[Congressional Record (Bound Edition), Volume 155 (2009), Part 15]
[Extensions of Remarks]
[Pages 20538-20540]
[From the U.S. Government Publishing Office, www.gpo.gov]




                         MINNESOTA HEALTH CARE

                                 ______
                                 

                          HON. BETTY McCOLLUM

                              of minnesota

                    in the house of representatives

                         Friday, July 31, 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 the 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.
  I would like to enter the testimony from the hearing witnesses from 
this event into the Congressional Record.

               Testimony of Representative Thomas Huntley

       Good morning Rep. McCollum. I commend you for holding this 
     hearing on the need for national health care reform.
       Minnesota is one of the nation's healthiest states with one 
     of the highest insured rates in the nation. Investments in 
     coverage for low-income families, strong public health 
     initiatives, and a primarily non-profit insurance system have 
     all contributed to our state's reputation for a health care 
     system that provides high-quality care at a relatively low-
     cost compared to other states. Yet due to rising costs, our 
     state's current system is unsustainable without substantial 
     payment reform at the federal level.
       In 2008, health care leaders from around the state 
     collaborated on comprehensive health care reform legislation 
     that mirrors many of the proposals being discussed at the 
     federal level: an individual insurance mandate, investment in 
     prevention, insurance market reforms, and care coordination 
     incentives for providers. One of the central components of 
     the legislation--and the one that has the most potential for 
     cost-savings--was payment reform. There was a bipartisan 
     consensus that transforming the health care system must start 
     with changing the way we pay for health care. Without 
     substantial cost containment at the state and federal levels, 
     neither Minnesota, nor the United States, can hope to afford 
     the costs of universal coverage.
       The underlying payment structure fails to adequately meet 
     the care needs of patients and undermines health care 
     providers' attempts to provide high quality health services. 
     Our entire health care system's payment regimen is built on 
     Medicare standards that emphasize a ``tyranny of the visit'' 
     philosophy which pressures providers to increase volume, does 
     not value quality, and prioritizes specialty care at the 
     expense of primary care. In too many instances, the result is 
     inappropriate care provided to patients which does nothing 
     more than increase total health spending.
       In order to begin to contain costs, Minnesota's legislation 
     included a number of reforms that restructure the payment 
     system, moving us away from Medicare-based standards and 
     toward a system that promotes quality-care and transforms the 
     way health care is delivered and received. The payment reform 
     included three components to both hold providers accountable 
     and encourage evidence-based, high-quality health care. At 
     each level there was an emphasis on the need for transparency 
     for both providers and consumers.
       1. Explicitly pay providers for the quality of care they 
     provide.
       2. Encourage care coordination through a medical home model 
     that improves access to primary care.
       3. Establish a system of accountability for the total cost 
     of care through bundled care pricing.
       Without similar, or even more aggressive payment reforms in 
     Medicare, our health care system's growth will be 
     unsustainable. Medicare's participation is essential in order 
     to create a critical mass of payers in the new system. 
     Providers in Minnesota have spoken up regarding the 
     disincentives in the current payment system to develop new 
     strategies to provide more efficient forms of health care. 
     For instance, in Minnesota a number of health care systems 
     have initiated new approaches to managing chronic conditions 
     including congestive heart failure, hypertension and 
     diabetes. While their patient outcomes have dramatically 
     improved and they have seen reductions in hospitalization, 
     these systems have consistently lost money because the 
     current Medicare-based payment structures do not reimburse 
     for non-office visit treatment.
       Similar reforms are also being discussed in Congress. A 
     Call to Action released by Senator Baucus in November 
     outlined the need for pilot programs around accountable care 
     organizations in Medicare as a way of testing new payment 
     structures. Similarly the House Tri-Committee bill authorizes 
     the Secretary of Health and Human Services to develop new 
     cost containment methodologies including accountable care 
     organizations and medical homes. In Minnesota we have already 
     started down this path and should be rewarded for our 
     innovation.
       Representative McCollum, I know you are aware of the 
     situation health care providers face in Minnesota. I want to 
     thank you, as well as Minnesota Representatives Oberstar, 
     Paulsen, Walz and Ellison, for your recent letter on this 
     issue. As the health care reform bill moves through the 
     House, I know you will be a strong voice for the change we in 
     Minnesota deserve. I fear that if Congress waits to enact 
     real payment reform that we all will pay the price.
       As we all know there is no silver bullet to solving our 
     nation's health care crisis. We must work together to achieve 
     the kind of health care system we all deserve. The 
     consequences of doing nothing will leave us with an 
     impossible situation. We must begin to change the system we 
     have into a system that works. This is a unique opportunity 
     to make a difference; a point in time that will not last 
     forever.
       President Obama made the case in his February Address to 
     Congress this year stating ``... a century after Teddy 
     Roosevelt first called for reform, the cost of our health 
     care has weighed down our economy and the conscience of our 
     nation long enough. So let there be no doubt: Health care 
     reform cannot wait, it must not wait, and it will not wait 
     another year.''
                                  ____


                Testimony of Representative Erin Murphy

       Good morning. My name is Erin Murphy. I am a registered 
     nurse and a State Representative from district 64 A in St. 
     Paul. Thank you for holding this hearing in Minnesota and for 
     the invitation to testify today.

