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<P ALIGN="left"> September 29, 2007

<H2>Health Insurance News</H2> <P ALIGN="left"> Florida Health Insurance Web Examines Republican Stand on Health Insurance <P ALIGN="left"> The State of Florida is home to millions of uninsured residents. According to health insurance experts, most Floridians cannot afford the health care plans currently offered in the state, or they simply hope for the best, and live without health insurance at all. "If you are one of those millions in Florida without medical coverage; you might want to take a close look at each the 2008 Candidates for President, and see where they stand on health care," said Morgan Moran, a Florida health insurance consultant. <P ALIGN="left"> Florida Health Insurance Web, in its continuing series, examines the 2008 presidential race and its impact on the State of Florida and how the election may effect Florida Health Insurance benefits and available rates. Morgan Moran in a

phone interview said the "sadly the Republican candidates offer little to help Florida's uninsured." Insurance consultant Moran said, If you're one of the tens of million Americans without coverage, or if you don't like the coverage you have, "next November you will have a chance to pick the person who will deliver the best health care plan." So far, "the Democrats seem to be winning the health insurance debate. <P ALIGN="left"> Democratic Senator Hillary Clinton spoke about her health care plan which, according to Moran, "gives the choice of health insurance plans to pick from and, Clinton said her insurance coverage plans will be affordable." Clinton also said, if you like the health insurance plan you currently have, you can keep it, or switch to a less expensive plan. <P ALIGN="left"> On the other side of the isle, Republicans are pointing to terror and border security rather than addressing Americas health care crisis. <P ALIGN="left"> Republican Senator John McCain's website John McCain under 'the issues', fails to mention healthcare, Moran said, instead of giving America a health plan; "McCain is focusing on 'fighting Islamic Extremists, Government Spending, Border Security, and Iraq." To be fair, McCain is not the only Republican ignoring healthcare. Former Mayor Rudy Giuliani has posted nothing about health insurance in his bid for the White House. His Join Rudy web site says, the issues for the upcoming election are: Fiscal Discipline, Cutting Taxes, Winning the War on Terror, Iraq, Public Safety, Judges, Education, The Right to Bear Arms and Marriage. <P ALIGN="left"> Governor Mitt Romney, on his 'True Strength for America's Future' website Mitt Romney has his list of campaign issues as: Defeating the Jihadists, Competing with Asia, Taxes, Immigration, Energy, Education and yes, finally, Healthcare. In USA Today, July 5, 2005 Romney said, "We can't have 40 million people saying, 'I don't have insurance', and if I get sick, I want someone else to pay." Individuals have responsibility for their own health care. Romney went on to say "The health of our nation can be improved by extending health insurance to all Americans, not through a government program or new taxes, but through market reforms." <P ALIGN="left"> Arkansas Governor Mike Huckabee's campaign said, "The health care system in this country is irrevocably broken, in part because it is only a 'health care' system, not a 'health' system." Huckabee said, "We don't need universal health care mandated by federal edict or funded through ever-higher taxes." We can make health care more affordable by reforming medical liability; adopting electronic record keeping; making health insurance more portable from one job to another; expanding health savings accounts to everyone, not just those with high deductibles; and making health insurance tax deductible for individuals and families as it now is for businesses, the Gov said. <P ALIGN="left"> Senator Sam Brownback on his web site said the "healthcare system will thrive with increased consumer choice, consumer control and real competition." Brownback went on to say "I will continue to work at the forefront to create a consumer-centered, not government-centered, healthcare model that offer both affordable coverage choices and put the consumer in the driver's seat." <P ALIGN="left"> Congressmen Tom Tancredo stand on health care focuses on the uninsured. Tancredo said, "The two major problems are the high cost of care and the number of uninsured." Tort reform and immigration enforcement would save the system billions and drive down costs. As for the uninsured: as many as 25% of them are illegal aliens and should be deported or encouraged to leave. For citizens and legal residents who are employed by businesses which cannot afford coverage, "Tancredo favors association health plans which band small businesses together to access lower cost insurance." For those out of work, state governments should be the

primary source of relief, although I would not rule out federal incentives or limited subsidies to make sure families who have fallen on hard times are not without coverage.

<H3>Medicare Coverage & Cancer</H3> <P ALIGN="LEFT"> A 2003 overhaul of Medicare that changed the way oncologists are reimbursed for their services did not alter cancer patients' perceptions of their quality of care, a new survey found. <P ALIGN="LEFT"> The poll also found that cancer patients are waiting the same amount of time for chemotherapy treatments to begin and traveling the same distance to a treatment location as they did before 2003. <P ALIGN="LEFT"> "In 2003, Congress changed the way Medicare charges for oncology therapy, and following that there was a lot of controversy and concern that, in fact, patients would be denied access," said study co-author Dr. Kevin Schulman. <P ALIGN="LEFT"> "But at least in terms of what we found in this survey, there is no evidence that that has occurred," he said. "We did find some evidence that patients who didn't have supplemental insurance might have some negative changes -- more difficulty with access. But it was a really small number of people -- too small to say that definitively." <P ALIGN="LEFT"> Schulman is a professor of medicine and director of the Center for Clinical and Genetic Economics at Duke University's Clinical Research Institute. His team's finding were published online Oct. 8 in the journal Cancer and were expected to be published in the Nov. 15 print issue. <P ALIGN="LEFT"> The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 is widely considered the most sweeping change made to the government-run health insurance program since its inception in 1965. <P ALIGN="LEFT"> Key alterations included adding a new prescription drug benefit and expanding subsidies for rural hospitals. At the same time, however, Medicare reimbursements to oncologists for cancer treatments were cut by 30 percent to 40 percent -raising fears of service cuts, staff lay-offs, facility consolidations, and a resulting drop in patient access to timely quality care, the study authors said. <P ALIGN="LEFT"> To gauge how close those fears match reality, Schulman and his colleagues began an Internet survey of cancer patients in 2006. <P ALIGN="LEFT"> Approximately 1,400 men and women participated, drawn from every Medicare jurisdiction in the United States. The majority were female and white, with an average age of 60. About one-quarter came from rural areas, and about half said they had private, employer-based health insurance when they began treatment -insurance that supplemented their Medicare coverage for those 65 and older. <P ALIGN="LEFT"> About half the patients had started and finished their chemotherapy treatment between January 2003 and January 2005; the other half began their treatment in February 2005 and continued on. <P ALIGN="LEFT"> Patients were asked about their type of cancer, insurance status, income, educational background, race/ethnicity, waiting time for treatment, travel time to treatment facility, changes in facilities or physicians, and overall satisfaction with their care and ability to handle out-of pocket costs. <P ALIGN="LEFT">

