All blog posts related to the issue: Health Care
  • Medicare for Future Generations

    Today, we celebrate 48 years since the Medicare and Medicaid programs were signed into law.

    By signing these laws, Lyndon Johnson pledged that the most vulnerable Americans would always have the medical care they needed. Sustaining the promise of Medicare and Medicaid requires stretching every dollar to the fullest, and making sure that the programs keep up with the changing needs of the people they serve.

    These programs have fulfilled their promise, but it’s important to reflect on the challenges ahead.

    Medicare, in particular, is on an unsustainable fiscal path over the long-term. Every day, for the next two decades, we are adding 10,000 new enrollees per day. Yet, if left unchanged, the program will be insolvent in 2026.

    The needs of people being served by Medicare have also changed a great deal over the last 48 years. Americans are not only working longer and living longer, they are generally sicker than their parents were when they first enrolled in the program. Today, it’s far more common for seniors to suffer from multiple chronic conditions like heart disease, high blood pressure, cancer or diabetes.

    To get seniors the best possible care – and the best health outcomes – at the lowest possible cost, there needs to be a shift in the way that Medicare deals with chronic illness. Insurers and providers throughout the country should be allowed, and encouraged, to work in multidisciplinary teams to focus on chronic care. It’s an opportunity to save money and provide better care so that seniors can live healthier lives, with security and dignity. Essentially, it means making good on the Medicare guarantee.

    The Affordable Care Act (ACA) provided some very important steps forward, and we already seeing positive results for millions of Americans. But, our job is far from done. Now, we must build on the forward momentum of the ACA and take additional steps to reach the goal of a fully integrated, patient-centered health care system for all.

  • Wyden Outlines Major Medicare Reforms at Accountable Care Organization Summit

    Today Senator Wyden outlined major Medicare reforms at the Accountable Care Ogranization (ACO) Summit. 

    Through reform of the accountable care program, ACOs can improve the care of Americans with chronic disease while driving down costs. Reform will also be aimed not only at addressing Medicare’s major cost driver, chronic conditions, but also at improving health outcomes and the quality of care for patients.


    Watch Senator Wyden's speech here or read below:

    Wyden Keynote Speech at Accountable Care Organization Summit by Senator Ron Wyden

  • Wyden op-ed: To Save Medicare, Think Like The Patients

    The Atlantic: Senator Ron Wyden has been an advocate for senior citizens for nearly four decades. Prior to joining Congress, Wyden served as the director of Oregon Legal Services for the Elderly, was a member of the Oregon State Board of Examiners of Nursing Home Administrators and a co-founder of the Oregon Gray Panthers. He penned an op-ed recalling the evolution of Medicare and the pressing need for meaningful reform to keep the promise of Medicare to millions of American seniors.

    "Medicare" means different things to different people. Some say it's the best argument for a national single-payer health insurance system. Others will tell you that it's the federal budget's biggest villain, while election strategists call it a campaign defining issue. However, for the nation's 50 million Medicare beneficiaries, Medicare is neither an ideological argument nor a political talking point. For them, Medicare is their health insurance plan. 

    Of course, it's more than just a health insurance plan. It is a lifeline for millions of our senior citizens. Before Congress created Medicare, in 1965, more than 50 percent of American seniors didn't have health insurance, mostly because the increased health risks associated with aging made health insurance unaffordable. At the time, it was not uncommon for the sick elderly to be treated like second-class citizens, and many aging Americans ended up destitute without necessary health care.

    Medicare changed that. As a rock-solid guarantee of essential health services for every American over the age of 65, Medicare has been our country's most important social safety net. But as a health insurance plan, Medicare has never been perfect.

    From its outset, Medicare only covered essential inpatient (Part A) and outpatient (Part B) services, which has long meant that seniors had to purchase supplemental private insurance to cover what Medicare does not. One of the reasons I ran for Congress in the early 1980s was to help regulate the market for supplemental Medicare insurance plans, because unscrupulous agents were exploiting holes in the Medicare law to sell seniors worthless policies. (In 1990, former Senator Tom Daschle and I passed the "Medigap" law to regulate the market for supplemental Medicare insurance.)

    In 1997, Congress passed Medicare Part C to give Medicare beneficiaries the choice to receive their Medicare benefits through a private health insurance plan. This reform has become a lifeline for seniors in states like Oregon, where Medicare's low reimbursement rates have made it increasingly hard for seniors to find a doctor. Right now, 41 percent of Oregon's Medicare beneficiaries get their Medicare from a private insurance company.   

    In 2003, Congress added Medicare Part D to give seniors a prescription drug benefit that had not previously been available through Medicare. And the Affordable Care Act (ACA), passed in 2010, included a number of provisions to enhance Medicare's preventative care services, while ensuring that more seniors have high-quality private sector options in addition to traditional Medicare.

