take massive amounts of money. I can't even believe she would say that I don't want to negotiate against drug prices. I think drug prices are wildly too high. I will actually do something about it because I'm not taking Big Pharma money. I'm not taking special-interest money. Her partner is making money off of it and doesn't even disclose the profit she's making.

Address racial disparities in health care system

Tammy Baldwin (D): Increase. "No American should have to choose between basic necessities... and paying for the drugs they need." Introduced the Capping Prescription Costs Act. Supports expanding Obamacare, Medicare, and Medicaid. Calls for addressing "racial disparities that exist in our nation's health care system."

Eric Hovde (R): Decrease. "Obamacare created monopolies and oligarchies and wiped out the family doctor." Repeal it. It's "stupid" to keep young adults on their parents' insurance until age 26. Would continue protecting benefits for pre-existing conditions.

Good health care for all, especially the most vulnerable

Take repeal off the table & work to improve ObamaCare

Tammy Baldwin (D): Support. "Take repeal off the table & work to improve." Ultimately prefers Medicare for All.

Leah Vukmir (R): Repeal. "Leah supports full repeal of ObamaCare. Period."

Supports single payer, public option, and Medicare for all

Baldwin hasn't advocated for socialized medicine. But she has pushed "Medicare for all" legislation and she supports single payer and the public option--government elements that go beyond President Barack Obama's health care reform law.

MEDS Plan: Cover senior Rx under Medicare.

Summary of the Medicare Extention of Drugs To Seniors Act (Meds)

Coverage:

• First-dollar 80%/20% benefit (may charge beneficiary less for generics)
• Catastrophic coverage begins at $2000 out-of-pocket.
• No beneficiary would have to spend more than $2288 for prescription drugs (including premium)

Prescription Drug Prices:

• (Reimportation) Beginning 2003, all FDA-approved prescription would be allowed for importation at world market prices after being tested for safety. Once fully implemented, Medicare could set fee schedules based on imported drug prices.
• (Allen Bill) To eliminate price discrimination, manufacturers would charge Medicare and its beneficiaries the price equal to the lower of either the lowest price paid for the drug by other Federal Government agencies or the manufacturer’s best price for the drug.
• (Reasonable Prices) Drugs developed with taxpayer funds would be subject to “reasonable price” agreements when patents are transferred to pharmaceutical companies.

Premiums and Low-income Assistance:

The Government would subsidize low-income beneficiaries to the following levels:
• 100% of the premium and cost sharing for beneficiaries below 135% of poverty.
• Partial subsidy on a sliding scale for those between 135% and 150%

Employer Incentive Program:

Limit anti-trust lawsuits on health plans and insurers.

OFFICIAL CONGRESSIONAL SUMMARY:

• Delineates the relationship between the antitrust laws and negotiations between groups of health care professionals and health plans and health care insurance issuers.
• Applies the `rule of reason` standard to negotiations between a health plan and two or more physicians.
• Awards attorneys` fees to a substantially prevailing plaintiff only when the defendant`s conduct was unreasonable or in bad faith.
• Prohibits tying arrangements (linking the participation in one product line to participation in another) between a health plan and health care professional.
• Excludes from this Act any negotiations or agreements including Medicare, Medicaid, SCHIP, or other federal programs.

EXCERPTS FROM CONGRESSIONAL FINDINGS:

Congress finds the following:
1. A large number of Americans receive their health care coverage from managed health care plans.
2. The market power of insurance companies has increased tremendously since the early 1990`s, due to mergers and acquisitions.
3. Health plans improperly manipulate the practice of medicine through such mechanisms as inappropriately making medical necessity determinations, and knowingly denying and delaying payment.
4. The intent of the antitrust laws is to encourage competition and protect the consumer, and the current per se standard for enforcing the antitrust laws in the health care field frequently does not achieve these objectives.
5. An application of the `rule of reason` will tend to promote both competition and high-quality patient care.
6. In any action under the antitrust laws challenging a health plan, conduct shall not be deemed illegal per se, but shall be judged on the basis of its reasonableness, taking into account all relevant factors affecting competition and proposed contract terms.

