WASHINGTON, DC – Health care reform legislation introduced today by Senate Majority Leader Harry Reid (D-NV) includes major initiatives on coverage, quality and cost control authored by Senator Maria Cantwell (D-WA). The “melded” legislation, a combination of work by two Senate committees, includes a restructuring of the Medicare payment system and a basic health plan giving states power to negotiate with private insurance on behalf of their uninsured. Both provisions were authored by Cantwell and added to the Senate Finance Committee’s version of the bill. Reid today melded that legislation with a health reform bill drafted by the Senate Health, Education, Labor and Pensions Committee. The melded bill is estimated to reduce the federal budget deficit by $127 billion in the first 10 years.

 

“None of the reforms that I believe are critical to expanding coverage while maintaining quality can happen if we do not control health care costs, and I am pleased to hear that the legislation we will debate on the Senate floor reduces the federal budget over the next 10 years,” said Cantwell. “The historic debate will give us an opportunity to strengthen this legislation further, while ensuring that the many strong provisions in the bill remain.   I will be pushing to strengthen provisions to help our seniors remain in their homes and communities when they need long-term care.  I will also work to pass the most robust plan possible to cover the uninsured and put pressure on private insurance companies to lower rates for those already insured.”

 

Four Cantwell measures included in the bill introduced today aim to increase access to quality care while reining in out-of-control health care and health insurance costs. The following is a summary of Cantwell’s key amendments included in the legislation:

 

 

·         Basic Health Plan: Gives states the ability to negotiate directly with health insurers to provide high quality health care coverage at a lower cost.  Rather than handing tax subsidies to insurance companies, Cantwell’s amendment directs money to the states, and lets them use their purchasing power to negotiate with private insurance carriers. The measure is modeled after Washington state’s Basic Health Plan, which has a 20-year track record of reducing costs and providing quality care.

 

·         Medicare reform: Establishes a “value-based index” to reward doctors for providing high quality, efficient, and coordinated care. The amendment is designed to fix flaws in the current system that rewards practitioners for ordering often redundant or unnecessary tests and procedures.  Currently, Medicare wastes an estimated $120 billion a year, or 30 percent of all Medicare spending.  This waste is due, in part, to incentives in the Medicare physician payment structure.  Cantwell’s amendment rewards doctors who provide  the best outcomes, instead of paying them for ordering more services that don’t help patients.

 

·         Primary Care: With the nation experiencing a shortage of primary care doctors, the bill includes concepts championed by Cantwell to expand the nation’s graduate medical education training capacity to more suburban and rural hospitals, and to provide incentives for medical students to opt for a career in primary care. Primary care physicians play the vital role of coordinating care so that patients have a single doctor looking over all of their health care needs, supervising their medications and the specialists they see.

 

·         Pharmacy Benefit Managers (PBMs):  Serving as the middlemen between health insurance plans (including both private health insurance plans and Medicare Part D), pharmaceutical manufacturers and pharmacies, PBMs manage most of the prescriptions filled in the United States but are the only unregulated area of the health insurance industry.  Cantwell’s proposal requires reporting by PBMs to ensure that savings from drug price negotiations are being passed on to consumers and not contributing more to pharmaceuticals’ bottom lines.

 

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