The study authors found that among those 65 and older, the wait time for chemotherapy treatment following diagnosis was the same both before and after 2003: three weeks. <P ALIGN="LEFT"> Most patients 65 and older on either side of the Medicare changes said it took about 30 minutes to get to their treatment center. And only 12 percent of both groups of patients said their health-care location had changed during their treatment regimen. <P ALIGN="LEFT"> Sixty-five percent of all patients 65 and older said they were "very satisfied" with their oncologist's services, and 76 percent said they were "very satisfied" with staff service at their place of chemotherapy treatment. <P ALIGN="LEFT"> Among younger patients, the number who were "very satisfied" with their oncologist actually rose from 58 percent pre-2003 to 67 percent post-2003. <P ALIGN="LEFT"> However, when it came to out-of-pocket costs, the post-2003 picture wasn't as rosy. While 46 percent of those 65 and older said they had money left over after paying out-of-pocket expenses before the Medicare changes of 2003, less than 26 percent said the same was true after 2003. <P ALIGN="LEFT"> Rural patients now appear to be waiting nearly a week longer for treatment to begin -- almost four weeks, compared with three -- since the changes were put into place. <P ALIGN="LEFT"> But, patients without any private insurance to supplement their Medicare said there was virtually no change in waiting times -- an average of 4.3 weeks before 2003, compared with four weeks after 2003. <P ALIGN="LEFT"> While the authors called for additional research to continue monitoring the impact of the Medicare changes, they concluded that physician reimbursement reductions have not yet had a major impact on patient care. <P ALIGN="LEFT"> "Given the amount of controversy at the time the changes took place, I think our findings were surprising to us," Schulman said. "But, at some level, I think the good news is that the policy process seems to have been responsive to the expressed concerns and helped to mitigate them." <P ALIGN="LEFT"> Others took issue with Schulman's evaluation, suggesting that the Medicare glass is actually half empty, not half full. <P ALIGN="LEFT"> "I'm surprised that the finding is neutral. I would've expected that the findings would be better," said Robert M. Hayes, president of the Medicare Rights Center, an independent, nonprofit national consumer service organization. "And they should be so much better given the amount of public money invested. But there's no sign of improvement." <P ALIGN="LEFT"> "So, I'd say that this is another call for structural reform of Medicare," Hayes added. "Putting tens of billions of dollars into a program that seems not to be having any improved impact on very sick people raises obvious concerns about how well designed the program is. And this is another piece of evidence suggesting that we could be getting so much more positive outcome than we are." <P ALIGN="LEFT"> <HR>

<H3>Medicaid Spending Jumps</H3> <P ALIGN="left">

Medicaid spending has started to soar again, a sharp reversal from last year when costs unexpectedly fell for the first time since the program began in 1965. The state-federal health care program for the poor experienced a 10.7% jump in costs during the first six months of the year, according to a USA TODAY analysis of Bureau of Economic Analysis data. That's the biggest increase since 2001 and puts Medicaid on pace to spend a record $330 billion in 2007. <P ALIGN="left"> "States are going to have to make some tough decisions on who receives care, what care they get and what the limitations are," says Robert Campbell, vice chairman of Deloitte & Touche USA, an accounting and consulting firm that works with state and local governments. <P ALIGN="left"> He expects costs to continue to rise for the foreseeable future as states try to reduce the number of the uninsured amid rising medical costs. <P ALIGN="left"> Higher Medicaid spending could squeeze state finances at a time when revenue growth in many states is being slowed by the slumping housing market. State tax collections have grown about 5% this year, down from 9% growth in 2005, according to Bureau of Economic Analysis data. Medicaid recently surpassed education as the biggest item in state budgets. <P ALIGN="left"> The Medicaid spending burst may signal the end of a two-year period when costs seemed to be coming under control. Costs grew 5.1% in 2005 and declined 1.7% in 2006. <P ALIGN="left"> Spending fell last year because a variety of cost controls — such as moving patients from nursing homes to lower-cost home health care — produced unexpectedly large savings. Also, Medicaid shifted some costs into the new Medicare prescription-drug benefit program. Medicare, the federal program for the elderly, will cost about $440 billion this year. <P ALIGN="left"> Medicaid and the related Children's Health Insurance Program are state-run health insurance plans for the poor. States pay 43% of the cost. The federal government pays the rest and sets broad rules. Medicaid pays nursing home costs for seniors who have exhausted their savings. <P ALIGN="left"> It's not clear why Medicaid costs have started to rise again. Possible causes: <P ALIGN="left"> •Efforts to cover the uninsured. States have won federal approval to expand coverage to groups that don't normally qualify for Medicaid, Campbell says. These high-profile efforts to reduce the uninsured population rely heavily on the federal government paying costs through the Medicaid and children's health programs. The Bush administration had encouraged these efforts until recently but now is expressing concerns about costs. President Bush last week vetoed expanding the child health program, saying it has gone too far beyond its mission of insuring low-income children. <P ALIGN="left"> •Enrollment growth. Medicaid temporarily bumped tens of thousands of qualified people from the program last year because Congress imposed tougher proof-ofcitizenship requirements. Now, the application backlog is being cleared and retroactive payments made for medical costs incurred in 2006.

