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September 15, 2009 Vol 3, Issue 19


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Discussion With Senator Begich: Health Reform Prospects
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Health Industry Contributions to the Alaska Congressional Delegation
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From the Editor

Dear Reader,

In this issue of Alaska Health Policy Review we have two feature articles I think you will find quite interesting. The first is a candid, in-depth discussion by Senator Begich covering his views on health policy and related issues. This is the transcript of a presentation he gave a few weeks ago to the Anchorage Chamber of Commerce. We just missed the deadline for last month's issue of AHPR for this defining talk, but it is such a good, comprehensive statement by our newest senator on the subject we could not resist publishing it in this issue. It remains timely and revealing, as you will see.

Our second feature article is very timely indeed. It is an original, never before published detailed analysis of who within the health industry has been giving money to our Alaska congressional delegation, and who has been spending money to lobby the delegation on health policy matters. It is a fascinating discussion of the intersection of money and power among our top elected officials. This is one of those times when, even if you are not a fan of tables, you will find yourself fascinated by the lists of corporate contributors and lobbyists, and the amounts of money involved in the high-stakes game of influencing public policy.

Here are a few other things that have crossed my desk recently you may find interesting...
  • The Foraker Group, based in Anchorage, commissioned an analysis of how the national health reform proposals will have potential implications for the Foraker group benefit health plan marketed to nonprofit organizations in Alaska. Regardless of its origins, it is an interesting and concise analysis of the national health reform political process.

  • Bill Hall, (907) 748-3216, with Alaska Common Ground is contemplating organizing a small discussion session around the cost of health care. Discussion materials are available through the National Issues Forum. Give him a call if you would like to know more.

  • The Commonwealth Fund recently released a case study of the "high performance" nonprofit Marshfield Clinic, a rural Wisconsin organization. "Marshfield Clinic's experience shows how an organized group of physicians can improve patient outcomes and reduce costs by undertaking a population-based approach to ambulatory care management supported by robust information technology." Might be something here for the Alaska situation.
These are exciting times. Your comments always appreciated.

Lawrence D. Weiss PhD, MS
editor, AHPR
[email protected]

Discussion With Senator Begich: Health Reform Prospects

Senator Mark Begich Senator Mark Begich was elected to the U.S. Senate in November 2008 after serving as the mayor of Anchorage beginning in April 2003. Since taking his seat in the Senate, Senator Begich has been appointed to the Senate Committee on Science, Commerce and Transportation, the Senate Committee on Armed Services, and the Senate Committee on Veterans Affairs. In this talk, given at the Anchorage Chamber of Commerce meeting August 10, 2009, Senator Begich discussed his take on a variety of health reform issues. Note his particularly pointed response to a question regarding his views on tort reform. This discussion has been minimally edited for length and clarity.

Thank you very much for this opportunity. It is truly an honor to be here at the chamber again to give you a couple of updates. But also, it is a pleasure to be home, where it is not as hot and humid. When I left Washington D.C., it was 90 degrees and humidity about 90 percent. It is a good way to get work done quick if you want to get out of town. So I'm glad to be here, I'm glad I could bring the beautiful sunshine today.

There's a lot of visitors coming here, over the next month. We're going to have several cabinet secretaries of delegation, fellow senators coming through Alaska over the next thirty days. Tomorrow I meet with the secretary of HUD and take him on a tour of Anchorage, and talk to him about Alaska issues, and then we'll have several up in Bethel. Also, I appreciate this invitation to talk to you about health care reform and health insurance reform. And what we're doing, we are going to have a power presentation here, in just a minute, to give you a sense of some of the issues we're facing, some of the challenges with the legislation, but also the risks that we have out there if we do nothing.

But before we do that, I want to give you just a couple updates on two issues. The first is climate change, which finally has risen to a high priority in Congress and the administration. To make sure Washington does this right, I've introduced seven pieces of legislation this last week to address the problems in the Arctic, almost all of them caused or worsened, by climate change. A week ago, I described the bills of Alaska's unique circumstances in my first speech on the Senate floor. I know that's difficult for you to be thinking that. You're probably surprised that it took me six and half months to finally say something on the floor of the Senate. But it's true: I patiently waited because I wanted to have a good presentation on something that I think is critical about Alaska. But also, I spent many hours presiding over the Senate, receiving the Golden Gavel award of a time of over a hundred hours presiding, that gave me a sense of the issues the Senate wants to deal with, but also how the process works, and make sure that we bring issues forward, that we truly are part of the equation.

