Big Pharma Buys Off The Senate

An eleventh-hour loophole in the “fiscal cliff” deal confirms our worst suspicions about how Congress operates.

The inauguration of a president is one of those spectacles of democracy that can make us remember we�re part of something big and enduring. So for a few hours this past Monday, the pomp and circumstance inspired us to think that government of, by, and for the people really is just that, despite the predatory threats that stalk it.

But the mood didn�t last. Every now and then, as the cameras panned upward, the Capitol dome towering over the ceremony was a reminder of something the good feeling of the moment couldn�t erase. It�s the journalist�s curse to have a good time spoiled by the reality beyond the pageantry. Just a couple of days before the inaugural festivities, The New York Times published some superb investigative reporting by the team of Eric Lipton and Kevin Sack, and their revelations were hard to forget, even at a time of celebration.

The story told us of a pharmaceutical giant called Amgen and three senators so close to it they might be entries on its balance sheet: Republican Minority Leader Mitch McConnell, Democratic Senator Max Baucus, chair of the Senate Finance Committee, and that powerful committee�s ranking Republican, Orrin Hatch. A trio of perpetrators who treat the United States treasury as if it were a cash-and-carry annex of corporate America.

The Times story described how Amgen got a huge hidden gift from unnamed members of Congress and their staffers. They slipped an eleventh-hour loophole into the New Year�s Eve deal that kept the government from going over the fiscal cliff. When the sun rose in the morning, there it was, a richly embroidered loophole for Amgen that will cost taxpayers a cool half a billion dollars.

Amgen is the world�s largest biotechnology firm, a drug maker that sells a variety of medications. The little clause they secretly sneaked into the fiscal cliff bill gives the company two more years of relief from Medicare cost controls for certain drugs used by patients who are on kidney dialysis, including a pill called Sensipar, manufactured by Amgen.

The provision didn�t mention Amgen by name, but according to reporters Lipton and Sack, the news that it had been tucked into the fiscal cliff deal �was so welcome that the company�s chief executive quickly relayed it to investment analysts.� Tipping them off, it would seem, to a jackpot in the making.

Amgen has 74 lobbyists on its team in Washington and lobbied hard for that loophole, currying favor with friends at the White House and on Capitol Hill. The Times reporters traced its �deep financial and political ties� to Baucus, McConnell and Hatch, �who hold heavy sway over Medicare payment policy.�

All three have received hefty campaign donations from the company whose bottom line mysteriously just got padded at taxpayer expense. Since 2007, Amgen employees and its political action committee have contributed nearly $68,000 to Senator Baucus, $73,000 to Senator McConnell�s campaigns, and $59,000 to Senator Hatch.

And lo and behold, among those 74 Amgen lobbyists are the former chief of staff to Senator Baucus and the former chief of staff to Senator McConnell. You get the picture: Two guys nurtured at public expense, paid as public servants, disappear through the gold-plated revolving door of Congress and presto, return as money changers in the temple of crony capitalism.

Inside to welcome them is a current top aide to Senator Hatch, one who helped weave this lucrative loophole. He used to work as a health policy analyst for � you guessed it � Amgen.

So the trail winds deeper into the sordid swamp beneath that great Capitol dome, a sinkhole where shame has all but disappeared. As reporters Lipton and Sack remind us, just weeks before this backroom betrayal of the public interest by elected officials and the mercenaries they have mentored, Amgen pleaded guilty to fraud. Look it up: fraud means trickery, cheating and duplicity. Amgen agreed to pay $762 million in criminal and civil penalties; the company had been caught illegally marketing another one of its drugs.

The fact that their puppet master had been the subject of fines and a massive federal investigation mattered not to its servile pawns in the Senate, where pomp and circumstance are but masks for the brute power of money.

Peter Welch, Vermont�s Democratic congressman, has just introduced bipartisan legislation to repeal the half billion�dollar giveaway to Amgen. Its co-sponsors include Republican Richard Hanna of New York and Democrats Jim Cooper of Tennessee and Bruce Braley of Iowa.