<P ALIGN="left"> •Paying doctors and hospitals more. Boosted by strong tax collections, many states have increased what they pay for Medicaid services. In most states, Medicaid pays less than private insurance or Medicare. <P ALIGN="left">

<HR> <H3>Giuliani Plan For Health Insurance</H3> <P ALIGN="left">Former New York City mayor and current presidential candidate Rudy Giuliani made headlines at a mid-August campaign stop in Columbia, South Carolina by warning of the dangers of "socialized medicine" and mentioning Democrat candidates are advocating a "nanny state" and may raise taxes by as much as 30 percent. <P ALIGN="left"> Two weeks earlier, on July 30, Giuliani had rolled out his own proposal to reform the U.S. health care system. On the list of "12 Commitments" that embody Giuliani's platform, No. 7, "[giving] Americans more control over and access to health care," is the focus of the proposal. <P ALIGN="left"> The plan was developed by Giuliani's team of health policy experts and free-market champions: Dr. Dan Kessler and Dr. Scott Atlas from the Hoover Institution, Dr. David Gratzer of the Manhattan Institute, Sally Pipes of the Pacific Research Institute, former Centers for Medicare and Medicaid Services (CMS) Administrator Dr. Mark McClellan, and consultant Don Moran.<P ALIGN="left"> The team reports to Giuliani's chief domestic advisor, former Indianapolis Mayor Steve Goldsmith, who held the same position in President George W. Bush's 2000 campaign. <P ALIGN="left"> Tax Deductions Key <P ALIGN="left"> Giuliani's plan centers on a concept Bush proposed in his January 2007 State of the Union address to provide tax deductions for those who buy health insurance--up to $15,000 for a family or $7,500 for an individual. <P ALIGN="left"> Taxpayers would get the full benefits of the deduction even if the insurance they purchased cost less, and payroll taxes on the deducted income would be recaptured. However, Giuliani's campaign has declined comment on who will recapture that money and how it will be used. The idea never gained enough traction to move on Capitol Hill and was declared "dead on arrival" by opponents. <P ALIGN="left"> Fostering Innovation <P ALIGN="left"> Under Giuliani's plan, Health Savings Accounts (HSAs) also would be expanded and improved. <P ALIGN="left"> And, borrowing from Bush's Value-Driven Health Care program (currently being spearheaded by Health and Human Services Secretary Mike Leavitt), Giuliani's plan includes investing in health information technology and increasing the transparency of health care cost and quality data. It is widely accepted that this kind of information is critical to the success of consumer-driven health care.

<P ALIGN="left"> Giuliani's plan would create a health insurance credit for low-income Americans that could be coordinated with employer contributions or government funds to purchase health insurance. <P ALIGN="left"> This idea has drawn fire both from the left, which alleges it will further privatize public health programs, and from the right. Michael Cannon, director of health policy studies at the libertarian Cato Institute in Washington, DC, suggested it "would increase government's influence and make health care markets less free." <P ALIGN="left"> Block Grants Possible <P ALIGN="left"> Guiliani also advocates block grants to encourage state innovation. While many state initiatives feature positive reform elements, others violate federal law and jeopardize the health care currently provided to more than 100 million Americans under employer-sponsored plans. <P ALIGN="left"> The business community is awaiting elaboration from Giuliani's campaign on whether his administration would withhold block grants from states whose health plans violate federal law. <P ALIGN="left"> Giuliani's proposal also mentions tying Medicaid payments to states' successes in promoting preventive care and lowering childhood obesity--a move supporters say could eventually lead to savings and to quality improvements in the Medicaid program. <P ALIGN="left"> The plan targets further savings by overhauling the Food and Drug Administration processes of approving prescription drugs to bring new drugs to the market faster. <P ALIGN="left"> Challenges to Reform <P ALIGN="left"> Giuliani's plan includes allowing interstate purchases of health insurance and creating incentives that encourage wellness, prevention, and chronic-disease management in health plans. He also promises medical liability (tort) reform. <P ALIGN="left"> These are initiatives reformers have been advocating for some time but have been unable to achieve on Capitol Hill. In the 109th Congress, Rep. John Shadegg (R-AZ) and Sen. Jim DeMint (R-SC) introduced bills that would allow Americans to buy insurance across state lines, and Sen. John Ensign (R-NV) developed several medical liability reform proposals. All were soundly defeated, and the policies have even fewer backers in the 110th Congress. <P ALIGN="left">

<Hr> <H3>Insurance SCAM</H3> <P ALIGN="left"> A recent federal audit has revealed that private insurance companies have been denying legitimate claims to Medicare recipients and put into practice deceptive marketing. Since March, 11th, health insurance companies have also been fined more

than $770,000 for issues involving Medicare recipients. <P ALIGN="left"> This revelation comes at a time when health insurance companies are under scrutiny for claim denials in their non-Medicare programs. The New York Times reviewed 91 audit reports and found a huge backlog “of claims and complaints”. The report also describes “improper termination of coverage for people with H.I.V. and AIDS.” <P ALIGN="left"> It is common practice for health insurance companies to change their plan benefits. Medicare officials say that three of the largest health insurance company participants in the Medicare market, UnitedHealth, Humana and WellPoint, have failed to give “timely” notice to their policyholders of those changes. <P ALIGN="left"> There are other problems. The report states that the health insurance companies have delayed access to urgently needed medications. They called the violation widespread and “could directly affect the health of patients”. <P ALIGN="left"> But it gets worse. Back in July, Medicare terminated its contract with a company in Florida. This left 11,000 residents without any health coverage. <P ALIGN="left"> There are problems with the new Medicare Part D drug coverage program as well. Robert Pear of the Times reports that the same abuses are involved in the new drug program. <P ALIGN="left"> There are also problems with the Medicare Advantage program, which provides doctor’s visits and hospital care. These plans have grown from 4.7 million participants in 2003 to more than 8 million today. <P ALIGN="left"> There were two common problem areas: Marketing and the way the companies handled their appeals. The deceptive marketing problems were most prevalent in the Medicare Advantage products. The problems were so widespread that in June the seven largest companies involved in the program, suspended sales of Advantage programs. <P ALIGN="left"> The Times gave some examples of problems with specific health insurance companies. UnitedHealth had to make changes after it was found that they denied claims without any explanation. WellPoint had a backlog of approximately 354,000 claims. Sierra Health Services “ended drug coverage for more than 2,300 Medicare beneficiaries with H.I.V./AIDS”. <P ALIGN="left"> Humana had complaints about their marketing. Also, the company did not always tell the beneficiaries about changes in their drug coverage. <P ALIGN="left"> Sterling Life Insurance had a problem paying claims. The company “demonstrated pattern of failure,” according to the report. <P ALIGN="left"> Health care costs have been escalating over the past decade. The Government Accountability Office (GAO) lists Medicare as a "high-risk" government program in need of reform, in part because of its vulnerability to fraud and partly because of its long-term financial problems. <P ALIGN="left">