The climate bills address oil and gas development, arctic shipping, the need for more arctic sites, reducing health disparities in the northern regions, and better coordination of arctic policy. Climate change truly poses challenges on the diplomatic, scientific, and national security fronts. We must, we must make the needed investments to ensure that the U.S. maintains its leadership at the top of our globe. We must listen to and address the needs of residents of the Arctic. I truly welcome the chamber's review of this legislation, and your comments and input on this, what I consider critical issues.

Another issue, which I know everyone in this room is concerned about and that's Alaska's economy, and the nation's economy. I was pleased, but not surprised to see the latest Anchorage Economic Development Corporation report predicting that Anchorage will be holding its own next year, before beginning a new era of growth. Rather than declining dramatically, as elsewhere, total jobs and overall building improvement values in Anchorage are projected to remain essentially steady through the next year before growing again. Despite some job losses in air cargo and tourism business, we're holding up a lot better than many places across this country, that are fighting their way out of the recession.

There are encouraging signs on the national level, with regard to the recession. With housing starts up in June, existing home sales up now three months in a row, unemployment slight adjustment down, but still potentially going up, but still, an adjustment down, not predicted. The GDP being cut in half, in the sense of its loss over the last period. There's evidence that the Recovery Act is truly starting to move, and work, within this economy. And there are all these mixed signals, that six months ago I would have had a whole different attitude, because no signal was a positive signal.

The Recovery Act that we passed, which I was proud to vote for, Alaska seems to be getting its fair share. For Alaska, it means big projects: a new arctic research vessel, a long overdue hospital replacement in Nome, and many other projects on military roads and many other communities throughout Alaska. As well as in this community, with additional police officers, to the tune of over two million dollars. The recovery bill will put $1.4 billion on the ground in Alaska and create, or save 8,000 jobs. Just down the street, Alaska legislature is taking action a few blocks from here, so we get our fair share of energy funds, to make homes more energy efficient.

I know it's going to take more time to move our economy, and hard work, but there's clearly signs that the economy is stabilizing, even though we still have some rough road ahead of us.

All of which leads me back to the subject of the day. Health reform, insurance reform. There are wheelbarrows of reports available to Congress, and just as many opinions on this issue. As I sat here -- and I appreciate all the folks that brought me ... It's a truly Alaskan, I love it. They bring me their packets of information, making sure that I know about health care, as well as letters. But there are an enormous amount of interest and issues around health care.

I want to give you a little bit of my take-away from the debates so far. It truly is a broken health care system, that leads to lost jobs, reduced productivity and less investment in capital [that will] ultimately stall business growth. That's why I believe one of the best ways Congress can support, and strengthen, and grow America's business is rebuild the economy through vast, meaningful health reform.

"Health care spending is truly out of control in this country. With a growing portion of our economy devoted solely to health care, as measured by the GDP.  In 2009, health care expenditures are approximately 18 percent of GDP. Without major reforms, health care's share of GDP will rise to 34 percent within thirty years."

We've broken the presentation down into four sections: why the status quo is not acceptable and sustainable, especially for the business community; how reform will help the average American; my priorities for health reform as the bills move forward; and the myths versus reality. And there's a lot of information out there that is flat-out wrong.

Health care spending is truly out of control in this country. With a growing portion of our economy devoted solely to health care, as measured by the GDP.  In 2009, health care expenditures are approximately 18 percent of GDP. Without major reforms, health care's share of GDP will rise to 34 percent within thirty years. That's one-third of our economy, owing just to health care. I don't need to tell you as business people, or heads of households, that an ever growing percentage of your business expenses and your own paycheck, is going to healthcare, the cost of premiums. This affects all of us. In just ten years, family insurance premiums have doubled in Alaska. The average employer-provided premium was about $6,000 in 1997. In 2006, the most recent year we have on the same data, the same coverage averaged over $12,000. Of course, wages didn't come close to keeping pace. You can see where we are headed if we don't act.