The Amgen deal �confirms the American public�s worst suspicions of how Congress operates,� Representative Welch told us this week. �As the nation�s economy teetered on the edge of a Congressional-created fiscal cliff, lobbyists for a private, for-profit company seized an opportunity to feed at the public trough. It�s no wonder cockroaches and root canals are more popular than Congress.�

In his inaugural address, Barack Obama said the commitments we make to each other through Medicare, Medicaid and Social Security don�t make us a nation of takers. But the actions of Amgen and its cronies under the dome on Capitol Hill show who the real takers are � not those who look to government for support in old age and hard times but the ones at the top whose avarice and lust for profit compel them to take as much as they can from that government at the expense of everyone else.

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How the Insurer Knows You Just Stocked Up on Ice Cream and Beer

Your company already knows whether you have been taking your meds, getting your teeth cleaned and going for regular medical checkups. Now some employers or their insurance companies are tracking what staffers eat, where they shop and how much weight they are putting on�and taking action to keep them in line.

The goal, say employers, is to lower health-care and insurance costs while also helping workers. Last month, 1,600 employees at four U.S. workplaces, including the City of Houston, strapped on armbands that track exercise habits, calories burned and vital signs, part of a diabetes-prevention program run by insurer Cigna. Some diabetic AT&T employees also use mobile monitors; in September, AT&T also started selling to employers its blood-pressure cuffs and other devices to track wearers 24/7.

But companies also have started scrutinizing employees’ other behavior more discreetly. Blue Cross and Blue Shield of North Carolina recently began buying spending data on more than 3 million people in its employer group plans. If someone, say, purchases plus-size clothing, the health plan could flag him for potential obesity�and then call or send mailings offering weight-loss solutions.

Marketing firms have sold this data to retailers and credit-card companies for years, and health plans have recently discovered they can use it to augment claims data. “Everybody is using these databases to sell you stuff,” says Daryl Wansink, director of health economics for the Blue Cross unit. “We happen to be trying to sell you something that can get you healthier.”

Some critics worry that the methods cross the line between protective and invasive�and could lead to job discrimination. “It’s a slippery-slope deal,” says Dr. Deborah Peel, founder of Patient Privacy Rights, which advocates for medical-data confidentiality. She worries employers could conceivably make other conclusions about people who load up the cart with butter and sugar.

Analytics firms and health insurers say they obey medical-privacy regulations, and employers never see the staff’s personal health profiles but only an aggregate picture of their health needs and expected costs. And if the targeted approach feels too intrusive, employees can ask to be placed on the wellness program’s do-not-call list.

For their part, companies say tracking employees’ medical data saves money because they use it to make people healthier�and sometimes reward them in other ways, too.

Johnson & Johnson, for example, pays employees $500 to submit their biometrics and other health information; J&J then offers eligible employees an additional $250 if they get pregnancy counseling, enroll in a disease-management program or get their colonoscopy on time. The “tailored and targeted messages” paired with the monetary incentives are a “great way to bring people to participate in the program,” says Dr. Fikry Isaac, the company’s vice president of global health services.

With companies under more pressure than ever to reduce health-care spending, the so-called advanced analytics industry provides an opportunity to zero in on errant employees and alter their behavior. “As an employer, I want you on that medication that you need to be on,” says Julie Stone, a Towers Watson TW +0.09% benefits consultant.

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Nurses Union Will Keep Fighting for Medicare for All

Now that the Supreme Court has upheld the Affordable Care Act, former insurance company executive Wendell Potter�s appeal to single payer advocates to �bury the hatchet,� recently published in The Nation, is both misdirected and shortsighted.

Potter argues that insurance industry pirates will exploit left critiques of the ACA to subvert implementation of the law. He calls on proponents of more comprehensive reform to forgive and forget, embracing the massive concessions made by the Obama administration and its liberal allies.

But there are some gaping holes in this thinking.

