Joel B. Finkelstein

WASHINGTON — What was a trend is looking more like a wave as an increasing number of states, no longer content to wait on the seemingly glacial pace of national politics, are seeking their own comprehensive solutions to the growing ranks of the uninsured, state health care reformers said at a conference sponsored by AcademyHealth.

"Can state innovations work on a national problem? It's somewhat of a rhetorical question. There's a growing sense of insecurity among our people that more and more of our citizens … are losing access to affordable health care. It's becoming more like a lottery with more losers," said Jim Leddy, a former Vermont senator who helped ferry through a sweeping health care reform law in that state.

States are coming to realize that the uninsured are a shared problem, said Kim Belshe, secretary of California's Health and Human Services Agency.

"We've seen in California that when we can draw a connection between a problem that affects a minority of people, relatively speaking, and how it relates to the broader California, that it creates a policy environment where we have a greater potential to effect meaningful reform," she said.

In California, this meant demonstrating that the uninsured were having a significant impact on others in the community.

For instance, uncompensated care leads to higher health insurance premiums, overuse of emergency departments leading to closures, and high rates of uncontrolled chronic disease leading to lost productivity, she said.

Although states are taking this problem on themselves, they have, so far, shied away from single-payer approaches.

Instead they are building on public programs, including the Medicaid and State Children's Health Insurance Program, which together provide states with substantial, if still insufficient, federal funds.

If the states are to serve as laboratories for reform, they will need to be empowered, not abandoned by the federal government, said Mr. Leddy.

"For too long, the laboratories have been bankrupt in terms of ability of states to address problems of their citizens because we fundamentally have not had the support of our national government."

Some state reform plans also include provisions to enable and even encourage companies to continue providing coverage for their workers.

"The erosion of employer-sponsored insurance plans must not be allowed to become a collapse. Whether we agree philosophically with it, we simply cannot afford a collapse of what is the foundation for what we have now," Mr. Leddy said.

Beyond expanded access, state health care reformers are focusing on prevention and wellness.

"We not only have to treat chronic conditions better, we also have to have strategies that deal with the incidence and the prevalence of these conditions, in particular diabetes and obesity," said Mr. Leddy.

Personal responsibility has to be an important component of that equation, but that should not be interpreted as a code word for social Darwinism, or survival of the healthiest, wealthiest, and luckiest, he said.

Although there still remains a lot of variability between states and their ability to undertake such broad reforms, an increasing number are turning to the examples set by Vermont, California, and a dozen other states in the process of passing reform measures.

Legislators and other officials are studying these states' programs not only for the lessons they hold, but also for the encouragement they provide, experts explained.

"A lot of people feel if California as a state can make meaningful inroads in terms of our coverage and cost challenges, then that offers some hope and promise for other states, just given the size and the magnitude of our challenges," said Ms. Belshe.

WASHINGTON — What was a trend is looking more like a wave as an increasing number of states, no longer content to wait on the seemingly glacial pace of national politics, are seeking their own comprehensive solutions to the growing ranks of the uninsured, state health care reformers said at a conference sponsored by AcademyHealth.

"Can state innovations work on a national problem? It's somewhat of a rhetorical question. There's a growing sense of insecurity among our people that more and more of our citizens … are losing access to affordable health care. It's becoming more like a lottery with more losers," said Jim Leddy, a former Vermont senator who helped ferry through a sweeping health care reform law in that state.

States are coming to realize that the uninsured are a shared problem, said Kim Belshe, secretary of California's Health and Human Services Agency.

"We've seen in California that when we can draw a connection between a problem that affects a minority of people, relatively speaking, and how it relates to the broader California, that it creates a policy environment where we have a greater potential to effect meaningful reform," she said.

In California, this meant demonstrating that the uninsured were having a significant impact on others in the community.

For instance, uncompensated care leads to higher health insurance premiums, overuse of emergency departments leading to closures, and high rates of uncontrolled chronic disease leading to lost productivity, she said.

Although states are taking this problem on themselves, they have, so far, shied away from single-payer approaches.

Instead they are building on public programs, including the Medicaid and State Children's Health Insurance Program, which together provide states with substantial, if still insufficient, federal funds.

If the states are to serve as laboratories for reform, they will need to be empowered, not abandoned by the federal government, said Mr. Leddy.

"For too long, the laboratories have been bankrupt in terms of ability of states to address problems of their citizens because we fundamentally have not had the support of our national government."

Some state reform plans also include provisions to enable and even encourage companies to continue providing coverage for their workers.

"The erosion of employer-sponsored insurance plans must not be allowed to become a collapse. Whether we agree philosophically with it, we simply cannot afford a collapse of what is the foundation for what we have now," Mr. Leddy said.

Beyond expanded access, state health care reformers are focusing on prevention and wellness.

"We not only have to treat chronic conditions better, we also have to have strategies that deal with the incidence and the prevalence of these conditions, in particular diabetes and obesity," said Mr. Leddy.

Personal responsibility has to be an important component of that equation, but that should not be interpreted as a code word for social Darwinism, or survival of the healthiest, wealthiest, and luckiest, he said.

Although there still remains a lot of variability between states and their ability to undertake such broad reforms, an increasing number are turning to the examples set by Vermont, California, and a dozen other states in the process of passing reform measures.

Legislators and other officials are studying these states' programs not only for the lessons they hold, but also for the encouragement they provide, experts explained.

"A lot of people feel if California as a state can make meaningful inroads in terms of our coverage and cost challenges, then that offers some hope and promise for other states, just given the size and the magnitude of our challenges," said Ms. Belshe.

WASHINGTON — What was a trend is looking more like a wave as an increasing number of states, no longer content to wait on the seemingly glacial pace of national politics, are seeking their own comprehensive solutions to the growing ranks of the uninsured, state health care reformers said at a conference sponsored by AcademyHealth.

"Can state innovations work on a national problem? It's somewhat of a rhetorical question. There's a growing sense of insecurity among our people that more and more of our citizens … are losing access to affordable health care. It's becoming more like a lottery with more losers," said Jim Leddy, a former Vermont senator who helped ferry through a sweeping health care reform law in that state.

States are coming to realize that the uninsured are a shared problem, said Kim Belshe, secretary of California's Health and Human Services Agency.

"We've seen in California that when we can draw a connection between a problem that affects a minority of people, relatively speaking, and how it relates to the broader California, that it creates a policy environment where we have a greater potential to effect meaningful reform," she said.

In California, this meant demonstrating that the uninsured were having a significant impact on others in the community.

For instance, uncompensated care leads to higher health insurance premiums, overuse of emergency departments leading to closures, and high rates of uncontrolled chronic disease leading to lost productivity, she said.

Although states are taking this problem on themselves, they have, so far, shied away from single-payer approaches.

Instead they are building on public programs, including the Medicaid and State Children's Health Insurance Program, which together provide states with substantial, if still insufficient, federal funds.

If the states are to serve as laboratories for reform, they will need to be empowered, not abandoned by the federal government, said Mr. Leddy.

"For too long, the laboratories have been bankrupt in terms of ability of states to address problems of their citizens because we fundamentally have not had the support of our national government."

