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Health Care: Affordable Solutions for Healthy Families

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Across our country, ordinary Americans are struggling to maintain their health care coverage as premiums rise, insurance covers less, drug prices escalate, and health plans discriminate against those with chronic conditions. All the while, the climbing unemployment rate and the increasing number of baby boomers entering retirement means that fewer Americans will have access to health coverage because they are no longer eligible for an employer-based health plan. Every year these problems get worse, and they’ll keep getting worse until we reverse this downward spiral and make sure all Americans have access to affordable health care.

Kay Hagan has been a strong supporter of health care reform in the state Senate. Under her leadership, North Carolina extended health insurance to uninsured children, expanded preventive and primary care for uninsured patients in rural North Carolina, and fought to end insurance discrimination against mental health care. Kay believes that by investing in higher quality and more efficient care, focusing on keeping people healthy instead of treating them when they are sick, and streamlining the system to cut down on costs and waste, we can make health care more affordable and accessible for families and businesses.

As a U.S. senator, Kay will work hard to:

• Reduce Health Care Costs and Modernize Our Health Care System for the 21st Century
• Expand Access to Health Care Coverage for Children, Families and Those Suffering from Mental Health Diseases
• Prioritize Prevention of Diseases and Illnesses
• Bring More Young People Into Health Professions

REDUCE COSTS AND MODERNIZE AMERICAN HEALTH CARE

Costs associated with health care pose a serious challenge to individuals, businesses, and government. Americans and small businesses often do not have access to health care because the cost is too high. Health care costs also have a significant impact on the national economy: the non-partisan Congressional Budget Office considered escalating health care costs “the nation’s single most important long-term fiscal challenge.” Kay Hagan understands that the only way we can make health care truly accessible is to make it affordable. She will work to implement a series of initiatives aimed to deliver high quality health care at a lower cost.

Facilitate the Use of Privacy-Protected Electronic Health Records. The current system for medical record-keeping has too much room for error, duplication and waste. Right now, there’s more advanced record-keeping in many neighborhood grocery stores than in most hospitals. We need to obtain better health care for every dollar we spend, and that starts with implementing cost-saving mechanisms such as privacy-protected electronic medical records. The technology has arrived, and we should make sure that every person’s complete, private health record is available wherever and whenever they seek care. As a state senator, Kay voted to include prescriptions in electronic medical records in order to lower health care costs. In the U.S. Senate, she will support legislation that promotes the development of uniform standards for electronic health records and creates incentives for health care providers to adopt health information technology. She will also support grants for regional health organizations to buy and use information technology for medical records.

Reform the Medicare Prescription Drug Benefit. In 2003, after years of delay, Congress finally gave seniors a prescription drug benefit under Medicare. However, the intense involvement of the pharmaceutical and insurance industries in drafting the bill left it flawed in significant and outrageous ways. Unlike the VA health care system, the prescription drug law actually prohibits Medicare from negotiating lower prices with drug companies, which results in higher prescription drug costs for seniors. In addition, the law contains a “doughnut hole” that provides no benefit to seniors for annual prescription drug costs between $2,250 and $5,100, even as they continue to pay monthly premiums. This gap affects nearly one-fourth of all seniors enrolled in the program. Kay believes that Congress must significantly reform this law to ensure that all seniors have access to prescription drugs at affordable prices.

Reduce Costs for Prescription Drug Coverage Through Reimportation. Americans who do not participate in the Medicare prescription drug benefit also suffer from exorbitant prescription drug prices. It is simply unfair that the country which produces and markets the most prescription drugs pays more for these medications than all other developed countries. Americans should be able to buy their prescription drugs from licensed pharmacies in other developed countries if they can obtain better prices. Further, just as Kay believes we should reform the Medicare benefit, she also believes Congress should curb the drug industry’s ability to overcharge patients. As a U.S. senator, Kay will promote legislation that allows the reimportation of drugs made in the United States from Canada and other U.S. allies. In supporting such a measure, Kay will ensure that such reimportation is allowed only if the FDA ensures safety, inspects facilities, verifies chain of custody and requires registration from importers.

