By Julie Rovner, NPR News

This story comes from KaiserHealthNews partner NPR.

To reconcile or not to reconcile — when it comes to a health overhaul bill, that seems to be the biggest argument of the moment.

At issue is a process called budget reconciliation. By writing Obama’s health care plan as a budget bill, Democrats can prevent a Republican filibuster in the Senate and advance the bill with a simple majority instead of the 60-vote supermajority they no longer have.

Not surprisingly, that has Republicans crying foul.

Budget reconciliation, Sen. John Kyl (R-AZ) told reporters Tuesday, “was never designed for a large, comprehensive piece of legislation such as health care, as you all know. It’s a budget exercise, and that’s why some refer to it as the ‘nuclear option.’”

“The use of expedited reconciliation process to push through more dramatic changes to a health care bill of such size, scope and magnitude is unprecedented,” Sen. Orrin Hatch (R-UT) wrote in a letter to President Obama on Monday, urging him to renounce the possibility of trying to pass a bill using the procedure.

But health care and reconciliation actually have a lengthy history. “In fact, the way in which virtually all of health reform, with very, very limited exceptions, has happened over the past 30 years has been the reconciliation process,” says Sara Rosenbaum, who chairs the Department of Health Policy at George Washington University.

For example, the law that lets people keep their employers’ health insurance after they leave their jobs is called COBRA, not because it has anything to do with snakes, but because it was included as one fairly minor provision in a huge reconciliation bill, she says.

“The correct name is continuation benefits. And the only reason it’s called COBRA is because it was contained in the Consolidated Omnibus Budget Reconciliation Act of 1985; and that is how we came up with the name COBRA,” she says.

COBRA, which confusingly did not become law until 1986, was actually a much larger bill, including many nonhealth provisions and many other important health provisions as well (see chart). Among them was the so-called Emergency Medical Treatment and Active Labor Act (EMTALA), which requires hospitals that accept Medicare or Medicaid payments to at least screen patients who arrive for emergency treatment, regardless of their ability to pay.

Children’s Health

But the budget reconciliation process has been used for more far-reaching health policy changes as well, says Rosenbaum. The expansion of health insurance coverage for low-income children is a prime example.

“In 1980, children who were living at less than half the poverty level in the United States could not get a Medicaid card in half the states if they had two parents at home,” she says.

But via a series of budget reconciliation bills, beginning in 1984, Congress began expanding Medicaid coverage. In 1997, also in a budget reconciliation bill, it created the Children’s Health Insurance Program, known as CHIP.

Today, says Rosenbaum, who helped write many of the children’s health provisions in those bills, Medicaid and CHIP together cover 1 in every 3 children in the United States.

“So literally we’ve changed everything about insurance coverage for children and families, and we’ve changed access to health care all across the United States all as a result of reconciliation,” she says.

Medicare Changes

Budget reconciliation has also been an important tool for changing the Medicare program.

“Going back even close to 30 years, if you start say in 1982, the reconciliation bill that year added the hospice benefit, which is very important to people at the end of life,” says Tricia Neuman, vice president and director of the Medicare Policy Project for the Kaiser Family Foundation.

Over the years, budget reconciliation bills added Medicare benefits for HMOs, for preventive care like cancer screenings; added protections for patients in nursing homes; and changed the way Medicare pays doctors and other health professionals.

Because the point of budget reconciliation was usually to cut the deficit, the huge Medicare program was nearly always on the chopping block. But there’s another reason it became the bill of choice for other far-reaching changes.

“This happened primarily because it was the only train leaving the station, so if policymakers wanted to make a change in health policy, the only way to do it would be to amend a reconciliation bill, and that’s really why it happened,” says Neuman, a former congressional health policy staffer.

In fact, over the past three decades, the number of major health financing measures that were NOT passed via budget reconciliation can be counted on one hand.

And one of those — the 1988 Medicare Catastrophic Coverage Act — was repealed the following year after a backlash by seniors who were asked to underwrite the measure themselves. So using the process to try to pass a health overhaul bill might not be easy. But it won’t be unprecedented.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

The company has issued a voluntary recall of the three products:

• Queso Fresco

• Panela

• Requeson

Here is the full text of the advisory from the Washington State Department of Health in English and in Spanish.

