Poor Wages and Benefits

Working for food stamps Like other forms of historically female care work, direct care was underpaid and undervalued from the start, seen as unskilled “women’s work.” The women who did it – predominantly women of color – were expected to live in genteel poverty, or assumed to be earning “pin money” to supplement their husbands’ earnings. Those assumptions were built into the Medicaid and Medicare reimbursement systems that fund most long-term care, tying direct care worker earnings to the fate of two programs already under intense pressure to reduce costs in these tough economic times. As a result, direct-care workers – about 90 percent of whom are women – struggle to support themselves, let alone their dependent children, on their paltry wages. Many have to take a second or even third job to make ends meet. The national average for all direct care workers is less than $10 an hour, and about a third of the home health and nursing home aides who are single parents depend on food stamps. The situation is worst in home care – which is the fastest-growing type of long-term care service, and the one most consumers prefer. Personal care and home care aides average just $8.54 an hour, and their annual raises aren’t keeping up with inflation. A recent report found their wages fell by 4 percent between 1999 and 2006, after adjusting for inflation. Erratic hours and being ineligible for federal minimum wage and overtime protection also contribute to keeping many home care workers perilously close to the poverty line. Health care workers without health care In a particularly cruel irony, direct care workers often do not get health insurance through their jobs, even though their work is crucial to maintaining the health of the people they care for. Approximately 30 percent have no health insurance. That’s about twice the uninsurance rate of the general public. A lot of factors contribute to this crisis. Some workers are hired directly by the people they assist, who cannot offer health insurance or worker’s compensation. Some work for small businesses that can’t afford to subsidize high group insurance rates. Some can’t book enough hours to qualify for the company plan, which may offer insurance only to employees who work full-time. And many simply can’t afford the premiums and copays. It’s not as if direct care workers need health care less than other people. In fact they have higher than average rates of diabetes, asthma, and other chronic conditions – conditions that become much more serious when they go untreated. They also have one of the nation’s highest rates of on-the-job injuries, mostly back and neck injuries caused by lifting people or helping them move from place to place. These injuries often cause permanent impairments and pain that require ongoing medical treatment. Fighting for the right to minimum wage and OT pay The federal Fair Labor Standards Act requires employers to comply with minimum wage and overtime laws – with a few exceptions. A so-called “companionship” exemption was created to cover unskilled, part-time workers such as babysitters who are employed by individuals to work in the home. A controversial ruling by the U.S. Department of Labor (DOL) during the Bush Administration included all home care workers, even those who are employed by agencies, in that exemption. As a result, home care aides are denied the right to minimum wage and overtime protection from the federal government. Evelyn Coke, a home care attendant who worked for many years for an agency in Long Island, New York, challenged that ruling in 2007. Coke took her employer to court, charging that she was owed thousands of dollars in back pay because she was never paid overtime for the overnight shifts she worked. In fact, she was not paid at all for many of those hours (the agency subtracted time that was assumed to be spent sleeping or eating, saying that she would have been doing the same thing if she were in her own home), bringing the average amount she was paid per hour to less than the minimum wage. Her case got all the way to the United States Supreme Court. The court ruled in favor of the agency. The controversial ruling still stands -- but the DCA and its allies have been working to change that. In September 2007, the Direct Care Alliance board passed a resolution declaring that it would work to overturn the ruling. In letters sent to President-elect Obama (PDF) in 2008 and to newly appointed U.S. Secretary of Labor Hilda Solis (PDF) in early 2009, the DCA asked the new administration to reverse the ruling. In April 2009, the DCA organized a trip to DC to ask legislators to include direct care workers in health care reform -- and to sign onto a letter from members of Congress to Secretary Solis that asked the Secretary to overturn the DOL ruling. On May 18, 2009, 37 members of Congress sent the letter to Secretary Solis. Less than a month later, 15 U.S. Senators sent Secretary Solis a letter asking for the same thing. The Senate letter was sponsored by Senator Tom Harkin (D-IA) and signed by Edward M. Kennedy (D-MA), Chuck Schumer (D-NY), Arlen Specter (D-PA), and Robert P. Casey, Jr. (D-PA), among others. The day after receiving the senators' letter, Secretary Solis told an Associated Press reporter that her department was looking into whether the exemption should be overturned. Related materials DCA policy brief on the Coke case DCA fact sheet on the Coke case

Speeches about the Coke case by graduates of the first Voices Institute National Leadership Program

Be sure to check out the speeches. These are some of the people I spent that incredible week with.

This comes from the Direct Care Alliance.

National Direct Care Partnership Meeting Notice

Save the Date: Meeting Scheduled for June 29th at 4pm Eastern Time A detailed agenda for our next National Direct Care Partnership Meeting will be posted shortly. Meanwhile, please hold next Monday, June 29th at 4pm eastern time for our next call. Thank you.

Each of these Cans is a Human Being: Sharing Our Stories

By Megan Rosati Here in Maine, we want to remind our Senators of the human cost of our health care system. According to the consulting firm PricewaterhouseCoopers, employers' health care costs will increase by 9 percent next year. That means more American businesses struggling to compete and stay viable. And it means even higher premiums, deductibles, and co-pays for working families. At Change that Works, we're highlighting the stories of the men and women forced to reach out to their neighbors to cover the costs of expensive medical procedures that are either not covered, or are inadequately covered by their current insurance. And thanks to Maine Public Broadcasting Network, our message is being heard: "Sometimes I think we forget the humanity behind the cans, that each one of those cans is a human being," says Greg Howard, Maine spokesman for the Change that Works campaign from the Service Employees International Union. The group set up a display of collection jars in Portland. They'll be collecting more photographs of posters and collection jars to send to the state's Congressional delegation, and to help underscore the need for a public option. "We thought it was important to point these people out and to try to give them a voice that their cans scream every single day in convenience stores, but some don't seem to hear," Howard says. The rising cost of health care is a crushing burden on the hardworking families of Maine, and all across America. Last year, more than half of Americans postponed medical care or skipped their medications because they couldn't afford it. But what if you are the parents of a sick child that needs medical care? Then, like her parents, you could be forced to ask for help to ease the enormous financial burden of her health care: "She's been receiving chemo since she was three months old," says Sadie Bowden of Canaan, aunt to one-year-old Faylynn McEwen, who has a brain tumor. Insurance is covering hospital stays and a nurse comes to the home once a week. But Bowden says the parents have been relying on fundraisers like the concert she organized to help pay for things like long drives to the hospital in Bangor. But the $8,000-plus in donations does not make up for the fact that both parents had to leave their jobs to provide home care. "Honestly, with the fundraisers we've been doing, we're raising money but it's not a ton of money. It's helping them basically pay their bills while they're at home taking care of her," Bowden says. Until we reform our broken system, stories like Faylynn's will continue to remind us of how far we have to go before our system provides quality, affordable coverage to everyone who deserves it. An important part of reforming our heath care system so it works for everyone is providing a public health care plan option, for those who are unable to afford private insurance coverage. Although the MPBN story cites a report by the Lewin Group stating that a public plan option would siphon 119 million people off of private insurance, a FactCheck report by Newsweek refutes this claim as misleading and untrue: That's misleading. The 119 million figure comes from an analysis of a plan that would mirror Medicare and be open to every individual and business that wanted it. But that's not the type of public plan President Obama has proposed. Nor is such a plan gaining acceptance on Capitol Hill. The author of the study says that while some have backed the Medicare-like proposal, using the 119 million number "overstates the impact of what now is being considered." A public plan would provide support for those people who are unable to afford private coverage. The people of Maine should not be forced to ask their neighbors for help in order to pay their health care bills. There are faces behind these cans: let's stop begging for change, and start focusing on real reform. View more photos of Mainers 'Begging for Change' and send in your own pictures by emailing healthcarecans@gmail.com