First, the insurers hardly need to rely on the single-payer movement to sabotage elements of the law they don�t like. They have office towers full of high-priced lawyers who are adept at identifying loopholes in the much-touted consumer protection provisions, like the bans on pre-existing condition exclusions or dropping coverage when patients get sick, or limiting how much money can be siphoned off for profits and paperwork.

Second, let�s not have illusions about the history of the ACA.

Before he was elected, President Obama, an advocate of single-payer when he was in the Senate, called on progressives to push him. Instead, most of the liberals reduced themselves to cheerleading while all the pressure came from the right.

So when the healthcare bill was introduced, the President, with the active encouragement of groups like Health Care for America Now, blocked single payer from consideration. Persuading people through consent, rather than coercion, to accept inadequate solutions for societal needs has long been a key feature of the neoliberal agenda. It’s one reason so many people vote against their own interests.

To get any hearing from Sen. Max Baucus, who was running the Senate side of the debate, nurses, doctors, and single-payer healthcare activists had to get arrested in a Senate Finance Committee hearing. On the House side, Democrats who proposed single payer amendments endured heavy-handed threats from then-White House chief of staff Rahm Emanuel. Meanwhile, then-Press Secretary Robert Gibbs publicly attacked the �professional left� who will only �be satisfied when we have Canadian healthcare and we�ve eliminated the Pentagon.�

It should not come as a surprise that negotiating with your supporters before engaging political opposition, and lecturing, hectoring and seeking to silence healthcare activists who have worked for years for real reform, Obama and the Democrats ended up with a weaker bill. That bill lacked the public option HCAN and other liberals had claimed would be their bottom line, while HCAN and other liberals embraced the individual mandate � the brainchild of the right-wing Heritage Foundation � as high principle.

Even with its positive elements � yes, it does have some � the Affordable Care Act uses public money to pad insurance profits (the subsidies to buy private insurance), prevents the government from using its clout to limit price gouging by the pharmaceutical giants, does little to effectively control rising healthcare costs for individuals and families that have made medical bankruptcies and self-rationing of care a national disgrace, and falls far short of the goal of universal coverage.

We can, as Michael Moore has said, acknowledge that the Supreme Court decision was a defeat for the opponents of any reform of our healthcare system without pretending that our nation�s health care crisis is over.

For three weeks in June and July, the California Nurses Association/National Nurses United sponsored a tour that drew about 1,000 people to free basic health screenings and another 2,000 to town hall meetings in big cities and rural communities across California. We heard a lot of stories like this one, from Carolyn Travao of Fresno:

I worked for Aetna health insurance for 15 years. When I took early retirement, I thought my Cobra would be manageable. Then they sent me a bill in January for $1,300 a month and I couldn�t pay it.

Soon after,

I had a heart attack. I knew I didn�t have health insurance. I have a mortgage. I had a 401(k) that I knew would get wiped out, so I didn�t go to the hospital. I stayed at home for 16 hours, suffering chest pains, praying that I would die because my son would be left homeless and I do have insurance to pay off my mortgage so if I die he would at least have a home. I couldn�t take the pain any longer and I kept passing out, and he kept saying “Mom, you�re going to die.”

�OK,” I said, “take me to emergency.” So we went to emergency. But when I got home, my bill was $135,000. I have $13,000 left in my 401k. I don�t think I can even start [paying]. I never thought I would lay there and want to die. But I would have rather died knowing that my son would be left homeless with no job.

Since the ACA�s cost control mechanisms for insurance companies are so weak � for example permitting insurers to charge far more based on age and where you live � and hospitals will still largely have free reign to impose un-payable bills, will Carolyn and millions like her really have guaranteed healthcare under the ACA?

Sadly, nurses who have seen far too many patients like Carolyn know the answer all too well. That is why nurses and our organization will never stop fighting for guaranteed healthcare based on a single standard of quality care for all that is not based on ability to pay and is not premised on protecting the profits of healthcare corporations that long ago wrote off patients like Carolyn Travao.

