Mary Ellen Schneider

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending.

The health reform proposal unveiled by the Commonwealth Fund last month is similar to plans outlined by President Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed in April 2005 to study possible changes to the delivery and financing of health care.

The difference between this plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan. The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010. The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020. Costs incurred by the federal government would climb sharply during the first years of implementing these changes, but could be largely recouped by 2020, according to the report.

Under the proposal, the number of uninsured Americans would drop from about 48 million this year to about 4 million by 2012. Without reforms, the uninsured would increase to about 61 million by 2020, according to the Commonwealth Fund.

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending.

The health reform proposal unveiled by the Commonwealth Fund last month is similar to plans outlined by President Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed in April 2005 to study possible changes to the delivery and financing of health care.

The difference between this plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan. The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010. The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020. Costs incurred by the federal government would climb sharply during the first years of implementing these changes, but could be largely recouped by 2020, according to the report.

Under the proposal, the number of uninsured Americans would drop from about 48 million this year to about 4 million by 2012. Without reforms, the uninsured would increase to about 61 million by 2020, according to the Commonwealth Fund.

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending.

The health reform proposal unveiled by the Commonwealth Fund last month is similar to plans outlined by President Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed in April 2005 to study possible changes to the delivery and financing of health care.

The difference between this plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan. The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010. The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020. Costs incurred by the federal government would climb sharply during the first years of implementing these changes, but could be largely recouped by 2020, according to the report.

Under the proposal, the number of uninsured Americans would drop from about 48 million this year to about 4 million by 2012. Without reforms, the uninsured would increase to about 61 million by 2020, according to the Commonwealth Fund.

Nearly a million children would gain health insurance coverage for weight-management counseling under an obesity prevention initiative spearheaded by former President Bill Clinton.

As part of the initiative, a group of health insurers and employers have agreed to pay for at least four follow-up visits to a child's primary care physician and four visits with a registered dietitian for children aged 3-18 years whose body mass index is in the 85th percentile or above for their age.

Participating insurers include Aetna Inc., Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield of Massachusetts, and WellPoint Inc. Also, PepsiCo. Inc., Houston Independent School District, Owens Corning, and Paychex Inc. will offer these benefits to their employees. President Clinton announced the agreement in New York last month at a press conference.

The initiative is the latest obesity prevention effort from the Alliance for a Healthier Generation, an organization launched jointly in 2005 by the William J. Clinton Foundation and the American Heart Association. “This landmark agreement will allow children and their families to have access to important preventive medical services in most regions of the country,” said Dr. Tim J. Gardner, AHA president.

Research shows that overweight and obese children have up to an 80% chance of being so as adults, putting them at higher risk for conditions such as diabetes, heart disease, stroke, and even certain types of cancer, he said.

As part of the agreement reached with insurers and employers, nearly a million children are expected to gain access to new obesity prevention and treatment benefits during the first year of the initiative. But the long-term goal is to reach 6.2 million children—about a quarter of all overweight and obese children in the United States—within 3 years as more insurers and employers agree to participate.

During the first year of the initiative, insurers will collect health outcomes information and cost data to help determine the cost-effectiveness of certain approaches and identify best practices. “We need to know what really works here,” President Clinton said.

This new initiative takes the important step of removing the barriers that limit insurance payment for obesity prevention in the primary care setting, said Dr. David T. Tayloe Jr., president of the American Academy of Pediatrics, adding that it can be difficult for pediatricians to bill insurers for obesity counseling, and there has been a lot of confusion about what is covered.

Obesity can be successfully treated in the office, but pediatricians can't do it by themselves, Dr. Tayloe said. For example, physicians in his rural North Carolina practice work with registered dietitians and partner with community organizations like the YMCA to give obese patients and their families a comprehensive program of nutrition and fitness advice, and health assessments.

“To see successful long-term results, there must be an ongoing relationship involving patient, family, pediatrician, dietitian, and widespread community support,” Dr. Tayloe said.

This agreement will allow families 'to have access to important preventative medical services.' DR. GARDNER

Nearly a million children would gain health insurance coverage for weight-management counseling under an obesity prevention initiative spearheaded by former President Bill Clinton.

As part of the initiative, a group of health insurers and employers have agreed to pay for at least four follow-up visits to a child's primary care physician and four visits with a registered dietitian for children aged 3-18 years whose body mass index is in the 85th percentile or above for their age.

Participating insurers include Aetna Inc., Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield of Massachusetts, and WellPoint Inc. Also, PepsiCo. Inc., Houston Independent School District, Owens Corning, and Paychex Inc. will offer these benefits to their employees. President Clinton announced the agreement in New York last month at a press conference.

The initiative is the latest obesity prevention effort from the Alliance for a Healthier Generation, an organization launched jointly in 2005 by the William J. Clinton Foundation and the American Heart Association. “This landmark agreement will allow children and their families to have access to important preventive medical services in most regions of the country,” said Dr. Tim J. Gardner, AHA president.

Research shows that overweight and obese children have up to an 80% chance of being so as adults, putting them at higher risk for conditions such as diabetes, heart disease, stroke, and even certain types of cancer, he said.

As part of the agreement reached with insurers and employers, nearly a million children are expected to gain access to new obesity prevention and treatment benefits during the first year of the initiative. But the long-term goal is to reach 6.2 million children—about a quarter of all overweight and obese children in the United States—within 3 years as more insurers and employers agree to participate.

During the first year of the initiative, insurers will collect health outcomes information and cost data to help determine the cost-effectiveness of certain approaches and identify best practices. “We need to know what really works here,” President Clinton said.

This new initiative takes the important step of removing the barriers that limit insurance payment for obesity prevention in the primary care setting, said Dr. David T. Tayloe Jr., president of the American Academy of Pediatrics, adding that it can be difficult for pediatricians to bill insurers for obesity counseling, and there has been a lot of confusion about what is covered.

Obesity can be successfully treated in the office, but pediatricians can't do it by themselves, Dr. Tayloe said. For example, physicians in his rural North Carolina practice work with registered dietitians and partner with community organizations like the YMCA to give obese patients and their families a comprehensive program of nutrition and fitness advice, and health assessments.

“To see successful long-term results, there must be an ongoing relationship involving patient, family, pediatrician, dietitian, and widespread community support,” Dr. Tayloe said.

This agreement will allow families 'to have access to important preventative medical services.' DR. GARDNER

Nearly a million children would gain health insurance coverage for weight-management counseling under an obesity prevention initiative spearheaded by former President Bill Clinton.

As part of the initiative, a group of health insurers and employers have agreed to pay for at least four follow-up visits to a child's primary care physician and four visits with a registered dietitian for children aged 3-18 years whose body mass index is in the 85th percentile or above for their age.

Participating insurers include Aetna Inc., Blue Cross and Blue Shield of North Carolina, Blue Cross Blue Shield of Massachusetts, and WellPoint Inc. Also, PepsiCo. Inc., Houston Independent School District, Owens Corning, and Paychex Inc. will offer these benefits to their employees. President Clinton announced the agreement in New York last month at a press conference.

The initiative is the latest obesity prevention effort from the Alliance for a Healthier Generation, an organization launched jointly in 2005 by the William J. Clinton Foundation and the American Heart Association. “This landmark agreement will allow children and their families to have access to important preventive medical services in most regions of the country,” said Dr. Tim J. Gardner, AHA president.

Research shows that overweight and obese children have up to an 80% chance of being so as adults, putting them at higher risk for conditions such as diabetes, heart disease, stroke, and even certain types of cancer, he said.

As part of the agreement reached with insurers and employers, nearly a million children are expected to gain access to new obesity prevention and treatment benefits during the first year of the initiative. But the long-term goal is to reach 6.2 million children—about a quarter of all overweight and obese children in the United States—within 3 years as more insurers and employers agree to participate.

During the first year of the initiative, insurers will collect health outcomes information and cost data to help determine the cost-effectiveness of certain approaches and identify best practices. “We need to know what really works here,” President Clinton said.

This new initiative takes the important step of removing the barriers that limit insurance payment for obesity prevention in the primary care setting, said Dr. David T. Tayloe Jr., president of the American Academy of Pediatrics, adding that it can be difficult for pediatricians to bill insurers for obesity counseling, and there has been a lot of confusion about what is covered.

Obesity can be successfully treated in the office, but pediatricians can't do it by themselves, Dr. Tayloe said. For example, physicians in his rural North Carolina practice work with registered dietitians and partner with community organizations like the YMCA to give obese patients and their families a comprehensive program of nutrition and fitness advice, and health assessments.

“To see successful long-term results, there must be an ongoing relationship involving patient, family, pediatrician, dietitian, and widespread community support,” Dr. Tayloe said.

This agreement will allow families 'to have access to important preventative medical services.' DR. GARDNER

ACOG Objects to Immigrant Mandate

The American College of Obstetricians and Gynecologists has joined a coalition opposing the requirement that young women immigrating to the United States receive the human papillomavirus vaccine. Last summer, the Centers for Disease Control and Prevention established the requirement for women aged 11–26 years who are seeking permanent U.S. residence or entry to the country. The mandate was part of a routine update of CDC's list of required vaccinations for immigrants. The agency added the HPV vaccine on the basis of the 2007 recommendation of the Advisory Committee on Immunization Practices that the HPV vaccine be administered to all young women in the United States. In a letter to the CDC, ACOG and more than 100 women's rights and public health groups said that, unlike other infectious diseases on the list, HPV does not pose an immediate threat to public health. The requirement that women seeking to come to the United States receive the HPV vaccine also creates an “unfair financial barrier,” the groups wrote, since the three-dose series costs at least $360. The groups urged the CDC to remove the HPV vaccine from the list and to reexamine the process for adding new vaccination requirements for immigrants.

