Posts filed under ‘Medicare’
When Is a Hospital Inpatient Stay Not an Inpatient Hospital Stay – Hospital “Observation Services”
We introduce our readers to a new topic today: Being in a hospital bed in a Medicare-participating hospital is no guarantee that a Medicare beneficiary is an inpatient. In the Center for Medicare Advocacy’s December 11, 2008 Alert, we described the increasingly common practice of placing Medicare beneficiaries in acute care hospital beds and calling them outpatients, on “observation status.”[1] It may sound like Alice in Wonderland or 1984 or some other fiction. Unfortunately – it’s not.
Beneficiaries who remain in hospital beds for multiple days, or even weeks, receiving physician and nursing services, tests, medications, food, and supplies, are in many instances nevertheless identified as outpatients. One major consequence of outpatient status is that beneficiaries are denied coverage for a subsequent stay in a skilled nursing facility (SNF) on the grounds that they have not been inpatients in the hospital for three or more consecutive days. Beneficiaries receiving outpatient observation services, which are covered under Medicare Part B, are also billed for services such as prescription drugs that would ordinarily be covered under Medicare Part A during an inpatient hospital stay. Placement in observation services has the effect of shifting significant health care costs that should be covered under Medicare Part A from the Medicare program to Medicare beneficiaries.
At the same time that the use of observation services is becoming more extensive by hospitals throughout the country, some beneficiaries who have appealed the denials of their hospital stays have been successful. This Alert describes a new brochure from the Centers for Medicare & Medicaid Services (CMS) – CMS’s first description of observation services for beneficiaries. It also discusses three recent favorable decisions – two at the Administrative Law Judge level of appeal and a third at the level of the Qualified Independent Contractor (QIC), Maximus Federal Services. A fourth case, which is not about observation services, addresses the InterQual criteria and process that are used by hospitals to determine whether a patient is receiving inpatient care.
What are Observation Services?
Observation services are defined in Medicare’s manuals as a well-defined set of specific, clinically appropriate services, which include ongoing short term treatment, assessment, and reassessment, that are furnished while a decision is being made regarding whether patients will require further treatment as hospital inpatients or if they are able to be discharged from the hospital.[2]
The Manuals suggest that a patient may not remain in observation status for more than 24 or 48 hours.[3] Since 2004, CMS has authorized hospitalization utilization review (UR) committees to change a patient’s status from inpatient to outpatient, retroactively, if (1) the change is made while the patient is still hospitalized; (2) the hospital has not submitted a claim to Medicare for the inpatient admission; (3) a physician concurs in the UR committee’s decision; and (4) the physician’s concurrence is documented in the patient’s medical record.[4] CMS anticipated that retroactive reclassifications would occur infrequently, “such as a late-night weekend admission when no case manager is on duty to offer guidance.”[5]
CMS Brochure
A new six-page CMS brochure entitled “Are You a Hospital Inpatient or Outpatient?”[6] begins with the statement, “Did you know that even if you stay in the hospital overnight, you might still be considered an ‘outpatient’?” The brochure suggests that patients who are in the hospital for “more than a few hours” ask their doctor or hospital staff if they are inpatients or outpatients.
The brochure incorrectly suggests in two places that decisions to place a beneficiary in observation are made by the beneficiary’s own physician.[7] In fact, this is often not the case; CMS allows any physician to confirm a decision by a hospital’s UR committee to reverse an inpatient admission decision made by an attending physician.
Even more significant, while the brochure may give beneficiaries notice of their status as observation patients, it does not give them any rights to challenge their placement in observation. The brochure’s discussion of “rights” says only that beneficiaries have the right to “get a review of (appeal) certain decisions about health care payment, coverage of services.”
The brochure may have the effect of discouraging beneficiaries from appealing their placement in observation services if they erroneously believe that their attending physician ordered observation services. As discussed below, the Center encourages beneficiaries and their advocates to appeal observation decisions, regardless of whether the decisions are made by attending physicians or hospitals’ UR committees. Moreover, despite the lack of clarity about beneficiary appeal rights,[8] some beneficiaries have filed appeals and prevailed.