<H3>S-CHIP COVERAGE</H3> <P ALIGN="left"> Lawrence’s U.S. House members Dennis Moore and Nancy Boyda, both Democrats, voted for the proposed State Children’s Health Insurance increase and say they will vote to override President Bush’s veto of the bill. <P ALIGN="left"> But Nick Jordan, a Republican seeking to unseat Moore in 2008, says if he were in Congress, he would support Bush’s veto. <P ALIGN="left"> Moore represents the 3rd Congressional District, which includes East Lawrence. <P ALIGN="left"> Meanwhile, the campaign of Republican Jim Ryun, who wants to unseat Boyda, criticized the proposed SCHIP bill. And Treasurer Lynn Jenkins, another Republican who also wants to challenge Boyda, declined to say whether she supported the SCHIP bill or Bush’s veto. <P ALIGN="left"> Boyda represents the 2nd Congressional District, which includes west Lawrence. <P ALIGN="left"> Congress has approved a $35 billion increase over the next five years to SCHIP, a program that provides low-cost health coverage to 6.6 million children from families who earn too much to qualify for Medicaid but earn too little to afford most private insurance policies. The increase would be funded by a 61-cent per pack increase in the cigarette tax. In Kansas, the program provides health care to approximately 35,000 children. <P ALIGN="left"> Bush vetoed the proposed increase, saying it was too expensive and would lead to socialized medicine by luring some families from private insurance to governmentrun insurance. <P ALIGN="left"> Ryun’s campaign manager, Kyle Robertson, sided with Bush. <P ALIGN="left"> “We need to find a responsible way to fund the program without raising taxes or making it easier for illegal immigrants to receive taxpayer-funded health care,” Robertson said. <P ALIGN="left"> But supporters of the bill have denied that the program would go toward illegal immigrants, saying that a provision requiring people to show Social Security cards would prevent that from happening. <P ALIGN="left"> Jenkins, who will face Ryun in the Republican primary, declined to answer what she would have done about the bill if she were in Congress. <P ALIGN="left"> “I haven’t looked closely at the specific proposals, and unfortunately with everything as partisan as it is in Congress these days, folks can’t work out a compromise,” she said. “It seems to me that a Congress and president concerned about budgets and health care could come to a compromise instead of typical Washington gridlock.” <P ALIGN="left"> Both Moore and Boyda have been supporters of the SCHIP bill, which passed both the House and Senate with bipartisan support. <P ALIGN="left"> Moore said the proposal makes SCHIP “stronger and more efficient.” <P ALIGN="left"> Boyda stated: “SCHIP has not only proven successful at covering uninsured children, but it’s cost-effective to taxpayers. Health insurance prevents lowincome families from using the emergency room — the most expensive health care resource — as a first-stop clinic.” <P ALIGN="left">

<HR> <H3>End of Pre-existing Conditions</H3> <P ALIGN="left"> Medical insurance policy-holders can now rejoice. Insurance companies are reviewing claims settlement norms in case of preexisting diseases. This means, insurers may soon no longer deprive mediclaim holders for claims under the clause of “non-disclosure of diseases”. <P ALIGN="left"> Accordingly, policyholders who never underwent treatment nor showed symptoms of a disease before signing a policy document are likely to get the medical policy benefits in future. <P ALIGN="left"> At present, insurance companies often decline to settle insurance claims in case policyholders are diagnosed to have contracted the disease prior to the signing the mediclaim policy. <P ALIGN="left"> This is likely to change. The General Insurance Council of India, in consultation with all insurers, is working on the appropriate definition of preexisting diseases. <P ALIGN="left"> “Policyholders who did not undergo any diagnosis or treatment or show indications of a disease prior to the signing of a contract should not be considered in the know of having any preexisting disease,” said Mr BD Banerjee, a member of the committee, appointed by Insurance Regulatory and Development Authority (Irda) for examining issues related to health insurance for senior citizens. <P ALIGN="left"> He was talking to reporters on the sidelines of an interactive session on health insurance, organised by Bengal Chamber of Commerce and Industry here on Saturday. The seven-member committee is likely to submit its report by the first week of November. It is slated to meet in Mumbai from October 9 to 11. <P ALIGN="left"> The insurance regulator was formed by the committee in May this year in the wake of a over 200% hike in premium for medical insurance policies after September 2006. The insurers increased the premium for senior citizens defying the regulator’s advice not to hike it more than 70%. <P ALIGN="left"> Mr Banerjee felt “most private insurers turn down health policies to people aged above 60. Among the public sector insurers, only Oriental Insurance as of now does not offer health insurance policies to senior citizens. It has, however, applied for a policy for senior citizens to Irda. <P ALIGN="left"> Issues relating to health insurance for the elderly need special focus, as they are more vulnerable and fall in a higher risk category.

<P ALIGN="left">

<hr> Every Democratic and Republican presidential hopeful has come up with a health care plan for the nation. Some blueprints are more ambitious than others, but there is a collective acknowledgment that America's health care system is ailing. <P ALIGN="left"> The conversation to fix it, which began during the administration of Franklin D. Roosevelt, took a serious turn during the Clinton administration 14 years ago. It was ultimately dragged down by fear-mongering over a highly complicated plan conceived in secrecy by then-first lady Hillary Rodham Clinton. <P ALIGN="left"> Mrs. Clinton is now running for president, and her health care plan is more comprehensible than the earlier version, although it still has holes regarding universal coverage and realistic financing. <P ALIGN="left"> For several years after the Hillarycare debacle, most politicians were reluctant to lead on health care, even as the need for a better system grew. <P ALIGN="left"> Twenty years ago, 29.5 million Americans under the age of 65 had no health insurance. Today, that number is 44.8 million, surely a blot on the nation. Most of the uninsured live in working families and do not qualify for government help through Medicaid. <P ALIGN="left"> The number of uninsured is expected to continue rising. Moreover, the quality of care has deteriorated. Waiting times to see physicians has grown. Try making an appointment with a neurologist or urologist a month ahead. <P ALIGN="left"> Adversity creates opportunity for change, however. Pollsters tell us a majority of Americans favor guaranteed health care. Powerful interest groups from business, labor, hospitals and even insurers are calling for action. Automobile manufacturers are asking for a bigger government role in ensuring universal coverage. <P ALIGN="left"> The presidential candidates are responding because constituents are asking for,