Ensure Fair Reimbursement Rates for Doctors under Medicare and TRICARE. Although the Medicare Improvements for Patients and Providers Act enhanced reimbursement rates for doctors under Medicare, the current formula for Medicare reimbursement remains unsatisfactory. In the U.S. Senate, Kay will advocate to replace the current formula with new long-term guidelines that provide adequate reimbursement and predictability under Medicare and TRICARE. These changes will make it easier for patients who rely on these programs to have easier access to needed care. Further, Kay recognizes the special needs facing communities with large military populations, where TRICARE patients can receive basic care on bases but often need to leave the base to access specialty doctors or treat children with special needs. Some specialists limit the number of TRICARE patients they treat because of the added administrative burdens. Kay believes we must streamline the TRICARE system to reduce the administrative burden. She would also explore options for incentivizing specialists in military communities to accept more TRICARE patients, ensuring that servicemembers and their families can get access to needed care quickly without being forced to travel hundreds of miles.

Eliminate Waste in the Medicare Advantage Program. Proponents of the Medicare Advantage program, which pays private insurers to cover Medicare beneficiaries, argue that it saves taxpayers money by increasing competition among health insurance issuers. Unfortunately, reports by the Government Accountability Office and the Medicare Payment Advisory Commission have concluded the opposite: premiums for beneficiaries under Medicare Advantage plans cost taxpayers significantly more than traditional Medicare. Kay believes Medicare should be designed to benefit seniors, not insurance companies. As a U.S. senator, she will ensure that patients still have choices for care, but she will work to eliminate subsidies to Medicare Advantage providers in order to save up to $19 billion taxpayer dollars over the next 10 years.

EXPAND ACCESS TO QUALITY HEALTH CARE

Kay Hagan believes every American should have access to affordable, quality health care. It is simply immoral that approximately 47 million Americans do not have any health coverage. In many cases, Americans lack access to affordable health insurance because insurers discriminate against individuals with preexisting conditions and “cherry pick” healthy employees and firms to cover. Americans lacking health insurance are forced to use emergency room doctors as their primary care physicians. They do not have a “medical home” and do not have the benefit of health care providers familiar with their medical history. Ultimately, this leads to expensive medical care and poor results – and in many cases, financial ruin. As a result, Americans without health insurance are more likely to be sicker and die younger.

In the state Senate, Kay voted in favor of legislation that provided more health care options to state employees and extended coverage for children in low-income families. Just as she has done in the state Senate, Kay will work vigorously to expand health care coverage to more North Carolinians.

Expand the State Children’s Health Insurance Program. In 1997, Congress enacted the State Children’s Health Insurance Program (SCHIP), a bipartisan, efficient and effective program to provide high-quality, affordable health care to a large segment of America’s uninsured children. This program gives children who do not qualify for Medicaid, but who cannot afford private health insurance, access to affordable policies. Under SCHIP, children receive the vaccinations, primary care, prescription drugs, eye care, and hospital care they need. Just as important, they receive such care from their own provider, not a hospital emergency room. Even with SCHIP, approximately 9.4 million children are still without health insurance, and that number will continue to rise if Congress does not act to strengthen SCHIP.

Washington’s failure to improve SCHIP last year compelled Kay to step up and push for state funds to make sure children received coverage. She believes Congress should reauthorize SCHIP and improve it by increasing outreach to families who have not yet enrolled their qualifying children. Such measures would allow the nearly seven million children currently enrolled in SCHIP to maintain their coverage and could cover an additional three million currently uninsured children. In addition, Kay believes SCHIP should cover mental health care to be comparable with other medical care supplied by the program.

Simplify and Strengthen Medicaid Eligibility. Medicaid currently serves approximately 50 million low-income individuals through its low-overhead federal-state partnership. However, certain groups, such as low-income adults with no children, remain ineligible for health insurance under the program. Kay believes Congress should simplify Medicaid to cover all individuals below a specified income level and increase the federal share of the funding to achieve these new eligibility standards without overly burdening states. This modification will help Medicaid fulfill its purpose of providing health insurance to low-income Americans with more precision.

Assist States in Meeting Medicaid Demands. The ongoing economic downturn has led to an increased unemployment rate and has depleted state tax revenues needed to cover important programs like Medicaid. Kay will support legislation that provides a targeted and temporary increase in Medicaid matching rates to states such as North Carolina that are most susceptible to Medicaid shortfalls, as determined by high rates of unemployment, foreclosures and food stamp disbursements. This measure will not only ensure the sustainability of health coverage for current Medicaid recipients, but will also provide an economic stimulus that allows states to spur job creation in other sectors and allows individuals to use their income for other necessary purposes apart from health care.