LEGISLATIVE OUTCOME: Referred to the House Committee on the Judiciary; never called for a House vote.

Rated 100% by APHA, indicating a pro-public health record.

The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.

The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization`s preferred position.

Improve services for people with autism & their families.

Amends the Public Health Service Act to require the Secretary of Health and Human Services to:

1. convene, on behalf of the Interagency Autism Coordinating Committee, a Treatments, Interventions, and Services Evaluation Task Force to evaluate evidence-based biomedical and behavioral treatments and services for individuals with autism;
2. establish a multi-year demonstration grant program for states to provide evidence-based autism treatments, interventions, and services.
3. establish planning and demonstration grant programs for adults with autism;
4. award grants to states for access to autism services following diagnosis;
5. award grants to University Centers of Excellence for Developmental Disabilities to provide services and address the unmet needs of individuals with autism and their families;
6. make grants to protection and advocacy systems to address the needs of individuals with autism and other emerging populations of individuals with disabilities; and
7. award a grant to a national nonprofit organization for the establishment and maintenance of a national technical assistance center for autism services and information dissemination.
8. Directs the Comptroller General to issue a report on the financing of autism services and treatments.

Establish a national childhood cancer database.

Conquer Childhood Cancer Act of 2007 - A bill to advance medical research and treatments into pediatric cancers, ensure patients and families have access to the current treatments and information regarding pediatric cancers, establish a population-based national childhood cancer database, and promote public awareness of pediatric cancers.

Authorizes the Secretary to award grants to childhood cancer professional and direct service organizations for the expansion and widespread implementation of:
1. activities that provide information on treatment protocols to ensure early access to the best available therapies and clinical trials for pediatric cancers;
2. activities that provide available information on the late effects of pediatric cancer treatment to ensure access to necessary long-term medical and psychological care; and
3. direct resource services such as educational outreach for parents, information on school reentry and postsecondary education, and resource directories or referral services for financial assistance, psychological counseling, and other support services.

Establish a National Diabetes Coordinator.

A bill to reduce the incidence, progression, and impact of diabetes and its complications and establish the position of National Diabetes Coordinator. Establishes the position of National Diabetes Coordinator, whose duties shall be to:

1. serve as the principal advisor on reducing the rates of diabetes and its complications;
2. develop a measurement for the incidence of diabetes;
3. develop and coordinate implementation of a national strategy to reduce the incidence, progression, and impact of diabetes and its complications;
4. provide leadership and coordination to ensure that diabetes-related programs are coordinated internally and with those of relevant federal, state, and local agencies with a goal of avoiding duplication of effort, maximizing impact, and marshaling all government resources; and
5. coordinate public and private resources to develop and lead a public awareness campaign regarding the prevention and control of diabetes and its complications.

In carrying out the duties described, the Coordinator shall adhere to the mission of:
1. preventing diabetes in those individuals and populations at risk for the disease;
2. increasing detection of diabetes;
3. maximizing the return on diabetes research;
4. increasing diabetes control efforts;
5. improving the standard of diabetes care available; and
6. supplementing, but not supplanting, existing diabetes research programs.
7. Requires reports to the President on ways in which food programs and nutritional support can be better targeted at concerns specific to those at risk for diabetes or those already diagnosed whose complications could be reduced by more effective diet.

Remove restrictions on estriol (menopause medication).

A concurrent resolution expressing the sense of Congress that the Food and Drug Administration`s (FDA) new policy restricting women`s access to medications containing estriol does not serve the public interest.