Some state reform plans also include provisions to enable and even encourage companies to continue providing coverage for their workers.

"The erosion of employer-sponsored insurance plans must not be allowed to become a collapse. Whether we agree philosophically with it, we simply cannot afford a collapse of what is the foundation for what we have now," Mr. Leddy said.

Beyond expanded access, state health care reformers are focusing on prevention and wellness.

"We not only have to treat chronic conditions better, we also have to have strategies that deal with the incidence and the prevalence of these conditions, in particular diabetes and obesity," said Mr. Leddy.

Personal responsibility has to be an important component of that equation, but that should not be interpreted as a code word for social Darwinism, or survival of the healthiest, wealthiest, and luckiest, he said.

Although there still remains a lot of variability between states and their ability to undertake such broad reforms, an increasing number are turning to the examples set by Vermont, California, and a dozen other states in the process of passing reform measures.

Legislators and other officials are studying these states' programs not only for the lessons they hold, but also for the encouragement they provide, experts explained.

"A lot of people feel if California as a state can make meaningful inroads in terms of our coverage and cost challenges, then that offers some hope and promise for other states, just given the size and the magnitude of our challenges," said Ms. Belshe.

WASHINGTON — The advent of health savings accounts and consumer-directed health plans has inspired entrepreneurs and academicians to design innovative delivery systems that cater to patient demand, experts said at a conference on technology and health care innovation.

“The next big change in health care will be patients managing their own care,” said John Goodman, Ph.D., president of the National Center for Policy Analysis. “Last year 95 million people got on the Internet to research their health problems. They didn't always get the best information. They didn't always get accurate information, but they were out there searching for answers.”

Patients are already turning to online services for consultations, discounted drugs, simple blood tests, and even home strep tests, said Dr. Goodman. Increasingly, patients will also demand market-based bundling and pricing of health care services.

“Most of the entrepreneurs out there in this market are people who have stepped outside the third-party payment system,” he said.

One of those entrepreneurs is Michael Howe, chief executive officer of MinuteClinic, which offers “retail health care” through more than 100 sites in 15 states. Chain drug store giant CVS Corp. bought MinuteClinic earlier this year, and many of the health care centers are located in CVS/pharmacy stores.

The health care centers are staffed by nurse practitioners and physician assistants trained to deal with a limited number of conditions including routine infectious diseases and to administer common vaccinations.

The clinics have done for health care what automatic teller machines did for banking, said Mr. Howe.

“You wouldn't go to an ATM for a small business loan, and you wouldn't go to a MinuteClinic to reset a femur.”

For that reason, each location maintains a relationship with physicians' practices where they can refer patients whose needs are beyond the scope of the clinic's providers. The company is also working to ensure that patients' records can be transmitted to physicians' offices, he said.

The clinics use technology such as electronic health records, best-practice protocols, and quality monitoring to keep costs down, said Mr. Howe.

“On average, [our costs are] about 50% of what it cost at a primary care physician office, about 40% of urgent care, and significantly less than an ER,” he said. Patients also save time by coming to the walk-in clinics rather than waiting hours for medical attention somewhere else.

And private companies are not the only innovators making health care more consumer friendly.

At the Arizona Telemedicine Program's UltraClinic, if a woman has a positive result on her mammogram, she can undergo a core biopsy, have a pathologist read the slides, and receive a oncology consult all within 4 hours of walking in the door rather than the 4 weeks it can take to go through this process, said the program's Dr. Ronald Weinstein.

This approach saves a lot of suffering, he said. “Eighty percent of the problems I have to deal with, as the head of a large laboratory, is women waiting for their pathology results on their breast lesions.”

The program is possible only because of the availability of telemedicine technology allowing consultation between physicians at different hospitals and the development of an ultrarapid virtual slide scanner that allows a pathologist to assess the biopsy within minutes of the procedure.

“We were motivated because of the fact that consumer-driven health care is an emerging area, and that is essential to supporting these kinds of bundled services,” he said.

WASHINGTON — The advent of health savings accounts and consumer-directed health plans has inspired entrepreneurs and academicians to design innovative delivery systems that cater to patient demand, experts said at a conference on technology and health care innovation.

“The next big change in health care will be patients managing their own care,” said John Goodman, Ph.D., president of the National Center for Policy Analysis. “Last year 95 million people got on the Internet to research their health problems. They didn't always get the best information. They didn't always get accurate information, but they were out there searching for answers.”

Patients are already turning to online services for consultations, discounted drugs, simple blood tests, and even home strep tests, said Dr. Goodman. Increasingly, patients will also demand market-based bundling and pricing of health care services.

“Most of the entrepreneurs out there in this market are people who have stepped outside the third-party payment system,” he said.

One of those entrepreneurs is Michael Howe, chief executive officer of MinuteClinic, which offers “retail health care” through more than 100 sites in 15 states. Chain drug store giant CVS Corp. bought MinuteClinic earlier this year, and many of the health care centers are located in CVS/pharmacy stores.

The health care centers are staffed by nurse practitioners and physician assistants trained to deal with a limited number of conditions including routine infectious diseases and to administer common vaccinations.

The clinics have done for health care what automatic teller machines did for banking, said Mr. Howe.

“You wouldn't go to an ATM for a small business loan, and you wouldn't go to a MinuteClinic to reset a femur.”

For that reason, each location maintains a relationship with physicians' practices where they can refer patients whose needs are beyond the scope of the clinic's providers. The company is also working to ensure that patients' records can be transmitted to physicians' offices, he said.

The clinics use technology such as electronic health records, best-practice protocols, and quality monitoring to keep costs down, said Mr. Howe.

“On average, [our costs are] about 50% of what it cost at a primary care physician office, about 40% of urgent care, and significantly less than an ER,” he said. Patients also save time by coming to the walk-in clinics rather than waiting hours for medical attention somewhere else.

And private companies are not the only innovators making health care more consumer friendly.

At the Arizona Telemedicine Program's UltraClinic, if a woman has a positive result on her mammogram, she can undergo a core biopsy, have a pathologist read the slides, and receive a oncology consult all within 4 hours of walking in the door rather than the 4 weeks it can take to go through this process, said the program's Dr. Ronald Weinstein.

This approach saves a lot of suffering, he said. “Eighty percent of the problems I have to deal with, as the head of a large laboratory, is women waiting for their pathology results on their breast lesions.”

The program is possible only because of the availability of telemedicine technology allowing consultation between physicians at different hospitals and the development of an ultrarapid virtual slide scanner that allows a pathologist to assess the biopsy within minutes of the procedure.

“We were motivated because of the fact that consumer-driven health care is an emerging area, and that is essential to supporting these kinds of bundled services,” he said.

WASHINGTON — The advent of health savings accounts and consumer-directed health plans has inspired entrepreneurs and academicians to design innovative delivery systems that cater to patient demand, experts said at a conference on technology and health care innovation.

“The next big change in health care will be patients managing their own care,” said John Goodman, Ph.D., president of the National Center for Policy Analysis. “Last year 95 million people got on the Internet to research their health problems. They didn't always get the best information. They didn't always get accurate information, but they were out there searching for answers.”