and in many cases demanding, remedies. <P ALIGN="left"> It's not enough to run for or against the trillion-dollar war in Iraq, deal with Iran and make peace between Arabs and Israelis. Even those who have health care protection are uncertain about the future of their health care. <P ALIGN="left"> The federal government is failing to rise to the challenge. We have the most expensive health care system in the world, but Medicare's budget is under strain and Medicaid is in perpetual crisis. The government borrows money to keep both programs solvent. <P ALIGN="left"> The United States has the most technologically advanced health care system. Yet measured by key outcomes (life expectancy, infant mortality, access and affordability), our country doesn't rank among the top industrialized nations. <P ALIGN="left"> America remains alone among the rich and not-so-rich nations in the lack of health care coverage for all its citizens. The need for universal health care should be high on the agenda for next year's national election. It should not fall victim to foreign policy issues. <P ALIGN="left">

<HR> <H1>The Future?</H1> <P ALIGN="left"> In the face of polls that consistently cite health care as the voters' leading domestic concern, presidential candidates in both parties have offered a welter of proposals on how they would extend availability and contain costs, which now consume an estimated 16 percent of the gross domestic product. <P ALIGN="left"> Leading Democrats want to provide coverage to the estimated 47 million Americans who lack health care of any kind. The Republican candidates argue that the way to a better health care system lies in a greater role for the free market, not a greater role for the government. <P ALIGN="left"> Democrats have been willing to project overall price tags on sometimes ambitious plans, but even the most detailed blueprints leave unanswered important questions on how they would work in practice. <P ALIGN="left"> Candidates of both parties talk optimistically about driving down costs through systemic changes such as preventing medical errors, better record-keeping and steps to enhance preventive care and the spread of optimum treatment practices. But few health care experts see any realistic possibility for a real reduction in the price tag of a system that is as central to the health of the economy as it is to that of individuals.

<P ALIGN="left"> "I realize that they are running for office and outlining directional strategies, and often, during an election, that's as far as anyone is willing to go," said Rosemarie Greco, director of Pennsylvania's Office of Health Care Reform. "I would like a more concrete understanding of how they intend to proceed." <P ALIGN="left"> Those nitty-gritty answers are elusive. <P ALIGN="left"> Former Sen. John Edwards, of North Carolina, for example, staked out the health care issue early with a detailed plan for universal care. It asserts that its reforms would allow uninsured families to purchase coverage "at an affordable cost," and enable employers to "find it cheaper and easier to insure their workers." But no specific numbers are attached to those promises. <P ALIGN="left"> Former New York Mayor Rudy Giuliani proposes a system of tax deductions and credits to allow individuals to purchase coverage. But it would be a leap in the dark to see whether such tax breaks would be enough to provide coverage for most people, including those with chronic health problems. <P ALIGN="left"> Sen. Hillary Rodham Clinton, of New York, has called for a refundable tax credit to limit premiums to a percentage of income. But at this point, the percentage is undefined, so, however valuable it is as a concept, its worth to individual Americans is tough to assess. <P ALIGN="left"> While there has been much debate, chiefly on the Democratic side, on the plight of the uninsured, last week's strike and eventual agreement at General Motors highlighted another profound challenge for the nation's health care system, and one that has been the focus of less attention on the campaign trail. <P ALIGN="left"> GM's $51 billion in unfunded promises for health care is just one example of the unfunded liabilities of firms and governments across the nation. Pennsylvania, for example, projects an unfunded liability for retiree health care of roughly $14 billion. <P ALIGN="left"> Mrs. Clinton's health care plan includes a Retiree Health Care Legacy Initiative designed to give certain businesses and public health care systems some measure of relief. The plan discusses tax credits to defray part of the costs of insuring care for catastrophic illnesses. A spokesman for the Clinton campaign said the benefit would be extended to companies with a high ratio of retirees to workers. <P ALIGN="left"> It would also include a sunset provision, designed to cope with the enormous but temporary demographic challenge posed by the bulge of baby boom retirees. But the campaign could not explain a precise level or mechanism for the tax credit. The plan is meant to apply to certain public sector retirees as well but how the tax code could be used to help public systems is not clear either. <P ALIGN="left"> Some of the highlights of the health care concepts discussed in the campaign so far.

<P ALIGN="left"> The Democrats: <P ALIGN="left"> Sen. Hillary Rodham Clinton's is the latest of the health care proposals unveiled by the Democratic candidates. She estimates its cost at $110 billion. Like Former Sen. John Edwards, she would demand that every American have health insurance. She would ask that employers either cover their workers directly or pay for their costs under one of the other options of her plan. To soften the requirement for smaller businesses, she would offer a tax credit for coverage. Individuals could enroll in private insurance programs patterned on the options given to federal employees or join a new public insurance program modeled on Medicare. <P ALIGN="left"> Edwards has called for a similar insurance mandate for employers along with a coverage mandate for individuals. Although he maintains that his plan would ease the costs of covering employees, he does not call for the same tax credit mechanism for small business. His option for coverage include new "health care markets" -- large purchasing pools that would allow businesses and individuals to take advantage of economies of scale in obtaining coverage. He estimates that his plan would cost between $90 billion and $120 billion. <P ALIGN="left"> In addition to private insurers, the new health care markets would include a public coverage option modeled on Medicare. Over time, if enough individuals and employers end up opting for the Medicare clone, it could evolve into something resembling the single-payer system in place in many other countries. <P ALIGN="left">None of the Democrats, however, with the exception of Rep. Dennis Kucinich, is proposing a near-term overall shift to a single-payer system. <P ALIGN="left"> Like Edwards and Clinton, Sen. Barack Obama, of Illinois, would mandate employer contributions for the cost of health care. He would require coverage for all children but not for adults, although he argues that the cost savings he'd promote at the same time would have the effect of moving the country to universal coverage. In a feature common to the Democratic plans, he would demand that insurers be barred from refusing or terminating coverage because of medical history. Obama would create a so-called national insurance exchange designed to make it easier for consumers to shop among private plans, along with a public option modeled on choices available to federal workers. Obama has projected his plan's cost at between $50 billion and $65 billion. <P ALIGN="left"> The Republicans <P ALIGN="left"> Former Massachusetts Gov. Mitt Romney is the Republican most identified with health care reform. As governor, he was one of the architects of an innovative Massachusetts program that mandates coverage while creating a "connector" to provide information about private plans along with a state sponsored program for basic coverage. The plan has attracted national attention. Romney, however, does not want to use it as a model for the nation. Rather, he has called for the 50 states to be the incubators of health care reforms with a general reliance on the private market. He has encouraged the health savings accounts favored by the Bush administration. He would use tax breaks to make it easier for individuals to