Kennebec Valley Organization Delegates Assembly

MSEA-SEIU, as one of the member groups of the Kennebec Valley Organization, has three voting delegates at KVO's Delegates Assembly. The Delegates Assembly is being held on Thursday, June 25, 6-8 pm, at the First Congregational Church on the corner of Main Street and Eustis Parkway in Waterville. The KVO's Health Care Team will be putting forth a proposal as to the issues and direction Delegates want the team to persue. KVO's Health Care Team has had a very busy year since our Delegates Assembly last June. Come and learn about our successes as well as things we were not so successful with. MSEA-SEIU members are encouraged to come, learn more about KVO, and get involved.

Are You Begging for Change?

Across the state, Mainers are begging for change. We are begging for change to pay our health care bills, and we are begging for the change that is needed to fix our broken health care system.With fliers, posters, and hand-written signs, more and more Mainers have had to ask their neighbors for help to pay for the increasingly high cost of health care. Devastated by the enormous financial burden they are forced to shoulder under our current system, Maine's families have put out cans and jars with hand-lettered signs, forced to pay their bills by asking for spare change.

View pictures of these signs and our music video here

At Change that Works, we are also Begging for Change: change in our current health care system. Real change that provides options for more Americans, through the choice of a public health insurance option. A public option would give us more choices, more control over our care, and ensure everyone has access to a quality plan. Real change that not only provides quality coverage, but makes sure everyone can afford it.

Do your part: submit your own photos of "begging for change" here

If we can collect enough of these photos, we can convince Senator Snowe, Senator Collins, and every member of our Congress that the cost of health care is hurting Maine's families. Families like that of Faylynn McEwen's, a one-year-old with a brain tumor. With both parents forced to stay home to provide her with round the clock care, her family has had to ask friends and neighbors for the money they need to live. Read more about Faylynn's struggle here.

If we're going to have an economy that works for everyone, we need a health care system that works for everyone. Economic security and affordable, quality health care go hand-in-hand. By including a strong public option, we introduce competition in the market and give people a choice in their health care. This can help rein in the outrageous costs that come with health care and protect families like Faylyn's from facing financial ruin.

We know we need health care reform now, but we can't get there without you - will you join us today?

http://action.seiu.org/page/s/beggingforchange

Thank you for all you do,

Phil Bailey

Maine Change that Works

MSEA-SEIU Helps Members of 771

Last Friday, June 19th, the MSEA-SEIU Board of Directors voted to match Local 771's expenditure of $300 for two scholarships for two 771 members to attend the Direct Care Alliance's VOICES Institute in late September. Local 771 voted to spend $300 for scholarships back on June 4th. The two 771 members are very active working on worker issues. Ted Rippy is 771's secretary. DeeDee Strout is active through Maine PASA, advocating for workers. MSEA's Board of Directors also gave Local 771 the green light to join the National Direct Care Partnership. The Partnership is an initiative of the Direct Care Alliance. The Partnership is advocating for workers at the federal level, where a lot of the funding stems from. Local 771 joined the National Direct Care Partnership at Saturday's meeting. To learn more about the Partnership or the Direct Care Alliance, use the links to the right, under "Links of Interest." I want to express my sincere thanks to MSEA's Board.

NATIONAL CALL-IN DAY for A STRONG ELDERCARE WORKFORCE in REAL HEALTH REFORM

Please excuse the cross posts on this important message! On Tuesday, June 23, the DIRECT CARE ALLIANCE will join other members of the Eldercare Workforce Alliance (EWA), in a National Call-in Day to send a clear message to Congress: A Strong Eldercare Workforce is Essential to Real Health Reform. What Does a Strong Eldercare Workforce Mean for You? By 2030, one in five Americans will be age 65 or older, 75% of whom will have one or more chronic conditions. Many older adults and those with chronic diseases do not receive the care they need because of an inadequately trained healthcare workforce, clinician and faculty shortages, and poor working conditions for direct-care workers. How Can We Strengthen the Eldercare Workforce? By urging Congress to include the following measures in health reform:

• Increase the federal match for all home- and community-based services funded under Medicaid.
• Expand the Geriatrics Health Professions Education and Training Programs under Titles VII and VIII of the Public Health Service Act to increase the supply of essential healthcare professionals.
• Extend greater federal minimum wage and overtime protection under the Fair Labor Standards Act to 1,500,000 home care workers.
• Provide loan forgiveness for professional training in geriatric care.
• Support appropriate care coordination services under Medicare and Medicaid.
• Provide training and support for direct-care workers and family caregivers.

Please Mark Your Calendar for June 23 and watch for upcoming e-mails on the National Eldercare Workforce Alliance Call-in Day. Thank you. Roy G Gedat, MSW National Advocacy Director Direct Care Alliance PO Box 710 Norway, Maine 04268 207 739-9179 http://www.directcarealliance.org/

Department of Labor Looking into Including Home Care Workers in FLSA

U.S. Secretary of Labor Hilda Solis says her department is looking into its interpretation of the Fair Labor Standards Act to see if the current exemption of home care workers should be overturned.

The Associated Press reported that the Secretary’s announcement came a day after 15 senators sent her a letter asking her to reverse the ruling. That letter followed another letter sent to Secretary Solis in May by 37 members of the House of Representatives, in an effort spearheaded by the Direct Care Alliance.

Secretary Solis told the AP her department is looking at whether its regulations “effectively express the statutory exemption,” though she did not say when a decision will be made.

“As secretary of labor, I intend to fulfill the department’s mandate to protect America’s workers, including home health care aides, who work demanding work schedules and receive low wages,” she said.

If you haven’t already done so, please visit the DCA’s Legislative Action Center now. It just takes a minute to send Secretary Solis a letter asking her to reverse the ruling and extend minimum wage and overtime protection to home care workers.