What about the impact on business? It's even more dramatic. The next several slides come from the Small Business Majority, a group that I'm working with in Washington, D.C. I helped them unveil a plan and report in June that makes a very compelling case for reform. It was done by a respected health economist from MIT. His definition of small business is a business that employs a hundred or fewer employees. In other words, the vast majority of Alaska businesses. This slide shows that without reform, small business in America will spend more than $2 trillion dollars in health benefits for their workers over the next ten years.

The impact on jobs is just as dramatic. With no reform, an estimated 178,000 small business workers will lose their jobs over the next decade because of dollars diverted to health care. Small Business Majority is not pushing for a specific bill or plan. They took major elements of a variety of plans that we have, and proposals by groups, as well as Congress, and put them into three categories: limited reform, expanded reform, or significant reform.

So what happens with reform if it passes? Look at the red line on slide seven, I hope that's correct. Yes, I had to look at the number there. It says that even with the middle of the road reform, they just took the middle case, small businesses will save over $800 billion over the next ten years. Money that won't have to be spent on health care. Considering that small business will drive economic recovery in America, it's huge. About $800 billion saved, and available, for investment, and infrastructure, innovation, increasing productivity, and providing stable jobs.

Let's turn next to the impact of health reform on individuals and families. What's in it for the average person?  Approximately 46 million Americans are uninsured. In Alaska, about 116,000 don't have health care coverage today, 18 percent of our population. Those statistics are amazing to me by themselves. Matter of fact, an additional statistic, by the time, I'm on break here for the next four weeks, when I get back, another almost 700 Alaskans will lose their health care coverage. Thousands of Alaskans report avoiding the doctor because of high costs. When this basic care is delayed, it usually becomes more expensive later. People end up getting sicker, going to clinics or their emergency room for their primary care. Hospitals do not turn people away. And they don't just absorb the cost of valuable, uncompensated care. It is passed to the rest of us, in the form of higher medical charges, which in turn lead to higher premiums for those who are covered.

As you can see here, nationally, the average family pays a hidden tax of around $1100. But here in Alaska, for the uninsured, we pay about $1900 dollars per family. Out of control health care costs are having a dramatic effect on Americans across not only this nation, but also here in Alaska. Nationally, 62 percent of bankruptcies and 50 percent of home foreclosures are the result of unaffordable medical bills. And of those 62 percent that go to bankruptcy, 75 percent have health insurance. So it has a huge impact, with or without. Those ones that had health insurance are the underinsured.

The question keeps coming up: What is in this for the average person? The answer is clearly one word: stability. Besides the family savings I just outlined, reform will bring stability in many ways. These are the basic standards for any health care reform and insurance reform within Congress. No more coverage denied because of pre-existing conditions. You get to keep the doctor and your current insurance plan, if you like. You keep them. No more reason to make job decisions based on fear of losing health insurance. No more lifetime caps on how much insurance companies will pay. And you and your doctor make the health decisions, not the insurance companies. And don't let anyone tell you health reform won't benefit every single one of us.

There are so many personal stories. Today I had several people come to my office and tell me some stories, and send me letters. An acquaintance from Anchorage stood up in my town hall meeting that I held in June, and said his life was changed forever when he was diagnosed with cancer. He's fighting back, but he can't quit his job or find one that's less stressful because he'll lose his current employer-provided coverage. And he won't be able to get new insurance because of his pre-existing condition. Or, the heartbreaking column in the paper two weeks ago, from a business owner in Palmer, who described two friends hit by colon cancer. One sister had good insurance, got early screening, and is in recovery. The other sister was self-employed and couldn't afford insurance, or coverage of any kind. She did not get early screening, and the cancer was not caught in time. After months of expense and uncompensated chemotherapy, she died.

I hope you are beginning to see why I am working for a solution on health care. Trying to do something before the year is out. It's going to be tough, it means rolling up our sleeves, and making sure that everything is looked at from every corner.

As I work with my Senate colleagues, there are several Alaska priorities I am pushing for in Washington when it comes to health care. Besides the general ones I just laid out, there are some very Alaska-oriented ones. A problem obviously which affects this group, but also businesses across the country, is keeping small businesses healthy. Expanding our work force, of course will lead to more doctors, but there must be an expanded role for physician assistants, advanced nurse practitioners, dental health aides and other professionals that make a difference in our health care delivery system.

Strengthening Native health care and reducing alarming health disparities in Alaska, and improving health care for our vets. We count on our service men and women to be there for us in our times of need, and after their service is over, and they have their own needs, we have an obligation to care for them. With 11 percent of our state population veterans, to me, it is clearly an Alaskan priority.