Unlike Wendell Potter and many of the liberals, nurses see the ACA as a floor, not a ceiling. It�s time now for those who say they recognize its limitations and believe in genuinely universal healthcare to join us in pushing for an improved and expanded Medicare for all.

Nurses respect the president. But they love their patients far too much not to go the distance for their patients� health and survival.

Seniors Fight Back Against Medicare Fraud

President Obama is making unprecedented strides in cracking down on health care fraud � already over $10.7 billion has been recovered since he took office.� And thanks to the Affordable Care Act, we have even more tools to stop fraud � including more law enforcement boots on the ground and more time in prison for criminals.� We�re also using state-of-the-art technology to spot fraud, similar to what�� your credit card company �uses . �As a result, prosecution of health care fraud cases is up 75% since 2008.

But for all of our new technology and investigative muscle, the most valuable resource we have in the fight against Medicare are the millions of seniors who serve as �our eyes and ears.� Seniors who notice services they never �received on their Medicare statements� often provide the �first tip that fraud is happening, so we�ve redesigned Medicare statements to make them easier to read and understand.� And our Senior Medicare Patrol (SMP) programs are educating seniors, family members, and caregivers around the country about the importance of reviewing their Medicare notices to identify errors and report potentially fraudulent activity.

That�s why the Obama Administration is investing more in the Senior Medicare Patrol. Today, the HHS Administration for Community Living announced more than $7 million in new funding to support Senior Medicare Patrol projects around the country.� This investment means more seniors will learn how to stand up for Medicare and will have even more support when they suspect that something isn�t quite right.

Seniors are paying attention and they are fighting back against the fraudsters who are trying to steal from Medicare. ��

I heard from a Medicare beneficiary in Texas who was asked to sign a work order for his diabetes supplies.� He said that normally he would have just signed and thrown the paper away.� But he had recently heard a presentation from the SMP at his adult day center, so he looked more closely and noticed that he was being charged $7,000 for one month�s supply.� So he asked his home nurse to help him call the National Hispanic SMP and together they figured out that the supplier was going to charge Medicare for 100 boxes of diabetes test strips and 100 boxes of lancets, even though he�d received only one of each.� The SMP helped resolve the case and made sure that Medicare only paid for the supplies he actually needed and received.�

Jerry Gilman, a 68 -year-old Vietnam veteran from California, has a medical condition that often makes him dizzy and in danger of falling.� His daughter, Deborah, and his doctor arranged for him to have a motorized chair to help him get around.� But the chair that arrived was not the chair that Mr. Gilman ordered.� It was smaller, flimsier, and made by an entirely different manufacturer.� Deborah called the supplier, but their hands were tied � Medicare had already processed the payment for the chair.� So Deborah turned to the SMP for help.� After weeks of investigating, they uncovered that someone had intercepted Mr. Gilman�s order and replaced it with the less sturdy chair.� The SMP was able to work with Medicare to correct the problem, get Mr. Gilman the correct chair, and make sure that Medicare wasn�t charged twice.

Chuck Johnson in Montana received a telemarketing call offering him diabetic testing supplies that he didn�t want or need.� But even though he was clear with the caller that he did not want anything, charges for those supplies showed up on his Medicare statement anyway.� Mr. Johnson got in touch with the SMP to see if they could help fix the problem.� Not only did his call mean that Medicare recovered money in his case, it also opened up a broader investigation into the organization that called him and could result in additional savings and prevented fraud.�

These three stories are eye opening, but they are not unique.� More than 1.5 million seniors have called SMP programs in cities around the country to ask questions and report potential fraud.� Together they�ve saved Medicare and the federal government in excess of $100 million. �

To all of you reading your Medicare statements carefully and tipping us off to fraud, I say thank you.� And I know your fellow American taxpayers say thank you, too. To learn more about the SMP program and to join us in our fight against Medicare fraud, go to www.stopmedicarefraud.gov.