Elise Nakhnikian

Communications Director

Direct Care Alliance

Call Congress to Ensure Quality Healthcare for Older Adults

By Allison Lee June 16, 2009 On Tuesday, June 23, PHI will join other members of the Eldercare Workforce Alliance (EWA), in a National Call-in Day to send a clear message to Congress that a strong eldercare workforce is essential to real health reform. As an advocate for quality long-term care, your Member of Congress needs to hear from you! What Does a Strong Eldercare Workforce Mean for You? By 2030, one in five Americans will be age 65 or older, 75% of whom will have one or more chronic conditions. Many older adults and those with chronic diseases do not receive the care they need because of an inadequately trained healthcare workforce, clinician and faculty shortages, and poor working conditions for direct-care workers. How Can We Strengthen the Eldercare Workforce? By urging Congress to include the following measures in health reform:

• Increase the federal match (FMAP) for all long-term care services funded under Medicaid, which will give states incentives to increase these vital services.
• Expand the Geriatrics Health Professions Education and Training Programs under Titles VII and VIII of the Public Health Service Act to increase the supply of essential healthcare professionals.
• Extend greater federal minimum wage and overtime protection under the Fair Labor Standards Act to 1,500,000 home care workers.
• Provide loan forgiveness for professional training in geriatric care.
• Support appropriate care coordination services under Medicare and Medicaid.
• Provide training and support for direct-care workers and family caregivers.

Please Mark Your Calendar for June 23 and watch for upcoming posts on the National Eldercare Workforce Alliance Call-in Day which will include more instuctions. Visit the Eldercare Workforce Alliance for more on their work and legislative priorities. Thank you for your help. Allison Lee National Campaign Manager Health Care for Health Care Workers alee@phinational.org

Timetable for Congressional Health Reform

by Allison Lee June 16, 2009 While things can change on a daily basis given the complexity and scale of this legislation, the current timetable for the Senate and House committees with jurisdiction over health reform is now as follows. June 16 - June 30 Senate HELP Committee mark up: this is when the committee debates and finalizes specific provisions of the bill. Mark up on the coverage provisions are likely to begin Monday, June 22. June 23 - June 30 Senate HELP Committee mark up: this is when the committee debates and finalizes specific provisions of the bill. Mark up on the coverage provisions are likely to begin Monday, June 22. June 19 - July 4 Release of House bill will happen sometime in this period, though it may not come until after the July 4 recess. July 4 - August 10 Bills move to the floor, where each chamber will vote on their bill. August 10 through September 4 Conference committee meets to combine bills from House and Senate. September through November The final legislation comes out of committee and is voted on by each Chamber. A final bill goes to the President to sign before Thanksgiving. Resources: HELP Health Reform Bill (615 pages) PHI Comments on HELP Bill Workforce and Long-Term Care Provisions PHI Comments on Senate Finance Papers (Combined) House Bill Summary of Provisions Carol Regan Director Health Care for Health Care Workers cregan@phinational.org

Begging for Change

By Greg Howard 7:25 PM Eastern - June 16, 2009 Campaign for Public Health Insurance Option Highlights Families Forced to Ask for Spare Change When Facing Crippling Health care Costs Send in your pictures to: healthcarecans@gmail.com The Maine Change That Works campaign today launched "Begging for Change," a multimedia effort to highlight Maine families' urgent need for comprehensive health care reform that includes an affordable public health insurance option. Throughout Maine, cans or jars with messages asking for spare change to help a local family facing a health care catastrophe are commonplace at neighborhood convenience stores and gas stations. Mainers also regularly see fliers promoting yard sales, community suppers or other events to raise money for a Maine family that has been devastated by medical bills. "Please support a health plan that is the equivalent of yours--it's only fair. It should allow me to choose my own doctor, it should emphasize preventative care and it should cover everyone," Roxanna of York Harbor wrote to one member of Maine's congressional delegation. "I urge you to support legislation to provide health coverage for all. Allow your constituents to choose from a menu of public or private coverage. Don't fail your fellow Mainers--imagine what it must be like for them," Dorothy, also from York Harbor wrote to another member of the state's delegation. "Nothing could more vividly illustrate the need for health care reform than when members of our community face such staggering health care costs that they must ask their neighbors for financial assistance," said Dr. Wayne Myers, M.D., former Director of the Federal Office of Rural Health Policy at the U.S. Department of Health and Human Services and past President, National Rural Health Association. "It's difficult to overstate how urgent it is for Congress to act to pass legislation that will help Mainers avoid financial ruin when faced with a health care emergency. When you read the messages on these collection cans, you see that these families simply cannot wait." The "Begging for Change" campaign will collect as many of these images as possible and present them to Maine's members of Congress to underscore the need for immediate action on health care legislation that will help Maine families who cannot pay the costs of a health care crisis on their own. A public health insurance option would provide Mainers with a choice - keep the insurance they have if they like it or be guaranteed quality, affordable coverage through a public health insurance plan. Such an option is needed to bring down costs, make coverage affordable, encourage private health insurance companies to compete, and guarantee that quality, affordable coverage will be there for people no matter what happens. "Maine people do not have time to wait for relief from the skyrocketing cost of health care. In this time of economic uncertainty, we need health care coverage to be a sure thing, and that is what the public option brings" said Nicole Witherbee of the Maine Center for Economic Policy. "Every day that we wait, families across our state and our country are forced to delay care and make life-or-death medical decisions, pushing the financial well being of families and the economic viability of our nation into further peril." * View more photos of Mainers 'Begging for Change' and send in your own pictures by emailing healthcarecans.gmail.com. * You can listen to--and download--the mp3 of Portland musician Peter Alexander's original song, "Begging for Change--The Healthcare Blues." Lyrics for 'Begging for Change' after the break. (by Peter Alexander, copyright 2009, www.peteralexander.us) Talking 'bout my health care: My baby has the blues; She needs to see the doctor But the HMO refused. I'm not looking for a handout. That would make me feel ashamed. But since I lost my health care, Brother can you spare me some change? ¬ All my friends are wondering: We look around the world; Everywhere there's public care And the cost is just a third Of what the HMOs are charging. They're on the stock exchange; Their CEOs are millionaires While we're all begging Change. Same old thing in Congress: They've got their feathered nest. THEY'VE got Public healthcare And their healthcare is the best. But we're all out here dying While they play the same old games. I lost my private health care; Brother can you spare me some change? So we're all out here begging. We were promised Change. The HMOs all cost too much; The system is insane. The Corporations' rip us off, They've got it all arranged. 'Til we get friends in Congress. Brother can you spare me some change? I lost my private health care Brother can you spare me some change? 'Til we get friends in Congress. Brother can you spare me some change?

"BEGGING FOR CHANGE" PRESS CONFERENCE WEDNESDAY, JUNE 17th

We are forwarding you some important information on a press conference being held tomorrow, June 17th at 11:00 am. Our allies with SEIU are holding the "Begging for Change" event at the intersection of Western Promenade and West Street in Portland to highlight the need for change in our health care system. EVENT: More and More Mainers "Begging for Change" to Meet Health Care Needs Campaign for Public Health Plan Option Highlights Those Forced to Ask for Spare Change; Unveil "Begging for Change--The Healthcare Blues" WHO: Maine families who have been forced to collect spare change to pay for health care; Dr. Wayne Myers, M.D., former Director, Federal Office of Rural Health Policy, U.S. Department of Health and Human Services, and past President, National Rural Health Association; Nicole Witherbee, Maine Center for Economic Policy; Portland musician Peter Alexander, who will perform his new composition, the "Begging for Change-The Healthcare Blues."Thank you for your help in achieving quality, affordable health care for all Maine people and Americans! WHAT: A press conference to announce the launch of the "Begging for Change" campaign here in Maine. Throughout our state, local convenience stores and gas stations display cans or jars to solicit spare change for a Maine family faced with a health care catastrophe. Or, one will see fliers for yard sales, community suppers or other events to raise money for a Maine family that has been devastated by medical bills and has resorted to asking strangers for help. An example of one of those cans is at the bottom of this advisory. We have been collecting these pictures for over a month. The campaign will collect as many of these images as is possible and present them to our members of Congress to underscore the need for a strong and immediate public health insurance option. Every day we wait, these families and many more across the state delay care and make life-or-death medical decisions based on economic factors. WHEN: Wednesday, June 17th at 11:00 AM EDT WHERE: At the intersection of Western Promenade and West Street in Portland. RAIN LOCATION: The Salt Institute for Documentary Studies, 561 Congress Street, Portland FOR MORE INFO: Contact Greg Howard at 207-232-2863 or ctwmaine@gmail.com Thank you for your help in achieving quality, affordable health care for all Maine people!