Patients are already turning to online services for consultations, discounted drugs, simple blood tests, and even home strep tests, said Dr. Goodman. Increasingly, patients will also demand market-based bundling and pricing of health care services.

“Most of the entrepreneurs out there in this market are people who have stepped outside the third-party payment system,” he said.

One of those entrepreneurs is Michael Howe, chief executive officer of MinuteClinic, which offers “retail health care” through more than 100 sites in 15 states. Chain drug store giant CVS Corp. bought MinuteClinic earlier this year, and many of the health care centers are located in CVS/pharmacy stores.

The health care centers are staffed by nurse practitioners and physician assistants trained to deal with a limited number of conditions including routine infectious diseases and to administer common vaccinations.

The clinics have done for health care what automatic teller machines did for banking, said Mr. Howe.

“You wouldn't go to an ATM for a small business loan, and you wouldn't go to a MinuteClinic to reset a femur.”

For that reason, each location maintains a relationship with physicians' practices where they can refer patients whose needs are beyond the scope of the clinic's providers. The company is also working to ensure that patients' records can be transmitted to physicians' offices, he said.

The clinics use technology such as electronic health records, best-practice protocols, and quality monitoring to keep costs down, said Mr. Howe.

“On average, [our costs are] about 50% of what it cost at a primary care physician office, about 40% of urgent care, and significantly less than an ER,” he said. Patients also save time by coming to the walk-in clinics rather than waiting hours for medical attention somewhere else.

And private companies are not the only innovators making health care more consumer friendly.

At the Arizona Telemedicine Program's UltraClinic, if a woman has a positive result on her mammogram, she can undergo a core biopsy, have a pathologist read the slides, and receive a oncology consult all within 4 hours of walking in the door rather than the 4 weeks it can take to go through this process, said the program's Dr. Ronald Weinstein.

This approach saves a lot of suffering, he said. “Eighty percent of the problems I have to deal with, as the head of a large laboratory, is women waiting for their pathology results on their breast lesions.”

The program is possible only because of the availability of telemedicine technology allowing consultation between physicians at different hospitals and the development of an ultrarapid virtual slide scanner that allows a pathologist to assess the biopsy within minutes of the procedure.

“We were motivated because of the fact that consumer-driven health care is an emerging area, and that is essential to supporting these kinds of bundled services,” he said.

WASHINGTON — What was a trend is looking more like a wave as an increasing number of states, no longer content to wait on the seemingly glacial pace of national politics, are seeking their own comprehensive solutions to the growing ranks of the uninsured, state health care reformers said at a conference sponsored by AcademyHealth.

“Can state innovations work on a national problem? It's somewhat of a rhetorical question. There's a growing sense of insecurity among our people that more and more of our citizens … are losing access to affordable health care. It's becoming more like a lottery with more losers,” said Jim Leddy, a former Vermont senator who helped ferry through a sweeping health care reform law in that state.

States are coming to realize that the uninsured are a shared problem, said Kim Belshe, secretary of California's Health and Human Services Agency.

“We've seen in California that when we can draw a connection between a problem that affects a minority of people, relatively speaking, and how it relates to the broader California, that it creates a policy environment where we have a greater potential to affect meaningful reform,” she said.

In California, this meant demonstrating that the uninsured were having a significant impact on others in the community such as uncompensated care, leading to higher health insurance premiums, overuse of emergency departments leading to closures, and high rates of uncontrolled chronic disease leading to lost productivity, she said.

Although states are taking this problem on themselves, they have, so far, shied away from single-payer approaches. Instead they are building on public programs, including the Medicaid and State Children's Health Insurance Program, which together provide states with substantial, if still insufficient, federal funds.

If the states are to serve as laboratories for reform they will need to be empowered, not abandoned by the federal government, said Mr. Leddy.

“For too long, the laboratories have been bankrupt in terms of ability of states to address problems of their citizens because we fundamentally have not had the support of our national government.”

Some state reform plans also include provisions to enable and even encourage companies to continue providing coverage for their workers.

“The erosion of employer-sponsored insurance plans must not be allowed to become a collapse.

Whether we agree philosophically with it, we simply cannot afford a collapse of what is the foundation for what we have now,” Mr. Leddy said.

Beyond expanded access, state health care reformers are focusing on prevention and wellness.

“We not only have to treat chronic conditions better, we also have to have strategies that deal with the incidence and the prevalence of these conditions, in particular diabetes and obesity,” said Mr. Leddy.

Personal responsibility has to be an important component of that equation, but that should not be interpreted as a code word for social Darwinism, or survival of the healthiest, wealthiest, and luckiest, he said.

While there remains a lot of variability between states and their ability to undertake such broad reforms, an increasing number are turning to the examples set by Vermont, California, and a dozen other states in the process of passing reform measures, not only for the lessons they hold, but also for the encouragement they provide, experts said.

“A lot of people feel if California as a state can make meaningful inroads in terms of our coverage and cost challenges, then that offers some hope and promise for other states, just given the size and the magnitude of our challenges,” Ms. Belshe said.

WASHINGTON — What was a trend is looking more like a wave as an increasing number of states, no longer content to wait on the seemingly glacial pace of national politics, are seeking their own comprehensive solutions to the growing ranks of the uninsured, state health care reformers said at a conference sponsored by AcademyHealth.

“Can state innovations work on a national problem? It's somewhat of a rhetorical question. There's a growing sense of insecurity among our people that more and more of our citizens … are losing access to affordable health care. It's becoming more like a lottery with more losers,” said Jim Leddy, a former Vermont senator who helped ferry through a sweeping health care reform law in that state.

States are coming to realize that the uninsured are a shared problem, said Kim Belshe, secretary of California's Health and Human Services Agency.

“We've seen in California that when we can draw a connection between a problem that affects a minority of people, relatively speaking, and how it relates to the broader California, that it creates a policy environment where we have a greater potential to affect meaningful reform,” she said.

In California, this meant demonstrating that the uninsured were having a significant impact on others in the community such as uncompensated care, leading to higher health insurance premiums, overuse of emergency departments leading to closures, and high rates of uncontrolled chronic disease leading to lost productivity, she said.

Although states are taking this problem on themselves, they have, so far, shied away from single-payer approaches. Instead they are building on public programs, including the Medicaid and State Children's Health Insurance Program, which together provide states with substantial, if still insufficient, federal funds.

If the states are to serve as laboratories for reform they will need to be empowered, not abandoned by the federal government, said Mr. Leddy.

“For too long, the laboratories have been bankrupt in terms of ability of states to address problems of their citizens because we fundamentally have not had the support of our national government.”

Some state reform plans also include provisions to enable and even encourage companies to continue providing coverage for their workers.

“The erosion of employer-sponsored insurance plans must not be allowed to become a collapse.

Whether we agree philosophically with it, we simply cannot afford a collapse of what is the foundation for what we have now,” Mr. Leddy said.

Beyond expanded access, state health care reformers are focusing on prevention and wellness.

“We not only have to treat chronic conditions better, we also have to have strategies that deal with the incidence and the prevalence of these conditions, in particular diabetes and obesity,” said Mr. Leddy.

