[Congressional Record Volume 155, Number 118 (Friday, July 31, 2009)]
[Extensions of Remarks]
[Pages E2130-E2132]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                              HEALTH CARE

                                 ______
                                 

                          HON. BETTY McCOLLUM

                              of minnesota

                    in the house of representatives

                        Thursday, July 30, 2009

  Ms. McCOLLUM. Madam Speaker, on July 20th, I held a health care 
hearing in the Minnesota State Capitol to discuss the challenges and 
opportunities for health care reform presents for Minnesota. 
Representatives from patient advocate groups, health plans, hospitals, 
health plans, County Commissioners, and State House Representatives 
were in attendance. The speakers discussed the need to expand 
preventative care, to end the practice of denying coverage for pre-
existing conditions, and to improve access to quality, affordable care.
  In hearing I heard over and over again that the current flawed 
Medicare reimbursement formula is harming Minnesota. The people of 
Minnesota want health care reform that addresses the three major 
challenges in health care reform--cost, quality, and access--none of 
which can be addressed without fixing the Medicare reimbursement 
formula. I support moving towards a system that ensures that all 
patients will receive evidence-based, quality care as the standard.

           Opening Statement by Congresswoman Betty McCollum


 Federal Health Care Reform: Opportunities and Challenges for Minnesota

       Good morning. Thank you all for joining me for this 
     morning's hearing.
       My goal today is to hear from a distinguished and diverse 
     group of Minnesota experts on the subject of health care 
     reform in Washington. I want to hear not just a view of the 
     need for national reforms--but more specifically--the 
     opportunities, challenges, costs, and consequences for 
     Minnesota as we reform our nation's health care system.
       Let me start by saying I support President Obama's goal of 
     reforming health care with a focus on reducing cost, 
     increasing access, and ensuring quality care for all 
     Americans. The current system is not sustainable for our 
     families, businesses, tax payers, or the providers of health 
     care. In addition, almost 50 million Americans are uninsured 
     and too often left to access care in the emergency room where 
     it is too expensive and too late.
       As we look ahead I want to maintain a system where people 
     can keep their doctors and private insurance plans if they 
     are working well for them.
       I support a public insurance option that will expand the 
     opportunity for coverage and create a competition in the 
     marketplace to keep premium costs down and ensure quality 
     care.
       I believe we have both an opportunity and an obligation to 
     ensure every child in America is not only covered by 
     insurance but able to access the care they need to grow up 
     healthy, safe and successful.
       We can do all of these things, but I have a concern--a 
     major concern. Comprehensive health care reform in my opinion 
     must mean that all 50 states move forward under any 
     legislation passed by Congress and signed by President Obama. 
     In other words--I want a bill in which no state is left 
     behind--and that means Minnesota.
       In Minnesota we are doing a lot of things right. And, each 
     and every one of the people testifying today is contributing 
     to making health care in Minnesota successful. We are not 
     perfect and I want to see even greater strides forward here 
     at home, but when compared to many other places across the 
     U.S. we are doing a good job.
       In Congress health care reform is dominating the agenda and 
     we are at a crucial time.
       Minnesota's successes must not only be acknowledged, they 
     should be rewarded. Instead, the legislation currently 
     proposed has the real potential to actually harm Minnesota's 
     delivery of health care and that is simply unacceptable.
       About fifteen years ago while serving here in the Minnesota 
     House of Representatives I worked on the issue of geographic 
