First 100 Days Health Agenda:
Building Momentum for Reform
The First 100 Days Health Agenda is building momentum for quality, affordable and accessible health care for all, and to improve the nation’s health. It responds immediately to the deepening economic crisis by shoring up and expanding existing public health insurance programs. And it makes a down payment on eliminating the social and economic inequalities that make people sick.
When enacted, the provisions of the Agenda will themselves provide a substantial financial stimulus and relieve serious financial pressures facing individual and families as well as businesses, unions and state and local governments. They strengthen existing public sector social insurance programs, which are uniquely equipped to extend coverage to everyone while controlling costs.
The Agenda consists of two parts. The first comprises measures that can be enacted in the First 100 Days. They expand health coverage and access through public sector programs, halt the erosion of traditional Medicare and improve access to affordable medicine. The Agenda alleviates the economic crisis by extending health coverage through Medicaid to all who receive unemployment insurance, and increases federal matching funds to states. It protects Medicare by eliminating excess payments to private Medicare Advantage plans, and ends the prohibition on government negotiating for lower drug prices. It supports the extension of coverage for children through SCHIP, and increased funding for safety net institutions.
The second part identifies policy and program initiatives that we should launch now even though they won’t be finished in 100 days. These aim to ensure greater health justice for veterans, improve the health of the nation by tackling social and economic conditions that create preventable inequities in health, and build the basis for effective, efficient financing and delivery of health care.
We believe that these actions will forcefully address the crushing immediate needs of our country for continuity and expansion of health care coverage during the economic crisis. Taken together, they will set the stage for the more far reaching reforms that must be enacted to achieve health security for all residents of the United States.
We encourage organizations and individuals to endorse this Agenda, and to contact members of Congress and the Administration in support of these proposals.
A First 100 Days Health Agenda
We ask Congress and President to act in the First 100 Days to expand health care and improve the public’s health: [a]
Extend and expand health coverage and access.
■ Children – Expand SCHIP to cover ages 0 – 25 by enacting the CHAMP Act of 2007.[b]
■ Medicare – Extend coverage and access:
· Lower the eligibility age to 50.
· Eliminate the 24-month wait for Medicare benefits for persons with qualifying disabilities.
■ Medicaid – Increase enrollment and access:
· Increase the federal match in Medicaid funding and minimize cost shifting to patients.
· End the categorical nature of Medicaid eligibility and extend eligibility to everyone living in poverty (proposed by Sen. Baucus), and to all recipients of unemployment compensation.
· Simplify the documentation and application requirements.
· Increase transparency of the state waiver process that is eroding federal standards for Medicaid.
■ Safety-net institutions: Increase funding for public hospitals, and for community and migrant health centers.
Halt erosion of traditional, public Medicare.
■ Stop the excess payments to Medicare Advantage plans. (President Obama favors this.)
■ Cancel the 2010 Medicare Comparative Cost Adjustment demonstration. (Speaker Pelosi favors this.)
■ Eliminate the arbitrary 45 percent cap on general revenue funding for Medicare. (The House refuses to implement it).
■ Eliminate means-tested (income-based) premiums for Medicare Part B.
Improve access to affordable medicines.
■ Create a public prescription drug benefit within traditional Medicare, requiring CMS to negotiate drug prices.
■ Allow re-importation of prescription drugs.
Policy and Program Initiatives for the First Year
Ensure health justice for veterans.
■ Eliminate the barriers (financial, administrative and gender) to timely health care for veterans.
Improve the health of the nation.
■ Take steps now to link action across government sectors (employment, housing, education, environment, commerce and trade, health) to address the social and economic conditions and policies that make people sick and produce health inequities: economic deprivation, discrimination, and adverse conditions at work, in the environment, and in the neighborhood.[c] Make improving health and reducing health inequities a criterion for all government initiatives.
Build a basis for effective, efficient financing and delivery of health care.
■ Speed up the development of an adequate primary care workforce.
■ Investigate the effectiveness, efficiency, and discriminatory practices in the health insurance industry.
■ Compare effectiveness of medical treatments and implement best practices.
■ Propose adequate, stable Medicare financing with cost-growth containment to ensure Medicare’s continued ability to meet beneficiary needs without being burdensome financially.
■ Enact universal coverage for quality, affordable, publicly accountable health care.
Ellen Shaffer, MPH, PhD, APHA Executive Board
[a] Our nation’s hard-won commitment to parity for mental health coverage must be implemented throughout.