Personal responsibility has to be an important component of that equation, but that should not be interpreted as a code word for social Darwinism, or survival of the healthiest, wealthiest, and luckiest, he said.

While there remains a lot of variability between states and their ability to undertake such broad reforms, an increasing number are turning to the examples set by Vermont, California, and a dozen other states in the process of passing reform measures, not only for the lessons they hold, but also for the encouragement they provide, experts said.

“A lot of people feel if California as a state can make meaningful inroads in terms of our coverage and cost challenges, then that offers some hope and promise for other states, just given the size and the magnitude of our challenges,” Ms. Belshe said.

WASHINGTON — What was a trend is looking more like a wave as an increasing number of states, no longer content to wait on the seemingly glacial pace of national politics, are seeking their own comprehensive solutions to the growing ranks of the uninsured, state health care reformers said at a conference sponsored by AcademyHealth.

“Can state innovations work on a national problem? It's somewhat of a rhetorical question. There's a growing sense of insecurity among our people that more and more of our citizens … are losing access to affordable health care. It's becoming more like a lottery with more losers,” said Jim Leddy, a former Vermont senator who helped ferry through a sweeping health care reform law in that state.

States are coming to realize that the uninsured are a shared problem, said Kim Belshe, secretary of California's Health and Human Services Agency.

“We've seen in California that when we can draw a connection between a problem that affects a minority of people, relatively speaking, and how it relates to the broader California, that it creates a policy environment where we have a greater potential to affect meaningful reform,” she said.

In California, this meant demonstrating that the uninsured were having a significant impact on others in the community such as uncompensated care, leading to higher health insurance premiums, overuse of emergency departments leading to closures, and high rates of uncontrolled chronic disease leading to lost productivity, she said.

Although states are taking this problem on themselves, they have, so far, shied away from single-payer approaches. Instead they are building on public programs, including the Medicaid and State Children's Health Insurance Program, which together provide states with substantial, if still insufficient, federal funds.

If the states are to serve as laboratories for reform they will need to be empowered, not abandoned by the federal government, said Mr. Leddy.

“For too long, the laboratories have been bankrupt in terms of ability of states to address problems of their citizens because we fundamentally have not had the support of our national government.”

Some state reform plans also include provisions to enable and even encourage companies to continue providing coverage for their workers.

“The erosion of employer-sponsored insurance plans must not be allowed to become a collapse.

Whether we agree philosophically with it, we simply cannot afford a collapse of what is the foundation for what we have now,” Mr. Leddy said.

Beyond expanded access, state health care reformers are focusing on prevention and wellness.

“We not only have to treat chronic conditions better, we also have to have strategies that deal with the incidence and the prevalence of these conditions, in particular diabetes and obesity,” said Mr. Leddy.

Personal responsibility has to be an important component of that equation, but that should not be interpreted as a code word for social Darwinism, or survival of the healthiest, wealthiest, and luckiest, he said.

While there remains a lot of variability between states and their ability to undertake such broad reforms, an increasing number are turning to the examples set by Vermont, California, and a dozen other states in the process of passing reform measures, not only for the lessons they hold, but also for the encouragement they provide, experts said.

“A lot of people feel if California as a state can make meaningful inroads in terms of our coverage and cost challenges, then that offers some hope and promise for other states, just given the size and the magnitude of our challenges,” Ms. Belshe said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are ready to support health care reform, said Sen. Ron Wyden (D-Ore.).

“In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Meanwhile, democrats' first focus is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP).

However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage.

States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for the program.

This year, 14 states are expected to run out of federal funds by May.

The federal government currently is spending $5 billion a year on SCHIP.

To keep the program running at current levels of enrollment, Congress will need to add $13 billion to $15 billion in funding to the program over the next 5 years, according to an estimate by the Congressional Budget Office.

It will cost even more if lawmakers want to enable states to expand coverage to those children who are not currently enrolled and a lot more for those not currently eligible.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement.

SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.

With reauthorization also comes the chance to make other changes. Republicans have suggested that states may need more flexibility in how they spend their SCHIP funds to make them go as far as possible.

SGR Fix

Both parties are interested in finding a solution to decreasing physician pay under the sustainable growth rate formula, but no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” a Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act. [In light of this], why are we talking about making fundamental changes to this program?” said the Republican congressional staffer.

Short Window for Action

While action seems likely, there is a short window of opportunity before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true now this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are ready to support health care reform, said Sen. Ron Wyden (D-Ore.).

“In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Meanwhile, democrats' first focus is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP).

However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage.

States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for the program.

This year, 14 states are expected to run out of federal funds by May.

The federal government currently is spending $5 billion a year on SCHIP.

To keep the program running at current levels of enrollment, Congress will need to add $13 billion to $15 billion in funding to the program over the next 5 years, according to an estimate by the Congressional Budget Office.

It will cost even more if lawmakers want to enable states to expand coverage to those children who are not currently enrolled and a lot more for those not currently eligible.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement.

SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.

With reauthorization also comes the chance to make other changes. Republicans have suggested that states may need more flexibility in how they spend their SCHIP funds to make them go as far as possible.

SGR Fix

Both parties are interested in finding a solution to decreasing physician pay under the sustainable growth rate formula, but no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” a Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act. [In light of this], why are we talking about making fundamental changes to this program?” said the Republican congressional staffer.

Short Window for Action

While action seems likely, there is a short window of opportunity before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true now this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are ready to support health care reform, said Sen. Ron Wyden (D-Ore.).

“In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Meanwhile, democrats' first focus is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP).

However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage.

States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for the program.

This year, 14 states are expected to run out of federal funds by May.

The federal government currently is spending $5 billion a year on SCHIP.

To keep the program running at current levels of enrollment, Congress will need to add $13 billion to $15 billion in funding to the program over the next 5 years, according to an estimate by the Congressional Budget Office.

It will cost even more if lawmakers want to enable states to expand coverage to those children who are not currently enrolled and a lot more for those not currently eligible.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement.

SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.

With reauthorization also comes the chance to make other changes. Republicans have suggested that states may need more flexibility in how they spend their SCHIP funds to make them go as far as possible.

SGR Fix

Both parties are interested in finding a solution to decreasing physician pay under the sustainable growth rate formula, but no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” a Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act. [In light of this], why are we talking about making fundamental changes to this program?” said the Republican congressional staffer.

Short Window for Action

While action seems likely, there is a short window of opportunity before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true now this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — Companies both large and small are finding it increasingly difficult to afford the health insurance coverage they have traditionally provided to their workers, experts warned at a conference sponsored by AcademyHealth.

Employer-based insurance remains the dominant source of coverage in the American health care system. However, the proportion of companies that provide health benefits dropped from 70% in 2000 to 60% in 2005. Small businesses, those with only a handful of employees, have been especially hard hit by rising premiums, said Todd McCracken, president of the National Small Business Association.

“We have reached a point in the past couple of years where for the first time in memory, most of these companies now do not provide health benefits to their employees,” he said.

