Issue Position: Health Care

Issue Position

Ensuring access to quality health care for all Americans is the goal that brought me to Congress, and the cause that keeps me here. Last year our nation took an important step toward that goal when President Obama signed health care reform into law. The new law is not perfect, and I will continue to work to improve it as it is phased in over the next four years. In particular, I strongly believe that allowing Americans the choice of a public option is essential. I will continue to work tirelessly to make sure we make our system fair and equitable for every American.

Wisconsinites are already benefiting from the new health care law: insurers are no longer allowed to discriminate against children and others who are sick; small businesses are receiving billions of dollars in tax credits to provide health care coverage for their employees; and seniors are saving money on prescription drugs and receiving free preventive care through Medicare.

Health Care Reform Helps Wisconsin Families and Small Businesses:
The new health care law will bring significant relief to Wisconsin's families and small businesses. Specifically, in Wisconsin's 2nd Congressional District, the new health care law will:

* Improve coverage for 539,000 residents with health insurance.
* Give tax credits and other assistance to up to 162,000 families and 16,800 small businesses to help them afford coverage.
* Improve Medicare for 97,000 beneficiaries, including closing the donut hole.
* Extend coverage to 6,000 uninsured residents.
* Guarantee that 7,400 residents with pre-existing conditions can obtain coverage.
* Protect 1,100 families from bankruptcy due to unaffordable health care costs.
* Allow 68,000 young adults to obtain coverage on their parents' insurance plans.
* Provide millions of dollars in funding for 6 community health centers.
* Reduce the cost of uncompensated care for hospitals and other health care providers by $64 million annually.

The new health care law is a critical step in achieving health care for all. While this is a comprehensive piece of legislation, a few key provisions stand out:
Establishes Crucial Consumer Protections in the Insurance Industry

* Bars insurance companies from discriminating based on pre-existing medical conditions, health status, and gender
* Prohibits lifetime and annual caps on coverage
* Allows parents to keep children on their health insurance until they turn 26
* Prevents rescissions -- the practice of dropping patients from coverage when they get sick

Contains Health Care Costs
* Pays health care providers based on the quality, not the quantity, of care they provide
* Encourages the formation of care models in which health care providers work together to manage patient care, allowing them to share in the savings they achieve
* Cracks down on fraud and abuse by strengthening screenings on new providers and increasing penalties on bad actors
* Focuses on prevention by eliminating patient co-pays for preventive services in Medicare, Medicaid, and private plans, and promoting individual and community health through targeted initiatives

Expands Coverage
* Extends coverage to 32 million uninsured Americans
* Establishes state-run health insurance exchanges, in which individuals, families and small businesses can shop for insurance
* Provides tax relief to individuals and small businesses to help them with the costs of insurance
* Provides federal support to states to cover low-income individuals through the Medicaid program

Strengthens Medicare
* Fills the Medicare doughnut hole gradually over ten years; in 2010, Medicare beneficiaries who are in the doughnut hole will receive a $250 rebate
* Provides better chronic care, with doctors collaborating to provide patient-centered care for the 80 percent of older Americans who have at least one chronic medical condition like high blood pressure or diabetes
* Reduces overpayments to private Medicare Advantage plans
* Adds at least nine years to the solvency of the Medicare Hospital Insurance Trust Fund

Finally, this legislation is fully paid for by revenue provisions within the health care system. In fact, the legislation reduces the deficit in the next ten years and beyond. This legislation takes a responsible step forward, both fiscally and socially.

Advancing Medical Research:
Improving health care for Americans requires a continued federal investment in medical research. The National Institutes of Health supports innovative and foundational research programs, including many in south central Wisconsin. The work of these researchers is critical to increasing our understanding of diseases and the development of new treatments to combat them. I will continue to be a strong advocate for adequate funding of these important medical research programs.

One specific area of medical research that holds enormous promise is stem cell research. In 1998, a group of researchers led by Dr. James Thomson at the University of Wisconsin-Madison developed a technique to isolate and grow cells, which provided the basis for new lines of inquiry that hold the potential to yield life-saving treatments and cures for the most debilitating diseases and injuries. Stem cell research provides hope to millions of Americans and their families who are affected by diseases like Parkinson's, Alzheimer's, AIDS, cancer, heart disease, diabetes, and arthritis, as well as conditions such as spinal cord injuries.

On March 9, 2009, I was honored to be with President Obama when he signed an executive order removing barriers to responsible stem cell research. The executive order eradicates the limitations that have been imposed on human stem cell research and expands the authority of the U.S. Department of Health and Human Services, through the National Institutes of Health, to conduct responsible, scientifically worthy human stem cell research. I also support measures that would codify this executive order into law to ensure that this vital research is impeded down the road.