Trouble for Octuplets' Physician?

The Center for Genetics and Society, a public interest group that focuses on the “responsible” use of genetic and reproductive technology, is taking to task the professional organizations that set guidelines for assisted reproduction. In the wake of news that the octuplets born recently in California to single mother Nadya Suleman were conceived through in vitro fertilization, the center has called on the American Society for Reproductive Medicine and its affiliated organization, the Society for Assisted Reproductive Technology, to revoke the membership of the fertility specialist who performed the in vitro procedure. The Los Angeles Times identified Dr. Michael Kamrava of Beverly Hills as the physician who performed this and previous fertility treatments on Ms. Suleman. “While most fertility practices are responsible, some routinely and openly violate ASRM and SART guidelines in a number of areas,” Marcy Darnovsky, Ph.D., associate executive director of the Center for Genetics and Society, said in a statement. Dr. R. Dale McClure, ASRM president, recently issued a statement saying that the group has concerns about the octuplet pregnancy and that it is pleased that the California Medical Board is investigating the matter. ASRM officials have contacted the physician involved, Dr. McClure said, but they need to gather more information before taking action.

NYC Facebook Page on Condoms

The New York City Department of Health and Mental Hygiene is stepping up its efforts to get city residents to use condoms. Officials at the health department recently set up a page on the social-networking Web site Facebook to tell people where they can obtain free condoms and to provide facts about HIV/AIDS and other sexually transmitted diseases. The Facebook page, which was rolled out just in time for Valentine's Day, allows visitors to send an “e-condom”—a page of information about HIV and condoms—to their friends. The online effort is only the latest condom-awareness campaign from the New York City health department. In 2007, New York launched the country's first city-branded condom, which the health department distributes at clinics, clubs, salons, and other venues.

Resolved: Health Care for Women

A new congressional resolution calls for passage of health care reform legislation within 18 months and for the bill to directly address the health care needs of women. The Health Care for Women Resolution, which was introduced in the House and Senate last month, calls on Congress to create and pass legislation that would promote primary and preventive care including family planning. “Women are the gatekeepers of their families' health,” Sen. Debbie Stabenow (D-Mich.), the Senate sponsor of the legislation, said in a statement. “If we are serious about keeping children and families healthy, we must focus more attention on keeping women healthy.” The resolution was introduced in the House by Rep. Jan Schakowsky (D-Ill.), cochair of the bipartisan Congressional Caucus on Women's Issues. The two lawmakers introduced the resolution last summer, but it never reached either the House or Senate floor.

ACOG Objects to Immigrant Mandate

The American College of Obstetricians and Gynecologists has joined a coalition opposing the requirement that young women immigrating to the United States receive the human papillomavirus vaccine. Last summer, the Centers for Disease Control and Prevention established the requirement for women aged 11–26 years who are seeking permanent U.S. residence or entry to the country. The mandate was part of a routine update of CDC's list of required vaccinations for immigrants. The agency added the HPV vaccine on the basis of the 2007 recommendation of the Advisory Committee on Immunization Practices that the HPV vaccine be administered to all young women in the United States. In a letter to the CDC, ACOG and more than 100 women's rights and public health groups said that, unlike other infectious diseases on the list, HPV does not pose an immediate threat to public health. The requirement that women seeking to come to the United States receive the HPV vaccine also creates an “unfair financial barrier,” the groups wrote, since the three-dose series costs at least $360. The groups urged the CDC to remove the HPV vaccine from the list and to reexamine the process for adding new vaccination requirements for immigrants.

Trouble for Octuplets' Physician?

The Center for Genetics and Society, a public interest group that focuses on the “responsible” use of genetic and reproductive technology, is taking to task the professional organizations that set guidelines for assisted reproduction. In the wake of news that the octuplets born recently in California to single mother Nadya Suleman were conceived through in vitro fertilization, the center has called on the American Society for Reproductive Medicine and its affiliated organization, the Society for Assisted Reproductive Technology, to revoke the membership of the fertility specialist who performed the in vitro procedure. The Los Angeles Times identified Dr. Michael Kamrava of Beverly Hills as the physician who performed this and previous fertility treatments on Ms. Suleman. “While most fertility practices are responsible, some routinely and openly violate ASRM and SART guidelines in a number of areas,” Marcy Darnovsky, Ph.D., associate executive director of the Center for Genetics and Society, said in a statement. Dr. R. Dale McClure, ASRM president, recently issued a statement saying that the group has concerns about the octuplet pregnancy and that it is pleased that the California Medical Board is investigating the matter. ASRM officials have contacted the physician involved, Dr. McClure said, but they need to gather more information before taking action.

NYC Facebook Page on Condoms

The New York City Department of Health and Mental Hygiene is stepping up its efforts to get city residents to use condoms. Officials at the health department recently set up a page on the social-networking Web site Facebook to tell people where they can obtain free condoms and to provide facts about HIV/AIDS and other sexually transmitted diseases. The Facebook page, which was rolled out just in time for Valentine's Day, allows visitors to send an “e-condom”—a page of information about HIV and condoms—to their friends. The online effort is only the latest condom-awareness campaign from the New York City health department. In 2007, New York launched the country's first city-branded condom, which the health department distributes at clinics, clubs, salons, and other venues.

Resolved: Health Care for Women

A new congressional resolution calls for passage of health care reform legislation within 18 months and for the bill to directly address the health care needs of women. The Health Care for Women Resolution, which was introduced in the House and Senate last month, calls on Congress to create and pass legislation that would promote primary and preventive care including family planning. “Women are the gatekeepers of their families' health,” Sen. Debbie Stabenow (D-Mich.), the Senate sponsor of the legislation, said in a statement. “If we are serious about keeping children and families healthy, we must focus more attention on keeping women healthy.” The resolution was introduced in the House by Rep. Jan Schakowsky (D-Ill.), cochair of the bipartisan Congressional Caucus on Women's Issues. The two lawmakers introduced the resolution last summer, but it never reached either the House or Senate floor.

ACOG Objects to Immigrant Mandate

The American College of Obstetricians and Gynecologists has joined a coalition opposing the requirement that young women immigrating to the United States receive the human papillomavirus vaccine. Last summer, the Centers for Disease Control and Prevention established the requirement for women aged 11–26 years who are seeking permanent U.S. residence or entry to the country. The mandate was part of a routine update of CDC's list of required vaccinations for immigrants. The agency added the HPV vaccine on the basis of the 2007 recommendation of the Advisory Committee on Immunization Practices that the HPV vaccine be administered to all young women in the United States. In a letter to the CDC, ACOG and more than 100 women's rights and public health groups said that, unlike other infectious diseases on the list, HPV does not pose an immediate threat to public health. The requirement that women seeking to come to the United States receive the HPV vaccine also creates an “unfair financial barrier,” the groups wrote, since the three-dose series costs at least $360. The groups urged the CDC to remove the HPV vaccine from the list and to reexamine the process for adding new vaccination requirements for immigrants.

Trouble for Octuplets' Physician?

The Center for Genetics and Society, a public interest group that focuses on the “responsible” use of genetic and reproductive technology, is taking to task the professional organizations that set guidelines for assisted reproduction. In the wake of news that the octuplets born recently in California to single mother Nadya Suleman were conceived through in vitro fertilization, the center has called on the American Society for Reproductive Medicine and its affiliated organization, the Society for Assisted Reproductive Technology, to revoke the membership of the fertility specialist who performed the in vitro procedure. The Los Angeles Times identified Dr. Michael Kamrava of Beverly Hills as the physician who performed this and previous fertility treatments on Ms. Suleman. “While most fertility practices are responsible, some routinely and openly violate ASRM and SART guidelines in a number of areas,” Marcy Darnovsky, Ph.D., associate executive director of the Center for Genetics and Society, said in a statement. Dr. R. Dale McClure, ASRM president, recently issued a statement saying that the group has concerns about the octuplet pregnancy and that it is pleased that the California Medical Board is investigating the matter. ASRM officials have contacted the physician involved, Dr. McClure said, but they need to gather more information before taking action.

NYC Facebook Page on Condoms

The New York City Department of Health and Mental Hygiene is stepping up its efforts to get city residents to use condoms. Officials at the health department recently set up a page on the social-networking Web site Facebook to tell people where they can obtain free condoms and to provide facts about HIV/AIDS and other sexually transmitted diseases. The Facebook page, which was rolled out just in time for Valentine's Day, allows visitors to send an “e-condom”—a page of information about HIV and condoms—to their friends. The online effort is only the latest condom-awareness campaign from the New York City health department. In 2007, New York launched the country's first city-branded condom, which the health department distributes at clinics, clubs, salons, and other venues.