Of the small companies that can still offer health coverage, few can give their workers a choice of health plans, and they are often not happy with the plans they can offer.

In any given year, 60% of small companies are shopping around for another health plan, but only 24% make a switch, according to data from the Kaiser Family Foundation.

“Small businesses are constantly in the marketplace looking for a better deal, sure that there's something out there for them that can bring prices in line, when in fact, they don't find much or they find choices that are even worse,” he said.

When they come up empty, most companies have few options available other than shifting more of the cost of premiums to their workers or reducing benefits, a trend that will continue over the next 5 years, according to projections by the Bureau of Labor Statistics.

“The share that employees will be asked to bear simply outstrips any realistic ability they may have to pay,” Mr. McCracken said.

Large companies also face rising health insurance premiums and are passing them on to their employees, said Mary Kay Henry, who leads the health systems division of the Service Employees International Union.

The union represents 700,000 workers worldwide. About half of them have no health coverage and the other half are being asked to share more of the cost of their health insurance.

Over the past few years, the Service Employees International Union has increasingly found itself in difficult negotiations with employers over health benefits at both the level of collective bargaining and that of individual workers. “Beyond the bargaining problem, we also had a crisis happening for individual workers, which was [that] they were, by virtue of no coverage, having to face not getting the medical care they needed in order to live,” she said.

Every physician has a horror story about some uninsured patient who should have come in sooner, said Dr. Eduardo Sanchez, director of the Institute for Health Policy at the University of Texas Health Science Center in Houston.

“My horror story involves a gentleman, a laborer who came in to see me for a 'blister.' When we got his shoe off, he actually had a through-and-through diabetic ulcer on one of this toes. He went straight to a hospital and had a couple of toes amputated. Do the math and you can figure out that had this gentleman been diagnosed with diabetes 5 years earlier, it would have cost a whole lot less money with a whole lot less trauma,” he said.

The uninsured end up with a greater level of need for care, which is often uncompensated. That cost is passed on to those who can pay, which in turn causes insurance premiums to rise. The result is that more employers drop coverage because of high premiums and the cycle starts all over again.

That cycle needs to be broken, he said.

What the solution will look like is not clear, but there does seem to be a movement for everyone to come to the table, the experts said.

“We're not going to stand on the sidelines of a political debate, we're going to engage the debate in our mutual interest and figure out a solution for everyone in this country,” said Ms. Henry.

WASHINGTON — Companies both large and small are finding it increasingly difficult to afford the health insurance coverage they have traditionally provided to their workers, experts warned at a conference sponsored by AcademyHealth.

Employer-based insurance remains the dominant source of coverage in the American health care system. However, the proportion of companies that provide health benefits dropped from 70% in 2000 to 60% in 2005. Small businesses, those with only a handful of employees, have been especially hard hit by rising premiums, said Todd McCracken, president of the National Small Business Association.

“We have reached a point in the past couple of years where for the first time in memory, most of these companies now do not provide health benefits to their employees,” he said.

Of the small companies that can still offer health coverage, few can give their workers a choice of health plans, and they are often not happy with the plans they can offer.

In any given year, 60% of small companies are shopping around for another health plan, but only 24% make a switch, according to data from the Kaiser Family Foundation.

“Small businesses are constantly in the marketplace looking for a better deal, sure that there's something out there for them that can bring prices in line, when in fact, they don't find much or they find choices that are even worse,” he said.

When they come up empty, most companies have few options available other than shifting more of the cost of premiums to their workers or reducing benefits, a trend that will continue over the next 5 years, according to projections by the Bureau of Labor Statistics.

“The share that employees will be asked to bear simply outstrips any realistic ability they may have to pay,” Mr. McCracken said.

Large companies also face rising health insurance premiums and are passing them on to their employees, said Mary Kay Henry, who leads the health systems division of the Service Employees International Union.

The union represents 700,000 workers worldwide. About half of them have no health coverage and the other half are being asked to share more of the cost of their health insurance.

Over the past few years, the Service Employees International Union has increasingly found itself in difficult negotiations with employers over health benefits at both the level of collective bargaining and that of individual workers. “Beyond the bargaining problem, we also had a crisis happening for individual workers, which was [that] they were, by virtue of no coverage, having to face not getting the medical care they needed in order to live,” she said.

Every physician has a horror story about some uninsured patient who should have come in sooner, said Dr. Eduardo Sanchez, director of the Institute for Health Policy at the University of Texas Health Science Center in Houston.

“My horror story involves a gentleman, a laborer who came in to see me for a 'blister.' When we got his shoe off, he actually had a through-and-through diabetic ulcer on one of this toes. He went straight to a hospital and had a couple of toes amputated. Do the math and you can figure out that had this gentleman been diagnosed with diabetes 5 years earlier, it would have cost a whole lot less money with a whole lot less trauma,” he said.

The uninsured end up with a greater level of need for care, which is often uncompensated. That cost is passed on to those who can pay, which in turn causes insurance premiums to rise. The result is that more employers drop coverage because of high premiums and the cycle starts all over again.

That cycle needs to be broken, he said.

What the solution will look like is not clear, but there does seem to be a movement for everyone to come to the table, the experts said.

“We're not going to stand on the sidelines of a political debate, we're going to engage the debate in our mutual interest and figure out a solution for everyone in this country,” said Ms. Henry.

WASHINGTON — Companies both large and small are finding it increasingly difficult to afford the health insurance coverage they have traditionally provided to their workers, experts warned at a conference sponsored by AcademyHealth.

Employer-based insurance remains the dominant source of coverage in the American health care system. However, the proportion of companies that provide health benefits dropped from 70% in 2000 to 60% in 2005. Small businesses, those with only a handful of employees, have been especially hard hit by rising premiums, said Todd McCracken, president of the National Small Business Association.

“We have reached a point in the past couple of years where for the first time in memory, most of these companies now do not provide health benefits to their employees,” he said.

Of the small companies that can still offer health coverage, few can give their workers a choice of health plans, and they are often not happy with the plans they can offer.

In any given year, 60% of small companies are shopping around for another health plan, but only 24% make a switch, according to data from the Kaiser Family Foundation.

“Small businesses are constantly in the marketplace looking for a better deal, sure that there's something out there for them that can bring prices in line, when in fact, they don't find much or they find choices that are even worse,” he said.

When they come up empty, most companies have few options available other than shifting more of the cost of premiums to their workers or reducing benefits, a trend that will continue over the next 5 years, according to projections by the Bureau of Labor Statistics.

“The share that employees will be asked to bear simply outstrips any realistic ability they may have to pay,” Mr. McCracken said.

Large companies also face rising health insurance premiums and are passing them on to their employees, said Mary Kay Henry, who leads the health systems division of the Service Employees International Union.

The union represents 700,000 workers worldwide. About half of them have no health coverage and the other half are being asked to share more of the cost of their health insurance.

Over the past few years, the Service Employees International Union has increasingly found itself in difficult negotiations with employers over health benefits at both the level of collective bargaining and that of individual workers. “Beyond the bargaining problem, we also had a crisis happening for individual workers, which was [that] they were, by virtue of no coverage, having to face not getting the medical care they needed in order to live,” she said.