    Yet some seniors still find that Medicare fails to meet all of their health care needs. While the ACA included an annual out-of-pocket cap and removed lifetime limits for insured Americans under the age of 65, there remains no catastrophic benefit in the Medicare program, and Medicare continues to enforce a lifetime limit on the number of days Medicare beneficiaries can spend in the hospital.  

    Medicare's copays and deductibles are also not insignificant for American seniors, 62 percent of whom currently live on a fixed-income of less than $30,000 a year. For example, while Americans under the age of 65 pay an average of 3 percent of their total income on health care, Americans over the age of 65 are currently spending 16 percent of their total income on their health needs.  

    As a fee-for-service health insurance plan, Medicare, like much of our health care system, promotes quantity over quality, by reimbursing providers for the number of services they perform versus the quality of their care. States that have found ways to lower Medicare costs, like Oregon, continue to be punished with lower reimbursement rates for providers, for the very reason that they have established lower annual costs. Meanwhile, Congress's inability to come up with a long-term solution for Medicare's provider reimbursement problems means that more and more doctors are limiting the number of Medicare beneficiaries they are willing to treat--just at the time when, as of the beginning of this year, 10,000 Americans turn 65 every day, a rate that will continue for the next 20 years. The Congressional Budget Office projects that the Medicare Hospital Trust Fund will run out of money in ten years. If Congress does nothing before that time, we will be reneging on the promise of Medicare to millions of American seniors.

    Yes, Medicare means many things to many people. But upholding the guarantees of Medicare requires each of us to start thinking like the 50 million Americans who rely on it for their health benefits. Those 50 million Americans don't care about talking points or ideological battles nearly as much as they care about being able to find a doctor and get the care they need when they need it. Unless Congress starts looking for meaningful solutions to ensure that every Medicare beneficiary will be able to find a doctor and get needed care, seniors are going to be the ones forced to endure increasingly higher premiums and arbitrary cuts to benefits--until Medicare doesn't guarantee much of anything.

    Learn more about Wyden’s recent Medicare reform proposals: Medicare Better Health Rewards and Wyden-Ryan white paper.

  • Standing Up for Seniors, Wyden Outlines Medicare Reform Principles

    As the Senate debated various budget proposals this week, Senator Wyden cut through the rhetoric fueled by ideology and stood up – once again – for America’s most vulnerable.

    Citing his own experience working for Oregon’s elderly, Senator Wyden rallied to defend Meals on Wheels, the home-delivery food program that is a lifeline for so many of our seniors. In the state of Oregon, nearly 52,000 seniors rely on these hot, nutritious meals. The fact that these meals are delivered by thousands of generous volunteers provides these older folks regular contact with someone who cares.  Some of these budgets would have cut Meals on Wheels funding anywhere from 17-59%, a staggering amount considering the great impact the program has on the lives of tens of thousands – an even greater impact given the financial hardship of the Americans it serves. 

    As Congress tackles the various challenges of increasing federal commitments, however, the future of Medicare is front and center.  Wyden spoke plainly stating, “We are going to have…for the next 20 years, 10,000 seniors turning 65 every single day….If nothing is done, the Medicare guarantee is in peril.”  Senator Wyden believes doing nothing is not an option and instead laid out principles that he feels must be included to achieve meaningful Medicare Reform, including:

    1. Preserving Traditional Medicare
    2. Protection for the sickest & most vulnerable (meaning, among other things, Medicaid may not be block-granted)
    3. Strong, comprehensive consumer protections
    4. Maintain Medicare’s purchasing power so that competition between government and private sector innovation can make each other better

    Finally, as in every major reform Senator Wyden has spearheaded, any effort at Medicare Reform must be bipartisan. Protecting the Medicare Guarantee is too important to let partisan politics get in the way.

    Watch highlights of Senator Wyden’s speech:

    Learn more about Wyden’s bipartisan Medicare reform proposal with Representative Paul Ryan:

  • ICYMI: Register-Guard Lauds Wyden’s Efforts on Medicare Reform, Compares to Buying Wine

    On Friday, the Register-Guard’s Don Kahle published an opinion piece on the challenges to reform government-run health care, highlighting Senator Wyden’s innovative and bipartisan efforts to improve health care for seniors while adding more choice and competition. Earlier this spring Wyden also introduced legislation with Senator Rob Portman (R-Ohio) which experts say could save Medicare billions by helping seniors get and stay healthy.

     “The Medicare reform package put together by Wyden — along with Rep. Paul Ryan, R-Wisc. — uses a Vickrey auction to set local prices for privately run health care plans. Government-run Medicare coverage would then be required to at least match that benefit package. Those on the political left expect the “single-payer” option (aka traditional Medicare) to offer more benefits at the same price.

    Wyden has shrewdly devised a system where the private sector sets the price and defines the package of benefits.

    Government sets the minimum coverage required by all, but then only has to match or exceed what the Vickrey auction winner will provide.

    Setting limits or recognizing synergies will be done by companies competing for access to the senior health care market.