Favorable Decisions
In January 2010, Administrative Law Judge (ALJ) P. Arthur McAfee overruled a decision by Maximus Federal Services and held that a Medicare beneficiary’s entire five-day stay in an acute care hospital should have been covered by Medicare Part A.[9]
The beneficiary’s physician had ordered that she be admitted “for inpatient care secondary to a diagnosis of an L1 compression fracture.” Her condition was “fair” and she required monitoring, assessment, and intravenous fluids, including multiple doses of intravenous morphine. On her third day in the hospital, October 25, 2008, she was notified that her status was being changed from inpatient to outpatient. On appeal, the Quality Improvement Organization (QIO) found that inpatient coverage was appropriate for days three through five, October 25-27. The QIO did not review the beneficiary’s observation status for the first two days of her hospital stay. On appeal, Maximus issued an unfavorable decision, finding that the claim had already been processed for payment.
The ALJ cited the Medicare statute and two Manual provisions as guiding his analysis. First, he cited the Medicare Benefit Policy Manual, which describes the decision to admit a patient [as] a complex medical judgment which can be made only after the physician has considered a number of factors, including the patient’s medical history and current medical needs, the types of facilities available to inpatients and to outpatients, the hospital’s by-laws and admissions policies, and the relative appropriateness of treatment in each setting.[10]
Relevant factors to be taken into consideration include “the severity of the signs and symptoms exhibited by the patient,” “the medical predictability of something adverse happening to the patient,” “the need for diagnostic studies that appropriately are outpatient services,” and “the availability of diagnostic procedures at the time when and at the location where the patient presents.”[11] He also cited Chapter 1, §10 of the MBPM, which uses “a 24-hour period as a benchmark” and wrote, “physicians should order admission for patients who are expected to need hospital care for 24 hours or more.”
The second Manual relied on by the ALJ was the QIO Manual, which gives guidance to QIOs on reviewing inpatient hospital admission decisions and directs a physician reviewer to “consider, in his/her review of the medical record, any preexisting medical problems or extenuating circumstances that make admission of the patient medically necessary.”[12] Inpatient care is “required only if the patient’s medical condition, safety, or health would be significantly and directly threatened if care was provided in a less intensive setting.”
Applying these criteria, the ALJ reversed Maximus’s denial of inpatient status for the beneficiary’s entire five-day stay, finding “The documentation provides no foundation to go against the judgment of the admitting physician.”
A second favorable decision, issued by Maximus on November 10, 2009, involved “a 79-year old man who presented to the emergency room (ER) from his assisted living facility with progressive altered mental status over the prior week.”[13] The man had been “fully oriented,” but at the time he was brought to the ER, he was “quite disoriented” or delirious.
The Maximus decision recognized that “Delirium represents an acutely life-threatening condition, evaluation and management of which can be complex and extended.” Although it turned out that the management of the patient was not complex, Maximus wrote, “it was not reliably predictable at the time of admission that the necessary work-up of the balance of the differential diagnosis would have been able to be completed within a reasonable period of hospital observation.” Relying on the Medicare Benefit Policy Manual, Pub. 100-2, Chapter 1, §10, the same provision relied on by the ALJ in the decision discussed above, and on the Program Integrity Manual, Pub. 100-8, Chapter 8, §6.5.2,[14] Maximus authorized inpatient hospital coverage for the entire five-day period.
A third decision addressed the denial of coverage for a 30-day stay in a SNF because of the absence of a three-day prior hospital stay, despite the fact that the beneficiary, classified as an outpatient receiving observation services, had been hospitalized for 13 days. Following a telephone hearing, ALJ Michael D. Bartko ruled both that the beneficiary met the three-day qualifying hospital stay required for SNF coverage and that she needed and received Medicare-covered care in the SNF.[15]
The fourth decision addressed whether a Medicare Advantage beneficiary’s inpatient hospital admission ended, as set out in the Notice of Denial of Medicare Coverage, or should continue.[16] The ALJ discussed the hospital’s reliance on InterQual criteria, which are also used in observation cases to determine whether a beneficiary should be classified as an inpatient.