Every physician has a horror story about some uninsured patient who should have come in sooner, said Dr. Eduardo Sanchez, director of the Institute for Health Policy at the University of Texas Health Science Center in Houston.

“My horror story involves a gentleman, a laborer who came in to see me for a 'blister.' When we got his shoe off, he actually had a through-and-through diabetic ulcer on one of this toes. He went straight to a hospital and had a couple of toes amputated. Do the math and you can figure out that had this gentleman been diagnosed with diabetes 5 years earlier, it would have cost a whole lot less money with a whole lot less trauma,” he said.

The uninsured end up with a greater level of need for care, which is often uncompensated. That cost is passed on to those who can pay, which in turn causes insurance premiums to rise. The result is that more employers drop coverage because of high premiums and the cycle starts all over again.

That cycle needs to be broken, he said.

What the solution will look like is not clear, but there does seem to be a movement for everyone to come to the table, the experts said.

“We're not going to stand on the sidelines of a political debate, we're going to engage the debate in our mutual interest and figure out a solution for everyone in this country,” said Ms. Henry.

WASHINGTON — Companies both large and small are finding it increasingly difficult to afford the health insurance coverage they have traditionally provided to their workers, experts warned at a conference sponsored by AcademyHealth.

Employer-based insurance remains the dominant source of coverage in the American health care system. However, the proportion of companies that provide health benefits dropped from 70% in 2000 to 60% in 2005. Small businesses, those with only a handful of employees, have been especially hard hit by rising premiums, said Todd McCracken, president of the National Small Business Association.

“For the first time in memory, most of these companies now do not provide health benefits to their employees,” he said.

Of the small companies that can still offer health coverage, few can give their workers a choice of health plans, and they are often not happy with the plans they can offer. In any given year, 60% of small companies are shopping around for another health plan, but only 24% make a switch, according to data from the Kaiser Family Foundation.

“Small businesses are constantly in the marketplace looking for a better deal, sure that there's something out there for them that can bring prices in line, when in fact, they don't find much or they find choices that are even worse,” he said.

When they come up empty, most companies have few options other than shifting more of the cost of premiums to their workers or reducing benefits, a trend that will continue over the next 5 years, according to projections by the Bureau of Labor Statistics.

Large companies also face rising health insurance premiums and are passing them on to their employees, said Mary Kay Henry, who leads the health systems division of the Service Employees International Union.

The union represents 700,000 workers worldwide. About half of them have no health coverage and the other half are being asked to share more of the cost of their health insurance. Over the past few years, SEIU has increasingly found itself in difficult negotiations with employers over health benefits at both the level of collective bargaining and that of individual workers.

“Beyond the bargaining problem, we also had a crisis happening for individual workers, which was [that] they were, by virtue of no coverage, having to face not getting the medical care they needed in order to live,” she said.

The uninsured end up with a greater level of need for care, which is often uncompensated. That cost is passed on to those who can pay, which in turn causes insurance premiums to rise. The result is that more employers drop coverage because of high premiums and the cycle starts all over again. That cycle needs to be broken, said Dr. Eduardo Sanchez, director of the Institute for Health Policy at the University of Texas Health Science Center in Houston.

WASHINGTON — Companies both large and small are finding it increasingly difficult to afford the health insurance coverage they have traditionally provided to their workers, experts warned at a conference sponsored by AcademyHealth.

Employer-based insurance remains the dominant source of coverage in the American health care system. However, the proportion of companies that provide health benefits dropped from 70% in 2000 to 60% in 2005. Small businesses, those with only a handful of employees, have been especially hard hit by rising premiums, said Todd McCracken, president of the National Small Business Association.

“For the first time in memory, most of these companies now do not provide health benefits to their employees,” he said.

Of the small companies that can still offer health coverage, few can give their workers a choice of health plans, and they are often not happy with the plans they can offer. In any given year, 60% of small companies are shopping around for another health plan, but only 24% make a switch, according to data from the Kaiser Family Foundation.

“Small businesses are constantly in the marketplace looking for a better deal, sure that there's something out there for them that can bring prices in line, when in fact, they don't find much or they find choices that are even worse,” he said.

When they come up empty, most companies have few options other than shifting more of the cost of premiums to their workers or reducing benefits, a trend that will continue over the next 5 years, according to projections by the Bureau of Labor Statistics.

Large companies also face rising health insurance premiums and are passing them on to their employees, said Mary Kay Henry, who leads the health systems division of the Service Employees International Union.

The union represents 700,000 workers worldwide. About half of them have no health coverage and the other half are being asked to share more of the cost of their health insurance. Over the past few years, SEIU has increasingly found itself in difficult negotiations with employers over health benefits at both the level of collective bargaining and that of individual workers.

“Beyond the bargaining problem, we also had a crisis happening for individual workers, which was [that] they were, by virtue of no coverage, having to face not getting the medical care they needed in order to live,” she said.

The uninsured end up with a greater level of need for care, which is often uncompensated. That cost is passed on to those who can pay, which in turn causes insurance premiums to rise. The result is that more employers drop coverage because of high premiums and the cycle starts all over again. That cycle needs to be broken, said Dr. Eduardo Sanchez, director of the Institute for Health Policy at the University of Texas Health Science Center in Houston.

WASHINGTON — Companies both large and small are finding it increasingly difficult to afford the health insurance coverage they have traditionally provided to their workers, experts warned at a conference sponsored by AcademyHealth.

Employer-based insurance remains the dominant source of coverage in the American health care system. However, the proportion of companies that provide health benefits dropped from 70% in 2000 to 60% in 2005. Small businesses, those with only a handful of employees, have been especially hard hit by rising premiums, said Todd McCracken, president of the National Small Business Association.

“For the first time in memory, most of these companies now do not provide health benefits to their employees,” he said.

Of the small companies that can still offer health coverage, few can give their workers a choice of health plans, and they are often not happy with the plans they can offer. In any given year, 60% of small companies are shopping around for another health plan, but only 24% make a switch, according to data from the Kaiser Family Foundation.

“Small businesses are constantly in the marketplace looking for a better deal, sure that there's something out there for them that can bring prices in line, when in fact, they don't find much or they find choices that are even worse,” he said.

When they come up empty, most companies have few options other than shifting more of the cost of premiums to their workers or reducing benefits, a trend that will continue over the next 5 years, according to projections by the Bureau of Labor Statistics.

Large companies also face rising health insurance premiums and are passing them on to their employees, said Mary Kay Henry, who leads the health systems division of the Service Employees International Union.

The union represents 700,000 workers worldwide. About half of them have no health coverage and the other half are being asked to share more of the cost of their health insurance. Over the past few years, SEIU has increasingly found itself in difficult negotiations with employers over health benefits at both the level of collective bargaining and that of individual workers.

“Beyond the bargaining problem, we also had a crisis happening for individual workers, which was [that] they were, by virtue of no coverage, having to face not getting the medical care they needed in order to live,” she said.