"Sure, there are skeptics. I'm a skeptic. I'm spending my time looking at every element, to make sure we're doing it for the right reasons, not just because we want to pass something called health care reform. I have questions every day."

And promoting good health, bending the cost burden and cutting medical expenses must improve through prevention and involve prevention. Eighty percent of the Medicaid spending in Alaska goes to patients with chronic conditions. More than $800 million a year at last count. The vast majority of chronic conditions are caused by choices involving diet, exercise, tobacco. We clearly have to have a better handle on how to deal with that and take more personal responsibility.

Let me inject a dose of reality in what is becoming an exaggerated, misleading debate over health care reform. Sure, there are skeptics. I'm a skeptic. I'm spending my time looking at every element, to make sure we're doing it for the right reasons, not just because we want to pass something called health care reform. I have questions every day. I put my staff to work even though I don't sit on the committees. I'm dealing with finance and health, we have staff that works aggressively to try to input, to get input on the issues that I am concerned about.

But now the media are talking about swiftboating of health reform over the recess. Based on the nature of some of the ads and the subsequent calls to my office, I believe there are some truths to that.

Let me dispel a couple of common myths. First, health reform will not lead to anyone's grandmother going in front of a death panel. I know there are some laughs out there, but the claim has been repeated. People think that my mother, 70 years old, will be walking up to a panel and a decision will be made on her health. That's just factually incorrect; it's just not true.  

Here's a reality: Under the reform bill so far, Medicare will encourage and pay for consultation with your doctors over living wills, organ donation, to do resuscitation orders, and other end of life decisions. It's a chance to talk to your doctor about your wishes. It's not exactly radical. In fact, Alaska already has a model law on the books concerning living wills. It passed five years ago with only one no vote. The difference is, Medicare will have to pay for this, instead of you [paying out of your own pocket] for this advice, but you make the decision.

Here's another scare tactic cooked up by opponents of health reform: It will mandate government-funded abortions. There's a TV ad on one right now. And it actually targets me.  I was with UPS workers today and the question came up. It's a flat-out blatant lie. For a generation, the Hyde Amendment has prevented federal dollars from paying for abortion services. And health reform does not change that, it does not change the Hyde Amendment, there is no expansion of this issue. But it's amazing because when you watch the ad, it's very compelling. You know, seniors looking, choice of health care not covered, but jeez, government's going to do this on abortions, it's just a blatant lie. But what they're doing, it is just like TV media, you try to take thirty seconds to grab at the emotions, but facts are irrelevant, and that's what you see in that ad.

Here's another myth: Democrats are ramming this through and don't really care about reaching across the aisle. Again, not true. I belong to the 2008 class of senators. A high percentage of them are moderate Democrats. We have Montana Senator Baucus, who is the Finance Chair, and [we] continue to pressure him, to get some reform, but at the same time, bring as many Republicans across the line as you can, because it's important.

This is an American issue. This is not a Democrat, Republican, Independent, Green, or whatever other party you belong to. It is about solving this problem for the benefit of Americans, today and into the future. And he is working. Matter of fact, I can tell you in caucuses, he gets beat up all the time by folks, from Democrats saying, "you're not doing enough with the Democrats, you spend more time with Republicans." But a lot of us in the 2008 class have a different view. We're here to solve this problem. We're not here to get into the parts of bickering, or in the media, things that you see on there, we're trying to resolve this issue.

Matter of fact, in the Senate HELP bill, which is the Health, Education, Labor, and Pension bill, Republicans' voices were heard. Of over 350 plus amendments, 161 of them were Republicans'. They didn't vote for the bill then, but they had a lot of amendments. A matter of fact, I'm happy to say Senator Murkowski had an amendment ensuring that Native American tribes are eligible for various health workforce programs. She addressed the workforce shortages that will make funding available to Alaska health providers. Another one of her fixes allows insurers to charge tobacco users more because smokers have higher medical bills. Costs that the rest of us shouldn't have to bear.

To me, these are not technical changes, these are substantive changes. Almost half of the amendments in that bill came from Republicans. That's a fact.

Another, more facts versus fiction: Health insurance reform will not produce choices. In fact, more Americans have access to greater choices of doctors and plans by taking away the insurance industry's ability to deny coverage.