Direct Care Alliance's Effort Gains Momentum as Senators Demand Minimum Wage and Overtime for Home Care Workers

June 12, 2009 Add your voice to the growing chorus! If you haven't already sent Secretary Solis a letter of your own, visit the Direct Care Alliance's Legislative Action Center now and send one in. It will only take a minute of your time. A powerful group of senators has joined the effort the DCA has been spearheading to extend minimum wage and overtime protection to home care workers. Fifteen senators led by Tom Harkin (D-IA) have asked U.S. Department of Labor (DOL) Secretary Hilda Solis to grant basic labor protections to home care workers. The senators - including Edward M. Kennedy (D-MA), Chuck Schumer (D-NY), Arlen Specter (D-PA), and Robert P. Casey, Jr. (D-PA) - sent the Secretary a letter yesterday. Last month, after the DCA brought a group of direct care workers and their allies to Capitol Hill to ask legislators for their support, 37 members of the House of Representatives sent Secretary Solis a letter asking for the same fix. Leonila Vega Executive Director Direct Care Alliance lvega@directcarealliance.org (212) 730-0741

Poetic Venting

By Steve Hoad Emma's Family Farm Windsor, Maine See what we're doing on the Farm at http://twitter.com/TheHoads “Let ‘em Eat Cake” Is Governor Baldacci the reincarnation of Marie Antoinette? “Please, I’m disturbed by the noise that you make, If you can’t make your bread, You’ll have to eat cake! Your car broke down while I was out golfing? Relax, check in for a session of rolfing. We’re bowling and skiing, it doesn’t tax us, If your car doesn’t work, You must ride the bus! If there’s no bus and you can’t get to work, Stay home, bake a cake, Stop grousing, you jerk! As Mainers we must host all for their pleasure, We can’t help those folks whose work ethic’s a treasure!” This poet ponders and looks at new taxes, His car’s all broke down while our gov’nor relaxes. Taxing repairs will punish the poor, While bowlers and golfers don’t have to pay more. And then, when its winter, the weather is cold! The poor person’s car needs repair ‘cause its old, Its sales tax increasing the bill that he’s seeing, While pleasurful folks go scot free for their skiing. Logic does dictate that taxes are there, We know its important, we should pay our share. While others seek pleasure, it just isn’t fair, That those who must work pay tax on repair.

Find a Maine Farmer's Market Online

The Maine Department of Agriculture offers a service to allow you to find a local farmers' market. Farmers' markets offer foods a agricultural products, harvested fresh and sold directly to you by the farmers. Markets are located throughout the state and each offer a variety of products. The service is available online at http://www.getrealmaine.com/ by clicking on "Farmers' Markets" on the left. You may also search for Maine food products and farms throughout this site. email from Representative David Cotta, House District 55

Maine Center for Disease Control & Prevention offers tips to prevent Lyme Disease and other Illnesses

Officials from the Maine Center for Disease Control & Prevention (CDC) have outlined a series of steps Mainers can take to reduce the chance of ticks and mosquito bites and prevent Lyme Disease, Eastern Equine Encephalitis (EEE), and the West Nile Virus. Lyme Disease, a bacterial infection that is transmitted through tick bites, is on the rise in Maine. EEE and the West Nile Virus are mosquito-borne infections. Since mosquito and tick season has arrived, now is the time to take precautions. The CDC advocates three basic ways to minimize exposure: 1) Clean up unnecessary standing water, rain gutters, leaf litter, brush, and logs in order to reduce tick and mosquito habitats around the yard; 2) Cover up with a long-sleeve shirt and pants, and/or appropriately use a DEET-containing insect repellent or other EPA-registered repellent to reduce the chances of being bitten by ticks and mosquitoes; 3) Check your skin and your children's skin daily for ticks after being outside. It is very important to enjoy the outdoors and by taking these steps, you can minimize your risk of contracting these diseases. For more information, visit the Maine CDC website on EEE and the West Nile Virus at www.maine.gov/hhs/boh/ddc/arbovirus/index.htm and the Maine CDC website on Lyme Disease at http://www.maine.gov/dhhs/boh/ddc/epi/vector-borne/lyme/. an email from Representative David Cotta, House District 55

Study: Medical Bills Behind Most Bankruptcies

by Mike Hall, Jun 5, 2009 Crushing medical bills were the major cause of 62 percent of all personal bankruptcies in 2007. Even worse—75 percent of those with medical bill-related bankruptcies had health insurance. More bad news: The percentages cited above were based on data collected before the nation’s economy began its long nose dive. Says one of the study’s authors, David Himmelstein, an associate professor of medicine at Harvard Medical School: Unless you’re a Warren Buffett or Bill Gates, you’re one illness away from financial ruin in this country. If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that’s the major finding in our study. The U.S. health care financing system is broken, and not only for the poor and uninsured. Middle-class families frequently collapse under the strain of a health care system that treats physical wounds, but often inflicts fiscal ones. Researchers from Harvard and Ohio University published the study in the American Journal of Medicine. In the AFL-CIO’s 2009 Health Care for America Survey, thousands of the more than 23,000 respondents cited the burden of high medical costs, even with insurance coverage, as a major problem facing working families. The survey’s full findings will be released later this month. In the bankruptcy cases studied, hospital costs accounted for nearly half the medical expenses (48 percent), followed by prescription drugs (18.6 percent), doctor bills (15.1 percent) and insurance premiums (4.1 percent). Medical equipment and nursing home care rounded out the list. Says Himmelstein; For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when a prolonged illness causes job loss—precisely when families need it most. One of the key elements of health care reform backed by President Obama and the AFL-CIO is inclusion of a public health insurance option to enable workers and families who either have private insurance coverage or no coverage to choose between private or public insurance plans. It has been vigorously attacked by the private insurance industry and most congressional Republicans. Deborah Thorne, associate professor of sociology at Ohio University and a co-author of the study, says medical costs leading to bankruptcy affect families who have played by the rules of our economic system, and they deserve nothing less than affordable health care. AFL-CIO Blog