purchase insurance and would shift Medicaid funding to states to a block grant to allow more latitude for experimentation. <P ALIGN="left"> In contrast to the Massachusetts model, he would not mandate coverage for individuals. And in common with his GOP rivals, he does not hold out universal coverage as a near-term priority for national health care policy. <P ALIGN="left"> Giuliani similarly heralds the private market as the best bet to deliver better coverage and cost control. He would provide a tax deduction for individuals purchasing health insurance along with tax credit for lower income Americans to obtain coverage. He would offer block grants to states to promote innovation in coverage solutions, including issues such as the difficulty in obtaining coverage for individuals with prior medical conditions. Giuliani, who was once treated for prostate cancer, contends that the private market is the most reliable promoter of the kind of high quality health care he received. He has denounced various Democratic proposals as recipes for "socialized medicine." <P ALIGN="left"> Former Tennessee senator Fred Thompson, relatively new to the race, warns against bigger government solutions to health care, but has offered few specifics as yet on what initiatives he might promote. <P ALIGN="left"> "Those who propose a one-size-fits-all Washington-controlled program ignore the cost, inefficiency, and inadequate care that such a system offers," he says in a statement on his Web site. "Access to affordable, portable health care can be made available for all Americans without imposing new mandates or raising taxes." <P ALIGN="left"> Sen. John McCain of Arizona, focused chiefly on national security, hasn't offered any detailed proposals on health care in the course of the campaign. <P ALIGN="left">

<HR> <H2>Bush Out Of Touch</H2> <P ALIGN="left">The Bush administration is talking more loudly about compromise on children's health insurance. That sounds like President Bush has begun to worry that he is completely out of touch with the public. <P ALIGN="left"> If other Republicans want to help working families, the quickest route would be for a few more of them to agree to override the president's veto of a bipartisan plan for expanding insurance opportunities. The president put preserving insurers' market shares ahead of protecting kids.

<P ALIGN="left"> Mike Leavitt, Bush's secretary of Health and Human Services, said Sunday that the president would be willing to compromise. But there already is enough compromise in the bipartisan plan to add an estimated 4 million children to insurance coverage. An earlier House version of the bill would have added 6 million kids, much closer to making a real dent in the scandalous situation of a rich country denying routine health care to children. <P ALIGN="left"> With polls showing big support for doing more, Leavitt's likely aim is to keep House GOP backing for the veto. The administration also could be worried about lawsuits by Washington and other states on rule changes to block better coverage. <P ALIGN="left"> In this state, only U.S. Rep. Doc Hastings backs Bush, with an ever-changing array of explanations. The bottom line remains the same: Without the bipartisan bill, more kids than necessary will be denied coverage, even if Bush does compromise. <P ALIGN="left">

<HR> <P ALIGN="left"> Call it the health insurance companies and nursing homes versus doctors and the AARP, a classic, inside-the-Beltway struggle that erupted when House Democrats sought changes to Medicare. <P ALIGN="left"> Publicly, all sides trumpeted their concern for older people in the United States and scarcely mentioned their own financial and political self-interests, if at all. <P ALIGN="left"> Together, they have spent millions on lobbyists, television ads and polling to influence lawmakers. They stand ready to renew the battle this fall, all the while previewing possible lines of attack for the 2008 elections. <P ALIGN="left"> _"The bill preserves access for Medicare patients and lowers seniors' out of pocket costs," the American Medical Association and AARP said in ads endorsing the Democrats' bill. <P ALIGN="left"> Not mentioned was that the legislation would put $65 billion more into doctors' pockets over the next decade. Or that AARP, which has 39 million members over age 50, was eager to court favor with Democrats newly in control of the House. <P ALIGN="left"> _"Three million seniors could be pushed out of their Medicare Advantage plan, while millions more will have to pay higher out-of-pocket costs for health care and lose important benefits they depend on," the American Health Insurance Plans countered in their ad opposing the bill. <P ALIGN="left"> Left unsaid was that the measure would cut $157 billion over a decade from planned payments to the companies that operate Medicare health maintenance organizations