[[Page 20539]]

       We must reform health care in America. In the middle of the 
     debate, it may seem impossible to traverse the sharp policy 
     and political questions before us but we must. The status quo 
     is unsustainable and unacceptable. While individuals expect 
     and often receive excellent care and cure, American lacks a 
     coherent system of care delivery and payment. The result is a 
     highly fragmented system delivering fragmented episodes of 
     care. Too little attention is paid to the ultimate goal of 
     health.
       Americans are paying a high price for underwhelming 
     individual and population outcomes. We are in that rare 
     moment of opportunity to change course. We must change 
     course.
       I am delighted to have the opportunity to share with you a 
     perspective from Minnesota. As you well know, Minnesota is an 
     innovator and has long led the nation's efforts in health 
     policy, value and reform. Along with our upper Midwestern 
     neighbors, we are a high value low cost state.
       We must reform the nation's health care delivery and 
     payment systems to set the foundation for continued 
     innovation and demonstration in Minnesota. We must embed what 
     we know is working in Minnesota and the upper Midwest to 
     deliver high value for lower relative cost across the 
     Country. Finally, we must ensure that every American is 
     covered so they get the right care at the right time for a 
     good price.


                                Coverage

       For many years we have focused on coverage as a primary 
     solution. That so many Americans lack coverage for needed 
     care is wrong, plain and simple. That health care is so 
     expensive that necessary treatment of disease is financially 
     out of reach for so many is wrong, plain and simple. Relying 
     on the emergency room as the primary point of care for the 
     uninsured is wrong, plain and simple.
       Getting everyone into coverage is imperative, morally and 
     financially. An individual mandate and guaranteed issue of 
     coverage, regardless of preexisting condition will yield more 
     coverage with shared responsibility between individuals and 
     insurers. A public option will give Americans a choice 
     between private coverage and a publicly backed coverage.
       A public option provides opportunity to further drive 
     delivery and payment reforms. If the public option cements 
     the status quo in terms of payment and delivery, it will 
     compound the problems with which we are already struggling. 
     But if the public option serves to propel reforms, it 
     enhances efforts to deliver better care for a better price.
       Minnesota has worked over two decades to assure coverage 
     employing Medicaid, Minnesota Care and General Assistance 
     Medical Care. The Governor's line item veto of General 
     Assistance Medical Care has undermined 20 years of effort in 
     Minnesota. I ask that Congress consider this as it 
     contemplates any state maintenance of effort. Maintenance of 
     effort is an important means to balance state and federal 
     efforts. Allowing state flexibility in policy reform while 
     maintaining access provides state policymakers with the tools 
     necessary for continued innovation.


                            Delivery Reform

       Our fragmented delivery system is providing fragmented care 
     and we are paying a high price. Care for those with chronic 
     conditions such as diabetes and heart disease accounts for 
     upwards of 60 percent of all Minnesota's health care costs. 
     This stark fact has served as a focal point in Minnesota. We 
     must pursue policies to prevent the onset of disease and 
     invested in care that will keep those with chronic conditions 
     healthy and out of the hospital.


                             Payment Reform

       Current payment is weighted to specialists and procedures 
     and away from interventions to maintain health. For example, 
     a surgeon is paid more for the amputation of a diseased 
     diabetic limb than is a primary care provider for disease 
     management preventing the loss of the limb.
       Medicare sets the standard in payment. I urge the inclusion 
     of large scale payment reform such as accountable care 
     organizations or a total cost of care model. Without similar, 
     or even more aggressive payment reforms in Medicare, our 
     health care system's growth will be unsustainable. Medicare's 
     participation is essential in order to create a critical mass 
     of payers in the new system.
       Short of large scale change, I urge state flexibility in 
     Medicare payment. A Minnesota or upper Midwest demonstration 
     in payment will permit us to demonstrate the Congress and the 
     nation the means to deliver high quality care for a better 
     price.
       Achieving significant health care reform in this country 
     has for decades been a uniquely challenging and complex 
     issue. The grind between dogged political frames has proved 
     insurmountable for policy makers. Entwined state and federal 
     policy and funding, limits state policy reform efforts and 
     calls for federal action. The urgency of growing costs and 
     shrinking access compels our action. 40 years ago, America 
     put a man on the moon, a seemingly unachievable goal. We did 
     that--and we will do this too. We must.
       Thank you for your courage and hard work. I stand with you 
     in your efforts to enact federal reform while promoting and 
     protecting the value the care delivered in Minnesota.
                                  ____