Another myth is that health reform means bureaucrats will ration health care. Truth is, it will expand access and improve the quality of care, not ration it. Doctors, nurses, and patients will make medical decisions, not the insurance companies.

Finally, I want to mention Medicare. Despite what you hear, most people who have Medicare like it, and count on it. Yes, we have problems in Alaska and in other parts of the country with access and ensuring that we have more doctors available and nurse practitioners and other professionals. But the majority of people who have Medicare, love it, it makes a difference in their life. We're still waiting for the details from the Senate Finance Committee, but the House bill, makes significant changes, including eliminating the planned 21 percent cut in doctor fees. Making sure again, doctors get reimbursed for the fees they charge in Medicare, putting payment rates on a sustainable path, and expanding programs that reward physicians for better coordination of patient care. It eventually will eliminate what they call the 'Donut Hole' in the prescription drug plan, where seniors will no longer be stuck paying expensive bills when their yearly coverage runs out.

You know, I've covered a lot of health care issues, and it's a constant moving target. What I mean by that is, today, when I was with those employees, they asked me, "Are you going to support that bill?" And I have to remind them, for example, on the House side, are three bills. There's no single bill yet. There are three bills that have not made it to the Floor. On the Senate side, there is the Health, Education, Labor and Pension Committee that has finished their bill. There's the Finance Committee that has not finished their bill yet, but it's moving through, and we hope to see something in September.

[Garbled] well ends up, the Senate will try to combine those into one bill, the House will combine theirs hopefully into one bill, and then we'll have even more significant debate. Then it will hit the floor of the Senate, we will debate it, and there will be an enormous amount of amendments to debate this issue. Same thing on the House side.

Then once those bills come forward, they'll end up in what they call a conference committee and they will end up in even more debate, so there is no single movement. This is one of the most significant pieces of legislation touching 300 million people. We're not going to rush it; we're going to do it for the right reasons. We're going to ensure every voice is heard, and we may not always agree. But we're going to try to make sure that we have a health care system that's affordable, sustainable, and has impact on the people who have insurance now in a positive way.

President Obama wanted this bill on the desk in mid-October, and it's probably unlikely that that we'll meet that deadline because of all these reasons I just laid out. But I do think we are focused on bringing as many groups together. You know, I've met with a variety of folks around this issue: business owners, union leaders, consumer groups, AARP, insurance executives, doctors, nurses, everyday people who receive the health care coverage and those who don't have health care coverage.

"Will it end up, I think, hitting these points: eliminating pre-existing conditions and out-of-pocket expenses and making sure prevention is paid for, making sure we don't have gender discrimination and those types of coverage? Absolutely."

We're trying to gather all that information, so we can make the right decision at the end of the day. So as you go home tonight, or today, as you walk out this door, push through all the media hype and the exaggeration, on both sides, and focus on what we're trying to do. There is no single answer yet, but I do believe based on all the information being put on the table, we are moving in the right direction. We recognize the financial components of this, many of us in the '08 class sent a letter to Senator Baucus, reminding him that we need to make sure this is deficit-neutral, that it's sustainable, but that it also has impact to the people who currently have health care coverage today, and making it better for them. As well as looking out for the next 46 million that are out there uninsured.

This is probably, you know, in my six months now, serving in the U.S. Senate, we've done a lot of stuff, I've got to tell you. This one will have an impact on not only this generation, but for many generations. It takes thoughtful, rational debate, and that's what we're going to have, that's what we're going to continue to have. Will it end up with something that I'm going to like a hundred percent? Probably not. Will it end up, I think, hitting these points: eliminating pre-existing conditions and out-of-pocket expenses and making sure prevention is paid for, making sure we don't have gender discrimination in those types of coverage? Absolutely. Because we are unified on that. Those are some of the points we have to make sure occur.

I have a brother-in-law who is a small business person just down the street here. He pays about $460 a month in premiums, $15,000 deductible. He's basically waiting for a major incident to occur, for him to have something taken care of. The end result is: when he needs preventive, for minor incidences, he's not doing it. Sooner or later, we're all going to pay for that.  So, it's personal, but it is also important, because it drives and has an impact on the economy, [and on] the small business community it has an incredible negative impact ... that we have to resolve because the small business community of this country and this state is the drivers of our economy. And if they are given a choice, affordable health care coverage, or not employing a person, those are choices you don't want, because it will have a negative impact on this economy.