     disparities in Medicare reimbursement. The flawed and 
     discriminatory formula that funds Medicare continues to 
     penalize Minnesota tax payers and patients, doctors, 
     hospitals, counties and the entire health care sector which 
     is providing high quality, low cost care.
       If the health care reform legislation moving through 
     Congress simply extends the existing out-of-date Medicare 
     reimbursement system into the future--rewarding high cost, 
     low quality states while continuing to penalize Minnesota--
     then this is not reform.
       Even worse, if this flawed Medicare reimbursement formula 
     is extended as the basis of a public insurance option this 
     will not only penalize Minnesota, it will undermine and 
     deteriorate the very success our state has attained in 
     delivering quality, low cost care.
       In Congress, I have been outspoken about Minnesota's unfair 
     treatment among the leaders of the Democratic Caucus and 
     Chairmen Waxman, Rangel and Miller who are writing the bill.
       I have distributed a letter I sent to Democratic 
     leadership, signed by 19 other Democrats. Let me read from 
     the letter:
       ``We represent states in which the quality of care exceeds 
     the national average and per-beneficiary fee-for-service 
     Medicare costs are substantially lower than the national 
     average. Our ``low-cost, high quality'' states are setting 
     the national standard for Medicare, yet we are penalized by 
     the current Medicare reimbursement formula. Furthermore, any 
     public insurance option that is based on Medicare's current 
     reimbursement formula would only result in an unacceptable 
     further penalization of our states.''
       I was pleased to have Congressmen Walz, Ellison, and 
     Oberstar join me on this letter because we got the attention 
     of the leadership.
       The next day I was invited by Speaker Pelosi to a meeting 
     with leadership and the three committee chairman--Chairmen 
     Waxman, Rangel, and Miller and Majority Leader Steny Hoyer to 
     discuss this issue. In the meeting a study of the Medicare 
     reimbursement formula was offered ... and quickly rejected. I 
     made it clear that we don't need to study this problem; it 
     has been studied to death. Now is the time to fix the 
     formula.
       I'm committed to working with President Obama and leaders 
     in Congress to pass health care reform that works to make our 
     system meet the needs of all Americans. But this doesn't mean 
     I will allow Minnesota to be left behind or disadvantaged 
     because we are a leader.
       Our group of twenty Democrats will again be meeting 
     tomorrow. My message to leadership is clear--I want to pass 
     health care reform but I will not vote for a bill that hurts 
     Minnesota while benefiting other states. That is not reform, 
     but rather a recipe for disaster.
       In closing, this is the most important legislation I've 
     worked on in my nine years in Congress.
       It must meet Minnesota's needs and if it does not it will 
     be difficult for our delegation to support it.
       In my first year in Congress--2001--education reform 
     legislation was passed called ``No Child Left Behind.'' It 
     was championed as a bill that would transform public 
     education--except for one thing--I was sure it was going to 
     hurt Minnesota and set back the reforms we already had in 
     place. I was the only Democrat on the Education Committee to 
     vote against ``No Child Left Behind'' and eventually 8 of the 
     10 members of the Minnesota delegation voted against it.
       I want health care reform but I will not put my 
     constituents and the State of Minnesota at a disadvantage or 
     perpetuate a system that penalizes the excellent health care 
     we deliver in our state.
       I feel a sense of urgency as I return to Washington this 
     afternoon. Your testimony today I hope will reinforce the 
     need for reform and the need to ensure Minnesota's best 
     interests are reflected in any legislation that is considered 
     by Congress.
       Thank you and I look forward to hearing your testimony.
                                  ____