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Chris-Care: Providing the Health Care His Patients Need

Dr. Chris Lillis practices primary care medicine in Fredericksburg, Virginia. His patients range from 14 to 102, with about 40 percent of his practice being Medicare enrollees. He loves primary care medicine because �you really get to know your patients. � I get to help them stay healthy through good times and navigate the health care system through difficult times.�

Because of the health care law, Dr. Lillis says his patients can get affordable health coverage and are better able to pay for their prescriptions.

�The Affordable Care Act absolutely is making a difference for my patients�the young folks who can stay on their parents� insurance plans [and] my Medicare beneficiaries who can now afford their medicines more easily, especially when they fall into the coverage gap, the so-called �donut hole,�� said Dr. Lillis.

�In years past, I can remember patients who chose to avoid their screening mammogram or their screening colonoscopy because a deductible or copay was just too high and they had to make a decision between [paying] for the gas in the tank of their car or [getting] a preventive screening that could potentially save their life,� Dr. Lillis says. �Thanks to the Affordable Care Act, people don�t have to make those choices any more. They can receive their preventive care screenings without out-of-pocket costs, which is the best kind of care we can deliver as primary care doctors.�

And importantly, the Affordable Care Act encourages doctors to coordinate care for patients. The health care law is �going to help us focus on quality, not quantity. I want my patients to get the health care I think they need. The Affordable Care Act does that. It�s knocking down barriers to care,� he says.

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The Biggest Myth in Obama-GOP Showdown is the “Fiscal Cliff” Itself

As negotiations continue between the White House and House Speaker John Boehner, leading economist Dean Baker joins to discuss the myths about the so-called fiscal cliff. With little more than two weeks before the deadline, President Obama insists on an immediate increase in the top two income-tax rates as a condition for further negotiations on changes to spending and entitlement programs. But Boehner said Washington�s “spending problem” is the biggest roadblock to reaching a deal, and has urged the White House to identify more spending cuts. “This idea that if we do not get a deal by the end of the year we will see the economy collapse and go into recession, that is totally dishonest,” says Baker, the co-director of the Center for Economic and Policy Research. “The basis for this is that we don�t have a deal all year � the fact that you do not have a deal December 31 does not mean that you do not get a deal by December 31, 2013.”

Help From the Affordable Care Act to Quit Smoking and Live Longer

Quitting smoking by age 35 may add 10 years to your life, according to a new article in the New England Journal of Medicine. And quitting even in middle age can increase your life expectancy by as many as six years. In fact, non-smokers are twice as likely to live to age 80 compared to smokers.

That�s why the Administration is focused on helping people, especially youth, from taking up smoking in the first place and helping adult smokers quit.� It�s not easy to stop smoking. The good news is that now, because of the Affordable Care Act, Americans have greater access than ever to resources to help them quit.

For many Americans with private health insurance plans, tobacco use screenings for all adults, cessation interventions for tobacco users, and expanded counseling for pregnant women who smoke will be covered at no out-of-pocket cost. And seniors and people with disabilities with Medicare who smoke or use tobacco products are now covered for counseling to help them stop.

But that�s not all we are doing. We are making an unprecedented investment in programs like the Million Hearts initiative, because cigarette smokers are 2-4 times more likely to develop coronary heart disease than nonsmokers. And a national ad campaign by the Centers for Disease Control and Prevention helped tens of thousands of smokers to quit. Through investments in programs like these, we can prevent and detect heart disease early� and we can get people the information they need to stop smoking and make good health decisions.

Quitting smoking may be the single most effective thing you can do to improve your life expectancy, according to the article�s findings. And now the Affordable Care Act can help you find the way to quit and add years to your life.

Visit BeTobaccoFree.gov for additional resources on quitting and preventive tips for youth.

For more information about the CDC�s Tips From Former Smokers ad campaign, see www.cdc.gov/tips.

Listen to the Podcast: Be Tobacco Free.

For Americans Under 50, Stark Findings on Health

Younger Americans die earlier and live in poorer health than their counterparts in other developed countries, with far higher rates of death from guns, car accidents and drug addiction, according to a new analysis of health and longevity in the United States.