So, this is one issue, as I said, that's pretty important. It's exciting to have an opportunity to address the Chamber, and I'll be happy to take some questions. And again, thank you very much for this opportunity.

[Moderator reading questions]: If I were to ask a question first, it would be about health care and speedreading. I have never seen a larger number of questions that were more articulate and to the point. I'm very impressed, some of these are typed ... Senator, you haven't said anything about funding, and how will this program be funded?

Begich: You know, that is where it's stuck up in Senate Finance right now. And it's stuck because of the funding mechanisms. There's several debates on how to do it. A sizable amount of this is done through some of the savings, as I mentioned earlier. When you think of the national average, about $1,100 per premium, is paid now for the uninsured, so part of that is shifted out. The prevention has a critical piece of the equation, but there is a gap. We know the hospitals and the pharmaceutical companies have come to the table to the tune of almost 200 plus billion dollars of this cost. But there is a gap and we have not resolved that. That's the great debate right now. One example that came forward, which I totally oppose, and that's taxing insurance premiums. That has been proposed by some and I said I'm not for it. I think that's a big mistake, in the long haul. But that is going to be our great challenge, but the goal is we must be deficit-neutral, or we're done.

"Because right now I can tell you, there's a huge gap of demand for services in what we have available, especially in general practitioners, when it comes to docs, nurse practitioners, as well as physician assistants."

Moderator: Senator Begich, health care continues to see very strong job growth in Anchorage and Alaska. How do we protect this important part of our economy in the ongoing health care reform process?

Begich: Actually, in health care reform and I can't remember the latest statistic and I know Bill Popp will remind me once I've step down from here, but I think it's five or six out of the top ten employment categories are within health care related if not in [garbled] close health care-related industries. What this bill will do, it also adds workforce development, which is critical. As we know, when you start to move more people into preventive care and wellness type of programs, it means you have to have an allocation of workers in that arena. This bill focuses on ensuring that we have workforce development resources to ensure that nurses, nurse practitioners, physician assistants, doctors, have access to resources, maybe in the sense of general practitioners and nurses, and so forth, scholarships and other things to move folks into that arena and ensuring that we bring folks online. Because right now I can tell you, there's a huge gap of demand for services in what we have available, especially in general practitioners, when it comes to docs, nurse practitioners, as well as physician assistants. So, there is a workforce development component in there so we train, recruit, and put into employment in this growing field, because it is a growth field for us.

Moderator: There's always a question the few times I've done this that I hesitate to read out loud. This one I thought was interesting, it's first a comment: The insurance companies have us by the moose "part" here [garbled] competition. And the question is: How can we call it health care reform without including a public option?

Begich: You know, if I could go to the first part of that question ... if you debate this right now in the Senate, where the debate is we want to make sure insurance companies are held accountable for their pricing structure. There's two pieces to this, two different pieces of legislation in the different forms right now in the House and on the Senate side. But there's two fundamental areas. One is the insurance exchange. The exchange will show, very publicly, what the minimums will be, which each insurance company would offer, you would actually see that in the transparency, you would have some choice, you can see the competition among each other.

No offense to the insurance company folks that are here, but if you ever try to go out and get insurance yourself, it is a complicated process. Trying to compare apples to apples, because there really is no comparison, because each one offers a little bit different. The goal of the exchange is to create some similarities as a baseline, they can offer more, but at least the base programs that are to be offered, you're going to be able to at least compare apples to apples.

On the flip side, the debate right now is public option, co-op, some sort of format that is not funded with government dollars in the sense of its sustainability, like Medicare, Medicaid. But it's self-funded, like the co-op idea, like a credit union would be run. It's a very similar concepts. Senator Schumer, and several others, are kicking that idea around. There will probably be some mechanism like that, is my bet, at the end of the day. And the goal is not to provide it at government cost at all. That's the goal, and I think that's achievable, clearly by what we're planning to do, or at least what the discussions are. But you do have to agree, competition does create quite a structure, it creates better pricing for the consumer. And, right now it's very complicated to figure out what plan is the best plan.