           Testimony from Brock Nelson, Regions Hospital, CEO

       Thank you Congresswoman McCollum for the opportunity to be 
     here today and share our thought on health care reform 
     legislation currently being debated by the United States 
     House of Representatives.
       My name is Brock Nelson. I am the CEO of Regions Hospital 
     in St. Paul. Regions Hospital is part of the HealthPartners 
     family of non-profit health care organizations.
       Let me start by stating clearly, We wholeheartedly support 
     President Obama's call for healthcare reform, and agree with 
     his position that ``the status quo is the one option that is 
     not on the table''. We applaud Congress and the White House 
     for their ongoing efforts to obtain universal coverage for 
     all Americans.
       Legislation in the House is bold in its effort to obtain 
     universal coverage through expanded subsidies and 
     requirements on both individuals and business to provide 
     coverage. Bold action is necessary if you want to address the 
     problem of 50 million Americans who currently lack health 
     coverage.
       Unfortunately, these efforts to provide coverage for all 
     will ultimately fall short unless Congress takes equally bold 
     action to address how we pay for health care in this country. 
     Our system currently rewards volume over value, and poor 
     outcomes over good outcomes. We must change that equation if 
     we want to make health care affordable in this country.

[[Page E2131]]

       We urge you to insist that reform legislation includes a 
     method that pays for value and quality, rather than the 
     quantity of medical procedures. Currently, Medicare pays the 
     most to less than one-half of the health care markets in a 
     minority of states that generally provide poorer outcomes, 
     safety, and service at higher cost, and much less to most of 
     the country where providers demonstrate generally better 
     outcomes, safety and service at lower cost. We believe that 
     insertion of a measurement of value into the payment system 
     is a critical step to change provider behavior throughout the 
     country and ``bend the cost curve'' in U.S. health spending 
     without compromising health.
       Much of the discussion in Washington has focused on a 
     ``public option'' and the development of an ``exchange'' or 
     ``gateway'' to help deliver that option. We are not opposed 
     to these mechanisms and in fact they could provide a benefit 
     for parts of the market. But any new federal mechanism to 
     provide coverage must operate under the same rules and market 
     controls that exist today. A public option, like the current 
     House proposal, that is based off of Medicare payments or an 
     exchange that tilts the rules in favor of the public plan are 
     bad choices and potentially devastating for local, non-profit 
     health care markets like Minnesota.
       `Pay for value' is the only tactic that will ``bend the 
     cost curve'' in U.S. health spending, improve the quality of 
     care that our citizens deserve, and create a long and healthy 
     future for both the American people and the American 
     healthcare system.
       Congresswoman McCollum, you have been fearless in your 
     efforts to address the geographic inequity in Medicare and 
     these underlying problems in our payment system. Thank you! 
     Please keep fighting and please let us know what we can do to 
     provide help and support in your efforts.

    Testimony of Melissa Winger, Chair of Family Advisory Council, 
             Children's Hospitals and Clinics of Minnesota

       I am the current Chairperson of the Family Advisory Council 
     at Children's Hospital and have been involved with the 
     Council for 11 years. Through the council I have met many 
     families who have a similar story as mine.
       Thirteen years ago my son Devin was born with a complex 
     chromosome disorder: he is missing 45 genes on chromosome 
     number 4 and has an extra 30 genes on chromosome 6.
       Devin has 17 medical conditions involving all organ 
     systems. This has required over 40 surgeries and procedures 
     and double that of hospitalizations all at Children's 
     Minneapolis.
       He sees over a dozen pediatric specialists who have all 
     been able to treat his unique needs.
       All of his care has been coordinated and family centered 
     which is something that Children's value with ALL their 
     families and patients.
       We are currently treating a virus in his bone marrow and a 
     deficiency in the immune system and he is getting IVIG 
     infusions. He also had a Brain Aneurysm in his carotid artery 
     repaired and needs to have annual testing involving high tech 
     imaging to make sure the aneurysm continues to be stable. He 
     also receives genetic testing to be able to pinpoint 
     potential problems before he even starts to have symptoms
       If Children's could no longer provide this care for him, I 
     am not sure he would survive. The aneurysm could return or 
     his immune system could fail to respond to common infections.
       I have my son today because of Children's. Through the 
     outpatient rehab clinics he learned to walk, communicate, and 
     manage table foods so he is no longer fully dependent on his 
     feeding tube. He goes to school and performs in music shows 
     and enjoys every minute of it!
       I worry about my son, what if he gets sick? What if his 
     bleeding disorder becomes too much to handle? What if he has 
     difficulty with his respiratory condition? I am instantly 
     reassured that Children's is just a few miles away with 
     everything needed to care for him and make him well again.
       There are hundreds if not thousands of families in this 
     state who have depended on the specialty care that Children's 
     provides when their child needed medical attention like my 
     little Devin. Children's has never given up hope for Devin, I 
     have certainly never given up hope and at the end of the day 
     I hope that our lawmakers won't give up on my son.
       I may hear one day ``that there is nothing more we can do 
     for Devin,'' as hard as that sounds I will have to somehow 
     accept that. However if that statement starts with ``because 
     of budget cuts there is nothing more we can do for Devin,'' I 
     will never be able to accept that.
       I see things as a wall going up between my son and the care 
     he needs at Children's. Everytime there is a Cut to Medicare 
     funding. Everytime a service or prescription is denied. 
     Everytime complex regulation and policy put into place. That 
     wall continues to rise to the point the care my son needs may 
     no longer be available.
       My son and I are caught in a never-ending circle. He gets 
     sick, he misses days of school, I am unable to go to work. If 
     we can access the best pediatric effective, high quality, 
     safe care that Children's provides, he can recover return to 
     school and live up to his full potential and I can continue 
     to work without being emotionally and financially ruined.
       I know these are tough times and difficult decisions need 
     to be made. But I urge you not to make decisions about health 
     care that will effect the care my son so desperately needs 
     and deserves.
                                  ____


   Testimony of Alan L. Goldbloom, MD, President and Chief Executive 
Officer, Children's Hospitals and Clinics of Minnesota, Minneapolis/St. 
                                Paul, MN