Home Care Workers Protest Budget Cuts That Would Drop 380,000 Patients

by James Parks, Jun 8, 2009 More than 3,000 members of the United Domestic Workers Homecare Providers Union (UDW/AFSCME) joined with other service workers and their allies in Los Angeles to support critical public programs from the budget ax. California Gov. Arnold Schwarzenegger (R) has proposed budget cuts that UDW says would all but destroy the In Home Supportive Services (IHSS) program, which provides home care for more than 420,000 low-income elderly and Californians with disabilities. Under the latest Schwarzenegger plan, some 380,000 individuals—nearly 90 percent of all IHSS participants—would be thrown out of the program. This comes on top of an earlier proposal from the governor that would cut the pay for the state’s home care providers back to minimum wage. UDW Executive Director Douglas Moore says: While the governor’s earlier proposals were foolish and shortsighted, his latest scheme is outrageous, vindictive and unconscionable. Despite the Golden State’s mounting state deficit, polls show a majority of California voters oppose cutting public services, but favor higher taxes on the wealthy and on specific industries like oil, tobacco and alcohol. Voters last month rejected several propositions to balance the budget, one of which would have put a cap on state spending. “The solutions are right there in front of us,” says UDW President Laura Reyes, a San Diego home care provider. The voters have spoken. The legislature and governor just need to listen to the will of the people. The next step is for lawmakers to develop a progressive state budget in 2010 that does not depend on ballot initiatives, UDW says. The real victims of the budget cuts would be the state’s seniors and people with disabilities. “We understand times are hard right now and we need to tighten up,” Evelyn Lopez of Bakersfield told the Los Angeles Times. “But what [the governor's] proposing are big cuts.” Lopez said that if state workers were going to be paid minimum wage, most would probably find other jobs that pay better. That would reduce the number of providers available to watch her developmentally disabled son while she is at work, Lopez said. Click here to learn more. AFL-CIO Blog

Maine governor signs health care legislation

By GLENN ADAMS , 06.10.09 Associated Press AUGUSTA, Maine -- After signing a bill that uses a new funding mechanism for his prized Dirigo program, Maine Gov. John Baldacci praised the Legislature on Wednesday for enacting that and several other laws he said will go a long way toward improving health care for Mainers. "Taken together, these bills will help advance the broad goals of the original Dirigo reforms to make quality, affordable health care available to all Mainers and to work to make Maine the healthiest state in the nation," Baldacci said at a news conference after signing several of the bills. Among them is one that replaces the funding mechanism for the subsidized health care program Dirigo, which Baldacci has championed since its start in 2003. The new law replaces the savings offset payment, now assessed at a variable rate of up to 4 percent of paid claims, with a fixed 2.14 percent payment on claims paid monthly. The new fixed rates will replace fluctuating savings offsets payments, which drew court challenges by the health insurance industry. By stabilizing the funding stream for Dirigo, the state will avoid costly litigation and open the door to more people who need health coverage, said Joseph Ditre, executive director of the advocacy group Consumers for Affordable Health Care. Other newly enacted bills establish medical school scholarships for Maine students, enhance telemedicine services and improve health care transparency. They also expand health coverage for temporarily laid off workers of small firms, take steps toward a universal wellness program and take steps to screen patients at Maine hospitals for infections that pose a risk to other patients. A bill still facing final votes would establish a Maine Health Care Bill of Rights, which would require that insurers give people more information about their health care plans before they face unexpected medical bills. Copyright 2009 Associated Press. All rights reserved. This material may not be published broadcast, rewritten, or redistributed

Changes in Dirigo

I don't know what this all means for LD 1059, the Direct Care Worker Insurance bill. It may end up like last session's LD 1687. 1687 made changes to Dirigo to let Direct Care Workers into it. It did not make it out of the Insurance and Financial Services Committee because there was no funding for Dirigo. As I know more about LD 1059, I'll post.

Oregon Bill Bans Mandatory Anti-Union Meetings

by Mike Hall, Jun 9, 2009 When Oregon workers are choosing to form a union and bargain for a better life, they would not be forced to attend coercive, mandatory anti-union meetings by management under the Worker Freedom Act passed Monday by the Oregon State Senate. It now goes to the House, where it won approval in 2007. The legislation will make it illegal for an employer to discipline or fire a worker who chooses not to attend a meeting on politics, religion or union organizing during work hours. Says Oregon AFL-CIO President Tom Chamberlain: Workers should not have to give up their opinions or be lectured about their employer’s beliefs to get a paycheck. Almost all anti-union campaigns are marked by mandatory meetings where employers or their union-busting consultants use a variety of tactics to intimidate workers. In many cases, workers who speak out for the union are disciplined and even fired. Chamberlain says the forced meetings are not always about politics. One Oregon worker told the state federation that he was disciplined after walking away from a lunchroom after his employer started making anti-Catholic statements. During the last election campaign, Wal-Mart forced workers to attend meetings in which managers told them electing Democrats to the White House and Congress could threaten their jobs. Wal-Mart is one of the leading corporate voices in the multimillion campaign battling the Employee Free Choice Act that would allow workers to form unions free of that type of intimidation and harassment The Worker Freedom Act (S.B. 519) was passed, 16-14, by the Oregon Senate, with two Democrats, Ginny Burdick of Portland and Betsy Johnson of Scappoose, joining all 12 Republicans in opposing the bill. Oregon Gov. Ted Kulongoski has said he will sign the bill if it reaches his desk.

Labor Expert call for Minimum Labor Protections for Home Care Workers

"Federal reform is urgently needed to provide home care workers with the compensation and respect they deserve," says Peggie Smith. Smith, who is the Murray Family Professor of Law at the University of Iowa College of Law and a graduate of Harvard Law, is talking about a U.S. Supreme Court decision that excluded home care workers from protection under the federal Fair Labor Standards Act (FLSA). The court said the workers were providing companionship services. In Protecting Home Care Workers under the Fair Labor Standards Act, (PDF) the second in a series of Direct Care Alliance policy briefs, Smith says the decision “threatens to destabilize the home care industry, erode the precarious economic status of home care workers, and undermine the quality of care that they provide to home care clients.” She outlines two approaches the federal government could take to reverse the ruling: 1. Amend the FLSA to explicitly include home care workers; and 2. Revise Department of Labor (DOL) regulations to significantly limit the reach of the companionship exemption. Smith recommends that the government do both, with the DOL taking immediate action to revise the companionship exemption while Congress works to reverse the impact of the Supreme Court decision by passing the Fair Home Health Care Act. Fixing an injustice “Professor Smith points out that U.S. Department of Labor Secretary Hilda Solis can immediately fix this injustice by simply implementing rules that had already been developed by the Clinton Administration,” says Leonila Vega, executive director of the Direct Care Alliance. As the attorney who argued the case told the Supreme Court, it is unjust to deny home care workers a right that applies to other social servants. “[P]olice and fire personnel are covered, hospital employees are covered, nursing home employees are covered, and other providers of essential services are covered,” he wrote. ”Why should homecare workers uniquely carry the burden of society’s need for their services?” “Home care workers are some of the hardest working people I know,” says Direct Care Alliance board member Tracy Dudzinski, a CNA and home care worker who chairs the board of a worker-owned home care co-op in Wisconsin. “We often put in a ten-hour day to get paid for six. Not being granted basic minimum wage and overtime protection on top of that is just plain wrong. Most every other profession in the U.S. is granted these rights under the Fair Labor Standards Act. Ours should be too.” Ask U.S. Department of Labor Secretary Solis to include home care workers in the Federal Fair Labor Standards Act click on bold text for link Related news and resources The DCA board passes a resolution in favor of the FLSA fix The DCA sends a letter to Secretary Solis asking her to undo the FLSA exemption The DCA sponsors a trip to DC, where one of the asks is that Congresspeople sign a letter to Secretary Solis, asking her to undo the FLSA exemption 37 members of Congress sign the letter to Secretary Solis The Eldercare Workforce Alliance asks for the FLSA fix Elise Nakhnikian Communications Director Direct Care Alliance