Making Health Care Services Available for Wisconsinites:
My work to ensure that all Americans have access to quality health care includes efforts to help Wisconsin health care providers secure the technology they need, particularly in our rural hospitals. My successful efforts to provide federal funding for a variety of health care access and delivery programs throughout south central Wisconsin, include:

* Monroe Clinic, to support their investment in health care information technology;
* St. Mary's Hospital, to support the expansion of their inpatient capacity;
* Madison Community Health Center (now Access Community Health), to provide care (including dental services) to the uninsured;
* Stoughton Hospital, for the purchase of biphasic defibrillators;
* Columbus Community Hospital, for a new Emergency Room;
* Madison Area Continuing Care Consortium, for long-term care services;
* St. Clare Hospital in Baraboo, for improved radiation treatment services; and
* Beloit Memorial Hospital, for medical equipment.

Addressing Mental Health and Substance Abuse Issues:
I believe that Americans should have comprehensive coverage for mental health services. For this reason, I support mental health parity. Mental illness and substance abuse are tangible, treatable health problems like hypertension, cancer and heart disease; yet, millions of hardworking men and women still find that their health plans place strict limits on both inpatient and outpatient coverage for mental health benefits. That disparity is why I am a member of the House Working Group on Mental Illness, a group dedicated to disseminating information about the causes and treatments of mental illness, and to working together to end stigma against those who suffer from mental illness.

As a supporter of mental health parity, I was pleased to support legislation to require health plans to provide mental health benefits at the same level as medical and surgical benefits. This bill is now law. I will continue to work with my colleagues in Congress to increase awareness about mental health, increase prevention efforts and secure access to quality treatment.

Bolstering the Health Care Workforce:
One of my highest priorities is to expand health care insurance coverage for all Americans. A critical element of this coverage, however, is a robust workforce to care for these individuals. Many health care professions are suffering shortages, but none more profoundly than nursing. It is estimated that the nation currently faces a shortage of more than 200,000 registered nurses--a number that is projected to grow to more than one million by 2020.

The nursing shortage is not for lack of people interested in entering the profession. Rather, the nation's nursing schools cannot meet the demand. Due to a shortage of qualified faculty members, one out of every three qualified nursing school applicants is turned away. And, due to the great demand for registered nurses, qualified nurses have little incentive to become nurse educators--particularly because the average annual salary for nurse educators is at least 20 percent less than their counterparts in clinical practice.

Exacerbating the crisis is the fact that a large percentage of current nurse faculty members--as much as 70 percent in some schools--are approaching retirement age within the next few years. With some estimates placing the current faculty shortage at nearly 10 percent, this crisis will quickly escalate without prompt and determined action to address it.

For this reason, I sponsored legislation to address the nursing shortage by providing education loan repayment for nurses who commit to teaching in nursing schools. I was pleased that this bill was included in the health care reform bill and is now law. I remain committed to ensuring that our nation's health care workforce is strong.

Another critical component of our public health workforce is public health veterinarians. Although we may not realize it, our health depends in part on a small army of veterinarians working in public health. Their role was never clearer than during the H1N1 virus outbreak--we now see that diseases can travel from animals to humans seemingly overnight. Public health veterinarians are our frontline defense against another outbreak. They inspect our slaughterhouses, prevent a foot-and-mouth disease outbreak from devastating our economy and agriculture industry, and protect our citizens against the threat of bio-terrorism.

Unfortunately, our current workforce cannot meet these public health challenges. In the next 20 years, experts predict a shortage of 15,000 veterinarians. And between 2006 and 2016, the Bureau of Labor Statistics predicts that the demand for veterinary services will increase by 35 percent.

For this reason, I have sponsored legislation to bolster our public health veterinary workforce, the Veterinary Public Health Workforce and Education Act. This bill would establish a new competitive grant program for schools, providing funds for recruiting faculty, expanding physical capacity, or developing new curriculum. Additionally, this legislation would provide for loan repayment for veterinarians who commit to teaching or working in public health and create a new fellowship program for public health veterinarians.

Ensuring Medicare Beneficiaries Have Access to Physicians:
I believe that it is critical for Medicare physicians to be reimbursed appropriately for their services. Proper payment is vital to ensure that seniors continue to have access to high quality care and a wide choice of doctors. For this reason, I have been a long-time supporter of correcting the flawed payment formula currently used to calculate Medicare reimbursement for physicians.

The Medicare physician fee schedule pays physicians a fee for each service or procedure they provide for a patient on Medicare. The fee schedule also affects the reimbursement of a variety of other health care providers, including physicians treating TRICARE patients. In 2001, the Centers for Medicare and Medicaid Services made a change to the physician fee schedule to including a component called the sustainable growth rate (SGR). The goal of the SGR is to adjust physician reimbursement according to changes in inflation; the SGR is tied to growth in our country's gross domestic product.

However, this flawed payment formula has serious consequences, including scheduled cuts to Medicare physician reimbursements. The SGR formula resulted in a negative update in payments per service for 2002. Additional reductions were slated to go into effect again beginning in 2003 and have been schedule for every year since then. Congressional action has prevented these reductions for taking place.

I am concerned that payment reductions would negatively impact Medicare beneficiaries' access to medical services. I strongly support a long-term solution for this flawed funding formula to prevent reimbursement cuts to physicians.

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