    Wyden’s plan has outsourced any “death panels” to private companies. Sometimes, we do want a government that “leads from behind.”

    What does all this have to do with wine?

    Restaurateurs long ago noticed that diners instinctively emulate a Vickrey auction. Most choose the second cheapest wine on the menu.

    Restaurant owners take advantage of this tendency and often make their second least expensive wine also their most profitable. In other words, you may be getting less quality at a higher price when you choose the wine that looks “safest” to your eye (and your social pride.)

    Wine lists are in this way no different than medical procedures.

    Whether it’s a Rogue Valley cabernet or a silver nitrate ulcer cauterization, consumers lack information about what it should cost. And they’re in no place or mood to do the necessary research.

    But Wyden does his homework. His plan combines the efficiency of capitalism with the effectiveness of government.

    I’d trust him to fill the glasses before these two leaders toast Oregon’s inventive medical solutions.”

    Click here to read the full Register-Guard article.

    Click here to learn about Senator Wyden’s bipartisan Medicare reform proposal.

    Click here to learn about Senators Wyden & Portman’s Better Health Rewards program.

  • Preserving the Medicare Guarantee: Why I've Been Working with Paul Ryan

    (Note: This blog was originally posted by Senator Wyden on Huffington Post.)

    People on both sides of the aisle want to know why a progressive Democrat is working with the author of last year's House Budget on Medicare reform. Here's why:

    When I was 27 years old, I organized legal aid clinics to help low-income seniors. It was a life-altering experience. I'd be invited into someone's home and after coffee and a few stories about the grandkids or the Great Depression, my host would reluctantly pull out a shoebox, swallow his or her pride and ask for my help.

    The shoebox would be full of supplemental Medicare insurance policies. Often there were more than 10 separate policies. These policies were supposed to cover the benefits, co-pays and deductibles that Medicare didn't, but most weren't worth the paper they were printed on. Unscrupulous insurance agents would prey on a senior's health concerns and fear of being a burden on loved ones in order to extract monthly payments often for multiple policies that offered benefits that the senior already had, didn't need and usually couldn't afford.

    The victims of these scams -- seniors who had lived through two world wars -- would look at me with shame in their eyes and tell me that they should have known better.

    Stopping those insurance rip-offs was one of the reasons I ran for Congress.

    Fighting for Seniors

    It took a little over a decade to build a coalition strong enough to beat the insurance companies, but in 1990, then Senator Tom Daschle and I passed a law regulating the private market for supplemental Medicare insurance policies. We created benefitstandards so that seniors would know exactly what they were signing up for and we imposed heavy fines on anyone who took advantage of seniors. That Medigap law is still the model for consumer protection today.

    I didn't stop fighting for seniors there. In the early 1990s then Representative Olympia Snowe and I were among the first to propose bipartisan legislation to add a prescription drug benefit to Medicare. When a Medicare Prescription Drug benefit was ultimately added to Medicare, Senator Snowe and I began pressing for legislation that would empower Medicare to use its market power to negotiate the best prices for seniors.

    Congressman Ed Markey and I authored a law to create Medicare's first home-based health program for seniors with chronic illnesses. I've written and passed laws to give Medicare beneficiaries access to life saving cancer drugs and to ensure that seniors don't have to give up the prospect of a cure when they go into hospice care. The Department of Health and Human Services recently reported that -- thanks in part to a reform I authored in the Affordable Care Act -- Medicare Advantage premiums are down, enrollment is up and more and more seniors have quality health coverage.

    In just the last year, I have introduced legislation to expand a senior's choice of mental health professionals, reduce Medicare fraud and bring transparency to Medicare payments. I also authored a discussion paper with Chairman Paul Ryan exploring ways in which Democrats and Republicans might work together to ensure a sound future for Medicare.

    The Medicare Guarantee is at Risk

    I know that polls show that the majority of Americans like Medicare the way it is today. But don't let that number confuse what's at stake: unless Congress enacts meaningful Medicare reform in the near future, seniors will be faced with inevitable cost-shifting and eventual benefit cuts until Medicare doesn't look anything like the program does today.

    The Congressional Budget Office projects that the Medicare Hospital Trust Fund will be out of money by 2022. And as MedPac explained in its report to Congress last year, Congress's continued inability to come up with a long-term solution for Medicare's reimbursement rate for doctors "is undermining confidence in the Medicare program."

    Last year, Congress passed a mere 60-day extension of Medicare physician pay rates in order to avoid asking doctors to swallow a 27.4 percent cut to Medicare physician pay. Although a 'deal' was eventually reached to pay doctors for their services through the end of this year, chronic payment uncertainty and already low reimbursement rates are forcing more and more doctors to consider dropping or limiting the number of Medicare patients they are willing to treat. This is a significant problem given that retiring Baby-Boomers are no longer a theoretical problem. Starting this year, an average of 10,000 Americans will enroll in Medicare each day for the next 20 years.