The problem we have in Alaska, 95 percent of the market is controlled by two companies. That's a problem. To the companies, who are here, I apologize for saying that but that's a fact. So, we have to create more competition in order to have some more stabilization in the pricing. So, the public option, or the idea of a co-op, or some mechanism, will probably be in place in the final end to ensure that everyone's playing on the same playing field. But, we're not there; we're a long ways away from that.

Senator Baucus is working aggressively with insurance companies, small business community, the providers, AARP, and others, to try and figure out what's the right mix to make that happen. They might not, you know my thinking is they'll get there, but I'm not sure. Senator Wyden has a bill that's separate; it's a whole other way of approaching it. But the idea is to keep some accountability and create some competition in the insurance company industry.

Moderator: We have a number of questions that address two specific areas. One is tort reform and the other is the approximate 114 million Americans currently in health care plans, and will they be forced to give those up?

Begich: Let me answer the first one on tort reform,or the last part of that. And the answer is no. Simply, no matter what you read, what you see on TV, these ads, or how people hype it up on talk radio. The reality is, if you've got an insurance plan now, you like it, you keep it. That's yours, you can do whatever you want. If you want to change, there'll be options, but what you have, you can keep. If you have a doctor you like, keep your doctor. None of these proposals, of four bills that are written today, and a fifth that's in draft form, or in process, does not mandate or change that. It doesn't force you to go into something that you don't want to go into.

With the tort reform, there is a little discussion, but not much. I'll be very frank with that. When you look at all the analysis, and the funding analysis or the cost of health care, tort reform is about this: about as much as between these two fingers here, it is that small in the equation, [but] not from the political end of interest among many members who take it up. The second part is, the value of it, the return in the savings that could be attained is so small that it's not worth the battle.

Moderator: We have a number of questions asking about the new program and how it would cover, or if it would cover non-U.S. citizens?

Begich: Non-U.S. citizens, no. Not unless they are citizens of the United States.

Moderator: Would proven citizenship be required?

Begich: Oh, I know where they're going with it, okay. Illegal immigrants are not covered under any of this. Does that answer the question?

Moderator: What about the amendment in HR 3200, which would allow Alaska and all states to do a state-government run health plan?

Begich: That's on the House side. What they're referring to, again, there are three bills on the House side, nothing have been formulated into a final bill and no vote on the floor in the House or Senate has occurred. So, one of the bills over there, the discussion is, that these exchanges, these public options ideas, also would be state, each state would have their own bill, have their own bill to set them up as they see fit. And that's what they're referring to, I believe is the question. That's one proposal.

I'm a little nervous, to be very frank with you. If you set up a 50 state exchanges, and 50 state public options, it gets very complex. If you're a small business person in the lower 48 and you have three businesses that go over state lines, which is very possible for one franchise, you have three different locations. How do you manage that? It becomes even more complex for the small business person. I don't think honestly they have looked at it from that side of the equation.

"I have always believed, and this is one of the pieces I've talked to other senators about, I campaigned on this, I believe to simplify the whole thing is to open up the federal program and let others buy into that. It's so simple."

Moderator: We have time for one more. Will federal, state, and local employees, including elected officials, be subject to the same program as the rest of us?

Begich: You know, I love answering this question because this is one of those mis-truths out there. People think that we have some "special plan" in the United States Senate. Let me tell you what our plan is. I'm with four million other federal workers; I pay 50 percent of my premium. I'm just like everyone else: certain things are covered, others are not, and it's a bargain-driven insurance program. There's no public program, it is an insurance-driven competitive program. But we get good rates. Why? Because we have a pool of four million people plus their dependents of eight million people. For a single person, if I was single it would cost me for -- if I paid it all, no employer contribution, if I decided I'm going to pay it all -- it's 460 bucks, approximately, per month.

For a program that does not deny you on pre-existing [conditions], has some prevention, it's not a bad program. It's not a great program, but it's not a bad program. For a family, it's right around $800-900. I have always believed, and this is one of the pieces I've talked to other senators about, I campaigned on this, I believe to simplify the whole thing is to open up the federal program and let others buy into that. It's so simple. You're always asking about what we're getting, we're already getting a very good rate. But you know, I pay 50 percent of my premium coverage, last year the premiums went up about seven plus percent, I paid that in this year's premium. So, like everyone else, I pay; I pay a lot over time.