Resolved: Health Care for Women

A new congressional resolution calls for passage of health care reform legislation within 18 months and for the bill to directly address the health care needs of women. The Health Care for Women Resolution, which was introduced in the House and Senate last month, calls on Congress to create and pass legislation that would promote primary and preventive care including family planning. “Women are the gatekeepers of their families' health,” Sen. Debbie Stabenow (D-Mich.), the Senate sponsor of the legislation, said in a statement. “If we are serious about keeping children and families healthy, we must focus more attention on keeping women healthy.” The resolution was introduced in the House by Rep. Jan Schakowsky (D-Ill.), cochair of the bipartisan Congressional Caucus on Women's Issues. The two lawmakers introduced the resolution last summer, but it never reached either the House or Senate floor.

The newly enacted economic stimulus law will infuse tens of billions of dollars into the health care sector, providing incentives for using health information technology, increasing funds for primary care training, and launching initiatives in comparative effectiveness research.

President Obama signed the $787 billion American Recovery and Reinvestment Act of 2009 (H.R. 1) into law on Feb. 17, following weeks of congressional debate and deal-making. A final compromise package largely kept health care priorities on the table.

In terms of health information technology, the law includes about $17 billion in financial incentives through the Medicare and Medicaid programs to physicians and other health care providers to adopt and use electronic health records (EHRs), as well as another $2 billion in funding for the Office of the National Coordinator for Health Information Technology to encourage health IT adoption, aid in standard setting, and support regional efforts at health information exchange.

The bulk of the $17 billion will create a program of financial carrots and sticks aimed at encouraging EHR adoption, starting in 2011. For example, under Medicare, providers could receive incentives for EHR use over 5 years starting at a maximum of $18,000 in the first year and dropping to a maximum of $2,000 in year 5. However, physicians who do not engage in “meaningful” EHR use by 2015 could see cuts to their Medicare payments starting at 1% in 2015 and rising to 3% in 2017 and subsequent years.

Physicians who have a Medicaid patient volume of at least 30% will be eligible to receive incentive payments for EHR adoption and use.

Eligible Medicaid providers could receive incentives of up to $75,000 over 5 years. Under the law, Medicaid providers could receive up to $25,000 for the purchase and initial implementation of a certified EHR system and up to $10,000 a year for the maintenance and use of the system.

The law includes expanded eligibility for pediatricians. For example, pediatricians who have a Medicaid patient volume of between 20% and 30% will be eligible to receive up to two-thirds of the incentive payments.

The funding in the law is likely to fuel significant activity in the health information technology area, said Dr. Don Detmer, president and CEO of the American Medical Informatics Association (AMIA). The question will be how fast physicians and other health care providers adopt the technology. In the meantime, the federal government will need to clarify some of the provisions in the law through regulation, particularly how the new privacy protections will be implemented, he said.

“The payments are probably significant enough to make a real difference,” said Douglas Peddicord, Ph.D., president of Washington Health Strategies Group, which represents AMIA in the District of Columbia.

Recent surveys show that the majority of physicians would be motivated to adopt EHRs if given this level of incentives, he said. The decrease in payments starting in 2015 is also likely to be a significant driver, he said.

The financial incentives and disincentives included in the law will finally make the business case for EHRs, said Blair Childs, senior vice president for public affairs at Premier Inc., an alliance of not-for-profit hospitals and health care systems.

“I think everyone agrees that this is what is necessary.”

As the federal government moves forward with regulations spelling out how the program will be implemented, Mr. Childs said officials at Premier hope to see standards issued that would require EHRs to automate the extraction of quality measures, something that is manual in many current systems.

Also under the new law, the Health and Human Services department will provide competitive grants to states to help them develop loan programs to drive adoption of EHRs by health care providers.

Providers will be able to use the loans to purchase, upgrade, or improve the security of EHR systems or to train staff on the technology.

Providing funds for health information technology garnered the most support in the stimulus package, but billions more were promised to improve basic health care and assess which products or procedures work best.

The law also includes $87 billion to help states pay for their Medicaid programs. The money will allow states to get a higher percentage of funds for their Medicaid programs from federal dollars as opposed to state dollars. As a result, “a state with a budget shortfall won't feel as much pressure to cut Medicaid back,” said Kathleen Stoll, deputy executive director of Families USA, noting that at least 40 states have proposed cuts to their Medicaid programs. “In some states, it may free up money to spend on other health programs,” but none of the federal stimulus money is allowed to fund any expansion of Medicaid.

Alan Weil, executive director of the National Academy for State Health Policy, said that although no one knows whether the Medicaid funding is sufficient, “states are going to need these dollars to retain the coverage that they have and deal with the expected increase in enrollment due to the economic downturn. Without it, we would have expected really substantial cuts in coverage.”

Another provision gives states $25 billion to help laid-off workers maintain their employee health benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Workers who lost their jobs between Sept. 1, 2008, and Dec. 31, 2009, will have 65% of their COBRA premiums paid for by the federal government for 9 months. The provision limits the subsidy to those workers with an individual income of up to $125,000 or a family income of up to $250,000, Ms. Stoll said.

“This will help a lot of folks become able to afford COBRA,” she added, noting that a recent report by her organization found that COBRA premiums eat up an average of 84% of a laid-off worker's unemployment benefits.

The law includes about $10 billion in funding for the National Institutes of Health to be used for research grants, construction, and the purchase of research equipment. The increased funding was praised by the American Heart Association for advancing the search for cures for heart disease, stroke, and other cardiovascular diseases.

“This is an important down payment on President Obama's pledge to double science funding over the next decade,” Nancy Brown, chief executive officer of the American Heart Association, said in a statement.

The significant boost in NIH funding also was praised by the nonprofit organization Research!America. “This step is a dramatic reversal of the discouraging funding our federal health research agencies saw in the past 6 years and will do much to make up for spending power lost during that time,” former Rep. John Edward Porter (R-Ill.), chair of Research!America, said in a statement. “In recent years, the NIH has been able to fund just 1 in 10 research projects deemed worthy of funding.”

A little over $1 billion has been directed toward comparative effectiveness research, with $300 million going to the Agency for Healthcare Research and Quality, $400 million to the NIH, and $400 million to be used at the HHS secretary's discretion.

The research will be overseen by a new national council that will advise Congress and federal agencies on priorities. Many in the pharmaceutical and medical device industry supported the notion of comparative effectiveness studies, but worked hard to ensure that the money would not be used to support coverage decisions. The House and Senate conference report specifically stated that the research could not be used to “mandate coverage, reimbursement, or other policies for any public or private payer.”

That brought applause from AdvaMed, the medical device industry trade group. “The purpose of the research is to assist patients and health professionals in making better treatment decisions, not to mandate one-size-fits-all coverage decisions that would deny patients access to safe and effective treatments,” Stephen J. Ubl, president and CEO of AdvaMed, said in a statement.

Primary care also got a boost in the bill, with $2 billion going to new and existing community health centers, and $500 million to training for primary providers including doctors, dentists, and nurses. Some of that $500 million will help cover medical school expenses for students who agree to practice in underserved communities through the National Health Service Corps.

Alicia Ault and Joyce Frieden contributed to this story.

The newly enacted economic stimulus law will infuse tens of billions of dollars into the health care sector, providing incentives for using health information technology, increasing funds for primary care training, and launching initiatives in comparative effectiveness research.

President Obama signed the $787 billion American Recovery and Reinvestment Act of 2009 (H.R. 1) into law on Feb. 17, following weeks of congressional debate and deal-making. A final compromise package largely kept health care priorities on the table.

In terms of health information technology, the law includes about $17 billion in financial incentives through the Medicare and Medicaid programs to physicians and other health care providers to adopt and use electronic health records (EHRs), as well as another $2 billion in funding for the Office of the National Coordinator for Health Information Technology to encourage health IT adoption, aid in standard setting, and support regional efforts at health information exchange.

The bulk of the $17 billion will create a program of financial carrots and sticks aimed at encouraging EHR adoption, starting in 2011. For example, under Medicare, providers could receive incentives for EHR use over 5 years starting at a maximum of $18,000 in the first year and dropping to a maximum of $2,000 in year 5. However, physicians who do not engage in “meaningful” EHR use by 2015 could see cuts to their Medicare payments starting at 1% in 2015 and rising to 3% in 2017 and subsequent years.

Physicians who have a Medicaid patient volume of at least 30% will be eligible to receive incentive payments for EHR adoption and use.

Eligible Medicaid providers could receive incentives of up to $75,000 over 5 years. Under the law, Medicaid providers could receive up to $25,000 for the purchase and initial implementation of a certified EHR system and up to $10,000 a year for the maintenance and use of the system.

The law includes expanded eligibility for pediatricians. For example, pediatricians who have a Medicaid patient volume of between 20% and 30% will be eligible to receive up to two-thirds of the incentive payments.

The funding in the law is likely to fuel significant activity in the health information technology area, said Dr. Don Detmer, president and CEO of the American Medical Informatics Association (AMIA). The question will be how fast physicians and other health care providers adopt the technology. In the meantime, the federal government will need to clarify some of the provisions in the law through regulation, particularly how the new privacy protections will be implemented, he said.

“The payments are probably significant enough to make a real difference,” said Douglas Peddicord, Ph.D., president of Washington Health Strategies Group, which represents AMIA in the District of Columbia.