Health Care Spending Disparities Stir a Fight

By ROBERT PEAR New York Times June 9, 2009 WASHINGTON — President Obama recently summoned aides to the Oval Office to discuss a magazine article investigating why the border town of McAllen, Tex., was the country’s most expensive place for health care. The article became required reading in the White House, with Mr. Obama even citing it at a meeting last week with two dozen Democratic senators. “He came into the meeting with that article having affected his thinking dramatically,” said Senator Ron Wyden, Democrat of Oregon. “He, in effect, took that article and put it in front of a big group of senators and said, ‘This is what we’ve got to fix.’ ” As part of the larger effort to overhaul health care, lawmakers are trying to address the problem that intrigues Mr. Obama so much — the huge geographic variations in Medicare spending per beneficiary. Two decades of research suggests that the higher spending does not produce better results for patients but may be evidence of inefficiency. Members of Congress are seriously considering proposals to rein in the growth of health spending by taking tens of billions of dollars of Medicare money away from doctors and hospitals in high-cost areas and using it to help cover the uninsured or treat patients in lower-cost regions. Those proposals have alarmed lawmakers from higher-cost states like Florida, Massachusetts, New Jersey and New York. But they have won tentative support among some lawmakers from Iowa, Minnesota, Montana, North Dakota, Oregon and Washington, who say their states have long been shortchanged by Medicare. Nationally, according to the Dartmouth Atlas of Health Care, Medicare spent an average of $8,304 per beneficiary in 2006. Among states, New York was tops, at $9,564, and Hawaii was lowest, at $5,311. Researchers at Dartmouth Medical School have also found wide variations within states and among cities. Medicare spent $16,351 per beneficiary in Miami in 2006, almost twice the average of $8,331 in San Francisco, they said. The Senate Finance Committee recently suggested that one way to pay for health care overhaul would be to reduce geographic variations by cutting or capping Medicare payments in “areas where per-beneficiary spending is above a certain threshold, compared with the national average.” Another proposal would spare health care providers in low-spending, efficient areas from across-the-board cuts in Medicare payments. The committee chairman, Senator Max Baucus, Democrat of Montana, and the panel’s senior Republican, Senator Charles E. Grassley of Iowa, are from lower-spending states. But the proposals are not just pork-barrel politics. They are based on the research by Dartmouth experts who have documented wide geographic variations in health spending. The research has become phenomenally influential on Capitol Hill since it was popularized by Peter R. Orszag, as director of the Congressional Budget Office and then as President Obama’s budget director. Aides said Mr. Obama had been intrigued by regional variations in health spending since before his inauguration. The topic came up at a meeting with Mr. Orszag in Chicago late last year. The magazine article, by Dr. Atul Gawande in the June 1 issue of The New Yorker, said a major cause of the high costs in McAllen was “overuse of medical care.” Dr. Elliott S. Fisher, one of the Dartmouth researchers, diagnosed the problem this way: “Medicare beneficiaries in higher spending regions are hospitalized more frequently, are referred to specialists more often and have a much smaller proportion of their visits to primary care physicians.” In his blog last month, Mr. Orszag wrote, “The higher-cost areas and hospitals don’t generate better outcomes than the lower-cost ones.” But other researchers and politicians are not so sure. They say it would be a mistake to cut or cap Medicare payments without knowing why spending in some places far exceeds the national average. “There is too much uncertainty about the Dartmouth study to use it as a basis for public policy,” said Senator John Kerry, Democrat of Massachusetts. “Researchers can’t explain why some areas of the country spend more on health care than others. There are many reasons spending could vary: higher costs of living, sicker people or more teaching hospitals.” “States like Massachusetts are concentrated centers of medical innovation where cutting-edge treatments are tested and some of the nation’s finest doctors are trained,” Mr. Kerry added. “This work might cost a little more, but it benefits the entire country.” Madeline H. Otto, an aide to Senator Bill Nelson, Democrat of Florida, said he was “adamantly opposed” to the proposed cuts in higher-spending areas because the cuts did not distinguish between necessary and unnecessary care. Mr. Orszag says health spending could be reduced by as much as 30 percent, or $700 billion a year, without compromising the quality of care, if more doctors and hospitals practiced like those in low-cost areas. The supply of hospitals, medical specialists and high-tech equipment “appears to generate its own demand,” Mr. Orszag has said. A Democrat from a low-spending state said critics were trying to “blow holes in the Dartmouth analysis.” Dr. Michael L. Langberg, senior vice president of Cedars-Sinai Medical Center in Los Angeles, is among the critics. “The statement that Medicare costs can be cut by 30 percent has been repeated so many times that it has come to be viewed as a proven fact by some,” Dr. Langberg said in a recent letter to the Senate Finance Committee. “It is not a fact. It is a gross oversimplification of an untested theory.” Dr. Langberg endorsed the goal of covering the uninsured, but said, “We do not believe that rushing to make large cuts in Medicare payments to hospitals is the right way to fund that coverage.” The Dartmouth team has cited Cedars-Sinai as having very high Medicare spending per beneficiary. Research by Dr. Robert A. Berenson and Jack Hadley of the Urban Institute suggests that much of the geographic variation in health spending can be explained by differences in “individual characteristics, especially patients’ underlying health status and a range of socio-economic factors, including income.” “Some patients may benefit from higher spending,” said Mr. Hadley, who is also a professor at George Mason University in Virginia. “They could be adversely affected if they live in geographic areas where payments are cut.” Dr. Berenson, who was a Medicare official in the Clinton administration, said, “There remains too much uncertainty about the Dartmouth findings to ground public policy on them.”