under the Medicare Advantage program. <P ALIGN="left"> _"Slashing billions could jeopardize quality, threaten thousands of health care jobs and return Medicare funding to levels of almost a decade ago," two nursing home groups said in ads that angered top Democratic lawmakers. <P ALIGN="left"> No word, however, that payments to the nursing homes would drop by $6.5 billion over a decade. The commercials were financed by the Alliance for Quality Nursing Home and the American Health Care Association. <P ALIGN="left"> The flash point for the high-dollar struggle was a complex bill that passed the House with two separate, largely unrelated halves. <P ALIGN="left"> One included an expansion of health insurance for lower-income children, largely paid for with higher tobacco taxes. <P ALIGN="left"> The second made numerous multibillion-dollar changes in Medicare, which covers about 43 million elderly and disabled people. The largest change took $157 billion from private plans that Republicans long nurtured as an alternative to the traditional government-run program. <P ALIGN="left"> Democrats wanted to use much of that money to raise Medicare fees to doctors, who otherwise face a 10 percent cut on Jan. 1., and provide more aid for lower-income beneficiaries. <P ALIGN="left"> Ultimately, Democrats broke their bill in two and temporarily sidetracked the Medicare changes. <P ALIGN="left"> The children's health care issue is now at the center of a veto struggle between Congress and the White House. To the irritation of the administration, the interest groups that parted company over Medicare are virtually unanimous in supporting expanded kids' health insurance. <P ALIGN="left"> Still, the maneuvering over Medicare has been a quiet presence in recent weeks and is certain to flare when Democrats turn anew to the issue. <P ALIGN="left"> In the interim, some Democrats strategists express concern that vulnerable lawmakers needlessly exposed themselves to potential political harm by voting to roll back private Medicare, only to have the measure sidetracked. <P ALIGN="left"> Rep. Steny Hoyer, the House majority leader, rejected that contention recently. "I don't think we put any member at risk," Hoyer, D-Md., said at a news conference. <P ALIGN="left"> First-term Rep. Rep. Jason Altmire, D-Pa., attacked for supporting the bill, was satisfied with his vote afterward. "You have to make tough choices to move the ball forward," he said, citing the need to prevent a cut in Medicare payments to

doctors. <P ALIGN="left"> House Republicans previewed a possible campaign season line of attack. For a small amount of money, their campaign committee ran an ad in a weekly newspaper in Altmire's district. Older people "could lose preventative care, face higher out of pocket costs for their stays and pay more for their prescription drugs," it said. <P ALIGN="left"> Said Altmire: "I'm not excited politically for the opportunity for an opponent" to use the issue. <P ALIGN="left"> Statistics compiled by the Center for Responsive Politics show that the health service/HMO industry has made more than $8 million in campaign donations from 2005-2006. Republicans got 60 percent of the money. <P ALIGN="left"> At its heart, the struggle over Medicare touches on ideology as well as politics. <P ALIGN="left"> Many Democrats vehemently oppose GOP-driven changes in Medicare in recent years that revitalized a private Medicare market for insurance companies. <P ALIGN="left"> More than 8 million older people are enrolled for private coverage, about 18 percent of the total Medicare population. The share is expected to rise to 22 percent by next year. <P ALIGN="left"> The government pays an estimated $112 on Medicare patients in private coverage for every $100 it spends on the traditional program. Critics say the private alternative is wasteful. Supporters argue it often provides benefits such as vision care that are unavailable in government-run Medicare. <P ALIGN="left"> House Democrats decided to eliminate that $12 difference gradually, assuming that many plans would disappear and people would return to government-run coverage. <P ALIGN="left"> Outside interests on both sides quickly enlisted Democratic strategists and lobbyists for help with the new majority. <P ALIGN="left"> United Health Group circulated a memo from prominent Democratic pollster Mark Mellman. "A vote to cut Medicare Advantage will elicit major negative political consequences," he predicted. He added that 54 percent of Republicans, 66 percent of Democrats and 57 percent of swing independents believe that "cutting Medicare is a very convincing reason to vote against a candidate." <P ALIGN="left"> Democrats lined up groups in support of their bill. <P ALIGN="left"> No endorsement loomed as important as the one bestowed by the AARP. Polling consistently shows that older voters view the group as the most trustworthy source of information on issues such as Medicare and Social Security.

<P ALIGN="left"> Backing the measure required something of a turnabout for AARP. The group infuriated Democrats in 2003 when it supported the Republican legislation that launched the Medicare Advantage program. More than a dozen lawmakers, aides and lobbyists said AARP officials made it clear privately their current goal was to aid Speaker Nancy Pelosi, D-Calif., and the newly empowered Democrats. <P ALIGN="left"> Drew Nannis, an AARP spokesman, said, "Our position has not changed on wanting to level the playing field between private ... plans and traditional Medicare payment rates passed in the 2003 bill." <P ALIGN="left"> For insurance companies and AARP alike, the fight is far from over. Democrats are determined to prevent the Jan. 1 cut in doctor fees, and they still must find money to cover the costs. <P ALIGN="left">

<HR> <P ALIGN="left"> Bush’s veto of health care plan for kids can be overridden <P ALIGN="left"> By RUBY L. BAILEY <P ALIGN="left"> U.S. Rep. John Dingell said he believes he has a chance of getting enough congressional support to override a presidential veto of his expanded health care plan for children. <P ALIGN="left"> The Dearborn Democrat appeared today at Oakwood Hospital in Dearborn, and said he’s working to get the votes to override President George W. Bush’s Oct. 3 veto of the State Children’s Health Insurance Program Reauthorization Act (SCHIP). <P ALIGN="left"> House Democrats plan to hold an override vote on Oct 18, Dingell said. Republicans have said they can sustain the veto. <P ALIGN="left"> SCHIP covered 6.6 million low-income children whose families are not eligible for Medicaid insurance but who cannot afford private health insurance. In Michigan, the program, known as MIChild, covers about 55,000 children monthly. If approved, the bill would have extended coverage to an additional 4 million children nationally and as many as 25,000 in Michigan. <P ALIGN="left"> “We have no other choice but to override this veto,” Dingell told the group of

doctors, nurses and others at a news conference. Dingell wrote the legislation, which called for spending $35 billion over five years to expand the benefits to $60 billion. <P ALIGN="left"> Bush and other critics said the measure would have expanded the program to cover middle-class children and raised taxes. The bill would have been funded by a 61cents-per-pack increase in the tobacco tax. <P ALIGN="left">