• Whereas menopause is often a challenging transition for millions of women that requires specialized medications and medical treatments;
• Whereas physicians prescribe a variety of pharmaceutical treatment options to treat women experiencing the symptoms of menopause;
• Whereas individual women respond differently to different treatment options;
• Whereas women`s physicians determine on a case-by-case basis which treatment option is optimal for each woman;
• Whereas many physicians prescribe compounded estrogen and other bioidentical hormone treatments for patients for a variety of reasons;
• Whereas many physicians prescribe compounded estrogen treatments that contain estriol to treat menopausal and perimenopausal women;
• Whereas estriol is one of three estrogens produced by the human body;
• Whereas estriol has been prescribed and used for decades in the United States;
• Whereas the Food and Drug Administration (FDA) has announced that it will no longer permit compounding pharmacists to prepare medications containing estriol pursuant to a doctor`s prescription;
• Whereas insurers are now denying women reimbursement for compounded medications containing estriol as a result of the FDA`s announcement; and
• Whereas the FDA has acknowledged that it is unaware of any adverse events associated with use of compounded medications containing estriol:

Now, therefore, be it Resolved, That it is the sense of the Congress that--
1. physicians are in the best position to determine which medications are most appropriate for their patients;
2. the FDA should respect the physician-patient relationship; and
3. the FDA should reverse its policy that aims to eliminate patients` access to compounded medications containing estriol.

Require insurers to cover breast cancer treatment.

Congressional Summary: Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require coverage and radiation therapy for breast cancer treatment.

• Prohibits restricting benefits for any hospital length of stay to less than 48 hours in connection with a mastectomy or breast conserving surgery or 24 hours in connection with a lymph node dissection; or
• Prohibits requiring that a provider obtain authorization from the plan for prescribing any such length of stay.

Congressional Findings:

1. According to the American Cancer Society, excluding cancers of the skin, breast cancer is the most frequently diagnosed cancer in women.
2. An estimated 40,480 women and 450 men died from breast cancer in 2008, and an estimated 182,460 new cases of invasive breast cancer were diagnosed in women, plus 1,990 cases in men.
3. Most breast cancer patients undergo some type of surgical treatment.
4. Treatment for breast cancer varies according to type of insurance coverage and State of residence.
5. Currently, 20 States mandate minimum inpatient coverage after a patient undergoes a mastectomy.
6. Breast cancer patients have reported adverse outcomes, including infection and inadequately controlled pain, resulting from premature hospital discharge following breast cancer surgery. Source: H.R.111 11-HR111 on Jan 5, 2011

   Increase funding for occupational & physical therapy.

   Baldwin signed Medicare Access to Rehabilitation Services Act (MARS)

   Medicare Access to Rehabilitation Services Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act to repeal the cap on outpatient physical therapy, speech-language pathology, and occupational therapy services of the type furnished by a physician or as an incident to physicians` services.

   SEC. 2. OUTPATIENT THERAPY CAP REPEAL.

   Section 1833 of the Social Security Act (42 U.S.C. 1395(l)) is amended by striking subsection (g).

   [Explanatory note from Wikipedia.com `Therapy Cap`]:

   In 1997 Congress established per-person Medicare spending limits, or `therapy cap` for nonhospital outpatient therapy, but responding to concerns that some people with Medicare need extensive services, it has since placed temporary moratoriums on the caps. The therapy cap is a combined $1,810 Medicare cap for physical therapy and speech language pathology, and a separate $1,810 cap for occupational therapy ($1870 for 2011). Medicare patients requiring rehabilitation from disabilities, car accidents, hip injuries, stroke, and other ailments would be limited to roughly two months worth of treatments at an outpatient therapy clinic. Any patients that exceed the cap, whether they are healed or not, would have to stop therapy, or pay for the therapy services out of their own pocket.Several medical associations have lobbied against therapy caps because the bill inadvertently restricted disabled seniors, stroke patients, and other severe cases from receiving therapy treatments.

   Source: HR.1546&S829 11-HR1546 on Apr 14, 2011

   Establish a public insurance option via healthcare Exchanges.