    The Medicare Guarantee is Our Nation's Most Solemn Promise

    I believe the most important aspect of Medicare is not the structure of the program but the guarantee to all Americans that they will have high quality health care as they get older. I will always fight to protect traditional Medicare, but in my mind, what makes Medicare so important is its guarantee. It is one of our nation's most solemn promises and history has shown what can happen when it doesn't exist.

    Before Congress created Medicare in 1965, more than 50 percent of American seniors didn't have health insurance, mostly because of its unaffordable cost. It was not uncommon for the sick elderly to be treated like second class citizens, and as a result, many aging Americans without family to care for them, ended up destitute without necessary health care, or on the street. It was a disgraceful time in our nation's history; we must take steps to ensure that it never happens again.

    Traditional Medicare Doesn't Work the Same for Everyone

    Contrary to popular belief, every Medicare beneficiary is not currently enrolled in Medicare's government-administered health insurance plan. In Oregon, for example, 56 percent of seniors currently get all or some of their health coverage from a private plan. (15 percent of Oregon seniors purchase private Medigap policies to supplement their traditional Medicare, while 41 percent of Oregon's Medicare beneficiaries are enrolled in private health insurance plans through Medicare Advantage.) It is worth noting that many Medicare Advantage plans in Oregon save money over traditional fee-for-service Medicare.

    While most seniors are very happy with the Medicare benefits that they get from the government, it is important to remember that Medicare isn't perfect and doesn't work the same for everyone.

    For example, traditional Medicare does not offer catastrophic coverage or dental benefits. To get those options, seniors have to pay for supplemental private insurance. While many private plans offer the option of prescription coverage as part of their insurance packages, under traditional Medicare, seniors have to sign up for those benefits separately. While some seniors like the freedom Medicare gives them to find and choose their own participating doctors, some prefer an integrated private health plan that has identified a network of doctors, testing facilities and pharmacies that work together, collaboratively on the needs of their enrollees.

    And again, just because you are enrolled in Medicare's government-administered option does not mean that you are guaranteed to find a doctor willing to take on new Medicare patients. Seniors in historically-low reimbursement states like Oregon have long had difficulty finding doctors and more and more seniors in other parts of the country are starting to encounter this problem. For this reason, many seniors in Oregon have been grateful to learn that Medicare gave them the option of enrolling in a private plan.

    Finally, Medicare's copays and deductibles are not insignificant for a senior living on a fixed income, regardless of plan choice. While Americans under the age of 65 pay an average of 3 percent of their total income on health care, Americans over the age of 65 are spending 16 percent of their total income on their health needs. It is projected that by 2020, that number will reach 26 percent. With nearly 62 percent of seniors living on incomes of less than $30,000 annually, this is particularly worrisome no matter what it says on a beneficiary's Medicare card.

    Not All Plans that Include Private Insurance Choices are Created Equal

    While allowing seniors to choose between traditional Medicare and privately-administered health plans would not "end Medicare as we know it," (since this choice already exists in Medicare) changing the program in a way that would undermine or end the Medicare Guarantee certainly deserves that description.

    There is no question in my mind that last year's House Republican Budget would have ended the Medicare Guarantee, that is why I voted against it. Not only did the Republican plan eliminate Medicare's traditional government-administered insurance program, it failed to include tough consumer protections for seniors. The vouchers it would have given seniors to purchase health insurance weren't guaranteed to cover the cost of health insurance over time. Seniors aren't guaranteed to have health insurance if affordability isn't guaranteed as well.

    Voters would be right to consider their representative's vote on that budget as an indication of their representative's commitment to the Medicare Guarantee. Put simply, if you want to be sure that your Member of Congress will not vote to end the Medicare Guarantee in the future, you would probably be better off with a representative who didn't vote to end it in the past.

    But doing nothing is also a direct threat to the Medicare Guarantee. Congress must pass meaningful reform within the next few years and since it is highly unlikely that Democrats are going to win a super majority of seats in both the House and the Senate this year, the only way to pass legislation upholding the Guarantee is for Democrats and Republicans to work together. To protect Medicare, we have to get the dangerous ideas off the table and start looking for solutions that will ensure that seniors will always be able to get the care they need.

    This is why I started talking to Paul Ryan about Medicare.

    What Wyden-Ryan Really Says

    There have been a lot of mischaracterizations. So, let's be clear about what the Wyden-Ryan plans really says.

    Wyden-Ryan doesn't eliminate the traditional Medicare plan, instead it guarantees that seniors who want to enroll in Medicare's traditional fee for service plan will always have that option.

    Wyden-Ryan doesn't privatize Medicare because Medicare beneficiaries already have the option of enrolling in private health insurance plans. Wyden-Ryan makes those private plans more robust and accountable by forcing them to -- for the first time -- compete directly with traditional Medicare.