Encourage Small Businesses to Offer Health Insurance to All Employees. Most insured Americans currently receive employment-based coverage. However, nearly 80 percent of uninsured Americans live in a family with at least one worker, but that worker is unable to receive employer-sponsored health insurance. The reason for this situation is that insurers often will not provide coverage or will provide only minimal coverage to employees with preexisting health conditions. Such “cherry picking” would only be exacerbated by proposals to bolster so-called association health plans, which call for the exemption of such insurance policies from important state laws that require certain benefits and protections. To curtail this unfair treatment, Kay will promote several proposals to encourage small businesses to provide health insurance to their employees:

• Provide a refundable tax credit on premiums for small businesses that agree to provide quality health insurance and to cover a substantial share of the cost for such insurance for all employees. Kay has consistently supported a similar tax credit for small businesses in North Carolina and first enacted the tax credit as co-author of the state budget in 2006.
• Give small businesses new options for buying insurance together in pools, provided such pools do not cherry pick healthy individuals and firms, making insurance more expensive for everyone else.

Allow Individuals Ages 55-64 to Buy Into Medicare. Many Americans are unable to receive health insurance because they do not have access to employer-based insurance and because their chronic conditions make buying private health insurance impossible. Without health insurance, these Americans, who have often worked their entire lives, could suffer from a catastrophic bankruptcy if they develop serious health problems. Further, there is an added strain on the Medicare system when 65 year olds, who were previously uninsured, enter the system because they are less healthy than their previously insured peers. Kay will sponsor legislation that allows Americans ages 55-64 who do not have access to a group or federal health insurance plan to buy into the Medicare system, which will prevent and detect illness and reduce costs when they finally enroll in Medicare at age 65.

Enforce Mental Health Parity in Health Plans. Mental illnesses are treatable, physical diseases of the brain that affect a fifth of the population and cost billions of dollars, yet many insurance plans discriminate by not providing coverage for these diseases. Kay believes that we must end the stigma associated with mental health diseases and substance abuse disorders. She helped pass a law in North Carolina that requires insurers to cover certain mental illness as a part of their health insurance policies and prohibits discriminatory terms within such policies. However, 87 million insured Americans still lack these sorts of protections. Just as she did in North Carolina, Kay will support legislation in the U.S. Senate that will require parity for common mental health conditions and substance abuse disorders under group health plans for both inpatient and outpatient care.

PRIORITIZE PREVENTION OF DISEASES AND ILLNESSES

Kay Hagan recognizes that our current approach to public health is “sick care,” not health care – that’s bad health care, and bad economics. We allocate approximately 80 percent of health spending on just 20 percent of the population with chronic diseases. Kay believes that the key to containing health care spending is making prevention and management of chronic diseases – not acute care – the centerpiece of our health care system.

Implement a Nationwide Preventive Benefit. The central component in changing our focus from treatment to prevention is ensuring that both public and private insurance plans cover preventive services. In the U.S. Senate, Kay will work hard to implement a national preventive benefit, under which insurers will reimburse doctors who perform immunizations and disease detection services. The recommendations of the U.S. Preventive Services Task Force, along with those from the Centers for Disease Control and Prevention, the Surgeon General, and the Department of Health and Human Services, determine the basis for services covered under the prevention benefit. Insurer reimbursement would be based on health care providers’ ability to promote community-based disease prevention measures and their willingness to use information technology to integrate preventive care with care for chronic illness.

Boost Funding for Health Care Research. The Bush Administration’s fiscal recklessness and hostility to science has forced Congress to make NIH funding a lesser priority. This funding reduction has decreased the number of young researchers and could have a long-term and devastating impact on research into cures for diseases. Kay believes we must bolster NIH funding to continue to advance our fight against fatal diseases. In particular, Congress should allocate funds for research that determines how health providers can deliver care most effectively and efficiently, and that examines how we can best organize and deliver health care to ensure that people receive the care they need. Further, Congress should reform NIH’s loan repayment program to lure young scientists to conduct groundbreaking research and retain these scientists for the long term. Kay will seek to strengthen this program by promoting the program to encourage researchers to enter governmental or university research academies, where much of our ground-breaking scientific research occurs.

Continue the Fight Against Cancer. Kay has been a strong advocate for cancer research and prevention efforts. In the state Senate, she supported legislation that provided $300 million for cancer research and treatment. She also supported $12.4 million for a new building to house NC Central University’s Biomanufacturing Research Institute and Technology Enterprise (BRITE), which is focused on developing tailor-made drugs for patients and creating new and better treatments and cures for genetic and acquired diseases. At the same time, Kay recognizes that federal government support for cancer prevention and treatment is instrumental in the fight against cancer. The American Cancer Society notes that federal support has facilitated improved cancer research and has compelled insurers to cover cancer screenings such as colonoscopies, mammograms, and PSA tests. Kay believes we should continue to develop a national strategy to fight all cancers at all stages. In particular, she believes Congress should restore full funding for the National Cancer Institute to ensure a coordinated approach for cancer research and prevention activities.