   Baldwin co-sponsored Public Option Deficit Reduction Act

   Amends the Patient Protection and Affordable Care Act [PPACA, known as ObamaCare] to require Exchanges to offer a public health insurance option that ensures choice, competition, and stability of affordable, high-quality coverage throughout the United States. Declares that the primary responsibility is to create a low-cost plan without compromising quality or access to care. Sets forth provisions related to the establishment and governance of the public health insurance option, including that such plan:

   1. may be made available only through Exchanges;
   2. must comply with requirements applicable to other health benefits plans offered through such Exchanges; and
   3. must offer bronze, silver, and gold plan levels.
   Requires the Secretary of Health and Human Services to:
   1. establish an office of the ombudsman for the public health insurance option;
   2. collect such data as may be required to establish premiums and payment rates;
   3. establish geographically adjusted premiums at a level sufficient to fully finance the costs of the health benefits provided and administrative costs related to the operation of the plan; and
   4. establish payment rates and provide for greater payment rates for the first three years.
   Requires repayment of start-up costs for the public health insurance option. Authorizes the Secretary to utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option. Source: H.R.191 11-HR191 on Jan 5, 2011

   Opposes repealing ObamaCare.

   Baldwin opposes the CC Voters Guide question on ObamaCare

   Christian Coalition publishes a number of special voter educational materials including the Christian Coalition Voter Guides, which provide voters with critical information about where candidates stand on important faith and family issues. The Christian Coalition Voters Guide summarizes candidate stances on the following topic: "Repealing "Obamacare" that forces citizens to buy insurance or pay a tax"

   Source: Christian Coalition Voter Guide 12-CC-q5a on Oct 31, 2012

   Religious exemption from ObamaCare individual mandate.

   Baldwin co-sponsored H.R.631 & S.352

   Congressional Summary: To provide an additional religious exemption from the individual health coverage mandate. This Act may be cited as the `Equitable Access to Care and Health Act` or the `EACH Act`. The `Religious Conscience Exemption` exempts individuals who are members of a recognized religious sect which relies solely on a religious method of healing, and for whom the acceptance of medical health services would be inconsistent with their religious beliefs.

   Supporters reasons for voting YEA: (TheHill.com weblog, April 29, 2013): `We believe the EACH Act balances a respect for religious diversity against the need to prevent fraud and abuse,` wrote Reps. Aaron Schock (R-IL) and William Keating (D-MA). `It is imperative we expand the religious conscience exemption now as the Administration is verifying the various exemptions to the individual mandate,` they wrote. Religious exemption from ObamaCare has come up before, including contraception. The EACH Act, however, deals only with exemptions from the insurance mandate.

   Opponents reasons for voting NAY: (CHILD, Inc. `Children`s Healthcare Is a Legal Duty`, Dec. 2014): The Christian Science church is pushing hard to get another religious exemption through Congress. The EACH Act exempts everyone with `sincerely held religious beliefs` from the mandate to buy health insurance. We are particularly concerned about uninsured children: hundreds of American children have died because of their family`s religious objections to medical care. The EACH Act increases the risk to children in faith-healing sects and the cost to the state if the children do get medical care. Some complain that their church members should not have to pay for health care that they won`t use. But insurance works on the assumption that many in the pool of policyholders will not draw from it. Most people with fire insurance don`t have their homes burn, for example.

   Source: EACH Act 15_S352 on Feb 3, 2015

   Make health care a right, not a privilege.

   Baldwin adopted the Progressive Caucus Position Paper:
   The Progressive Caucus is united in its goal of making health care a right, not a privilege. Every person should have access to affordable, comprehensive and high-quality medical care. We must use our health care dollars efficiently and ensure public accountability in all medical decisions. Based on this goal, we support the following principles:
   1. All Americans, including the 44 million currently without health insurance, deserve to have the health care they need, regardless of ability to pay.
   2. Medicare must remain solvent and available for the millions of seniors and individuals with disabilities who rely on the program. The Progressive Caucus supports expanding the program to cover prescription drugs and other needed products and services for beneficiaries. We support a Medicare buy-in for individuals age 55 and older. We support lowering out-of-pocket costs for seniors who currently pay, on average, 20% of their income for health care.
   3. Proposals should be rejected to change traditional Medicare from a defined benefit to a defined contribution or voucher system.
   4. Balanced Budget Act cuts that are negatively affecting patient access to hospitals, nursing homes, and home health agencies must be restored.
   5. Medicaid must have the resources to continue to provide coverage and care for low-income individuals, including children in the CHIP program.
   6. Individuals with disabilities should retain their health benefits when they return to work and to have access to rehabilitative and other needed services.
   7. Funding and outreach and other programs serving low-income Americans should be expanded. Examples of such programs are the Children’s Health Insurance Program (CHIP); Qualified Medicare Beneficiary (QMB), Specified Low-income Medicare Beneficiary (SLMB), and Qualified Individuals programs; transitional funds for Medicaid recipients who are also welfare-to-work recipients; and for HHS for mental health outreach for the elderly.
   Source: CPC Position Paper: Health Care 99-CPC2 on Nov 11, 1999

