Senator Shaheen Floor Statement on Health Care Reform, July 29, 2009

Mr. President, time and time again, we have heard that our health care system is not working. Costs are too high, outcomes are too poor, and access is too limited. I agree with so many of my colleagues who have spoken out over the last several weeks that the status quo is not sustainable. We must take action. We must all work together to ensure that every American has access to quality and affordable health care.

Everyone deserves stable health care coverage that they can count on, regardless of the job they hold or the curveballs that life may throw. All Americans should be able to count on insurance premiums and deductibles that will not continue to rise and eat away more and more of their paychecks. All Americans deserve stable health care that lets them keep their doctor and their health care plan, especially if they trust their doctor and their plan and they have built a relationship with both.

Let me be clear. Health care costs are too high. Every day, in New Hampshire and across our country, families are struggling. The crushing costs of health care threaten their financial stability, threaten leaving them exposed to higher premiums and deductibles, and put them at risk for possible loss of health insurance coverage and, too often, even bankruptcy. Studies have shown that medical problems contribute to over 40 percent of the personal bankruptcies in the United States today.

Unfortunately, too many of us are just one heart attack away from a potential personal financial disaster due to the cost of health care and inadequate coverage.

In 2007, our Nation spent $2.2 trillion, or 16.2 percent of the gross domestic product, on health care. This is twice the average of other developed nations. As a country, the quality of care we receive is no better. We still lag behind other countries when it comes to efficiency, access, patient safety, and adoption of information technology.

I have one proposal that I think will help with our current health care situation and, along with Senator Susan Collins, we have introduced a bipartisan piece of legislation that we are calling the Medicare Transitional Care Act of 2009. It would help address our health care crisis.

The Medicare Transitional Care Act would improve quality of care while saving money. This bill aims to reduce costly hospital readmission and improves the care patients receive while cutting Medicare costs. The legislation will help keep seniors who are discharged from the hospital from having to go back. Simply put, it provides transition planning for seniors on Medicare who are leaving the hospital and, in doing so, it will improve the health care we offer our seniors, while saving money; savings that experts estimate to be $5,000 per Medicare beneficiary.

According to a report from the New England Journal of Medicine, almost one third of Medicare beneficiaries discharged from the hospital were rehospitalized within 90 days. One-half of the individuals rehospitalized had not visited a physician since their discharge, indicating a real lack of followup care.

The study also estimated that, in 2004, Medicare spent $17.4 billion on these unplanned rehospitalizations. This problem is costly for our government and troublesome for our seniors. The good news is, it is avoidable.

Research shows the transition from the hospital to the patient's next place of care--whether that is home, a nursing facility or a rehabilitation center--can be complicated and risky. This is especially true for older individuals with multiple chronic illnesses. These patients talk about difficulty in remembering instructions for medications, confusion over the correct use of medications, and general uncertainty about their own condition.

Seniors need support and assistance to manage their health during the vulnerable time after discharge from a hospital to ensure they are not rehospitalized. This legislation provides that support. This is the type of commonsense legislation that needs to be included in our health reform. It saves money and it improves quality.

I am proud that in New Hampshire we have two exciting health reform initiatives underway to address health care costs and improve quality. We have a medical home pilot project with close to 40,000 patients across the State. The medical home pilot is changing the way health care is delivered and the way we think about health care, making it much more patient centered. It is encouraging doctors to collaborate with other providers to create health care plans for each patient. They also utilize electronic medical records to reduce errors, improve quality, and contain costs. It is a new way of practicing medicine, and it is one that will deliver better care for less money.

New Hampshire is also the home for the Dartmouth Institute for Health Policy, which is the leader in comparative effectiveness research. It helps empower patients to make vital health care decisions.

The research provided by the Dartmouth Atlas Project has provided critical analysis about the difference in the amounts of money we spend on health care in different regions of the country. The research also shows that these differences in spending have no impact on health outcomes. I want to repeat that because I think this goes to the crux of one of the problems we are having with our health care system. What the research at the Dartmouth Atlas Project and other places around the country has shown is that differences in spending have no impact on health outcomes.

It is amazing to me that regions that spend more money on health care do not necessarily produce better healthcare results. We must address this inadequacy as we turn to health care reform, and we must empower patients to make them equal partners in their health care decisions. Research supports this point. In fact, it shows that up to 40 percent of the time, patients who participate in decisions related to their care will choose procedures that are less invasive and less costly. These choices produce better outcomes with higher rates of satisfaction. We must remember to keep patients at the center of this debate on health care reform.

Finally, people are struggling because of the high cost of health insurance. It is a burden to families in New Hampshire and across the country. In my State, there are nearly 150,000 people who have no health insurance, even more who are underinsured with policies that do not provide the coverage they need. For those who do have insurance, the costs are very high.

Over the past 9 years, premiums for employer-sponsored health insurance have more than doubled--a growth rate that is four times faster than cumulative wage increases. This has created a huge burden on middle-class families.

In my State of New Hampshire, from 2002 to 2006, there was a 41.6-percent increase in the premiums businesses paid for an individual plan for their workers. For our smallest businesses, those with fewer than 10 employees, the increase was almost double that, a 70.6-percent increase. That is staggering, and that disturbing increase in premiums caused what one would expect: Many small businesses dropped their coverages. That is unacceptable. Health care costs and insurance costs must be contained.

Chuck Engborg from Ashland, NH, talked about the high cost of insurance and the instability of the insurance market at a recent health care roundtable I attended in New Hampshire.

Almost 30 years ago, Chuck was diagnosed with type 2 diabetes. He suffered a mild stroke, a heart attack, and he has had five bypass surgeries. He also developed a complication from his diabetes that required him to walk on crutches for 3 years. Despite all of that, Chuck has lived to tell his tale, but the turning point for him came 2 years ago when his wife Kathy was laid off from her job. They had to purchase COBRA health insurance and found that the cost of COBRA, plus high copays, amounted to 50 percent of their annual income. In the meantime, Kathy also suffered a heart attack that resulted in her own bypass surgery. They are two of the lucky ones because Kathy has found new employment and they have health insurance through her job. But that health insurance comes with a very high annual deductible.

I heard a similar situation from a woman named Laura Mick from Manchester who also struggles with high insurance costs. While she has not had surgery in 16 years, the insurance companies are able to target her and charge her outrageous rates under a preexisting condition loophole.

Laura was born with a cyst on her brain. Fortunately, it was recognized by doctors a few weeks after she was born, and at 1 month old she underwent surgery. A shunt was inserted into her brain to drain fluid and another surgery at 16 years old to relieve the pressure. She is currently an active young woman in her late twenties, and she works hard to maintain a healthy lifestyle. But she is not being rewarded for it. She has been denied from every insurance company in New Hampshire unless she accepts the high-premium, high-deductible plans.

We need to enact health care reform to help people like Chuck and Laura. We need to ensure that every American has access to affordable, quality health care they can count on when they need it. This is a basic principle on which many business groups, labor organizations, and medical professionals now agree. We must take steps as a nation to reduce the costs of health care while improving the quality of care Americans receive.

Health care reform is economic reform, and I believe that for our economy to truly recover and prosper, we must help middle-class families, businesses, and Federal, State, and local governments cope with the skyrocketing health care costs. The status quo is not working, and it is clearly not sustainable.

We need to act, and we need to act soon. I look forward to working with my colleagues on both sides of the aisle to enact health reform that addresses the health care cost crisis and ensures quality, affordable health care for everyone in New Hampshire and across this country.