Increase Funding for Domestic HIV/AIDS Research. Approximately 1.2 million Americans are living with HIV/AIDS in America. Although AIDS prevention has been improved through education and research, and the number of reported infections continues to decrease, the reduction in infections has leveled off. Kay believes that we must continue to promote HIV/AIDS prevention through educational efforts and research. She also supports programs that will ensure that antiretroviral (ARV) therapy is available to all HIV/AIDS patients. Further, she will encourage federal initiatives to reduce HIV/AIDS infection rates in minority communities, which are increasingly afflicted by the disease.

Institute Grant Programs for Comprehensive School Health Programs. Child obesity is an increasing concern in schools. Fewer children walk or bike to school, and physical education programs have been deemphasized as schools face greater accountability standards for traditional academic subjects like reading and math. As a state senator, Kay addressed the childhood obesity epidemic by supporting a statewide school lunch program that emphasized nutrition on public school campuses by limiting certain vending machine products and eliminating the use of trans-fatty acids in prepared foods. She believes the federal government should incentivize school systems to develop comprehensive anti-obesity programs for students. With federal help, these programs could include curriculum-based and compulsory child nutrition classes, student health screenings, increased budgets for, and participation in, physical education, and assistance in development of contracts with vendors for healthy food. Kay will support legislation to provide grants to school systems that are willing to develop these services.

BRING MORE YOUNG PEOPLE INTO HEALTH PROFESSIONS

Across the country, hospitals and clinics suffer from shortages of doctors, nurses, technicians, and other health care professionals. The problem is especially acute in rural areas, where nurses are in especially high demand. To combat these shortages, Kay will support measures to increase the number of people entering health care professions and ensure that those educated in the field are willing to practice in underserved regions where they are most needed.

Increase the Number of Doctors in Rural Areas.

Kay understands it is vital that we increase the number of doctors nationwide, and especially in rural areas, where specialists are in particularly high demand. She believes that Congress should consider several initiatives to draw more people into the medical profession and into rural areas, in particular. For instance, Kay would support tax credits for physicians who agree to practice in rural areas after they have paid off their student loans. She also will push to expand the Health Resources and Services Administration’s primary care loan program in order to increase the percentage of medical school graduates who choose to practice in primary care.

Reinvest in Allied Health Professional Training. The enactment of the Nurse Reinvestment Act in 2002 more than doubled applications for nursing schools, encouraging more young Americans to enter the underserved nursing profession. However, despite this important advance, many nursing schools have been unable to admit a large number of applicants because such schools do not have enough faculty members to teach the new base of students. Kay believes we must increase the number of qualified students, and that we should expand the capacity of nursing schools to enroll more of these qualified students. She will also support legislation that encourages more well-qualified instructors to train students, and establish cooperative interdisciplinary training between schools of nursing and other specified health-related fields.

Offer Loan Forgiveness for Allied Health Graduates. Many areas around the country – especially those in rural America – still suffer from a shortage of nurses and other health care providers. It is a great loss to America when willing young people find it impossible to serve the public because student loan debts are too expensive. Kay will work to amend current law to forgive federal loans after five years (rather than after 10 years under current law) for allied health professionals who work in underserved areas, including nurses and technicians, military servicemembers, first responders and educators.

Increase the Number of Health Providers in Rural America. Kay will address the dire shortages of health care personnel in rural communities by fighting for tax breaks for health workers who move to rural areas. Another barrier plaguing rural areas is that many emergency medical personnel serve on a volunteer basis and have trouble keeping up with the continuing education requirements due to time, funding and transportation concerns. These providers also are likely to burn out more easily because they must perform an overwhelming workload due to the scarcity of personnel. Kay will work to find innovative solutions to increase retention rates through cooperative and flexible education, and will reward employers who allow their employees to volunteer as emergency medical personnel.

PROTECT THE NEXT GENERATION WITHOUT SADDLING THEM WITH DEBT

Kay believes it is important to reduce costs and expand coverage, and she believes this can be done in a responsible way that doesn’t place the burden on our children and our children’s children. She will reduce costs through methods discussed in this proposal, which will ensure that more coverage can be provided at the same price. Kay will also roll back the Bush tax cuts for the top one percent, saving the government $131 billion, and she will reduce erroneous Medicare fee-for-service payments that are estimated to cost taxpayers up to $12 billion annually.

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