At the ALJ level, the hospital was required to produce the patient’s complete medical records, the CareEnhanced Review Manager Enterprise (CERME), and the InterQual/McKesson Manual. The ALJ found “a significantly limited independent review of the approximately 6000 pages of medical records in this case [italics in original]” by the QIO physician who cited physical therapy notes, wound care notes, and a single physician note in upholding the discharge notice. He then described the InterQual Manual and CERME as proprietary tools that are used for various purposes, including “coverage denial management programs.” He wrote, “Information is obtained from patient medical charts and from other captured data which is input into a software program that generates a summary report.” Although the ALJ sealed the InterQual and CERME documents because they were proprietary, he found that “the inputs are very subjective” and that, in this case, they were “inconsistent with the known medical treatment” provided to the patient, as described in her medical records. He concluded that the patient’s inpatient stay was medically necessary and that Medicare coverage properly continued after the beneficiary received the notice denying further coverage.
What Should Beneficiaries and Their Advocates Do?
The Center for Medicare Advocacy suggests that beneficiaries file an appeal from any hospital notices describing their observation status and any subsequent Advanced Beneficiary Notice/Notice of Exclusion from Medicare Benefits they receive from a SNF.[17] In the likely absence of any notice, particularly from a hospital, the Center recommends that beneficiaries appeal when they receive the Medicare Summary Notice, which sets out all health care services received by a beneficiary in the prior quarter.
In all cases, beneficiaries and their advocates should gather the complete medical records from the hospital to establish the entire set of services and treatments that were received during the period of hospitalization. Advocates should request copies of all documents used by the hospital, its UR committee, and outside consultants to determine beneficiaries’ status. Advocates should present the medical and nursing facts and cite any physician support for inpatient status to demonstrate that the beneficiary met Medicare’s criteria for an inpatient stay. If SNF coverage is also at issue, advocates must demonstrate not only that the beneficiary met the criteria for Medicare-covered care in the SNF but also that the beneficiary received Medicare-covered care in the SNF.
Advocates should not be discouraged if they lose at the early stages of appeal: reconsideration, QIO, and QIC review. Three of the four cases discussed in this Alert were won later, at the ALJ level.
Continuing Work
The increasing use of administratively-created observation services is undermining the Medicare Part A hospital benefit, which authorizes inpatient hospital care for both diagnosis and treatment,[18] by essentially redefining diagnosis as observation under Part B. Observation services also violate the Medicare statute by allowing hospital UR committees to issue retroactive and binding determinations that a patient, admitted to inpatient status by the patient’s attending physician, is instead receiving observation services.[19]
The Center for Medicare Advocacy is interested in hearing from advocates, beneficiaries, and providers about their experiences with hospital Observation status, including issues stemming from the lack of notice and the inability to use existing appeals processes.
For more information, or to share an experience with observation services, contact attorney Toby S. Edelman (tedelman @ medicareadvocacy.org) in the Center for Medicare Advocacy’s Washington, DC office at (202) 293-5760.
[1] “When Is a Hospital Stay Not a Hospital Stay? When the Patient Is in ‘Observation Status,” (Dec. 11, 2008 Weekly Alert), http://medicareadvocacy.org/InfoByTopic/SkilledNursingFacility/SNF_08_12.11.ObservationStatus.htm.
[2] Medicare Benefit Policy Manual, CMS Pub. 100-02, Chapter 6, §20.6; same language in Medicare Claims Processing Manual, CMS Pub. 100-04, Chapter 4, §290.1.
[3] Id.
[4] Medicare Claims Processing Manual, CMS Pub. No. 100-04, Chapter 1, §50.3, originally issued as CMS, “Use of Condition Code 44, ‘Inpatient Admission Changed to Outpatient,'” Transmittal 299, Change Request 3444 (Sep. 10, 2004).
[5] CMS, “Clarification of Medicare Payment Policy When Inpatient Admission Is Determined Not To Be Medically Necessary, Including the Use of Condition Code 44: ‘Inpatient Admission Changed to Outpatient,'” MedLearn Matters (Sep. 10, 2004), now at Medicare Claims Processing Manual, CMS Pub. No. 100-04, Ch. 1, §50.3.
“Use of Condition Code 44 is not intended to serve as a substitute for adequate staffing of utilization management personnel or for continued education of physicians and hospital staff about each hospital’s existing policies and admission protocols. As education and staffing efforts continue to progress, the need for hospitals to correct inappropriate admissions and to report condition code 44 should become increasingly rare.” Question and Answer 3.