Recent surveys show that the majority of physicians would be motivated to adopt EHRs if given this level of incentives, he said. The decrease in payments starting in 2015 is also likely to be a significant driver, he said.

The financial incentives and disincentives included in the law will finally make the business case for EHRs, said Blair Childs, senior vice president for public affairs at Premier Inc., an alliance of not-for-profit hospitals and health care systems.

“I think everyone agrees that this is what is necessary.”

As the federal government moves forward with regulations spelling out how the program will be implemented, Mr. Childs said officials at Premier hope to see standards issued that would require EHRs to automate the extraction of quality measures, something that is manual in many current systems.

Also under the new law, the Health and Human Services department will provide competitive grants to states to help them develop loan programs to drive adoption of EHRs by health care providers.

Providers will be able to use the loans to purchase, upgrade, or improve the security of EHR systems or to train staff on the technology.

Providing funds for health information technology garnered the most support in the stimulus package, but billions more were promised to improve basic health care and assess which products or procedures work best.

The law also includes $87 billion to help states pay for their Medicaid programs. The money will allow states to get a higher percentage of funds for their Medicaid programs from federal dollars as opposed to state dollars. As a result, “a state with a budget shortfall won't feel as much pressure to cut Medicaid back,” said Kathleen Stoll, deputy executive director of Families USA, noting that at least 40 states have proposed cuts to their Medicaid programs. “In some states, it may free up money to spend on other health programs,” but none of the federal stimulus money is allowed to fund any expansion of Medicaid.

Alan Weil, executive director of the National Academy for State Health Policy, said that although no one knows whether the Medicaid funding is sufficient, “states are going to need these dollars to retain the coverage that they have and deal with the expected increase in enrollment due to the economic downturn. Without it, we would have expected really substantial cuts in coverage.”

Another provision gives states $25 billion to help laid-off workers maintain their employee health benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Workers who lost their jobs between Sept. 1, 2008, and Dec. 31, 2009, will have 65% of their COBRA premiums paid for by the federal government for 9 months. The provision limits the subsidy to those workers with an individual income of up to $125,000 or a family income of up to $250,000, Ms. Stoll said.

“This will help a lot of folks become able to afford COBRA,” she added, noting that a recent report by her organization found that COBRA premiums eat up an average of 84% of a laid-off worker's unemployment benefits.

The law includes about $10 billion in funding for the National Institutes of Health to be used for research grants, construction, and the purchase of research equipment. The increased funding was praised by the American Heart Association for advancing the search for cures for heart disease, stroke, and other cardiovascular diseases.

“This is an important down payment on President Obama's pledge to double science funding over the next decade,” Nancy Brown, chief executive officer of the American Heart Association, said in a statement.

The significant boost in NIH funding also was praised by the nonprofit organization Research!America. “This step is a dramatic reversal of the discouraging funding our federal health research agencies saw in the past 6 years and will do much to make up for spending power lost during that time,” former Rep. John Edward Porter (R-Ill.), chair of Research!America, said in a statement. “In recent years, the NIH has been able to fund just 1 in 10 research projects deemed worthy of funding.”

A little over $1 billion has been directed toward comparative effectiveness research, with $300 million going to the Agency for Healthcare Research and Quality, $400 million to the NIH, and $400 million to be used at the HHS secretary's discretion.

The research will be overseen by a new national council that will advise Congress and federal agencies on priorities. Many in the pharmaceutical and medical device industry supported the notion of comparative effectiveness studies, but worked hard to ensure that the money would not be used to support coverage decisions. The House and Senate conference report specifically stated that the research could not be used to “mandate coverage, reimbursement, or other policies for any public or private payer.”

That brought applause from AdvaMed, the medical device industry trade group. “The purpose of the research is to assist patients and health professionals in making better treatment decisions, not to mandate one-size-fits-all coverage decisions that would deny patients access to safe and effective treatments,” Stephen J. Ubl, president and CEO of AdvaMed, said in a statement.

Primary care also got a boost in the bill, with $2 billion going to new and existing community health centers, and $500 million to training for primary providers including doctors, dentists, and nurses. Some of that $500 million will help cover medical school expenses for students who agree to practice in underserved communities through the National Health Service Corps.

Alicia Ault and Joyce Frieden contributed to this story.

The newly enacted economic stimulus law will infuse tens of billions of dollars into the health care sector, providing incentives for using health information technology, increasing funds for primary care training, and launching initiatives in comparative effectiveness research.

President Obama signed the $787 billion American Recovery and Reinvestment Act of 2009 (H.R. 1) into law on Feb. 17, following weeks of congressional debate and deal-making. A final compromise package largely kept health care priorities on the table.

In terms of health information technology, the law includes about $17 billion in financial incentives through the Medicare and Medicaid programs to physicians and other health care providers to adopt and use electronic health records (EHRs), as well as another $2 billion in funding for the Office of the National Coordinator for Health Information Technology to encourage health IT adoption, aid in standard setting, and support regional efforts at health information exchange.

The bulk of the $17 billion will create a program of financial carrots and sticks aimed at encouraging EHR adoption, starting in 2011. For example, under Medicare, providers could receive incentives for EHR use over 5 years starting at a maximum of $18,000 in the first year and dropping to a maximum of $2,000 in year 5. However, physicians who do not engage in “meaningful” EHR use by 2015 could see cuts to their Medicare payments starting at 1% in 2015 and rising to 3% in 2017 and subsequent years.

Physicians who have a Medicaid patient volume of at least 30% will be eligible to receive incentive payments for EHR adoption and use.

Eligible Medicaid providers could receive incentives of up to $75,000 over 5 years. Under the law, Medicaid providers could receive up to $25,000 for the purchase and initial implementation of a certified EHR system and up to $10,000 a year for the maintenance and use of the system.

The law includes expanded eligibility for pediatricians. For example, pediatricians who have a Medicaid patient volume of between 20% and 30% will be eligible to receive up to two-thirds of the incentive payments.

The funding in the law is likely to fuel significant activity in the health information technology area, said Dr. Don Detmer, president and CEO of the American Medical Informatics Association (AMIA). The question will be how fast physicians and other health care providers adopt the technology. In the meantime, the federal government will need to clarify some of the provisions in the law through regulation, particularly how the new privacy protections will be implemented, he said.

“The payments are probably significant enough to make a real difference,” said Douglas Peddicord, Ph.D., president of Washington Health Strategies Group, which represents AMIA in the District of Columbia.

Recent surveys show that the majority of physicians would be motivated to adopt EHRs if given this level of incentives, he said. The decrease in payments starting in 2015 is also likely to be a significant driver, he said.

The financial incentives and disincentives included in the law will finally make the business case for EHRs, said Blair Childs, senior vice president for public affairs at Premier Inc., an alliance of not-for-profit hospitals and health care systems.

“I think everyone agrees that this is what is necessary.”

As the federal government moves forward with regulations spelling out how the program will be implemented, Mr. Childs said officials at Premier hope to see standards issued that would require EHRs to automate the extraction of quality measures, something that is manual in many current systems.

Also under the new law, the Health and Human Services department will provide competitive grants to states to help them develop loan programs to drive adoption of EHRs by health care providers.

Providers will be able to use the loans to purchase, upgrade, or improve the security of EHR systems or to train staff on the technology.

Providing funds for health information technology garnered the most support in the stimulus package, but billions more were promised to improve basic health care and assess which products or procedures work best.

The law also includes $87 billion to help states pay for their Medicaid programs. The money will allow states to get a higher percentage of funds for their Medicaid programs from federal dollars as opposed to state dollars. As a result, “a state with a budget shortfall won't feel as much pressure to cut Medicaid back,” said Kathleen Stoll, deputy executive director of Families USA, noting that at least 40 states have proposed cuts to their Medicaid programs. “In some states, it may free up money to spend on other health programs,” but none of the federal stimulus money is allowed to fund any expansion of Medicaid.

Alan Weil, executive director of the National Academy for State Health Policy, said that although no one knows whether the Medicaid funding is sufficient, “states are going to need these dollars to retain the coverage that they have and deal with the expected increase in enrollment due to the economic downturn. Without it, we would have expected really substantial cuts in coverage.”

Another provision gives states $25 billion to help laid-off workers maintain their employee health benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA). Workers who lost their jobs between Sept. 1, 2008, and Dec. 31, 2009, will have 65% of their COBRA premiums paid for by the federal government for 9 months. The provision limits the subsidy to those workers with an individual income of up to $125,000 or a family income of up to $250,000, Ms. Stoll said.

“This will help a lot of folks become able to afford COBRA,” she added, noting that a recent report by her organization found that COBRA premiums eat up an average of 84% of a laid-off worker's unemployment benefits.

The law includes about $10 billion in funding for the National Institutes of Health to be used for research grants, construction, and the purchase of research equipment. The increased funding was praised by the American Heart Association for advancing the search for cures for heart disease, stroke, and other cardiovascular diseases.

“This is an important down payment on President Obama's pledge to double science funding over the next decade,” Nancy Brown, chief executive officer of the American Heart Association, said in a statement.