                 Testimony of Representative Maria Ruud

       Good morning Rep. McCollum. Thank you for holding this 
     hearing on federal health care reform. I appreciate the 
     opportunity to be here today.
       I have been a Nurse Practitioner for 21 years and am 
     serving my third term in the Minnesota House of 
     Representatives.
       Health care reform can only occur if we enact true payment 
     reform. With the current system there is a disincentive to 
     provide the care needed. Paying for more tests, more 
     procedures, and more visits rewards waste and inefficiency. 
     The focus needs to change from reimbursement based on volume 
     to reimbursement based on outcome.
       Part of the reason our health care system has been able to 
     function for as long and as well as it has is because there 
     are a number of individuals who are deeply committed to 
     serving their patients well. But our current payment system 
     is making it increasingly difficult to deliver effective 
     care.
       For example, pay for production--pay for the number of 
     patients seen or procedures performed--drives costs up and is 
     a disincentive to provide the appropriate care at the 
     appropriate time.
       We have evidence-based medicine to inform providers, about 
     what the most effective option is for the patient to achieve 
     a healthy outcome. Access to preventative care and 
     screenings, early and consistent management of chronic health 
     conditions.
       It comes down to providing the incentives that will help us 
     achieve the goals we seek--well-being and healthy outcomes.
       Now is the time to be bold. To align the incentives with 
     the outcomes we desire. Providers want to do it--it is their 
     calling to provide the most effective care possible.
                                  ____


    Testimony of Shane Davis, Secretary-Treasurer, SEIU Healthcare 
                               Minnesota

       Good Morning Representative McCollum: At this critical 
     moment, while Congress is deciding to pass quality affordable 
     healthcare for all, I want to sincerely thank you for this 
     opportunity to testify. I would also like to publicly 
     acknowledge your good work in supporting the principles of 
     healthcare reform, put forward by Health Care for America-
     Now, an important coalition SEIU is proud to support.
       My name is Shane Davis; I am the Secretary-Treasurer of 
     SEIU Healthcare Minnesota. We represent more than 17,000 
     healthcare workers around the state of Minnesota. Our 
     Members, by the thousands, work every day and night for 
     companies currently recognized nationally as models of high-
     quality, low-cost healthcare, such as Allina, HealthPartners, 
     and the Mayo Clinic. The Minnesota recipe for high-quality, 
     low-cost healthcare includes workers having a real voice on 
     the job. This encourages labor and management to work in 
     partnership; increasing productivity and putting patient care 
     experiences and health outcomes first.
       Those of us who bargain contracts have first-hand 
     experience in how badly we need health care reform. The 
     ability to bargain for higher wages, for training funds to 
     upgrade the skills of our members, for higher pensions so 
     that workers can look forward to a secure and dignified 
     retirement has been deeply compromised by escalating health 
     care costs. We've heard that the CEO of Starbucks complains 
     that he spends more money buying health insurance for his 
     employees than he does buying coffee beans. Well, in our 
     industry, as health care workers, it's not coffee bean prices 
     that are outstripped by the cost of health insurance, it's 
     training and upgrade funds, for instance, that would help our 
     members move up career ladders, just so that we can hold on 
     to health insurance.
       Our members' stories about how badly they need health care 
     reform are much like the stories of many other Minnesotans. 
     Last month, Pam Bundy told us about her son, a former 
     construction worker who was diagnosed with liver cancer. 
     After months of illness and treatments, he lost his job, 
     exhausted his COBRA benefits, maxed out his credit card with 
     co-pays for treatment, was told he needed to pay cash when he 
     came in for chemotherapy, and ultimately lost his home to 
     foreclosure because of the crushing debt-load that was 
     inevitable. Our members cannot wait for health care reform. 
     Millions like Pam's son cannot wait for healthcare reform. We 
     urge you to reject the siren song of delay and pass a bill.
       SEIU believes that a public plan option is an essential and 
     necessary component of real health care reform. It provides 
     an alternative to private insurance and applies competitive 
     pressure to the rest of the insurance industry. Research by 
     the Commonwealth Fund shows that including the public option 
     with other health care reform measures can help save another 
     77 billion to 1.8 trillion dollars over the next ten years. 
     We are encouraged that a public plan has been included in 
     health care reform legislation passed by the Senate HELP 
     committee, the House Ways and Means committee, and the House 
     Education and Labor committee. SEIU has strongly supported 
     votes to approve these bills.
       Once Congress has met the challenge of producing a final 
     bill that includes a public plan option, then Congress has 
     the opportunity to structure the best possible public

[[Page 20540]]

     plan. The deficiencies of our current payment system are well 
     known. As the Dartmouth Atlas Project has highlighted, 
     Medicare reimbursements currently reward high cost, low 
     quality states, and penalize low cost, high quality states. 
     For example, in Miami, Medicare will spend $15,000 per 
     patient per year, while here in Minnesota, that figure is 
     $7,000, less than half the reimbursement, with no difference 
     in patient outcome. We must change how health care is paid 
     for, so that we reward quality outcomes rather than quantity 
     of services. If such changes are incorporated into a strong 
     public plan option, it should reduce the overall cost to 
     taxpayers and produce improved care across the nation. Our 
     task is to make the most of this opportunity for payment 
     reform, while still meeting the immediate challenge of 
     passing real healthcare reform, including a public plan 
     option.
       Thank you very much for holding this hearing to ensure that 
     Minnesota's voice is heard in this debate on health care 
     reform.

                          ____________________