    Wyden-Ryan protects the purchasing power of traditional Medicare and private sector innovation to make both types of Medicare stronger and more senior-friendly. All participating private plans will be required to offer benefits that are at least as comprehensive as traditional Medicare and any plan that is found taking advantage of seniors or providing inadequate care will be kicked out of the system. Cherry picking healthier seniors will be made unprofitable by a robust risk-adjustment mechanism and policed by the Medicare administrators.

    Wyden-Ryan would also uphold the Medicare Guarantee by ensuring that seniors will always be able to afford their health benefits. Unlike a voucher program that would give seniors a fixed amount of money to purchase health plans, Wyden-Ryan would adjust premium support payments each year to reflect the actual cost of health insurance premiums. In addition, low-income seniors, including dual-eligibles will receive additional benefits to cover out-of-pocket costs -- ensuring that seniors have the same choices regardless of income. Yes, if private plans are able to devise a way to provide the same health benefits as traditional Medicare for less money, a senior might have to pay extra if he or she still wants to enroll in the government option. But if you could get the exact same benefits for less money, why would you want to pay more?

    Beyond that, Wyden-Ryan creates a catastrophic benefit that does not exist in traditional Medicare, ensuring that no senior is bankrupted by a major illness.

    Finally, Wyden-Ryan isn't a piece of legislation. It does not include legislative language or specifications detailing exactly how the system would work. If Wyden-Ryan or something like Wyden-Ryan gets to the legislative stage, those specifications will be important to get right, as the devil is always in the details. Right now, however, Wyden-Ryan is simply a policy paper intended to start a conversation about how Democrats and Republicans might work together to uphold the Medicare Guarantee.

    Using Wyden-Ryan for Political Cover Harms Seniors

    Yes, just as some in my party criticize Wyden-Ryan without knowing what the plan really does, some Republicans will undoubtedly declare their support for Wyden-Ryan without knowing what that means or believing in its principles. Mitt Romney, for example, claims to have helped write Wyden-Ryan even though I have never spoken to him about Medicare reform and have yet to hear him declare that there should always be a role for traditional government-run Medicare.

    Those who say they support Wyden-Ryan simply for political cover are neither helping seniors nor being bipartisan. Rather, using Wyden-Ryan for political purposes harms seniors by making a bipartisan agreement to uphold the Medicare Guarantee that much harder. Anyone who does this deserves to be called out on it.

    However, by that same token, those of us who care about the Medicare Guarantee shouldn't discourage Republicans from working in a bipartisan way to preserve the program in the future. Even though it might blunt some political attacks, we should be encouraging Republicans to take dangerous reforms off the table and pledge their support for Medicare. Just as we should be working to educate our conservative colleagues about the importance of a program many of them clearly don't understand. The upcoming election is important, but after the election, we're going to have to pass Medicare reform and that is going to require us to work together.

    This week, Congressman Ryan will be unveiling the House Republican Budget. I do not know what the details of the budget will be. I didn't write it and I can't imagine a scenario where I would vote for it. I do know, however, that because we worked together, Paul Ryan now knows more about the Medicare Guarantee and protecting seniors from unscrupulous insurance practices than he did before. If that is reflected in his budget this year, as someone who has been fighting for seniors since he was 27 years old, I think that's a step in the right direction.

  • Is the Administration Leaving a Promising Health Reform In the Cold?

    (Note: This blog was originally posted by Senator Wyden on Huffington Post.)

    When the Veterans Affairs Department implemented a program to provide home-based health care to veterans with multiple chronic conditions -- many of the system's most expensive patients to treat -- they received astounding results. The amount of hospital stays for the veterans participating in the program went down by 62 percent and the number of nursing home days went down by 88 percent. In total, the cost of providing healthcare to these chronically ill patients shrunk by nearly 25 percent.

    The University of Pennsylvania Medical Center found that a similar program instituted for a segment of the sickest Medicaid beneficiaries had similar results and not only saved Medicaid 23 percent of the cost of caring for these patients, it increased the survival rate for this group by 46 percent.

    How do these programs realize such savings? By doing a better job of caring for patients with multiple, chronic and often debilitating diseases. These are patients who regularly see multiple doctors and are in and out of emergency rooms and assisted living facilities. Instead of leaving these patients to fend for themselves, these programs send health care providers to their homes to check vital signs, organize pill bottles and coordinate the patient's overall care.

    Patients who have participated in these programs are healthier, spend less time in doctor's offices and are more able to continue aging in their own homes without burdening loved ones. And all of that saves the system money because it costs less to keep a patient healthy than it does to treat them only when they are sick.

    Given these results, Congressman Ed Markey and I thought it only made sense to create a version of the program for Medicare beneficiaries. After all, Medicare recipients with multiple chronic illnesses are among the highest-cost segment of the entire Medicare population -- making up roughly 5-8 percent of beneficiaries but accounting for more than 50 percent of total Medicare costs. If a home-based Medicare program realized even just a fraction of the other programs' success, Medicare could save a lot of money (potentially billions) while improving health outcomes for millions of seniors.