       I wish to thank Representative McCollum for inviting me to 
     testify on behalf of Children's Hospitals and Clinics of 
     Minnesota. I appreciate the opportunity to give a voice to 
     children in the health care debate.
       This is an exciting time in America. We have an 
     unprecedented opportunity to reform the health care system 
     and expand coverage to all. We applaud Congress for working 
     toward this goal, but also want to remind lawmakers that 
     expanding health insurance coverage doesn't automatically 
     guarantee access to quality care. No matter what we do on the 
     coverage side, if we don't also address Medicaid 
     reimbursement levels, many patients will still find it hard 
     to get the care and services they need.
       Thus far, much of the debate has focused on Medicare. I 
     will focus more on Medicaid. Medicaid is the single largest 
     insurer of children in the United States. Throughout the 
     country, children, and the children's hospitals that treat 
     them, are particularly vulnerable to the impact of inadequate 
     Medicaid reimbursement. At Children's of Minnesota, we served 
     more than 42 thousand children on Medicaid in 2008.
       Children's is the state's largest provider of care to 
     children with cancer, heart disease, severe prematurity, and 
     complex surgical conditions. We pride ourselves on superb 
     outcomes, and are committed to turn no child away, regardless 
     of insurance status.
       Medicaid represented 40 percent of our revenue last year. 
     Six years ago it was 30%. For most adult hospitals that 
     number is closer to 10 percent, and often less. Yet Medicaid 
     pays only 80% of our cost. Moreover, while the number of 
     children relying on Medicaid insurance seems to increase each 
     year, we have seen the reimbursement rates erode year by 
     year, usually because of state budget cuts. As the gap 
     between cost and reimbursement increases, our ability to 
     provide necessary care is increasingly threatened.
       Much of the health care reform debate has focused on 
     reimbursement rates for Medicare--coverage for our seniors. 
     It is generally 20-30% lower than private plans. The fact is 
     that Medicaid rates are 30% lower than Medicare! Across the 
     country, on average, Medicaid pays about 71% of the cost of 
     care, if you exclude disproportionate share (DSH) payments. 
     If you include those DSH payments it gets up to 77%. If 
     coverage is expanded, but the rates continue to reimburse 
     below the cost of care, then it will be even harder to assure 
     appropriate access to care.
       Here in Minnesota, we have an additional problem. The 
     hospitals in our state have justly earned a reputation for 
     providing some of the highest quality and lowest cost care in 
     the nation. Our reimbursement rates are among the lowest in 
     the country. We are therefore extremely concerned about 
     legislative proposals that would apply across-the-board cuts 
     to existing reimbursement rates, without taking into account 
     the value of care already being delivered. The simple message 
     to Minnesota appears to be: ``Thanks for leading the nation 
     in keeping costs down and providing the highest quality care. 
     As a reward for those efforts, we are going to cut your 
     reimbursement even further!''
       If health care reform is going to ensure real access to 
     health care for children, Congress needs to address a number 
     of issues.
       First, health care reform bills must include provisions to 
     set Medicaid reimbursements at a rate that is at least 
     comparable to Medicare. Ideally, Medicaid should cover the 
     true costs of care. The America's Affordable Health Choice 
     Act of 2009 does propose to increase primary care physician 
     payments under Medicaid to 100% of Medicare by 2012. But that 
     won't be sufficient. To ensure true access to care, Medicaid 
     must reimburse specialists and hospitals at this level as 
     well. For the sickest children, access to specialist care in 
     children's hospitals is essential.
       Second, we need to protect Disproportionate Share Hospital 
     payments, which help expand access to care by closing the gap 
     between Medicaid reimbursements and actual costs. If more 
     people are covered, but the reimbursement rates remain 
     significantly below cost, then the need for DSH payments will 
     in fact be even greater.
       Finally, health care reform needs to help eliminate 
     disparities, and address the unique health and developmental 
     needs of children including coverage for the Early Periodic 
     Screening, Diagnosis, and Treatment (EPSDT) Program.
       The investment in children's health makes a difference that 
     lasts for 70 or 80 years, not only in productive lives, but 
     in avoidance of long term health costs. No other health care 
     expenditure has that kind of return on investment. The needs 
     of children must be front and center in this debate.
       Again, thank you for allowing me to speak before you today. 
     I am happy to answer any questions you may have.

[[Page E2132]]



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