   Supported funding women's health needs.

   Baldwin adopted the Women's Caucus policy agenda:
   The teams of the Women’s Caucus are charged with advancing action on their designated issues in a bipartisan manner. Legislation from Team 2A: WOMEN’S HEALTH:
   • HR49—Treatment of Children’s Deformities Act—require coverage for congenital or developmental deformity or disorder due to trauma, infection, tumor, or disease. (Kelly)
   • HR306—Genetic Information Nondiscrimination in Health Insurance Act—prohibit discrimination against individuals on the basis of genetic information. (Slaughter)
   • HR1285—Cancer Screening Coverage Act —require coverage of breast, cervical, prostate, and colorectal cancer screening. (Maloney/Kelly)
   • HR1388—Medicare Cancer Clinical Trial Coverage Act—officially expand Medicare coverage to clinical trials (N.Johnson/Cardin)
   • HR116—Breast Cancer Patient Protection Act—and HR383—Women’s Health and Cancer Rights Act—and HR1070—require coverage for a minimum hospital stay for mastectomies and treatment of breast cancer. (DeLauro/Kelly/Eshoo)
   • HR1816—Eliminate Colorectal Cancer Act—require coverage for colorectal cancer screenings. (Slaughter/McIntosh)
   • HR961—Ovarian Cancer Research and Information Amendments—provide for programs regarding ovarian cancer. (Mink)
   • HR845—Beneficiary Health Coverage Notification Rights Act—require notification of impending termination of coverage resulting from the failure of a group health plan to pay premiums. (Thurman)
   • HR1966—Asthma Awareness, Education and Treatment Act—carry out programs regarding the prevention and management of asthma and allergies. (Millender-McDonald)
   • H. Con. Res. 64—Cervical Cancer Public Awareness Resolution—recognizing the severity of the issue of cervical health. (Millender-McDonald)
   • H.Res. 19—expressing the seriousness of mental illness. (Roukema)
   • HR1899—The Health Care Worker Needlestick Prevention Act—require regulations to minimize the risk of needlestick injury to health care workers. (Roukema/Stark)
   Source: Women's Caucus Agenda-106th Congress 99-WC2 on Jul 15, 1999

   Supported funding older women's health.

   Baldwin adopted the Women's Caucus policy agenda:
   The teams of the Women’s Caucus are charged with advancing action on their designated issues in a bipartisan manner. Legislation from Team 2B: OLDER WOMEN’S HEALTH:
   • HR762—Lupus Research and Care Amendments of 1999—A bill to provide for research and services with respect to lupus. (Meek)
   • HR925—Osteoporosis Early Detection and Prevention Act of 1999—A bill to require that health insurance plans provide coverage for qualified individuals for bone mass measurement. (Maloney/Morella)
   • HR933—Osteoporosis Federal Employee Health Benefits Standardization Act of 1999—A bill to ensure that coverage of bone mass measurement is provided under the health benefits program for federal employees (Morella)
   • HR1187—Medicare Medical Nutrition Therapy Act of 1999—A bill to provide for coverage under part B of the Medicare Program of medical nutrition therapy services furnished by registered dietitians and nutrition professionals. (N. Johnson)
   • HR2294—Osteoporosis Education and Prevention Act of 1999—A bill to amend the Older Americans Act of 1965 to help prevent osteoporosis. (Berkley/Roukema/DeLauro/Maloney)
   • HR2471—Public Health Osteoporosis Screening, Diagnosis, and Treatment Act of 1999—A bill to amend the Public Health Service Act to provide for screenings, referrals, and education regarding osteoporosis. (E.B. Johnson/Kelly)
   Source: Women's Caucus Agenda-106th Congress 99-WC3 on Jul 15, 1999

   Supported funding Prenatal and Postpartum Care.