That's one of those myths out there that I watch on TV, and I hear that the Senate's is golden, and I'm looking for it. People think when we turn 65 as a senator, once you're retired, or you're still in, if you're retired, you don't do Medicare. No, no, no, no, no. That's not how it works. I'm just like everyone else. If I get vested, or I'm in Medicare when 65 hits, I get Medicare, just like everyone else. There's no special program to put us aside. There's a great desire to do ... and I wish we had more prevention actually, in our health care program in the federal government because we don't do enough with wellness and prevention. But, again, that's the bigger the group, the more stabilized cost, and the lower the cost. That's the goal.

Thank you, Tony, and thank you, all of you, for allowing me to answer those questions as fast as I could. Thank you very much. 

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Health Industry Contributions to the Alaska Congressional Delegation

We spent part of the summer figuring out and documenting how much money has been spent by the health industry sector and related interested parties on the Alaska congressional delegation during their collective legislative careers. Bottom line: $707,046. Details to follow, but first an overview. The following information has been excerpted by permission from OpenSecrets.org, " ... your nonpartisan guide to money's influence on U.S. elections and public policy."

Health Companies and Drug Manufacturers Lead the Lobbying Pack During Year's Second Quarter

Given that so much national attention is focused on health care reform, it's perhaps not surprising that the pharmaceutical/health products industry and the broader health sector both spent the most cash on federal-level lobbying efforts in the year's second quarter. At stake is legislation that could significantly affect these companies' financial fortunes. The health sector was the number one overall sector, spending $133 million during the second quarter of 2009. And within the 100-plus industries that CRP tracks, the pharmaceutical/health products industry was again the top dog on K Street, spending roughly $68 million during the quarter.

Several of the businesses and organizations within the health sector fronted multi-million dollar lobbying operations. The biggest spenders in this arena are:

Organization Second Quarter, 2009

Pharmaceutical Rsrch & Mfrs of America   $6,150,000
Pfizer Inc $5,580,000
Blue Cross/Blue Shield $5,171,929
American Hospital Assn $4,160,000
American Medical Assn $4,115,000
Eli Lilly & Co $3,590,000
Amgen Inc $3,400,000
GlaxoSmithKline $2,280,000
Sanofi-Aventis $2,213,000
Merck KGaA $2,110,000
   
PhRMA was the third largest spender on lobbying of all clients during the second quarter, while Pfizer was the sixth-largest spender and Blue Cross/Blue Shield was the eighth largest.

As we noted on our money-in-politics health care cheat sheet, these groups share an opposition to a government-administered public health insurance option. Most, however, favor a mandate on health insurance for individuals. The pharmaceutical companies are also seeking strong protections of patent rights for drugs, which consumer groups say often delay the entry of cheaper generic drugs to the market. As Congress will likely continue to debate this legislation into the fall, there's little doubt that health-related lobbying activity will keep a strong pace during the third quarter.

Contributions from Health Sector to Lawmakers Increased Seven Percent in Second Quarter

Federal lawmakers collected about half a million dollars more from the health sector between April and June of this year than they did in the first quarter of the year -- a total of $15.3 million for 2009. This slight boost is likely the result of the increased intensity of the health care reform debate.

Pharmaceutical and health product companies and health insurance companies (including health and accident insurers and HMOs and health services) increased their contributions eight percent, while health professionals and hospitals maintained their rate of donations. (Note: As CRP codes more contributions by industry, these figures will likely rise.) Although nursing homes give less than the others overall, this industry ramped up contributions the most at 49 percent, from $278,100 to $413,350.

Here are contributions to date from the PACs and employees of health-related industries to the leadership PACs and candidate committees of current lawmakers:
     
Industry Total 2009

Health Sector $15,331,973
Health Insurance     $2,332,811
Pharmaceutical $3,268,376
Health Pros $7,968,294
Hospitals $1,530,429
Nursing Homes $691,469

So, in this context what has been happening with the Alaska congressional delegation? Quite a lot, actually, and you can find the details in our new study, Health Industry Contributions to the Alaska Congressional Delegation. We have provided a separate link for you to access this study because there are a few tables which do not lend themselves well to the format of Alaska Health Policy Review. As always, your comments invited.

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AHPR Staff and Contributors

Lawrence D. Weiss, PhD, MS, Editor
Kelby Murphy, Senior Policy Analyst
Jacqueline Yeagle, Newsletter design and editing
Asvad Gabul-zada, Intern

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