The significant boost in NIH funding also was praised by the nonprofit organization Research!America. “This step is a dramatic reversal of the discouraging funding our federal health research agencies saw in the past 6 years and will do much to make up for spending power lost during that time,” former Rep. John Edward Porter (R-Ill.), chair of Research!America, said in a statement. “In recent years, the NIH has been able to fund just 1 in 10 research projects deemed worthy of funding.”

A little over $1 billion has been directed toward comparative effectiveness research, with $300 million going to the Agency for Healthcare Research and Quality, $400 million to the NIH, and $400 million to be used at the HHS secretary's discretion.

The research will be overseen by a new national council that will advise Congress and federal agencies on priorities. Many in the pharmaceutical and medical device industry supported the notion of comparative effectiveness studies, but worked hard to ensure that the money would not be used to support coverage decisions. The House and Senate conference report specifically stated that the research could not be used to “mandate coverage, reimbursement, or other policies for any public or private payer.”

That brought applause from AdvaMed, the medical device industry trade group. “The purpose of the research is to assist patients and health professionals in making better treatment decisions, not to mandate one-size-fits-all coverage decisions that would deny patients access to safe and effective treatments,” Stephen J. Ubl, president and CEO of AdvaMed, said in a statement.

Primary care also got a boost in the bill, with $2 billion going to new and existing community health centers, and $500 million to training for primary providers including doctors, dentists, and nurses. Some of that $500 million will help cover medical school expenses for students who agree to practice in underserved communities through the National Health Service Corps.

Alicia Ault and Joyce Frieden contributed to this story.

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending by nearly $3 trillion over the next decade.

The health reform proposal, unveiled by the Commonwealth Fund on Feb. 19, is similar to plans outlined by President Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed to study possible changes to the delivery and financing of health care.

The difference between the Commonwealth Fund's plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

“The report's central message is that we all stand to gain by taking bold action,” Ms. Schoen said at a press briefing to release the report. “With middle- and low-income families at risk, and businesses struggling to provide insurance for their employees, there is broad public support for significant reforms.”

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan. The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010.

The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020.

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending by nearly $3 trillion over the next decade.

The health reform proposal, unveiled by the Commonwealth Fund on Feb. 19, is similar to plans outlined by President Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed to study possible changes to the delivery and financing of health care.

The difference between the Commonwealth Fund's plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

“The report's central message is that we all stand to gain by taking bold action,” Ms. Schoen said at a press briefing to release the report. “With middle- and low-income families at risk, and businesses struggling to provide insurance for their employees, there is broad public support for significant reforms.”

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan. The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010.

The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020.

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending by nearly $3 trillion over the next decade.

The health reform proposal, unveiled by the Commonwealth Fund on Feb. 19, is similar to plans outlined by President Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed to study possible changes to the delivery and financing of health care.

The difference between the Commonwealth Fund's plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

“The report's central message is that we all stand to gain by taking bold action,” Ms. Schoen said at a press briefing to release the report. “With middle- and low-income families at risk, and businesses struggling to provide insurance for their employees, there is broad public support for significant reforms.”

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan. The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010.

The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020.

Abbott Warned on Depakote

The Food and Drug Administration warned Abbott Laboratories that a promotional campaign for its products Depakote and Depakote ER was false and misleading and that it omitted important safety information. The campaign consisted of a flashcard sent to health care providers. The FDA said the card was misleading because it left out the risks, which include a boxed warning about hepatotoxicity, in the main body. It also implied the ER formulation was indicated for use in a broader group of patients than the conventional formulation, but that is not the case. The agency asked Abbott to immediately cease distribution of the card. The drugs are prescribed for seizure disorders, migraine, and bipolar disorder.

CNS Drugs Rank High in Cost

Medications that affect a person's central nervous system accounted for about $28 billion of the $208 billion American adults spent on prescription drugs in 2006, said the Agency for Healthcare Research and Quality. Metabolic drugs topped the list at $38 billion, cardiovascular drugs cost $33 billion, psychotherapeutic drugs cost more than $17 billion, and hormones cost $14 billion. The agency also found spending for outpatient prescription analgesics rose from about $4 billion in 1996 to more than $13 billion in 2006.

Boston Limits Tobacco Sales

Boston has banned tobacco-product sales at pharmacies and on college campuses. The Boston Public Health Commission's board of health also banned new permits for smoking bars, such as hookah and cigar bars, and prohibited the sale of blunt wraps, a tobacco leaf often used to roll marijuana. The board said it was working to increase people's access to smoking cessation resources. Last year, San Francisco imposed the first municipal ban on cigarette sales by pharmacies. Many college campuses already ban tobacco.

FDA Device Enforcement Lax

A nonprofit watchdog group says the Food and Drug Administration is not adequately monitoring manufacturers' testing of medical devices. The Project on Government Oversight (POGO) reviewed FDA enforcement of its quality assurance standards for devices such as implantable cardiac defibrillators, pacemakers, and stents. The group said agency inspections have dropped from 33 labs in 2005 to 1 in 2008, and that a laissez-faire culture exists at the FDA's Center for Devices and Radiological Health. It said internal FDA documents show that many CDRH scientists have challenged management on its lack of enforcement, but they have been rebuffed. POGO called on Congress to investigate what it alleges is a deliberate decision by CDRH senior management not to enforce FDA rules.

Court Shields Billing Records

An appeals court has ruled against the release of Medicare billing records, which was sought by the group Consumers' Checkbook so that it could grade physicians on quality. The nonprofit gorup had filed a Freedom of Information Act request for all 2004 Medicare claims from physicians in several locations, and the group won in a lower court in 2007. But the Department of Health and Human Services, joined by the American Medical Association, appealed, and the United States Circuit Court of Appeals for the District of Columbia ruled that HHS does not have to release the information. Disclosure of the requested data would constitute an invasion of physicians' privacy, the court said. The American Medical Association praised the decision. “The court clearly found that the release of personal physician payment data does not meet the standard of the Freedom of Information Act, which is to provide the public with information on how the government operates,” Dr. Jeremy A. Lazarus, AMA board member, said in a statement.

Abbott Warned on Depakote

The Food and Drug Administration warned Abbott Laboratories that a promotional campaign for its products Depakote and Depakote ER was false and misleading and that it omitted important safety information. The campaign consisted of a flashcard sent to health care providers. The FDA said the card was misleading because it left out the risks, which include a boxed warning about hepatotoxicity, in the main body. It also implied the ER formulation was indicated for use in a broader group of patients than the conventional formulation, but that is not the case. The agency asked Abbott to immediately cease distribution of the card. The drugs are prescribed for seizure disorders, migraine, and bipolar disorder.

CNS Drugs Rank High in Cost

Medications that affect a person's central nervous system accounted for about $28 billion of the $208 billion American adults spent on prescription drugs in 2006, said the Agency for Healthcare Research and Quality. Metabolic drugs topped the list at $38 billion, cardiovascular drugs cost $33 billion, psychotherapeutic drugs cost more than $17 billion, and hormones cost $14 billion. The agency also found spending for outpatient prescription analgesics rose from about $4 billion in 1996 to more than $13 billion in 2006.

Boston Limits Tobacco Sales

Boston has banned tobacco-product sales at pharmacies and on college campuses. The Boston Public Health Commission's board of health also banned new permits for smoking bars, such as hookah and cigar bars, and prohibited the sale of blunt wraps, a tobacco leaf often used to roll marijuana. The board said it was working to increase people's access to smoking cessation resources. Last year, San Francisco imposed the first municipal ban on cigarette sales by pharmacies. Many college campuses already ban tobacco.

FDA Device Enforcement Lax

A nonprofit watchdog group says the Food and Drug Administration is not adequately monitoring manufacturers' testing of medical devices. The Project on Government Oversight (POGO) reviewed FDA enforcement of its quality assurance standards for devices such as implantable cardiac defibrillators, pacemakers, and stents. The group said agency inspections have dropped from 33 labs in 2005 to 1 in 2008, and that a laissez-faire culture exists at the FDA's Center for Devices and Radiological Health. It said internal FDA documents show that many CDRH scientists have challenged management on its lack of enforcement, but they have been rebuffed. POGO called on Congress to investigate what it alleges is a deliberate decision by CDRH senior management not to enforce FDA rules.

Court Shields Billing Records

An appeals court has ruled against the release of Medicare billing records, which was sought by the group Consumers' Checkbook so that it could grade physicians on quality. The nonprofit gorup had filed a Freedom of Information Act request for all 2004 Medicare claims from physicians in several locations, and the group won in a lower court in 2007. But the Department of Health and Human Services, joined by the American Medical Association, appealed, and the United States Circuit Court of Appeals for the District of Columbia ruled that HHS does not have to release the information. Disclosure of the requested data would constitute an invasion of physicians' privacy, the court said. The American Medical Association praised the decision. “The court clearly found that the release of personal physician payment data does not meet the standard of the Freedom of Information Act, which is to provide the public with information on how the government operates,” Dr. Jeremy A. Lazarus, AMA board member, said in a statement.

Abbott Warned on Depakote

The Food and Drug Administration warned Abbott Laboratories that a promotional campaign for its products Depakote and Depakote ER was false and misleading and that it omitted important safety information. The campaign consisted of a flashcard sent to health care providers. The FDA said the card was misleading because it left out the risks, which include a boxed warning about hepatotoxicity, in the main body. It also implied the ER formulation was indicated for use in a broader group of patients than the conventional formulation, but that is not the case. The agency asked Abbott to immediately cease distribution of the card. The drugs are prescribed for seizure disorders, migraine, and bipolar disorder.