[6] CMS Product No. 11435 (Dec. 2009), http://www.medicare.gov/Publications/Pubs/pdf/11435.pdf
[7] “Your doctor may order ‘observation services’ to help decide whether you need to be admitted to the hospital as an inpatient or can be discharged,” page 4; and fifth example in the chart, page 3, indicates that if “your doctor” admits you as an in-patient and the hospital later changes your status to out-patient, “your doctor must agree.”
[8] The Center’s December 11, 2008 Weekly Alert addressed various notices that beneficiaries might receive advising them of appeal rights. See footnote 1, supra.
[9] ALJ Appeal No. 1-517883673 (Jan. 8, 2010), available at: www.medicareadvocacy.org\InfoByTopic\ObservationStatus\Decisions\VT_ALJ_01.10.pdf.
[10] Pub. No. 100-2, chapter 1, §10.
[11] Id.
[12] Pub. No. 100-10, chapter 4, §4110.
[13] Medicare Appeal No. 1-496442359 (Nov. 10, 2009), available at: www.medicareadvocacy.org\InfoByTopic\ObservationStatus\Decisions\MN_Maximus_11.09.pdf.
[14] The ALJ described the Manual as requiring medical reviewers to “consider any pre-existing medical problems or extenuating circumstances that make admissions of the beneficiary medically necessary.”
[15] ALJ Appeal No. 1-380068132 (April 9, 2009) available at: www.medicareadvocacy.org\InfoByTopic\ObservationStatus\Decisions\WI_ALJ_04.09.09.pdf.
[16] ALJ Appeal No. 1-424979831 (Dec. 9, 2009), available at: www.medicareadvocacy.org\InfoByTopic\ObservationStatus\Decisions\CA_ALJ_inpatient_InterQual_12.09.pdf.
[17] http://www.cms.hhs.gov/BNI/Downloads/CMS20014.pdf
[18] The Medicare statute defines “hospitals” as providing both diagnostic and treatment services to inpatients. 42 U.S.C. §1395x(e)(1)(A). It similarly defines “inpatient hospital services” to include diagnostic or treatment services. 42 U.S.C. §1395x(b)(3).
[19] 42 U.S.C. §1395.
Flash: Health Care Reform Now
The House of Representatives is poised to vote on historic health reform legislation in the next few days. The latest non-partisan Congressional Budget Office (CBO) report estimates that 32 million Americans will receive coverage if the legislation passes. The CBO further estimates that the bill would reduce the deficit by approximately $138 billion between 2010 – 2019 and predicts continued savings in the following decade.
Many provisions, including those that will protect people from health insurance discrimination will take effect soon. Click here to see the effective dates of some key insurance reform provisions.
Health care reform will strengthen and improve guaranteed benefits in traditional Medicare. It will protect the integrity of the Medicare program by extending the life of the Medicare Trust Fund and will reduce the outrageous overpayments to private Medicare Advantage plans. It will improve Medicare for all beneficiaries by slowing the growth of premiums and other out-of-pocket expenses, enhancing preventive benefits, and closing the “Donut Hole” gap in prescription drug cover. Health care reform will also provide coverage to millions of currently uninsured Americans and end discriminatory practices by insurance companies. Passing this legislation will strengthen Medicare, bring a similar promise of health coverage to younger people, and increase the economic security of all Americans.
It’s time to pass health care reform – now!
Seize The Day!
The Center for Medicare Advocacy urges Congress to pass health care reform now. According to Judith Stein, the Center’s Executive Director “We are the closest we have ever been to fixing our unfair and ineffective health care system. We must seize this opportunity to pass health reform. The status quo is not an option; we simply can’t afford to put this off yet again.”
Ms. Stein stressed that health care reform will strengthen and improve guaranteed benefits in Medicare and protect the integrity of the Medicare program by extending the life of the Medicare Trust Fund. “More specifically, health care reform will improve the Medicare program for beneficiaries by slowing the growth of premiums and other out-of-pocket expenses, improving preventive benefits, and closing the gap in prescription drug coverage,” said Ms. Stein.
Moreover, the legislation promotes delivery system reforms to encourage high quality, coordinated health care. “Most of the Center’s clients have chronic conditions – as do nearly all Medicare beneficiaries. We know from experience that well coordinated care is critical to our clients’ well-being. The Center has been advocating about this issue for many years,” said Ms. Stein.