Senate Feels Ted Kennedy’s Absence on Health Bill

By DAVID M. HERSZENHORN New York Times June 9, 2009 WASHINGTON — The run-up to major health care legislation is now a full-on frenzy, and some of the main power players were in yet another marathon meeting on Monday afternoon in the not-so-secret hideaway office of Senator Edward M. Kennedy. But Mr. Kennedy, the Democratic chairman of the Health, Education, Labor and Pensions Committee, who has been closely identified with the issue of health care over his nearly 47 years in the Senate, was back home in Massachusetts, where he is still being treated for brain cancer. Though Mr. Kennedy continues to work closely on the unfolding legislation and is in constant touch with staff members and colleagues, he is not expected to return to the Capitol as formal debate begins this month, either for committee hearings or when the legislation moves to the Senate floor. “I think we would all like to see Senator Kennedy here for many, many reasons,” said Senator Jack Reed, Democrat of Rhode Island and a member of the health committee. “But we are going to move forward.” Mr. Kennedy’s close friend, Senator Christopher J. Dodd, Democrat of Connecticut, who is the No. 2 Democrat on the health committee, has taken on the main role. He is supported by the leaders of three health care “working groups” that Mr. Kennedy created in November, which is when he tapped Mr. Dodd to be his “chief deputy.” Mr. Dodd met with Mr. Kennedy about the health legislation and had dinner at his home on Sunday. Mr. Kennedy is also in touch by phone with President Obama. Mr. Dodd, in a conference call with reporters, said he was holding out hope for Mr. Kennedy’s return. “My hope is he’ll be back at any, any one of these days,” he said. “There is also a spirit he brings to, a dynamic that is hard to quantify,” Mr. Dodd said. “And so, he’ll be missed when he’s not there. But my hope is that he will be back as frequently as he can to play that role.” Mr. Kennedy’s absence has raised alarm among Democrats and Republicans who say that his gravitas and the force of his personality, particularly his ability to usher colleagues past minor disputes in pursuit of larger goals, will be missed as the debate heats up. “He is the only guy who can bring us together, temper the demands of liberal advocacy groups and steer people toward a pragmatic solution,” said Senator Orrin G. Hatch, Republican of Utah, who is a member of both the health committee and the Finance Committee and is a longtime collaborator with Mr. Kennedy on health legislation. A draft of a bill by Mr. Kennedy began circulating late last week, including provisions that would guarantee health coverage for all Americans and would penalize employers who do not help provide insurance. Republicans say such a guarantee is unaffordable. As critics began to level sharp criticism of the proposal on Monday, Mr. Kennedy was not on hand to rebut it. A spokesman for Mr. Kennedy, Anthony Coley, said in an interview that the senator is “doing well and balancing his work on health care reform with his treatment plan.” In a statement, Mr. Coley said that universal health coverage for Americans is the “cause of his life” and that “he continues to lead.” He added, “That doesn’t depend on location.” The majority leader, Senator Harry Reid of Nevada, had raised hopes that Mr. Kennedy would return for the health care debate, telling reporters last month that both Mr. Kennedy and Senator Robert C. Byrd, Democrat of West Virginia, who at age 91 is the oldest senator, were recovering from illnesses. But neither man has been able to return, and Mr. Byrd’s staff said Monday that he remained hospitalized for treatment of an infection.

Moderates in Congress feel health care push

By John Fritze USA TODAY June 9, 2009 WASHINGTON — As Congress considers an overhaul of the nation's health care system, pressure is mounting on a small circle of Senate moderates who helped advance President Obama's economic stimulus this year. Centrists in both parties, including Sen. Susan Collins, R-Maine, and Sen. Ben Nelson, D-Neb. — both of whom played a critical role in shaping the stimulus — are being courted by interest groups and the White House as lawmakers seek a way to provide health care to 46 million uninsured people. "On the Senate side, there is more outreach … to Republicans than was the case during the early days of the stimulus," said Collins, who said she has heard frequently from the administration and Sen. Max Baucus, D-Mont., a key architect of the health care effort. "It's in everyone's interest to try to advance a bipartisan bill." Baucus, chairman of the Senate Finance Committee, said he hopes to have a draft bill this month. A separate proposal by Sen. Edward Kennedy, D-Mass., began circulating last week. Lawmakers have negotiated for weeks over controversial provisions such as a government-run insurance program and how to pay for the more than $1 trillion the proposal may cost. Democrats, including Baucus, say they want Republican support, but the effort has been strained as the White House has pushed aggressively for a government plan. Nine Republicans on the Finance Committee sent a letter to Obama, released Monday, arguing that such a plan would lead to "a federal government takeover of our health care system." The only GOP member of the committee who did not sign the letter is a moderate: Sen. Olympia Snowe of Maine. If Democrats want Republican support, they will probably need 60 votes, the threshold required to stop filibusters and proceed to a final vote. Democrats can count on 59 votes, but it is not clear whether all Democrats will vote for whatever proposal emerges. "I assume they'll place a great emphasis on trying to get to 60 votes, in which case moderate support will be very important," said Sen. Evan Bayh, D-Ind., who formed a coalition of centrist Democratic senators in March. "That's the ideal situation." Interest groups have been airing advertisements in states represented by moderates, including Maine, Nebraska, Indiana and Pennsylvania, where Sen. Arlen Specter abandoned Republicans to become a Democrat in April. MoveOn.org, a group that raises money and organizes for liberal causes, used a series of radio ads to seek support for the government-run insurance option. Those ads ran in six states, including Maine and Oregon. "We made a conscious decision to put that argument in front of senators who have a real role to play in securing this public health care option," said Ilyse Hogue, a MoveOn spokeswoman. One group, the Consumers Union, knocks on doors in Maine to talk with constituents about health care. Conservatives have also focused on centrists. The Americans for Prosperity Foundation has aired ads in Indiana, Arkansas, Montana and Nebraska, among other states, likening Democratic proposals to state-run health care in Canada. "We're bringing education to … where the education is going to matter," spokeswoman Amy Menefee said. Approval of the $787 billion economic stimulus bill in February hinged on the Senate's ability to find 60 votes. Three Republican senators, Collins, Specter and Snowe, voted for the bill. If bipartisanship fails, moderates may not be as important because Democrats can rely on a tactic known as reconciliation. If used, supporters could pass a bill with 51 votes, meaning Republicans might not be needed. Baucus and other Democrats have said they would prefer to find a compromise. "The moderates will be very important," said Richard Kirsch, national campaign manager for Health Care for America Now, which has run ads in several states represented by moderates. But, he added, Democrats have significantly more leverage because of the reconciliation option. Reconciliation, though, could be thorny. Democrats would have to secure fewer votes but "there's a huge, capital letter B-U-T," said Robert Dove, a former Senate parliamentarian. The minority party can put up roadblocks, some of which require 60 votes to overcome.