    Congressman Markey and I introduced what we called "Independence at Home" (IAH) in 2008 and we passed it into law with the help of Senate Finance Committee Chairman, Max Baucus, who included it in his committee's mark of the health care law signed last year. While much of the Affordable Care Act doesn't take effect until 2014, the IAH program is scheduled to start in January 2012 as a demonstration project for 10,000 seniors.

    However, as Congress and the administration have scrambled to find new ways of saving Medicare money, we've pointed out that there is no reason Independence at Home has to start as a demonstration project. Thanks to the Veterans Affairs program and the University of Pennsylvania study, there is already demonstrable evidence that home health programs work.

    So, instead of looking for ways to cut Medicare programs and benefits, why not save Medicare money by looking for ways to skip the demonstration project and expand the Independence at Home to millions of seniors from the start? It would make sense, right?

    Apparently not. Because not only isn't the administration not looking for ways to expand Independence at Home, they aren't even taking the steps necessarily to launch the demonstration project.

    While the law says that the IAH demonstration program needs to begin next month, the Center for Medicare and Medicaid Services (CMS) -- the federal agency tasked with putting this program into effect -- has yet to release guidelines for healthcare providers to sign up for the program. These guidelines were supposed to be issued months ago. Without them, providers can't apply to be a part of the program. And with only weeks left before the demonstration project is supposed to start, no one is signed up to take part.

    In other words, Independence at Home is being set up to fail.

    Last week, Rep. Markey and I sent a letter to the new Acting CMS director Marilynn Tavenner asking her to release these guidelines as soon as possible so that the program can get underway. It is our hope that with new leadership CMS will finally recognize the potential benefits of providing homes care for Medicare beneficiaries. It would be great if we could launch this program for millions of chronically ill seniors from the start, but at the very minimum, CMS should follow the law and launch the IAH demonstration program as the Affordable Care Act -- which the president signed -- requires. Seniors deserve more than cuts, they deserve an opportunity to reap the benefits of this proven approach.

  • Is This How You Want Your Senate To Do Business?

    (Note: This blog was originally posted by Senator Wyden on Huffington Post.)

    The U.S. Senate does not allow legislative provisions to be included in appropriations bills, for much the same reason that most Americans are concerned about earmarks: it creates a slippery slope by which lobbyists and special interest groups can sneak provisions into large, must-pass legislation.

    Today, Congress has passed a massive appropriations bill -- funding the entirety of the federal government for the rest of the year -- and it includes a number of legislative provisions that have never been considered by a congressional committee or debated on the House or Senate floors. If this bill had been brought up under normal Senate procedures, any senator could have raised a point of order preventing the bill from passing.

    One of the legislative provisions it included is the elimination of Free Choice Vouchers, a provision that I authored as part of the Patient Protection and Affordable Care Act to give employees some ability to hold their employers and insurance companies accountable for offering affordable health insurance. With the loss of Free Choice Vouchers, hundreds of thousands of workers will now be forced to choose between their employers' unaffordable insurance or going without health care.

    Groups like the Business Roundtable and lobbyists representing human resource managers -- and others who profit from the current employer-based system -- claim that Free Choice Vouchers would somehow undermine the employer based system. They argue that it would somehow encourage young and healthy workers to leave their employer's risk pools, which misses the reality that employers who don't want to offer Free Choice Vouchers, don't have to offer free choice vouchers as long as they offer their employees affordable health benefits.

    Without Free Choice Vouchers, there is little in the health reform law that discourages employers from increasingly passing the burden of health care costs onto their employees. In fact, since PPACA became law, employers have raised their employees' share of health insurance premiums by an average of 14 percent even though the premiums themselves have only gone up 3 percent.

    Free Choice Vouchers would have given workers recourse against employers who continued to jack up their workers' share of health costs because with FCVs if your employer raises your premium contribution above 8 percent of your total income, you would have the option of going to your employer and saying "either offer me more affordable health insurance or let me take my health benefit to the new insurance exchange marketplace where I can find a better value in health coverage."

    Without Free Choice Vouchers, no one will have that option.

    While the Affordable Care Act promises to "ensure that American families and businesses have, quality affordable health care coverage options," without Free Choice Vouchers, if your employer raises your health insurance premiums over eight percent of your total income (which is the point at which the law considers your benefits "unaffordable" and exempts you from having to purchase health insurance) you won't have any affordable health coverage options. In fact, unless your income drops or your health costs rise to more than 9.8 percent of your total income, the health law doesn't give you access to the health insurance exchange marketplace or give you any additional assistance to make your health insurance more affordable. The only option it gives you is to attempt to pay what your employer requires or go without health insurance altogether.