The uninsured end up with a greater level of need for care, which is often uncompensated. That cost is passed on to those who can pay, which in turn causes insurance premiums to rise. The result is that more employers drop coverage because of high premiums and the cycle starts all over again. That cycle needs to be broken, said Dr. Eduardo Sanchez, director of the Institute for Health Policy at the University of Texas Health Science Center in Houston.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals, small medical practices lack the resources to adopt electronic health records or other information technology, he said.

“There are knowledge barriers, there are cost barriers,” said Dr. Barr, adding that it is difficult to figure all this out while running a practice.

But health information technology does pay for itself, and as reimbursement becomes increasingly linked to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals, small medical practices lack the resources to adopt electronic health records or other information technology, he said.

“There are knowledge barriers, there are cost barriers,” said Dr. Barr, adding that it is difficult to figure all this out while running a practice.

But health information technology does pay for itself, and as reimbursement becomes increasingly linked to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

WASHINGTON — Eliminating “the stupid clipboard” may be the simplest, most straightforward benefit that would come from electronic interoperability standards designed to allow physicians' offices to communicate with hospitals, labs, insurers, and each other, according to Dr. John Halamka, the chairman of the Health Information Technology Standards Panel.

HITSP just delivered its first set of harmonization standards to the federal Office of the National Coordinator for Health Information Technology. The panel was convened just over a year ago by the American National Standards Institute (ANSI) under a Health and Human Services department contract to assist in the development of a Nationwide Health Information Network (NHIN).

The panel is developing a series of interoperability specifications that offer a road map for every vendor, hospital, and other stakeholder who wants to implement electronic health records that conform to a nationally recognized standard, Dr. Halamka said at a health care congress sponsored by the Wall Street Journal and CNBC.

For this first set, the panel sifted through 700 standards, a veritable hexadecimal soup including X12, HL7, NCPP, and the Continuity of Care record, whittling that down to 30. It was an emotional process that incorporated the best of all of those standards in what the panel calls a Continuity of Care Document, he said.

This is a work in progress, Dr. Halamka added. “As the industry begins to test these interoperability specifications we know there are going to be refinements. There are going to be areas of ambiguity that we need to clarify.”

“What's going on at the [American Health Information] Community, at HITSP, at the Certification Commission [for Healthcare Information Technology] are essential ingredients to successful transformation of health care,” said Dr. Michael Barr, vice president of practice advocacy and improvement at the American College of Physicians.

Unlike hospitals, small medical practices lack the resources to adopt electronic health records or other information technology, he said.

“There are knowledge barriers, there are cost barriers,” said Dr. Barr, adding that it is difficult to figure all this out while running a practice.

But health information technology does pay for itself, and as reimbursement becomes increasingly linked to quality, electronic records will be indispensable for documenting measures expected by payers, he said.

Physician groups that have adopted EHR systems expect them to make it easier to adapt to new payment requirements in the long run, but they offer the near-term benefits as well, said Bruce Metz, Ph.D., chief information officer for Thomas Jefferson University in Philadelphia.

The University's 500-physician group practice has spent the past 3 years implementing an $18 million electronic records system with an expected 16%–30% return on investment. Insurance companies are not yet ready to pay the group a premium for the efficiencies the system brings, but because of improved documentation, the system has already allowed significant upcoding, he said.

Although more physicians are becoming convinced of the benefits of EHR adoption, the government may be moving forward too aggressively, Dr. Barr said.

Congress wants Medicare to implement pay for performance now, although the industry is still struggling to identify appropriate measures. “The policy is well ahead of the practicality,” he said.

If the experience with HIPAA Administrative Simplification proved anything, it was that having standards is only the beginning of the process, Dr. Halamka said. The next step is to work out a logical time frame for compliance, what are the incremental phases along the way and how to test compliance.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health-care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” Dr. Ornstein said.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.). “In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, Sen. Wyden said. “You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement. (SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.)

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible. “It has helped a lot of families. But like any program now, we have the opportunity to take a look at it, see what's working, what's not, what needs to be improved,” a Republican congressional staffer said at the meeting.

SGR Fix

Both Democrats and Republicans have tried to find a solution to decreasing physician pay under the sustainable growth rate formula. But no one has yet come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act,” the Republican congressional staffer said.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, Dr. Ornstein said.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along,” he said.

That seems likely to hold true this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health-care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” Dr. Ornstein said.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.). “In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, Sen. Wyden said. “You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement. (SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.)

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible. “It has helped a lot of families. But like any program now, we have the opportunity to take a look at it, see what's working, what's not, what needs to be improved,” a Republican congressional staffer said at the meeting.

SGR Fix

Both Democrats and Republicans have tried to find a solution to decreasing physician pay under the sustainable growth rate formula. But no one has yet come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act,” the Republican congressional staffer said.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, Dr. Ornstein said.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along,” he said.

That seems likely to hold true this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health-care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank in Washington.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” Dr. Ornstein said.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.). “In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, Sen. Wyden said. “You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs that we have and who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement. (SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.)

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible. “It has helped a lot of families. But like any program now, we have the opportunity to take a look at it, see what's working, what's not, what needs to be improved,” a Republican congressional staffer said at the meeting.

SGR Fix

Both Democrats and Republicans have tried to find a solution to decreasing physician pay under the sustainable growth rate formula. But no one has yet come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act,” the Republican congressional staffer said.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, Dr. Ornstein said.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along,” he said.

That seems likely to hold true this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.).

“In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs … who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement. (SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.)

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible.

SGR Fix

Both Democrats and Republicans have expressed interest in finding a solution to decreasing physician pay under the sustainable growth rate formula. However, no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act. [In light of this], why are we talking about making fundamental changes to this program?” said the Republican congressional staffer.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.).

“In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs … who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement. (SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.)

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible.

SGR Fix

Both Democrats and Republicans have expressed interest in finding a solution to decreasing physician pay under the sustainable growth rate formula. However, no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act. [In light of this], why are we talking about making fundamental changes to this program?” said the Republican congressional staffer.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — The 110th Congress is fertile ground for health care legislation, from expanding coverage to fixing physician pay, according to Capitol Hill insiders and observers speaking at a conference sponsored by AcademyHealth.

“You can feel it in the air, not just in Washington but all across the country. The season is changing,” said Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. “The season is for real debate on health care reform. And it is long overdue.”

In the last election, Democrats won new seats in the House and Senate without losing any of their own by pointing to Republicans' lack of accomplishment, said Norman J. Ornstein, Ph.D., a resident scholar at the American Enterprise Institute, a conservative think tank.

“Having run vigorously against a do-nothing Congress, Democrats … now have to show that they are the do-something Congress,” said Dr. Ornstein.

There is also a sense that America's employers are more than ever ready to support health care reform, said Sen. Ron Wyden (D-Ore.).

“In 1994, the business community said, 'We can't afford health care reform.' In 2007, the business community is saying, 'We can't afford not to fix American health care,'” he said.

Democrats' first focus has been and still is on covering the uninsured, said Sen. Wyden.

“You cannot fix American health care unless you get everybody covered,” he said, drawing a round of applause. “And the reason that's so important is not only is it morally the right thing to do, which it clearly is, but if you don't get everybody covered, what we all know is the costs of people who don't have coverage get passed on to people who do.”