CNS Drugs Rank High in Cost

Medications that affect a person's central nervous system accounted for about $28 billion of the $208 billion American adults spent on prescription drugs in 2006, said the Agency for Healthcare Research and Quality. Metabolic drugs topped the list at $38 billion, cardiovascular drugs cost $33 billion, psychotherapeutic drugs cost more than $17 billion, and hormones cost $14 billion. The agency also found spending for outpatient prescription analgesics rose from about $4 billion in 1996 to more than $13 billion in 2006.

Boston Limits Tobacco Sales

Boston has banned tobacco-product sales at pharmacies and on college campuses. The Boston Public Health Commission's board of health also banned new permits for smoking bars, such as hookah and cigar bars, and prohibited the sale of blunt wraps, a tobacco leaf often used to roll marijuana. The board said it was working to increase people's access to smoking cessation resources. Last year, San Francisco imposed the first municipal ban on cigarette sales by pharmacies. Many college campuses already ban tobacco.

FDA Device Enforcement Lax

A nonprofit watchdog group says the Food and Drug Administration is not adequately monitoring manufacturers' testing of medical devices. The Project on Government Oversight (POGO) reviewed FDA enforcement of its quality assurance standards for devices such as implantable cardiac defibrillators, pacemakers, and stents. The group said agency inspections have dropped from 33 labs in 2005 to 1 in 2008, and that a laissez-faire culture exists at the FDA's Center for Devices and Radiological Health. It said internal FDA documents show that many CDRH scientists have challenged management on its lack of enforcement, but they have been rebuffed. POGO called on Congress to investigate what it alleges is a deliberate decision by CDRH senior management not to enforce FDA rules.

Court Shields Billing Records

An appeals court has ruled against the release of Medicare billing records, which was sought by the group Consumers' Checkbook so that it could grade physicians on quality. The nonprofit gorup had filed a Freedom of Information Act request for all 2004 Medicare claims from physicians in several locations, and the group won in a lower court in 2007. But the Department of Health and Human Services, joined by the American Medical Association, appealed, and the United States Circuit Court of Appeals for the District of Columbia ruled that HHS does not have to release the information. Disclosure of the requested data would constitute an invasion of physicians' privacy, the court said. The American Medical Association praised the decision. “The court clearly found that the release of personal physician payment data does not meet the standard of the Freedom of Information Act, which is to provide the public with information on how the government operates,” Dr. Jeremy A. Lazarus, AMA board member, said in a statement.

Nearly 11 million low-income children will receive health coverage under the reauthorization and expansion of the State Children's Health Insurance Program, which was recently signed into law by President Barack Obama.

The legislation (H.R. 2), which received broad support in both the House and Senate, was signed on Feb. 4. The State Children's Health Insurance Program (SCHIP) is now reauthorized through September 2013 and will provide coverage to the approximately 6.7 million children currently covered by the program, as well as 4.1 million new children.

“This bill is only a first step,” Mr. Obama said at a signing ceremony for the SCHIP law. “The way I see it, providing coverage to 11 million children through [SCHIP] is a down payment on my commitment to cover every single American. And it is just one component of a much broader effort to finally bring our health care system into the 21st century.”

Dr. Thomas J.A. Lehman, chief of the division of pediatric rheumatology at the Hospital for Special Surgery in New York, praised the passage of the SCHIP law, saying that it would benefit many children by helping to improve their access to care.

But the bill falls short for children with rheumatic diseases, he said, because it fails to address the shortage of trained pediatric rheumatologists in the United States.

“Even before the passage of this bill, children with rheumatic disease faced difficulty finding a pediatric rheumatologist to care for them, and long waits for available new-patient appointments if they did find one,” he said. “SCHIP may make care more affordable for children with rheumatic disease, but it will not make care more available.”

On the same day he signed the SCHIP law, Mr. Obama directed the Centers for Medicare and Medicaid Services to rescind a Bush administration directive that limited the flexibility of states to set higher income eligibility standards for their SCHIP programs.

Under the newly enacted SCHIP law, states are allowed to cover children in families earning up to 300% of the federal poverty level while retaining access to full federal matching funds. It also gives states the option to cover prenatal care for pregnant women. How-ever, it also requires states to phase out coverage of any low-income parents and childless adults currently covered under the program.

The new law eliminates the 5-year waiting period for legal immigrant children and pregnant women to gain access to SCHIP benefits, a change supported by the American Academy of Pediatrics.

In an effort to measure and improve health care quality, the law calls for development of an initial core set of child health quality measures for children enrolled in SCHIP and Medicaid by Jan. 1, 2010. The measures would be designed to assess the effectiveness and availability of preventive services, prenatal care, and treatments for acute and chronic conditions.

Excluded from the law was a House-passed provision that would have prohibited the construction of new physician-owned specialty hospitals or expansion of existing physician-owned hospitals.

While SCHIP has enjoyed wide support in Congress, members of the House and Senate had a vigorous debate over the last month about whether such a significant expansion of the program was appropriate.

Some Republicans in the House objected to the legislation, saying that it would undermine the original intent of the SCHIP legislation by expanding the program to adults, illegal immigrants, and families with higher incomes.

While the legislation bars the coverage of illegal immigrants, Republicans who spoke out against the legislation said that the lack of an adequate system to verify citizenship status would result in illegal immigrants gaining access to coverage.

The SCHIP law, which will infuse more than $30 billion into Medicaid over 5 years, will be paid for in large part through a 62-cent-per-pack increase in the federal tax on cigarettes, with proportional increases for other tobacco products.

Nearly 11 million low-income children will receive health coverage under the reauthorization and expansion of the State Children's Health Insurance Program, which was recently signed into law by President Barack Obama.

The legislation (H.R. 2), which received broad support in both the House and Senate, was signed on Feb. 4. The State Children's Health Insurance Program (SCHIP) is now reauthorized through September 2013 and will provide coverage to the approximately 6.7 million children currently covered by the program, as well as 4.1 million new children.

“This bill is only a first step,” Mr. Obama said at a signing ceremony for the SCHIP law. “The way I see it, providing coverage to 11 million children through [SCHIP] is a down payment on my commitment to cover every single American. And it is just one component of a much broader effort to finally bring our health care system into the 21st century.”

Dr. Thomas J.A. Lehman, chief of the division of pediatric rheumatology at the Hospital for Special Surgery in New York, praised the passage of the SCHIP law, saying that it would benefit many children by helping to improve their access to care.

But the bill falls short for children with rheumatic diseases, he said, because it fails to address the shortage of trained pediatric rheumatologists in the United States.

“Even before the passage of this bill, children with rheumatic disease faced difficulty finding a pediatric rheumatologist to care for them, and long waits for available new-patient appointments if they did find one,” he said. “SCHIP may make care more affordable for children with rheumatic disease, but it will not make care more available.”

On the same day he signed the SCHIP law, Mr. Obama directed the Centers for Medicare and Medicaid Services to rescind a Bush administration directive that limited the flexibility of states to set higher income eligibility standards for their SCHIP programs.

Under the newly enacted SCHIP law, states are allowed to cover children in families earning up to 300% of the federal poverty level while retaining access to full federal matching funds. It also gives states the option to cover prenatal care for pregnant women. How-ever, it also requires states to phase out coverage of any low-income parents and childless adults currently covered under the program.

The new law eliminates the 5-year waiting period for legal immigrant children and pregnant women to gain access to SCHIP benefits, a change supported by the American Academy of Pediatrics.

In an effort to measure and improve health care quality, the law calls for development of an initial core set of child health quality measures for children enrolled in SCHIP and Medicaid by Jan. 1, 2010. The measures would be designed to assess the effectiveness and availability of preventive services, prenatal care, and treatments for acute and chronic conditions.

Excluded from the law was a House-passed provision that would have prohibited the construction of new physician-owned specialty hospitals or expansion of existing physician-owned hospitals.

While SCHIP has enjoyed wide support in Congress, members of the House and Senate had a vigorous debate over the last month about whether such a significant expansion of the program was appropriate.

Some Republicans in the House objected to the legislation, saying that it would undermine the original intent of the SCHIP legislation by expanding the program to adults, illegal immigrants, and families with higher incomes.

While the legislation bars the coverage of illegal immigrants, Republicans who spoke out against the legislation said that the lack of an adequate system to verify citizenship status would result in illegal immigrants gaining access to coverage.

The SCHIP law, which will infuse more than $30 billion into Medicaid over 5 years, will be paid for in large part through a 62-cent-per-pack increase in the federal tax on cigarettes, with proportional increases for other tobacco products.

Nearly 11 million low-income children will receive health coverage under the reauthorization and expansion of the State Children's Health Insurance Program, which was recently signed into law by President Barack Obama.

The legislation (H.R. 2), which received broad support in both the House and Senate, was signed on Feb. 4. The State Children's Health Insurance Program (SCHIP) is now reauthorized through September 2013 and will provide coverage to the approximately 6.7 million children currently covered by the program, as well as 4.1 million new children.