Researchers have known for some time that the United States fares poorly in comparison with other rich countries, a trend established in the 1980s. But most studies have focused on older ages, when the majority of people die.

The findings were stark. Deaths before age 50 accounted for about two-thirds of the difference in life expectancy between males in the United States and their counterparts in 16 other developed countries, and about one-third of the difference for females. The countries in the analysis included Canada, Japan, Australia, France, Germany and Spain.

The 378-page study by a panel of experts convened by the Institute of Medicine and the National Research Council is the first to systematically compare death rates and health measures for people of all ages, including American youths. It went further than other studies in documenting the full range of causes of death, from diseases to accidents to violence. It was based on a broad review of mortality and health studies and statistics.

The panel called the pattern of higher rates of disease and shorter lives �the U.S. health disadvantage,� and said it was responsible for dragging the country to the bottom in terms of life expectancy over the past 30 years. American men ranked last in life expectancy among the 17 countries in the study, and American women ranked second to last.

�Something fundamental is going wrong,� said Dr. Steven Woolf, chairman of the Department of Family Medicine at Virginia Commonwealth University, who led the panel. �This is not the product of a particular administration or political party. Something at the core is causing the U.S. to slip behind these other high-income countries. And it�s getting worse.�

Car accidents, gun violence and drug overdoses were major contributors to years of life lost by Americans before age 50.

The rate of firearm homicides was 20 times higher in the United States than in the other countries, according to the report, which cited a 2011 study of 23 countries. And though suicide rates were lower in the United States, firearm suicide rates were six times higher.

Sixty-nine percent of all American homicide deaths in 2007 involved firearms, compared with an average of 26 percent in other countries, the study said. �The bottom line is that we are not preventing damaging health behaviors,� said Samuel Preston, a demographer and sociologist at the University of Pennsylvania, who was on the panel. �You can blame that on public health officials, or on the health care system. No one understands where responsibility lies.�

Panelists were surprised at just how consistently Americans ended up at the bottom of the rankings. The United States had the second-highest death rate from the most common form of heart disease, the kind that causes heart attacks, and the second-highest death rate from lung disease, a legacy of high smoking rates in past decades. American adults also have the highest diabetes rates.

Youths fared no better. The United States has the highest infant mortality rate among these countries, and its young people have the highest rates of sexually transmitted diseases, teen pregnancy and deaths from car crashes. Americans lose more years of life before age 50 to alcohol and drug abuse than people in any of the other countries.

Americans also had the lowest probability over all of surviving to the age of 50. The report�s second chapter details health indicators for youths where the United States ranks near or at the bottom. There are so many that the list takes up four pages. Chronic diseases, including heart disease, also played a role for people under 50.

�We expected to see some bad news and some good news,� Dr. Woolf said. �But the U.S. ranked near and at the bottom in almost every heath indicator. That stunned us.�

There were bright spots. Death rates from cancers that can be detected with tests, like breast cancer, were lower in the United States. Adults had better control over their cholesterol and high blood pressure. And the very oldest Americans � above 75 � tended to outlive their counterparts.

The panel sought to explain the poor performance. It noted the United States has a highly fragmented health care system, with limited primary care resources and a large uninsured population. It has the highest rates of poverty among the countries studied.

Education also played a role. Americans who have not graduated from high school die from diabetes at three times the rate of those with some college, Dr. Woolf said. In the other countries, more generous social safety nets buffer families from the health consequences of poverty, the report said.

Still, even the people most likely to be healthy, like college-educated Americans and those with high incomes, fare worse on many health indicators.

The report also explored less conventional explanations. Could cultural factors like individualism and dislike of government interference play a role? Americans are less likely to wear seat belts and more likely to ride motorcycles without helmets.

The United States is a bigger, more heterogeneous society with greater levels of economic inequality, and comparing its health outcomes to those in countries like Sweden or France may seem lopsided. But the panelists point out that this country spends more on health care than any other in the survey. And as recently as the 1950s, Americans scored better in life expectancy and disease than many of the other countries in the current study.