Obama Urges Quick Action on Insurance

New York Times By ROBERT PEAR and SHERYL GAY STOLBERG Published: June 2, 2009 WASHINGTON — President Obama on Tuesday affirmed his support for the creation of a government-sponsored health insurance plan, but he acknowledged that such a plan would sharply reduce the chances for Republican support of legislation to overhaul the health care system, Democratic senators said. The senators, who met with Mr. Obama at the White House, said he also set forth a timeline, calling on Congress to send him a comprehensive health care bill by October. “He wants the bill through the Senate and the House before the August recess, so we can conference and have it done in September and signed in October,” said Senator Barbara A. Mikulski, Democrat of Maryland. “He said we need to be unflinching and unflagging.” In remarks just before the meeting, Mr. Obama said: “This is going to be a heavy lift. I think everybody understands that. But I’m also confident that people want to get this done this year.” The Senate Democratic leader, Harry Reid of Nevada, said he believed that the full Senate should be able to take up the health care bill and “hopefully finish it” next month. “But, you know, I don’t know,” Mr. Reid added. “We’ll have to see how long things take.” In response to a question from Senator Jeff Bingaman, Democrat of New Mexico, Mr. Obama said that it was important to include a public plan option and that such a plan could help control health costs. Senator Sheldon Whitehouse of Rhode Island, one of two dozen Democratic senators who met with Mr. Obama, said the president “spoke very enthusiastically about a public plan” that would compete directly with private insurers. The president’s words were comforting to Democrats like Senator Sherrod Brown of Ohio. “The sentiment in the room, with the president and the rest of us, was that a public plan option will keep the insurance industry honest, will give people more choices in their health care and can save significant amounts of money,” Mr. Brown said. But other senators at the meeting reported that Mr. Obama also said he wanted a bipartisan health care bill, and they said he recognized that Republicans were strenuously opposed to a government-sponsored plan. Reid H. Cherlin, a White House spokesman, declined to characterize the president’s comments. Other Democrats said Mr. Obama suggested that as “a show of good faith,” Democrats might work with Republicans on other issues, like medical malpractice. Many Republicans would like to limit the amount or types of damages available to patients who sue doctors, hospitals and other health care providers. Another topic at the White House meeting was how to pay for covering millions of the uninsured. Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, said Mr. Obama indicated that he “might consider” the idea of taxing some employer-provided health benefits, a proposal favored by Mr. Baucus. “It’s on the table,” Mr. Baucus said. “It’s an option.” The White House pushed back, saying Mr. Obama “made it very clear” that he preferred his own revenue proposals. Mr. Obama campaigned against taxing health benefits last year. Labor unions and many employers adamantly oppose a limit on tax-free health benefits. But in a report on Tuesday, the Center on Budget and Policy Priorities, a liberal-leaning research and advocacy group, said, “Congress is unlikely to be able to finance health reform legislation that includes universal coverage unless it limits the exclusion of employers’ health insurance payments from workers’ income and payroll taxes.” Senator Edward M. Kennedy, Democrat of Massachusetts, who is battling brain cancer, did not attend the White House meeting and is not expected on Capitol Hill this week. But the Committee on Health, Education, Labor and Pensions, of which he is chairman, met for more than an hour Tuesday to sift through options. To help control costs, the administration indicated support on Tuesday for a proposal to strengthen a federal panel that recommends how much Medicare should pay doctors, hospitals, nursing homes and other health care providers. Senator John D. Rockefeller IV, Democrat of West Virginia, recently introduced a bill that would expand the role of the panel, the Medicare Payment Advisory Commission, and give its recommendations the force of law. Senators said Mr. Obama and his aides had expressed general support for such a change, which would establish the panel as an independent rate-setting body in the executive branch. Several senators said Mr. Obama had conveyed a sense of urgency and spoken emphatically about the importance of revamping the health care system in a way that would reduce costs. “The president made clear that history will judge us by whether this bill controls health costs,” said Senator Ron Wyden, Democrat of Oregon.

2 Democrats Spearheading Health Bill Are Split

New York Times By ROBERT PEAR Published: May 29, 2009 WASHINGTON — A significant split has developed between the two Democratic senators leading efforts to remake the nation’s health care system. They disagree over the contours of a public health insurance plan, the most explosive issue in the debate. One of the senators, Edward M. Kennedy of Massachusetts, reasserting himself after months of treatment for brain cancer, made clear this week that he favored a robust public health care plan, a government-sponsored entity that would compete with private insurers. As a starting point for his bill, Mr. Kennedy favors a public plan that looks like Medicare, the government-run program for older Americans created in 1965, when he was a young senator. By contrast, Senator Max Baucus, the Montana Democrat who is chairman of the Finance Committee, has been working for months with the panel’s senior Republican, Charles E. Grassley of Iowa, in the hope of forging a bipartisan bill, which would probably play down the option of a public plan. Mr. Grassley opposes creation of a new government insurance program and says “we cannot afford the public health plan we have already,” referring to Medicare. President Obama has championed a public plan, saying it would help “keep the private sector honest,” though he has indicated he will be flexible on the details. House Democratic leaders, including three committee chairmen drafting the House bill, are close to Senator Kennedy’s position. Democrats on the Finance Committee said Mr. Baucus was exploring a possible compromise. Under this proposal, the public plan would be created only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years. Senate Democrats said they believed that Mr. Baucus might settle for this “fallback plan,” which could win some support on both sides of his committee, from people like Senator Ron Wyden of Oregon, a Democrat, and Senator Olympia J. Snowe of Maine, a Republican. Passage of comprehensive health legislation this year is a top priority for Mr. Baucus and Mr. Kennedy, the chairman of the Committee on Health, Education, Labor and Pensions. So they may be able to resolve their differences, aides said. The split reflects not only political differences between the two men but also differences between their committees, racing to write the most ambitious health care legislation in the nation’s history. Over all, Democrats on the Finance Committee tend to be more moderate than those on the health committee, which includes more Democrats who identify themselves as liberals or progressives. The two Senate panels are drafting separate bills that are to be merged before going to the Senate floor. Describing his plan this week, Mr. Kennedy said: “Americans want the choice of enrolling in a health insurance program backed by the government for the public good, not private profit. So that option will be available.” Consumers, he said, will be able to enroll in “a publicly sponsored and guaranteed plan.” Senator Charles E. Schumer of New York, the third-ranking member of the Senate Democratic leadership, said Friday, “It’s pretty certain that Senator Kennedy could not support the Baucus plan, and Senator Baucus could not support the Kennedy plan.” But Mr. Schumer said “it’s possible” that both could support a version he is developing. Under Mr. Schumer’s proposal, any new public plan would have to comply with all the rules and standards that apply to private insurance. A public plan would also have to be self-sustaining, would have to rely on premiums and would not have a pipeline into the federal Treasury. Mr. Baucus said last month that while a government-run insurance plan was still on the table, “it might be a bit on the side of the table.” Erin Shields, a spokeswoman for Mr. Baucus, said Friday, “The Finance Committee has not decided or settled on what a public plan option would look like, if one were to be included in the bill.” Public opinion polls suggest that many consumers would like to have the choice of a public plan. But insurance companies and Republican lawmakers say a public plan could drive private insurers out of business and lead eventually to a single-payer system run by the government. Supporters of a public plan have been putting pressure on Mr. Baucus. Mr. Kennedy and 28 other senators signed up last week as co-sponsors of a resolution supporting creation of a public insurance option. “Health care reform must include insurance reform, and health insurance reform must include the option of a federally backed health insurance plan,” said Senator Sherrod Brown, Democrat of Ohio, the chief sponsor of the resolution. Many doctors and hospital executives fear that a public plan would pay them at Medicare rates, which are often lower than those paid by commercial insurers. Under Mr. Kennedy’s proposal, the government-sponsored plan might pay more than Medicare, perhaps 10 percent more, but less than private insurance. Under the House bill, the public plan would use Medicare fee schedules in setting payments to health care providers. Republicans denounce such rate-setting techniques as price controls or “administered prices.”