However, a Democratic congressional staffer speaking at the briefing pointed out that the tight federal budget means compromises and choices will have to be made.

“What we have done is target our efforts on children. And trying to make sure that we improve on the coverage that is there today and certainly try to find those children who would qualify for the public programs … who yet aren't enrolled,” she said.

Approximately 25% of children in the United States have health coverage through either Medicaid or the State Children's Health Insurance Program (SCHIP). However, 9 million children currently have no health insurance, and two-thirds of those are actually eligible for public coverage. States have been increasing their outreach efforts, but have been stymied by shortfalls in federal matching funds for SCHIP. This year, 14 states are expected to run out of federal funds by May.

As Congress considers SCHIP reauthorization this year—its mandate expires Sept. 30—some Democrats have suggested it's time to make the program an entitlement. (SCHIP currently is funded on a pay-as-you-go basis, meaning that any increased funding must be offset by a cut somewhere else in the federal budget.)

With reauthorization also comes the chance to make other changes to the program. Republicans have suggested that states may need even more flexibility in how they spend their SCHIP funds to make them go as far as possible.

SGR Fix

Both Democrats and Republicans have expressed interest in finding a solution to decreasing physician pay under the sustainable growth rate formula. However, no one has yet to come up with a remedy that fits into the current budget outlook.

“In order to get the physicians back to zero, we're talking costs of probably approximately $22 billion. And that isn't addressing the longer-term problem that Medicare's current payment formula is going to call for cuts for an additional 5 years beyond that,” the Republican congressional staffer said.

Recent proposals to fix the SGR have ranged in cost from $4 billion in the short-term to $250 billion in the long term.

Refining Medicare Part D

Democrats speaking at the conference said they hope to make refinements to the Medicare Part D drug benefit, such as improvements in the low-income subsidies and a reassessment of the higher payments that Medicare Advantage plans currently receive. Several proposals have already been introduced to allow the government to negotiate drug prices.

Republicans are expected to oppose significant changes to the program.

“From our perspective this program has been wildly successful beyond any estimation that we could have made back in 2003 when we passed the Medicare Modernization Act. [In light of this], why are we talking about making fundamental changes to this program?” said the Republican congressional staffer.

Short Window for Action

While action on these and other health care issues seem likely this year, there is a short window of opportunity to complete them before election politics come into play, said Dr. Ornstein.

“The conventional wisdom is that in a presidential election year where there's an open contest in the final 2 years of a two-term president, you have about an 8-month window to move things along. That doesn't mean you have to finish everything, but … you better be pretty close to field goal range at the end of that 8 months,” he said.

That seems likely to hold true this year given that, at last count, at least 26 members of Congress have announced or are considering announcing a run for the White House, Dr. Ornstein said.

WASHINGTON — Physicians who have yet to get on the health information technology bandwagon no longer have any excuses to maintain a low-tech approach to drug prescribing, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the launch. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership. “Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey guessed.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort.

“Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing. “But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, he added.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said. It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper.”

Who's on Board?

Members of the ePrescribing Patient Safety Initiative include:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations

WASHINGTON — Physicians who have yet to get on the health information technology bandwagon no longer have any excuses to maintain a low-tech approach to drug prescribing, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the launch. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership. “Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey guessed.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort.

“Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing. “But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, he added.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said. It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper.”

Who's on Board?

Members of the ePrescribing Patient Safety Initiative include:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations

WASHINGTON — Physicians who have yet to get on the health information technology bandwagon no longer have any excuses to maintain a low-tech approach to drug prescribing, according to members of the National ePrescribing Patient Safety Initiative, a coalition of health insurers and software companies.

The initiative—called NEPSI—is offering physicians' offices access to a secure, easy-to-use system that is compatible with software in 99% of the nation's pharmacies, coalition members said at a press briefing to announce the launch. NEPSI also includes regional organizations, university hospitals, and medical centers, which will act as a support network for physicians who choose to use the online tool.

“According to [the Institute of Medicine], 1.5 million Americans are injured and more than 7,000 die from medication errors every year. As a practicing physician, I find that unacceptable,” said Dr. Nancy Dickey, a family physician and president of the Health Science Center at Texas A&M University in College Station.

In a report released last year, the IOM identified electronic prescribing as the single most significant step physicians can take to reduce drug-related medical errors. That report also found that many of the errors are caused by illegible handwriting, unclear abbreviations, and miscalculated doses.

“More than 3 billion prescriptions are written every year, and even though we have the technology to make this problem virtually go away, less than one in five of my colleagues are using electronic prescribing,” said Dr. Dickey, former president of the American Medical Association.

No More Excuses

Time and money have been major barriers for the adoption of electronic prescribing, despite the fact that widespread use of electronic prescribing could save the U.S. health care system as much as $27 billion, as estimated by the Center for Information Technology Leadership. “Part of the problem is that the people who are being asked to take the time and to spend the money to put this in their offices—the physicians—aren't necessarily the ones who get the financial benefit,” she said.

That's why the coalition has come together to offer physicians an option that is not only free, but takes 15–30 minutes to learn, said Dr. Dickey.

“It is a truly easy system,” said Dr. Azar Korby, a family physician in Salem, N.H., who has been testing the software. Even someone who is not computer savvy should be able to learn the system in under 40 minutes, Dr. Korbey guessed.

There also is a growing incentive to adopt electronic prescribing, Dr. Mark McClellan said at the NEPSI launch.

Part D plans already are required to support electronic prescribing and Medicare Advantage plans are moving toward adoption of similar standards. Even in traditional fee-for-service Medicare, the Centers for Medicare and Medicaid Services is expanding efforts to boost reimbursement to physicians who report quality data, said Dr. McClellan, former CMS administrator and now a senior fellow at the AEI-Brookings Joint Center, a Washington think tank.

Patient Safety Is the Goal

To that end, the initiative is being wholly funded by the coalition of private stakeholders at an estimated cost of $100 million for the first 5 years. That is in contrast to other free electronic prescribing software that requires physicians to market personal health records or other products to patients.

The companies that are supporting and paying for NEPSI see this as an investment in the future, said Glen Tullman, chief executive officer of Allscripts Inc., which is leading the effort.

“Down the road, we're very hopeful that this encourages adoption of full electronic health records, and Allscripts is a leading provider of those health records,” he said at the briefing. “But I want to make it very clear that our first objective is to equip every physician in the United States with electronic prescribing software that is absolutely free of charge,” in an effort to improve patient safety, he added.

“The primary care system in England is virtually all electronic. The driving force behind that initially … was stand-alone prescription systems,” he said. It is not clear how physicians in this country will feel about adopting an electronic prescribing system that is not integrated with electronic medical records, but “there's no question it's a step up from paper.”

Who's on Board?

Members of the ePrescribing Patient Safety Initiative include:

Allscripts Inc.

Dell Inc.

Cisco Systems

Fujitsu Computers of America

Microsoft Corp.

Sprint Nextel

Wolters Kluwer Health

Aetna

WellPoint

SureScripts

Google

Twelve regional health care organizations