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Ashley-Care: Gaining Peace of Mind by Getting Coverage Through a Parent’s Health Plan

Ashley Matthews, recent graduate of the University of Miami School of Law, considers herself very aware of what is going on the world. But she admits, �Because I am so young, health care never entered my universe.� That is, until she got into a car accident one evening. That�s when she realized she didn�t have health insurance.

As she recalls: �I�m laying on the hospital bed � my shoes were knocked off my feet, my tooth is chipped and my knee is bleeding and I thought about the fact that I had just graduated from undergrad [and] I had no health care insurance because I wasn�t on my parents� plan and this is right before the Affordable Care Act.� Although the doctor wanted her to stay in the hospital for treatment, Ashley and her friends quickly left because she would not be able to afford the care without health insurance. �The threat of the bills was enough to send me running from the hospital,� she says.

Because of the Affordable Care Act, Ashley was later able to be added to her parents� insurance. More than 3 million young adults have been able to gain health insurance through their parents� health plans until they turn age 26 as a result of the new health care law. �When I found out that I could stay on my parents� insurance, it was like a blessing,� she says.

Ashley, who now has a job and health insurance through her employer, says she wants other young adults to find out about the protections afforded by the health care law because �you never know what�s going to happen in life. � You never know when that one accident will change your life � You�re one diagnosis away from being destitute.�

��The Affordable Care Act has meant stability to me and it�s meant peace of mind� Ashley says. �I would want everyone to please just take advantage of the opportunities that have been created by the Affordable Care Act.�

To learn more about young adult coverage and other benefits of the health care law, visit here.

Growth of Health Care Spending Remains at Historic Low

Today, we got some very good news when the official numbers for health care spending were released.� New statistics from the Centers for Medicare & Medicaid Services show that the overall growth in health spending was at a historic low for the third year in a row.� According to the annual Report of National Health Expenditures, total U.S. health spending grew 3.9 percent in 2011.� That�s the same rate of growth as in 2009 and 2010, and in all three years spending grew more slowly than in any other year in the 51 year history of the report.

As a share of our nation�s Gross Domestic Product (GDP), overall health care spending also remained the same as in the previous two years�17.9 percent.� This contrasts sharply with the pattern of the last thirty years, when health spending as a share of GDP grew by about 0.3 percent per year.

A number of provisions in the health care law that will help control costs and spending are still being implemented, but the statistics show how the Affordable Care Act is already making a difference. Growth in total private health insurance premiums remained low in 2011 at 3.8 percent. And the net cost ratio (which takes into account overhead and profits) for individual health polices declined thanks in part to the new 80/20 rule, which requires insurers to spend at least 80 percent of premiums on health care or provide rebates to their customers.�

The health care law takes other steps to save money for consumers. One provision of the law, called rate review, prevents insurance companies in all states from raising rates with no accountability or transparency. �These new standards ensure that insurance companies justify their actions if they want to raise rates by 10 percent or more.� So far, rate review has helped to save Americans an estimated $1 billion on their premium bills. �

But there is still more to do.� I strongly urge the states, our partners, to continue the work to hold insurance companies accountable by reviewing and building the capacity to deny unreasonable health insurance rate increases.� The Affordable Care Act made $250 million available to states for this important work, and 43 states, the District of Columbia and five territories have started to put this funding to good use.� The next deadline to apply for these valuable resources is February 1, 2013, and I encourage states to take advantage of this opportunity so we can all work to save consumers money and bring more transparency, competition, and accountability to health insurance markets.

The Affordable Care Act helps us to avoid the runaway growth in health care spending of the last decade, keep down costs for consumers, and ensure better health and better access to health care for millions of Americans.