“This bill is only a first step,” Mr. Obama said at a signing ceremony for the SCHIP law. “The way I see it, providing coverage to 11 million children through [SCHIP] is a down payment on my commitment to cover every single American. And it is just one component of a much broader effort to finally bring our health care system into the 21st century.”

Dr. Thomas J.A. Lehman, chief of the division of pediatric rheumatology at the Hospital for Special Surgery in New York, praised the passage of the SCHIP law, saying that it would benefit many children by helping to improve their access to care.

But the bill falls short for children with rheumatic diseases, he said, because it fails to address the shortage of trained pediatric rheumatologists in the United States.

“Even before the passage of this bill, children with rheumatic disease faced difficulty finding a pediatric rheumatologist to care for them, and long waits for available new-patient appointments if they did find one,” he said. “SCHIP may make care more affordable for children with rheumatic disease, but it will not make care more available.”

On the same day he signed the SCHIP law, Mr. Obama directed the Centers for Medicare and Medicaid Services to rescind a Bush administration directive that limited the flexibility of states to set higher income eligibility standards for their SCHIP programs.

Under the newly enacted SCHIP law, states are allowed to cover children in families earning up to 300% of the federal poverty level while retaining access to full federal matching funds. It also gives states the option to cover prenatal care for pregnant women. How-ever, it also requires states to phase out coverage of any low-income parents and childless adults currently covered under the program.

The new law eliminates the 5-year waiting period for legal immigrant children and pregnant women to gain access to SCHIP benefits, a change supported by the American Academy of Pediatrics.

In an effort to measure and improve health care quality, the law calls for development of an initial core set of child health quality measures for children enrolled in SCHIP and Medicaid by Jan. 1, 2010. The measures would be designed to assess the effectiveness and availability of preventive services, prenatal care, and treatments for acute and chronic conditions.

Excluded from the law was a House-passed provision that would have prohibited the construction of new physician-owned specialty hospitals or expansion of existing physician-owned hospitals.

While SCHIP has enjoyed wide support in Congress, members of the House and Senate had a vigorous debate over the last month about whether such a significant expansion of the program was appropriate.

Some Republicans in the House objected to the legislation, saying that it would undermine the original intent of the SCHIP legislation by expanding the program to adults, illegal immigrants, and families with higher incomes.

While the legislation bars the coverage of illegal immigrants, Republicans who spoke out against the legislation said that the lack of an adequate system to verify citizenship status would result in illegal immigrants gaining access to coverage.

The SCHIP law, which will infuse more than $30 billion into Medicaid over 5 years, will be paid for in large part through a 62-cent-per-pack increase in the federal tax on cigarettes, with proportional increases for other tobacco products.

President Barack Obama has made health care a top priority in his first budget proposal by setting aside $634 billion over the next decade to begin reforming the health care system and expanding health care coverage to all Americans.

The proposed “reserve fund” for health care would get half of its funding from new revenue and half from savings. The Obama administration wants to introduce a competitive bidding process to the Medicare Advantage program, a move estimated to save more than $175 billion over 10 years.

The administration acknowledged that $634 billion would not be enough to fully fund a comprehensive reform of the health care system and that administration officials would need to work with Congress to find more money.

President Obama delivered the 140-page outline of his fiscal year 2010 budget proposal to Congress on Feb. 26; complete documents will be submitted to Congress in April.

Key among the reforms identified by the Obama administration is the need to change the Medicare physician payment formula. The President supports “comprehensive, but fiscally responsible” changes to the current payment system, according to the budget proposal. “The Administration believes Medicare and the country need to move toward a system in which doctors face better incentives for high-quality care rather than simply more care.”

The FY 2010 budget proposal will account for the fact that payments to physicians under Medicare will not be significantly cut as called for under current law.

“President Obama's budget proposal takes a huge step forward to ensure that physicians can care for seniors by rejecting planned Medicare physician payment cuts of 40% over the next decade,” American Medical Association President Dr. Nancy H. Nielsen said in a statement. “Looming widespread physi-cian shortages coupled with aging baby boomers highlight the urgent need for permanent Medicare physician payment system reform to preserve seniors' access to health care.”

America's Health Insurance Plans praised the President's commitment to health reform. However, the group criticized the proposal to make Medicare Advantage plans engage in a competitive bidding process, saying that significant cuts to Medicare Advantage would “jeopardize the health security of more than 10 million seniors” enrolled in the program and reverse payment incentives designed to improve quality of care.

The FY 2010 budget proposal also includes $76.8 billion in discretionary funding for the Health and Human Services department. At press time, Congress was still finishing up work on the FY 2009 budget for HHS.

The FY 2010 budget proposal for HHS includes more than $6 billion in cancer research funding at the National Institutes of Health, on top of the $10 billion in NIH funding that was included as part of the American Recovery and Reinvestment Act, enacted earlier this month.

The administration's budget proposal also aims to address physician shortages by spending $330 million to expand loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas.

Finally, the proposal aims to reduce drug prices by accelerating access to generic versions of biologic drugs. The administration said it would establish a regulatory, scientific and legal pathway for the creation of generic versions of biologic drugs.

The administration's fiscal year 2010 budget proposal is available at www.whitehouse.gov/omb/budget/

President Barack Obama has made health care a top priority in his first budget proposal by setting aside $634 billion over the next decade to begin reforming the health care system and expanding health care coverage to all Americans.

The proposed “reserve fund” for health care would get half of its funding from new revenue and half from savings. The Obama administration wants to introduce a competitive bidding process to the Medicare Advantage program, a move estimated to save more than $175 billion over 10 years.

The administration acknowledged that $634 billion would not be enough to fully fund a comprehensive reform of the health care system and that administration officials would need to work with Congress to find more money.

President Obama delivered the 140-page outline of his fiscal year 2010 budget proposal to Congress on Feb. 26; complete documents will be submitted to Congress in April.

Key among the reforms identified by the Obama administration is the need to change the Medicare physician payment formula. The President supports “comprehensive, but fiscally responsible” changes to the current payment system, according to the budget proposal. “The Administration believes Medicare and the country need to move toward a system in which doctors face better incentives for high-quality care rather than simply more care.”

The FY 2010 budget proposal will account for the fact that payments to physicians under Medicare will not be significantly cut as called for under current law.

“President Obama's budget proposal takes a huge step forward to ensure that physicians can care for seniors by rejecting planned Medicare physician payment cuts of 40% over the next decade,” American Medical Association President Dr. Nancy H. Nielsen said in a statement. “Looming widespread physi-cian shortages coupled with aging baby boomers highlight the urgent need for permanent Medicare physician payment system reform to preserve seniors' access to health care.”

America's Health Insurance Plans praised the President's commitment to health reform. However, the group criticized the proposal to make Medicare Advantage plans engage in a competitive bidding process, saying that significant cuts to Medicare Advantage would “jeopardize the health security of more than 10 million seniors” enrolled in the program and reverse payment incentives designed to improve quality of care.

The FY 2010 budget proposal also includes $76.8 billion in discretionary funding for the Health and Human Services department. At press time, Congress was still finishing up work on the FY 2009 budget for HHS.

The FY 2010 budget proposal for HHS includes more than $6 billion in cancer research funding at the National Institutes of Health, on top of the $10 billion in NIH funding that was included as part of the American Recovery and Reinvestment Act, enacted earlier this month.

The administration's budget proposal also aims to address physician shortages by spending $330 million to expand loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas.

Finally, the proposal aims to reduce drug prices by accelerating access to generic versions of biologic drugs. The administration said it would establish a regulatory, scientific and legal pathway for the creation of generic versions of biologic drugs.

The administration's fiscal year 2010 budget proposal is available at www.whitehouse.gov/omb/budget/

President Barack Obama has made health care a top priority in his first budget proposal by setting aside $634 billion over the next decade to begin reforming the health care system and expanding health care coverage to all Americans.

The proposed “reserve fund” for health care would get half of its funding from new revenue and half from savings. The Obama administration wants to introduce a competitive bidding process to the Medicare Advantage program, a move estimated to save more than $175 billion over 10 years.

The administration acknowledged that $634 billion would not be enough to fully fund a comprehensive reform of the health care system and that administration officials would need to work with Congress to find more money.

President Obama delivered the 140-page outline of his fiscal year 2010 budget proposal to Congress on Feb. 26; complete documents will be submitted to Congress in April.

Key among the reforms identified by the Obama administration is the need to change the Medicare physician payment formula. The President supports “comprehensive, but fiscally responsible” changes to the current payment system, according to the budget proposal. “The Administration believes Medicare and the country need to move toward a system in which doctors face better incentives for high-quality care rather than simply more care.”

The FY 2010 budget proposal will account for the fact that payments to physicians under Medicare will not be significantly cut as called for under current law.

“President Obama's budget proposal takes a huge step forward to ensure that physicians can care for seniors by rejecting planned Medicare physician payment cuts of 40% over the next decade,” American Medical Association President Dr. Nancy H. Nielsen said in a statement. “Looming widespread physi-cian shortages coupled with aging baby boomers highlight the urgent need for permanent Medicare physician payment system reform to preserve seniors' access to health care.”

America's Health Insurance Plans praised the President's commitment to health reform. However, the group criticized the proposal to make Medicare Advantage plans engage in a competitive bidding process, saying that significant cuts to Medicare Advantage would “jeopardize the health security of more than 10 million seniors” enrolled in the program and reverse payment incentives designed to improve quality of care.