   Baldwin adopted the Women's Caucus policy agenda:
   The teams of the Women’s Caucus are charged with advancing action on their designated issues in a bipartisan manner. Legislation from Team 3B: Prenatal and Postpartum Care:
   • HR 1843—Mothers and Newborns Health Insurance Act—improve prenatal care and delivery of healthy babies by enrolling pregnant women under state CHIP programs and allowing the option of automatically enrolling the babies born to those women in CHIP. (Hyde/Lowey)
   • HR2538—Folic Acid Promotion and Birth Defects Prevention Act—provide for a national folic acid education program to prevent birth defects. 70% of neural tube birth defects could be prevented if women of childbearing age consumed 400 micrograms of folic acid daily. The problem is that a majority of women are still not aware of the benefits of folic acid, nor are they consuming the recommended daily amount. (Roybal-Allard/Emerson)
   • H. Res. 163—raise awareness of post partum depression. Approximately 400,000 women experience post partum depression each year. More than just the “baby blues,” the more extreme cases of post partum depression can result in sadness, fatigue, anxiety, irritability, and low self esteem in new mothers. The resolution provides statistics, and provides recommendations on how the US can work to reduce its incidence, including providing information, training of medical providers, and screening of new mothers for symptoms for early detection of the problem. Additionally, the resolution calls on the U.S. to begin to collect data on post partum depression, so that we can measure its extent. (Capps-Kingston)
   • HR1848—Right to Breastfeed Act—ensure a woman’s right to breastfeed her child on any part of federal property (federal parks, federal buildings, and national museums) where she and her child have a right to be. (Maloney/Morella/Roybal-Allard) [STATUS: enacted as part of the FY2000 Treasury-Postal Appropriations bill]
   Source: Women's Caucus Agenda-106th Congress 99-WC5 on Jul 15, 1999

   Supported funding Family and Children's Coverage.

   Baldwin adopted the Women's Caucus policy agenda:
   The teams of the Women’s Caucus are charged with advancing action on their designated issues in a bipartisan manner. Legislation from Team 3D: Family Planning and Children’s Coverage:
   • HR 1806—Access to Women’s Health Care Act —provide women in managed care plans with direct access to ob/gyn services and the option of choosing their ob/gyn provider (including non-physicians specialists) as their primary care provider. (Lowey/Lazio)
   • HR 1636—Teen Pregnancy Reduction Act—The federal government spends more than $200 million annually specifically for teen pregnancy programs or services. These amounts demonstrate a significant investment in a national effort to prevent teen pregnancy. However, we know very little about the effectiveness of teen pregnancy prevention programs because adequate evaluation is not taking place. In an effort to bolster evaluation of teen pregnancy prevention programs of every type, the bill would provide for both a substantial investment in rigorous, scientific evaluation as well as the dissemination of information on programs, models and processes that have proven effective in preventing teen pregnancy. (Lowey/Castle)
   • HR 827—Improved Maternal and Children’s Health Coverage Act of 1999—expand health coverage for uninsured children by improving the outreach to an enrollment of children into Medicaid and the State Children’s Health Insurance Program (S-CHIP). (DeGette)
   • HR 1085—Healthy Kids Act 2000—improve health care for pregnant women and newborns by ensuring direct access to obstetric and gynecological care for women and pediatric care for children, by giving states greater flexibility by allowing them to enroll income-eligible pregnant women in State Children’s Health Insurance Program (CHIP) and by increasing enrollment of Medicaid-eligible women. This bill also includes sections for pediatric medical education, public health promotion, and research. (Emerson)
   Source: Women's Caucus Agenda-106th Congress 99-WC6 on Jul 15, 1999

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