    With FCV, the federal government doesn't spend any additional money, because, as the Congressional Budget Office finds, the only money changing hands is employees making use of the employer health care subsidy -- which is already part of their compensation package. In fact, CBO found this week that the only revenue raised by repealing Free Choice Vouchers comes from employees who choose to go without health benefits having to pay taxes on income that would otherwise be tax free. And because CBO finds that many of these Americans would choose to go without health insurance versus pay for their employers unaffordable coverage, their choosing to convert their employer subsidies into a Free Choice Voucher wouldn't undermine their employer's risk pool -- as some employers claim -- because they wouldn't be in their employer's risk pool in the first place.

    The reality is that the special interest groups that have lobbied against Free Choice Vouchers object to any measure that would empower employees to have a say in their health benefits because it begins to erode their power in the current health care system. Big employers and labor unions and health benefits managers like the advantages that the current system affords them. They don't want their employees and members to be able to get better health benefits someplace else.

    But that isn't even the problem with today's bill.

    The problem with today's bill is that without any public debate or congressional consideration, legislative language was slipped into a massive appropriations bill to eliminate Free Choice Vouchers. One lobbyist called the move "an Early Easter gift."

    Is that the way we want the Senate to do business?

    Earlier this year, President Obama used his State of the Union Address to take on special interest groups saying that "the American people deserve to know that special interests aren't larding up legislation with pet projects." He promised to veto any appropriations bill that included earmarks. He should extend that pledge to appropriations bills that include legislative language.

    Because in my mind there is no difference between passing an appropriations bill with earmarks intended to reward lobbyists and passing an appropriations bill with legislative language intended to reward lobbyists. As President Obama said in that same State of the Union address, we should be "working to rebuild people's faith in the institution of government."

    I agree and I think we can do better.

  • So Much for Choice and Competition

    (Note: This blog was originally posted by Senator Wyden on Huffington Post.)

    It is hard to miss the irony in the fact that the very same week that Republicans were publicly heralding Congressman Paul Ryan's plan to inject market forces into the American health care system, they were crafting a budget deal to strip them from the health reform law. While Free Choice Vouchers didn't fulfill my vision of a health care system in which every American would be empowered to hire and fire their insurance company, they were a foothold for choice and competition and a safety valve for Americans whose employers are already forcing them to bear more and more of their family's health insurance costs.

    Free Choice Vouchers were a true marriage of both Democratic and Republican ideas and they were killed in last night's budget agreement. Given the battle it took to get them into the health reform law in the first place, I guess I shouldn't have been surprised by their execution.

    Under the new health law, Americans whose income falls below 400 percent of the federal poverty level and whose employer-sponsored health insurance premiums are between 8 and 9.8 percent of their total income will be exempt from having to purchase health coverage but will not be able to access the exchanges or qualify for government assistance to buy insurance.

    If an employee's share of their health insurance premiums rise to 9.9 percent of their total income, they would be allowed to shop for more affordable health insurance in the new health insurance exchanges, with a taxpayer-funded subsidy. But again, at 9.8 percent and below their only options will be to pay for their employer-sponsored coverage or to go without health insurance altogether.

    Had Free Choice Vouchers survived, they would have given this group a third option: to take the tax free money that their employer would otherwise contribute to the cost of their health insurance and use it to buy a more affordable health insurance plan at the exchange. This provision would have meant that fewer Americans would have to go without health insurance and by leveraging private dollars versus relying solely on taxpayer funded subsidies, it would have ultimately saved money. If employer premiums continued to rise, more and more Americans would have become eligible for this option and more choice and competition would have been injected into the health insurance market.

    Some employers -- especially small employers -- had already expressed interest in expanding the Free Choice Voucher provision so that they would no longer be in the position of having to pick their employees' health insurance. They liked the idea of giving their employees access to a health insurance system, much like the Federal Employee Health Benefits plan, in which employers can essentially subsidize their employees ability to shop on the new health insurance exchanges.

    This would be good for the employers because it would get them out of the health insurance business. It would be good for employees because they would be able to pick the plan that best works for them versus the plan that works best for their employer and it would be good for the system as a whole because it would get more Americans into the exchanges' risk pools, holding down costs for everyone.

    Not every employer likes this idea that Americans might be able to get good health insurance outside of their job or union. Which is why some of the most powerful interest groups spent most of 2009 fighting the inclusion of even this small version of Free Choice Vouchers into the health reform law.

    In my mind, that is a short-sighted position. The employer sponsored health insurance system is currently unsustainable. Premiums are going to keep going higher and higher burdening both employers and employees. Free Choice Vouchers offered a safety-net and a bridge to another system.

    I thought that those of us championing free choice won that argument when Free Choice Vouchers passed as part of the health reform law. And as employer premiums have continued to rise over the last year, it seemed that the case for Free Choice Vouchers was getting even stronger.

    Recently the Kaiser Family Foundation reported that while premiums had increased an average of 3 percent last year, the typical employer had shifted an additional 14 percent of the cost onto workers. With workers facing higher health costs combined with stagnant wages, more and more workers will face that Hobson's choice of unaffordable employer sponsored insurance or going without health care.