Ms. Stein stated that the Center for Medicare Advocacy strongly supports the goals of comprehensive health reform legislation, which expands coverage to millions of Americans, helps them purchase insurance, and ends discriminatory practices by insurance companies. “Everyone wins, including Medicare beneficiaries when all Americans have access to quality, affordable health care,” she said.
The Center for Medicare Advocacy urges Congress to pass health reform now. Passing this legislation will strengthen Medicare, bring a similar promise of health coverage to younger people, and increase the economic security of all Americans.
Judith Stein is available for comment and questions.
Extend the Life of Medicare: Pass Health Care Reform Now
If you have Medicare and want to keep it, you should be in favor of health care reform.
Recently the non-partisan Medicare Advisory Payment Commission (MedPAC) released its biannual report to Congress, which for the fifth consecutive year advised Congress to equalize reimbursements to Medicare Advantage plans with the traditional Medicare fee-for-service program.
According to non-partisan Congressional Budget Office (CBO) estimates, equalizing payments between Medicare Advantage programs and the traditional Medicare programs will generate $170 billion in savings over the next ten years.
MedPAC’s report concluded that the “Commission has consistently supported the concept of financial neutrality between payment rates for the fee-for-service program and private plans.” Under the current reimbursement system, Medicare Advantage plans are reimbursed on average 14 percent more than traditional Medicare plans. These extra costs are born by beneficiaries in the traditional Medicare program and all taxpayers.
The health care reform bills passed by both the House and the Senate, and the proposals by President Obama, would reduce wasteful Medicare Advantage spending – saving money for Medicare beneficiaries and taxpayers alike, and extending the solvency of the Medicare program. We urge Congress to pass health care reform now!
A Note to Republicans about Medicare and Health Care Reform
We at the Center for Medicare Advocacy listened to the concerns you expressed about Medicare at the Health Care Summit on February 25. Unfortunately, your descriptions of what happens to Medicare in the House, Senate, and President’s proposals does not accord with what the proposals actually do.
We want to remind you of some facts about Medicare and the healthcare bills that were passed by the Senate and the House and that are proposed by President Obama.
- None of the proposals cuts Medicare benefits.
- What Medicare covers today will be covered after legislation is enacted.
- Coverage is actually enhanced adding coverage of an annual exam.
- Costs to Medicare beneficiaries are reduced by:
- Eliminating cost-sharing for preventive services,
- Reducing the Part D donut hole,
- Limiting the cost-sharing Medicare Advantage plans may charge.
- Quality of care received by Medicare beneficiaries is improved through:
- The addition of new delivery systems to coordinate care,
- The reduction of unnecessary hospital readmissions.
- Cuts to Medicare Advantage plans reduce waste in the Medicare program by cutting unnecessary overpayments to private insurance companies.
- Medicare Advantage plans are paid, on average 14% more that Medicare would spend if the beneficiary were in the traditional Medicare program.
- Overall, the savings to Medicare extend the life of the Part A Trust fund by 9 years.
Please, when you talk about Medicare to your constituents, get the facts straight and stop scaring Medicare beneficiaries. On the whole, Medicare beneficiaries stand to benefit if health reform as proposed is enacted.
Republicans express concern about cuts to Medicare, but their actions don’t always follow their concerns. Republican Senator Jim Bunning from Kentucky is currently filibustering a bill that would delay the 21% cut in Medicare payments to physicians that is to take effect on Monday, March 1, 2010. If the payment cut is not addressed, many doctors indicate that they will stop accepting new Medicare payments in their practice. Instead of protecting Medicare, Senator Bunning’s actions will reduce access to doctors for the 44 million people who rely on the Medicare program.
Fool Me Once…
Newt Gingrich, staunch supporter of Medicare? That’s why he’s opposed to health care reform? If you read just the opening paragraph of Paul Krugman’s February 12, 2010 Op-Ed article, you might believe this. Well, you might believe it if you haven’t been paying attention to anything Gingrich and his fellow conservatives have been doing for the last couple of decades.
Gingrich himself is the man who enthusiastically declared in 1995, as Republicans pushed for Draconian cuts to the Medicare program, that Medicare would thus “wither on the vine.”
Yet, here we are 15 years later, and Mr. Gingrich is crying, according to Krugman, that “the reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong.”