Medicaid Fight Reinvigorated With Political Light On Health Care

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Estimated Costs Drive Debate As Florida Weighs Medicaid Expansion

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The ACA Leaves Out, Cuts Funds for Uninsured Immigrants

From the New York Times –

Hospitals Worry Over Cut in Fund for Uninsured

Community Health Centers Funding Cut

President Obama�s health care law is putting new strains on some of the nation�s most hard-pressed hospitals, by cutting aid they use to pay for emergency care for illegal immigrants, which they have long been required to provide.

The federal government has been spending $20 billion annually to reimburse these hospitals � most in poor urban and rural areas � for treating more than their share of the uninsured, including illegal immigrants. The health care law will eventually cut that money in half, based on the premise that fewer people will lack insurance after the law takes effect.

But the estimated 11 million people now living illegally in the United States are not covered by the health care law. Its sponsors, seeking to sidestep the contentious debate over immigration, excluded them from the law�s benefits.

As a result, so-called safety-net hospitals said the cuts would deal a severe blow to their finances.

The hospitals are coming under this pressure because many of their uninsured patients are illegal immigrants, and because their large pools of uninsured or poorly insured patients are not expected to be reduced significantly under the Affordable Care Act, even as federal aid shrinks.

The hospitals range from prominent public ones, like Bellevue Hospital Center in Manhattan, to neighborhood mainstays like Lutheran Medical Center in Brooklyn and Scripps Mercy Hospital in San Diego. They include small rural outposts like Othello Community Hospital in Washington State, which receives a steady flow of farmworkers who live in the country illegally.

No matter where they are, all hospitals are obliged under federal law to treat anyone who arrives at the emergency room, regardless of their immigration status.

�That�s the 800-pound gorilla in the room, and not just in New York � in Texas, in California, in Florida,� Lutheran�s chief executive, Wendy Z. Goldstein, said.

Lutheran Medical Center is in the Sunset Park neighborhood, where low-wage earning Chinese and Latino communities converge near an expressway. Hospitals are not allowed to record patients� immigration status, but Ms. Goldstein estimated that 20 percent of its patients were what she called �the undocumented � not only uninsured, but uninsurable.�

She said Congressional staff members acknowledged that the health care law would scale back the money that helps pay for emergency care for such patients, but were reluctant to tackle the issue.

�I was told in Washington that they understand that this is a problem, but immigration is just too hot to touch,� she said.

The Affordable Care Act sets up state exchanges to reduce the cost of commercial health insurance, but people must prove citizenship or legal immigration status to take part. They must show similar documentation to apply for Medicaid benefits that are expanded under the law.

The act did call for increasing a little-known national network of 1,200 community health centers that provide primary care to the needy, regardless of their immigration status. But that plan, which could potentially steer more of the uninsured away from costly hospital care, was curtailed by Congressional budget cuts last year.

That leaves hospitals like Lutheran, which is nonprofit and has run a string of such primary care centers for 40 years, facing cuts at both ends.

On a recent weekday in Lutheran�s emergency room, a Chinese mother of two stared sadly through the porthole of an isolation unit. The woman had active tuberculosis and needed surgery to drain fluid from one lung, said Josh Liu, a patient liaison.

The disease had been discovered during a checkup at one of Lutheran�s primary care centers, where the sliding scale fee starts at $15. But the woman, an illegal immigrant, had no way to pay for the surgery.

Another patient, a gaunt 44-year-old man from Ecuador, had been in New York eight years, installing wood floors, one in Rockefeller Center. The man had been afraid to seek care because he feared deportation. Finally, the pain in his stomach was too much to bear.

Dr. Daniel J. Giaccio, leading the residents on their rounds, used the notches on the man�s worn belt to underscore his diagnosis, severe B-12 deficiency anemia. The woodworker had lost 30 pounds in a month, and his hands and feet were numb. Reversing the damage could take months.

�This is a severe case of sensory loss,� Dr. Giaccio said. �Usually we pick it up much sooner.�

In some states, including New York, hospitals caring for illegal immigrants in life-threatening situations can seek payment case by case, from a program known as emergency Medicaid. But the program has many restrictions and will not make up for the cuts in the $20 billion pool, hospital executives said.

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