The FY 2010 budget proposal also includes $76.8 billion in discretionary funding for the Health and Human Services department. At press time, Congress was still finishing up work on the FY 2009 budget for HHS.

The FY 2010 budget proposal for HHS includes more than $6 billion in cancer research funding at the National Institutes of Health, on top of the $10 billion in NIH funding that was included as part of the American Recovery and Reinvestment Act, enacted earlier this month.

The administration's budget proposal also aims to address physician shortages by spending $330 million to expand loan repayment programs for physicians, nurses, and dentists who agree to practice in medically underserved areas.

Finally, the proposal aims to reduce drug prices by accelerating access to generic versions of biologic drugs. The administration said it would establish a regulatory, scientific and legal pathway for the creation of generic versions of biologic drugs.

The administration's fiscal year 2010 budget proposal is available at www.whitehouse.gov/omb/budget/

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending by nearly $3 trillion over the next decade.

The health reform proposal, unveiled by the Commonwealth Fund on Feb. 19, is similar to plans outlined by President Barack Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed in April 2005 to study changes to the delivery and financing of health care.

The difference between the Commonwealth Fund's plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

“The report's central message is that we all stand to gain by taking bold action,” Ms. Schoen said at a press briefing to release the report. “With middle- and low-income families at risk, and businesses struggling to provide insurance for their employees, there is broad public support for significant reforms.”

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan.

The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010. The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020.

Costs incurred by the federal government would climb sharply during the first years of implementing these changes, but could be largely recouped by 2020, according to the report.

Under the proposal, the number of uninsured Americans would drop from about 48 million this year to about 4 million by 2012. Without reforms, the uninsured would increase to about 61 million by 2020, according to the Commonwealth Fund.

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending by nearly $3 trillion over the next decade.

The health reform proposal, unveiled by the Commonwealth Fund on Feb. 19, is similar to plans outlined by President Barack Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed in April 2005 to study changes to the delivery and financing of health care.

The difference between the Commonwealth Fund's plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

“The report's central message is that we all stand to gain by taking bold action,” Ms. Schoen said at a press briefing to release the report. “With middle- and low-income families at risk, and businesses struggling to provide insurance for their employees, there is broad public support for significant reforms.”

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan.

The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010. The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020.

Costs incurred by the federal government would climb sharply during the first years of implementing these changes, but could be largely recouped by 2020, according to the report.

Under the proposal, the number of uninsured Americans would drop from about 48 million this year to about 4 million by 2012. Without reforms, the uninsured would increase to about 61 million by 2020, according to the Commonwealth Fund.

A national health insurance exchange that would allow individuals to choose among private plans or a new nationwide public plan is the cornerstone of an expert panel's proposal to cover nearly all Americans within 2 years and slow the growth of health care spending by nearly $3 trillion over the next decade.

The health reform proposal, unveiled by the Commonwealth Fund on Feb. 19, is similar to plans outlined by President Barack Obama and Senate Finance Chairman Max Baucus (D-Mont.). It was developed by the Commonwealth Fund's Commission on a High Performance Health System, a 19-member panel formed in April 2005 to study changes to the delivery and financing of health care.

The difference between the Commonwealth Fund's plan and other policy proposals under consideration is that it provides the details on how to implement these broad policies, as well as the financial and clinical consequences of the policies, said Karen Davis, president of the Commonwealth Fund. Modeling and estimates outlined in the report were performed by the Lewin Group.

Under the proposal, individuals could choose to keep their own coverage or obtain new coverage through the insurance exchange. The public plan would initially be available to those seeking insurance on the individual market and those working for small employers, but by 2014 it would be available to the entire under-65 population, including individuals working for large employers. The public plan would offer benefits similar to the standard option available to federal employees and members of Congress, but at premiums at least 20% lower than those of private plans offered in small group markets.

Private plans would be required to guarantee the issue and renewal of policies regardless of health status, and to provide community-rate premiums. But they would be able to stay competitive with the public plan, according to Cathy Schoen, lead author of the report and senior vice president of the Commonwealth Fund, because they would be able to reduce costs such as underwriting and marketing.

“The report's central message is that we all stand to gain by taking bold action,” Ms. Schoen said at a press briefing to release the report. “With middle- and low-income families at risk, and businesses struggling to provide insurance for their employees, there is broad public support for significant reforms.”

The Commonwealth Fund proposal would impose an individual insurance mandate, but would cap premiums at 5% of income for low-income individuals and 10% for those in higher income tax brackets. It would also require employers to either offer coverage or contribute about 7% of payroll into a coverage trust fund.

On the payment side, the Commonwealth Fund proposal endorses moving away from the fee-for-service system currently in use for Medicare and Medicaid and replacing it with a number of reforms, including bundling payments for acute care episodes, increasing payment for primary care while decreasing payment for specialty and procedural care, and providing additional payments for practices that provide a patient-centered medical home.

Under the proposal, all payment reforms would apply to Medicare, Medicaid, and the new public health plan.

The proposal would also raise Medicaid rates to Medicare levels and invest in health information technology, population health, and comparative effectiveness research.

The proposal would not lower current costs but could slow the rate of health care spending, according to the Commonwealth Fund. Instead of health care spending rising 6.7% each year over the next 11 years, as predicted by current trends, the increase in spending would slow to about 5.5% per year if the reforms were implemented in 2010. The combination of the proposed insurance and payment system reforms could slow spending by nearly $3 trillion by 2020.

Costs incurred by the federal government would climb sharply during the first years of implementing these changes, but could be largely recouped by 2020, according to the report.

Under the proposal, the number of uninsured Americans would drop from about 48 million this year to about 4 million by 2012. Without reforms, the uninsured would increase to about 61 million by 2020, according to the Commonwealth Fund.

Researchers in North Carolina and New York are beginning to recruit volunteers as part of a huge federal study that will examine the effects of genes and environment on children's development.

The researchers plan to track 100,000 women through pregnancy and then follow their children through age 21 years as part of the National Children's Study. In addition to tracking their development, they will collect biological and environmental samples from participants; aiming to use the information to identify environmental and genetic factors that contribute to conditions such as autism, cerebral palsy, learning disabilities, birth defects, diabetes, asthma, and obesity.

Women are being recruited and enrolled from areas of the country that are representative of the diversity of U.S. children. Recruitment began in mid-January in the borough of Queens, N.Y., and in Duplin County, N.C. In April, five other centers will begin recruiting. Ultimately, the study is expected to recruit participants from 105 locations across the country.

The National Children's Study was authorized by Congress in the Children's Health Act of 2000 and has been developed by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Environmental Protection Agency.

“Findings from the study will ultimately benefit all Americans by providing researchers, health care providers, and public health officials with information from which to develop prevention strategies, health and safety guidelines, and possibly new treatments for disease,” Dr. Peter Scheidt, director of the National Children's Study, said during a press briefing on the study.

Researchers in North Carolina and New York are beginning to recruit volunteers as part of a huge federal study that will examine the effects of genes and environment on children's development.

The researchers plan to track 100,000 women through pregnancy and then follow their children through age 21 years as part of the National Children's Study. In addition to tracking their development, they will collect biological and environmental samples from participants; aiming to use the information to identify environmental and genetic factors that contribute to conditions such as autism, cerebral palsy, learning disabilities, birth defects, diabetes, asthma, and obesity.

Women are being recruited and enrolled from areas of the country that are representative of the diversity of U.S. children. Recruitment began in mid-January in the borough of Queens, N.Y., and in Duplin County, N.C. In April, five other centers will begin recruiting. Ultimately, the study is expected to recruit participants from 105 locations across the country.

The National Children's Study was authorized by Congress in the Children's Health Act of 2000 and has been developed by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Environmental Protection Agency.

“Findings from the study will ultimately benefit all Americans by providing researchers, health care providers, and public health officials with information from which to develop prevention strategies, health and safety guidelines, and possibly new treatments for disease,” Dr. Peter Scheidt, director of the National Children's Study, said during a press briefing on the study.

Researchers in North Carolina and New York are beginning to recruit volunteers as part of a huge federal study that will examine the effects of genes and environment on children's development.

The researchers plan to track 100,000 women through pregnancy and then follow their children through age 21 years as part of the National Children's Study. In addition to tracking their development, they will collect biological and environmental samples from participants; aiming to use the information to identify environmental and genetic factors that contribute to conditions such as autism, cerebral palsy, learning disabilities, birth defects, diabetes, asthma, and obesity.

Women are being recruited and enrolled from areas of the country that are representative of the diversity of U.S. children. Recruitment began in mid-January in the borough of Queens, N.Y., and in Duplin County, N.C. In April, five other centers will begin recruiting. Ultimately, the study is expected to recruit participants from 105 locations across the country.

The National Children's Study was authorized by Congress in the Children's Health Act of 2000 and has been developed by the National Institutes of Health, the Centers for Disease Control and Prevention, and the Environmental Protection Agency.

“Findings from the study will ultimately benefit all Americans by providing researchers, health care providers, and public health officials with information from which to develop prevention strategies, health and safety guidelines, and possibly new treatments for disease,” Dr. Peter Scheidt, director of the National Children's Study, said during a press briefing on the study.