No, Mr. Gingrich, what’s wrong is the gall of hypocrites who will grasp any tactic to frighten people and fight the real health care reform our country so desperately needs.
It Takes 2 To Tango: Senator Baucus Tells The Truth About (Not)Bipartisan Health Care Reform
Senate Floor Remarks of Senator Max Baucus December 22, 2009
“Mr. President, it has been more than a month since the Majority Leader moved to proceed to the health care reform bill before us today. At long last, the Senate is now in the final throes of passing this historic legislation.
From the beginning, this Senator has sought out what Abraham Lincoln called “the better angels of our nature.” That’s the way that this Senator has always sought to legislate.
A year and a half ago, I convened a bipartisan retreat at the Library of Congress. Half a year ago, I convened three bipartisan roundtables with health care experts. Half a year ago, the Finance Committee conducted three bipartisan walk-throughs of the major concepts behind the bill before us today.
We went the extra mile. I reached out to my good friend, the Ranking Republican Member of the Finance Committee. I reached out to the ranking Republican Member of the Health Committee. We sought to craft a bill that would appeal to the broad middle. We sought to craft a bill that could win the support of Republicans and Democrats alike.
We met, a group of six of us, three Democrats and three Republicans. We met more than 30 times. We met for months. No, we did not reach a formal agreement. The Leadership on the other side of the aisle went to great lengths to stop us from doing so.
But even though we did not reach a formal agreement, we came very close to doing so. The principles that we discussed are very much the principles upon which the Finance Committee built its bill. The principles that we discussed are very much the principles reflected in the bill before us today.
From the debate that the Senate has conducted this past month, you would not know it. During this debate, some on the other side of the aisle have mischaracterized the bill before us. Some on the other side of the aisle have set about a systematic campaign to demonize this bill. Through bare assertion alone, with the thinnest connection to fact, they have sought to vilify our work. If one listened to their assertions alone, one would not recognize the bill before us.
And so, let me, quite simply, state the facts.
Some on the other side of the aisle assert that this bill is a Government takeover of health care. The fact is that the nonpartisan Congressional Budget Office says that this bill would reduce the Government’s fiscal role in health care. Just 3 days ago, CBO wrote, and I quote:“CBO expects that the proposal would generate a reduction in the federal budgetary commitment to health care during the decade following the 10-year budget window.”
Some on the other side of the aisle assert that this bill would add to our Nation’s burden of debt. The fact is that the nonpartisan Congressional Budget Office says that this bill would reduce the deficit by $132 billion in the first 10 years and by between $650 billion and $1.3 trillion in the second 10 years. The fact is that this is the most serious deficit reduction effort in more than a decade.
Some on the other side of the aisle assert that this bill would harm Medicare. The fact is that Medicare’s independent Actuary says that this bill would extend the life of Medicare by 9 years. The fact is that this is the most responsible effort to shore up Medicare in more than a decade.
Some on the other side of the aisle assert that this bill does not do enough to ensure the uninsured. The fact is that the nonpartisan Congressional Budget Office says that this bill would extend access to health care to 31 million Americans who otherwise would have to go without. The fact is that CBO says, and I quote: “the share of legal nonelderly residents with insurance coverage would rise from about 83 percent currently to about 94 percent.”
Nothing that Senators on the other side of the aisle have proposed would come close. CBO estimated that the Republican substitute offered in the House of Representatives would have extended coverage to just 3 million people. The fact is that CBO says of that plan, and I quote: “The share of legal nonelderly residents with insurance coverage in 2019 would be about 83 percent, roughly in line with the current share.”
I would cite the facts about the Republican substitute in the Senate. But the fact is that there is no Republican substitute.
Some on the other side of the aisle assert that they simply prefer a more modest reform of health care. The fact is that the Republicans controlled the Senate from 1995 to 2001 and from 2003 to 2006. The fact is that before they took control, in 1994, 36 million Americans, 15.8 percent of non-elderly Americans were without health insurance coverage. In the last year of their control, in 2006, nearly 47 million Americans, 17.8 percent of non-elderly Americans were without health insurance coverage. The legacy of Republican control was 10 million more Americans uninsured.
Some on the other side of the aisle say that we are moving too fast. The fact is that it was 1912 when former President Theodore Roosevelt first made national health insurance part of the Progressive Party’s campaign platform. The fact is that people of good will have been working at this for nearly a century.