<P ALIGN="left"> As House members are at home for the Columbus Day weekend, a coalition of labor and advocacy groups is stepping up the battle over the federal children's healthcare program, known as SCHIP. <P ALIGN="left"> House Speaker Nancy Pelosi says she hopes to "peel off" 14 Republican votes for the SCHIP bill. <P ALIGN="left"> The coalition, which includes the AFL-CIO and MoveOn.org, rolled out a nearly $1 million television ad campaign and is targeting about 20 Republicans to vote to override the president's veto of the bill. <P ALIGN="left"> The national ad, sponsored by Americans United for Change, an umbrella group of liberal organizations, is running on cable networks. <P ALIGN="left"> It includes images of a baby and other children with an announcer saying "George Bush just vetoed Abby." The coalition also promises to rally activists in districts of another 20 House Republicans over the next two weeks. <P ALIGN="left"> This push by Democratic groups comes on top of the Democratic Congressional Campaign Committee's efforts to zero in on eight House Republicans who opposed the bill. The campaign arm started running radio ads and funding automated calls to voters last week in districts it considers competitive for Democratic challengers. Watch Speaker Nancy Pelosi call for the override of Bush's veto » <P ALIGN="left"> Sunday, House Speaker Nancy Pelosi, D-California, sounded cautiously optimistic in an interview with Fox News about her party's chances. <P ALIGN="left">

Democrats begin push to override SCHIP "We take it one day at a time," Pelosi than 20 votes" in the House to get the veto. Pelosi admitted Democrats needed against the bill last month.

veto said, adding that Democrats needed "less two-thirds vote required to override the to "peel off" 14 Republicans who voted

<P ALIGN="left"> A vote in the House is scheduled for October 18. <P ALIGN="left"> On Sunday, Health and Human Services Secretary Mike Leavitt told the Associated Press he expected the House to sustain the president's veto. <P ALIGN="left"> Leavitt also told the AP President Bush was willing to work with Democrats to reauthorize the current program, which covers children from families with incomes up to 200 percent of the poverty level, and to increase funding by 20 percent. <P ALIGN="left"> "The president knows bad policy when he sees it," Leavitt told the AP. "But we need to have a serious conversation that involves all of the points of view." <P ALIGN="left"> In his weekly radio address Saturday, Bush said, "If putting poor children first takes a little more than the 20 percent increase I have proposed in my budget for SCHIP, I am willing to work with leaders in Congress to find the additional money." <P ALIGN="left"> Forty-five Republicans voted with the Democrats on September 25 to reauthorize the program and direct $35 billion over the next five years to states to cover children's health-care costs. Eight Democrats voted against the bill. <P ALIGN="left"> Despite the two-week delay on the override vote, designed to pressure Republicans, House GOP leaders sounded confident heading into the weekend that there would not be any additional Republican defections. House GOP Whip Roy Blunt, R-Missouri, predicted Wednesday the number of Republican votes against the measure "will go up, not down." <P ALIGN="left"> House Republican Conference Chairman Adam Putnam, R-Florida, said Thursday that GOP leaders expected to pick up more votes against overriding the veto from at least a couple of Republicans who were absent for the first SCHIP vote. <P ALIGN="left"> Asked Sunday about President Bush's suggestion that there was room for compromise on the size of the program, Pelosi said, "It's hard to imagine how we could diminish the number of children who are covered. The president calls himself the decider, and I don't know why he would want to decide that one child has health care and another does not." <P ALIGN="left"> House Democratic Whip James Clyburn of South Carolina said if the veto is upheld, House Democrats should push for an even broader version of the children's healthcare bill, even if it is opposed in the Senate. <P ALIGN="left">

He argued Democrats would gain politically if Republicans blocked the program. <P ALIGN="left"> "And let's say to them, go ahead, filibuster," he said. "Our base will understand what a filibuster is, the American people will understand what a filibuster is. They don't understand this 60-vote-rule business. But they remember which party filibustered against all the civil rights bills back in the '50s and '60s, and to have that same party stand up there and start filibustering against health care for children? Man, I would love that picture <P ALIGN="left">

<HR> <P ALIGN="left"> Florida has millions of residents who need basic health coverage, and still millions more who cannot afford the coverage they currently have. If you are one of the millions in this state without coverage, or if you can't afford, or don't like the coverage you have, you might want to take a look at Presidential Candidate Hillary Clinton's health care plan. Clinton's American Health Choices Plan "has coverage for all of us, guaranteed at a price everyone can afford" said Morgan Moran, a Florida health insurance consultant. <P ALIGN="left"> Moran in a phone interview said a few candidates, Senator Hillary Clinton (D), Former Sen. Edwards (D), and Sen. Romney (R), have mentioned health care at various fund raising events in the past few weeks, but Hillary Clinton's 'American Health Choices' insurance plan seems to be getting the most attention from the media, some calling it "very promising." Insurance consultant Moran said, If you're one of the tens of million Americans without coverage, or if you don't like the coverage you have, "you will have a choice of health insurance plans to pick from and best of all, coverage will be affordable." Of course, if you like the health insurance plan you have, you can keep it. <P ALIGN="left"> The Clinton camp posted on their website that "Clinton's health care plan will secure, simplify and ensure choice in health coverage for all Americans". <P ALIGN="left"> Clinton said "Insurance companies won't be able to deny you coverage or drop you" <P ALIGN="left"> The insurance plan from Clinton differs in many ways from current health insurance plans. The new proposal provides tax credits for working families to help them cover their costs. Moran said, "The tax credits will ensure that working families never have to pay more than a limited percentage of their income for health care." Some of the innovative ideas in this plan will put an end to discrimination for pre-existing conditions. The insurance companies will not be able to deny coverage

to you anymore" health insurance consultant Moran said. <P ALIGN="left"> "Insurance companies won't be able to deny you coverage or drop you" because their computer model says you're not worth it. They will have to offer and renew coverage to anyone who applies and pays their premium. And like other things that you buy, they will have to compete for your business based on quality and price. "Families will have the security of knowing that if they become ill or lose their jobs, they won't lose their coverage." <P ALIGN="left"> The new array of choices offered in the Clinton plan will "provide benefits at least as good as the typical plan offered to Members of Congress", which includes mental health parity and usually dental coverage. Clinton promises "that job loss or family illnesses will never lead to a loss of coverage or exorbitant costs." One important thing to note, said Moran, "Americans who are satisfied with the coverage they have today can keep it, while benefiting from lower premiums and higher quality." It looks like a win-win situation. Individuals will be required to get, and keep insurance in a system where insurance is affordable and accessible. <HR>

<H2>Health Insurance Consultant</H2>

Florida Health Insurance Web -- Morgan Moran -- (800) 554-9142

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