    But last night, after weeks of closed-door negotiations to keep the federal government open, Free Choice Vouchers were placed on the chopping block even though there is no budget savings from cutting them this year.

    I'll leave you to speculate how they got there.

  • Missing the Point

    (Note: This blog was originally posted by Senator Wyden on Huffington Post.)

    In December of 2006, I introduced the Healthy Americans Act to reform the nation's health care system. Some on both sides of the aisle liked my bill, while others on both sides of the aisle did not. But the time has long since passed for debating the merits of the Healthy Americans Act. While I like to think that the legislation I spent many years developing helped advance and inform last year's debate, it became pretty clear at the beginning of 2009 that the White House and the Congressional leadership of both parties wanted to go a different way. 

    It's correct that I wanted health reform to do more to create choices and promote competition. But instead of spending the year on the sidelines criticizing my colleagues and advocating for my personal approach, I spent the year looking for opportunities to improve the legislation that WAS advancing through Congress. The same can be said of my health advocacy today, as I continue to look for ways to improve what is now law. 

    For example, in writing the Healthy Americans Act and working with theCongressional Budget Office on its score, I learned that giving consumers more choices isone of the most powerful ways to reduce health insurance costs and hold insurance companies accountable. While I certainly didn't get everything that I wanted, I did geta provision included in the final bill that will allow a small group of Americans to convert their tax-excluded employer subsidies into vouchers that they can use to choose their own plans on the new health insurance exchanges. And I am already looking for opportunities to expand this provision so that more and more Americans are ultimately empowered to make their own health care choices.

    Another provision that I got included in the final law came directly from my original legislative proposal. "Empowering States to be Innovative" (Section 632 in the Healthy Americans Act and Section 1332 of the Patient Protection and Affordable Care Act) reflects my long held view that when it comes to health policy what works best for people in Tampa Bay, Florida doesn't always work as well for the residents of Coos Bay, Oregon. My state of Oregon has, in fact, long led the country in innovating approaches that have played a major factor in Oregon having some of the highest quality and lowest cost health care in the country. So both in writing my legislation and working to improve what is now law, I wanted to make it possible for states to keep innovating new approaches. 

    However, for states to really be empowered to be innovative the federal government has to be willing to give states a little leeway to implement their own approaches. A state, for example, will struggle to offer a public option on its exchange if it has to follow the exact standards of the federal law that doesn't provide for one. And, of course, no state-based approach -- no matter how innovative -- can work if everyone who participates in the state program gets fined by the federal government for failing to comply with the federal mandate.

    So, in both the Healthy Americans Act and in the current health reform law, I included a provision that would allow states to gain an exemption from certain federal requirements -- such as the individual mandate, the employer penalty and the exact standards for designing the exchanges, subsidies and basic health insurance policies -- if they could find a way to do a better job of covering their state's citizens. And I have been working to help states, like my home state of Oregon, take advantage of this option and hopefully move-up the date when states can start applying for waivers. The reason for this -- as the legislators in my state will attest -- is that it's a lot less cost effective for states to implement their own approaches in 2017 if they also have to pay to implement the federally mandated approach in 2014. For those who claim this position represents a retreat from the health reform law, they are mistaken. I have been advocating virtually non-stop for states to have the right to go their own way, including during the Senate Finance Committee's mark-up up last fall when I got the provision included in the Senate bill. My letter to the state of Oregon last week was a continuation of my effort to promote state innovation in health care.

    Of course, the temptation in today's gotcha political culture is to take any senator's comments on health care as being about scoring political points and either helping or hurting the White House. The truth here is that I have supported both an individual mandate and a state waiver for more than five years. 

    Again, both the individual mandate and the state waiver were a part of legislation that I introduced in 2006. And while this provision would allow states to opt-out of the federal health insurance mandate -- which is what some politically motivated people are calling for right now -- under my approach states will only be granted a waiver if they demonstrate they can do a better job of providing health care in their state than under the new federal law. To date, I haven't seen a single one of those states currently filing lawsuits against the individual mandate propose better ways of covering their citizens. In fact, one of the reasons I have been drawing attention to the state waiver is to highlight the insincerity of those filing lawsuits. If states aren't happy with the federal law they should be spending their energy innovating ways to do better rather than wasting taxpayer dollars on lawsuits that -- if successful -- would leave their state's citizens with nothing.

    I continue to support the individual mandate unless a state can demonstrate that it will provide equal or better health care without one. I continue to prefer the individual mandate from the Wyden-Bennett bill to the one contained in the bill that passed, because it was accompanied by greater consumer choice and a rock-solid guarantee that all Americans would receive the same level of health coverage as their Member of Congress. 

    I voted for the Patient Protection and Affordable Care Act, not because I thought it was the best we could do, but because I thought it was a whole lot better than the current system. I still know that to be true. But in my mind, passing that law is far from "mission accomplished" and my constituents can count on me to keep working to improve that law and our nation's health care system, regardless of which way the political winds may be blowing.