The fact is, health care reform for America is now within reach. The fact is, the most serious effort to control health care costs is now within reach. The fact is, life-saving health care coverage for 31 million Americans is now within reach.
Let us, at long last, grasp that result. Let us, this time, not let this good thing slip through our hands. And let us, at long last, enact health care reform for all.”
The Connecticut-Based, Center for Medicare Advocacy, Joins the Washington Post in Applauding our Senior Senator, Chris Dodd, and Apologizes for the Actions of Joe Lieberman, our Junior Senator, to Bar Real Health Reform.
The essay below is from the 12/15/2009 Washington Post:
The heroes of health-care reform
Right on the heels of Joe Lieberman trying to kill the bill because it had a Medicare buy-in proposal, Howard Dean is exhorting Democrats to kill the bill because it doesn’t have a Medicare buy-in proposal. Sigh.
So let this serve as an encomium to Ron Wyden, Tom Harkin, Chuck Schumer, Sherrod Brown, Chris Dodd and Jay Rockefeller, among many others. All of these senators could have been the 60th vote. All of them had issues they believe in and worked for. Chris Dodd built and passed a bill. Sherrod Brown whipped up liberal support for the public option. Chuck Schumer spent countless hours devising compromises and searching for new paths forward. Ron Wyden spent years crafting the Healthy Americans Act, getting a CBO score, pulling together co-sponsors, speaking to activists and industry groups and other legislators. Jay Rockefeller has spent decades on this issue and wasn’t even invited into the Gang of Six process.
But you know what? They’re all still there. Because in the end, this isn’t about them, and though their states and their pet issues might benefit if they tried to make it about them, the process, and thus the result, would be endangered. I’ve said before that the remarkable thing isn’t that Joe Lieberman acts the way he does but that so few join him. The legislative process is given a bad name by the showboats and grandstanders, but the only reason it functions at all is because the vast majority of the participants keep their role in perspective.
If this bill passes, it will not be because Lieberman was pacified. It will be because senators such as Rockefeller, Wyden, Schumer, Harkin, Brown and Dodd swallowed their pride and their passion and allowed him to be pacified. They are the heroes here, and beneath it all, their quiet determination made them the key players.
Photo credit: By Jose Luis Magana/Associated Press
ANSWER to Pop Quiz! Who Said This? About What?
As a spokesman for the AMA, Ronald Reagan said this about the dangers of passing Medicare: “… behind it will come other federal programs that will invade every area of freedom as we have known it in this country. Until one day, as Norman Thomas said, we will awake to find that we have socialism. And if you don’t do this and if I don’t do it, one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.”
Ronald Reagan, our beloved Republican president, said this as a spokesman against Medicare. Now Republicans laud Medicare, say they are its champion, but say that health care reform must not pass as it will lead to socialism and the demise of Medicare. There is little new under the sun!
Tell your senators to vote for health care reform – with a public option. Like Medicare it is desperately needed and, if passed, it too will become a beloved institution.
Someone, someday, will thank you for fighting for it and will praise your senators’ votes.
Connecticut’s Senators, Health Care Reform, and Lessons From Medicare
The Center for Medicare Advocacy is incorporated and headquartered in Connecticut. People from this state can be proud of the courage our senior senator, Chris Dodd, has shown in leading health care reform. As a leader of the Senate’s efforts, Senator Dodd is once again speaking and fighting for real reform, to include a public option. We urge our other Senator, Joe Lieberman, to review the true costs and principles involved in this historic opportunity to insure all Americans, and to vote along with Senator Dodd for real health care reform.
The Center has been representing people with Medicare since 1986. We know what we’re talking about when we talk about the benefits and costs of public health insurance.
Medicare is public health insurance. It brought basic health coverage to older people in 1965, when 50% of people over 65 had NO insurance because the private market didn’t want to insure them. All the arguments being made now against health care reform and a “public option,” were also made against Medicare before it passed. Medicare was hardly bi-partisan legislation; it barely passed.
Now most everyone appreciates Medicare and the health and economic security it brings to older people and their families. We can only hope Congress, and both of our Connecticut senators, will vote courageously again, as those before them did to enact Medicare. This time we call upon Congress to bring health and economic security to younger Americans by voting for health reform – with a public option.
CMA Health Policy Blog 