Yakima-made cheese products linked to illnesses: consumers shouldn’t eat it

Listeria found in soft Mexican cheeses — manufacturer issues product recall

OLYMPIA  - State health officials are warning against eating soft Mexican cheese products made by a Yakima company after a Washington resident was confirmed with listeriosis.

The affected products made by the Yakima-based Queseria Bendita are subject to a voluntary recall.

Health officials linked the illness of a pregnant woman in King County to cheese products contaminated with Listeria. Samples taken from stores and from the plant confirmed the bacteria.

Listeria monocytogenes

The woman was ill in January and has since recovered.

The baby was delivered without complications; however, the disease caused by Listeria monocytogenes can be very serious.

Healthy people infected with Listeria may have diarrhea or flu-like illness — fever, headache, muscle aches. It can result in bloodstream infection or meningitis.

People with weak immune systems or other health conditions are at higher risk.

Women who are infected during pregnancy may pass it to their babies. This can result in early delivery or stillbirth.

Pregnant women and their newborns are 20 times more likely than healthy adults to get a Listeria infection.

Queseria Bendita has announced the recall of three different types of cheeses (www.fda.gov/Safety/Recalls/ucm201350.htm)

• Queso Fresco

• Panela

• Requeson

These products are sold in stores, and also supplied to many restaurants in the Pacific Northwest (www.oregon.gov/DHS/news/2010news/2010-0219a.pdf).

Health officials urge anyone who has these products not to eat them (www.doh.wa.gov/Publicat/2010_news/QuesBendList-sp.pdf).

Listeriosis (www.doh.wa.gov/ehsphl/factsheet/listeriosis.htm) is mostly a foodborne infection caused by Listeria bacteria.

Listeria is often found in soft cheeses, including feta, Brie, Camembert, Roquefort, bleu, and Mexican–style cheeses.

It’s commonly found in raw milk and other ready-to-eat foods — smoked fish, vegetables, salads, and items purchased at store delis. The bacteria may also be found in hot dogs and other processed meats.

There are some steps everyone can take to reduce the risk of acquiring a Listeria infection:

• Avoid unpasteurized milk or foods made from unpasteurized milk (including cheese).

• ·Wash raw vegetables thoroughly before eatingThoroughly cook raw food from animal sources, such as beef, pork, or poultry.

• Keep uncooked meats separate from vegetables and cooked or ready-to-eat foods.

• Wash hands, knives, and cutting boards after handling uncooked foods.

• Consume perishable and ready-to-eat foods as soon as possible.

The Department of Health recommends people avoid eating certain foods and practice safe food handling.

Information on food safety (www.doh.wa.gov/ehp/food/safetytips.html) is on the state health department’s Web site.

Online, there are several other tips on how to avoid listeriosis:

(www.kingcounty.gov/healthservices/health/communicable/diseases/listeriosis.aspx).

Spanish text:

Productos de queso hechos en Yakima asociados con enfermedades: los clientes no deberían comerlo

Se encontró listeria en quesos blandos de México – El fabricante solicita que se retire el producto

OLYMPIA – Los representantes estatales de la salud advierten a los residentes que no coman productos de queso blando tipo Mexicano hechos por una compañía de Yakima, después de que se confirmó listeriosis en un residente de Washington.

Los representantes de la salud encontraron que la enfermedad de una mujer embarazada en el condado de King fue asociado con productos de queso contaminado con la Listeria. Pruebas recolectadas de las tiendas y la compañía confirmaron la bacteria. La mujer estuvo enferma en enero y se ha recuperado desde entonces. El bebé nació sin complicaciones; sin embargo, la enfermedad causada por Listeria monocytogenes puede ser muy seria.

Las personas sanas infectadas con listeria pueden tener diarrea o síntomas parecidos a la gripe — fiebre, dolor de cabeza, dolores musculares. Puede resultar en una infección del flujo sanguíneo o la meningitis. Las personas con el sistema inmune comprometido u otras condiciones de salud también corren mayor riesgo. Las mujeres que se infectan durante el embarazo pueden transmitir la infección a sus bebés. El resultado puede ser nacimiento precoz o parto donde nace muerto el bebé. Las mujeres embarazadas y sus recién nacidos tienen 20 veces más la probabilidad de contraer una infección de listeria que los adultos sanos.

La Queseria Bendita ha anunciado que se retire el producto de tres tipos diferentes de quesos (www.fda.gov/Safety/Recalls/ucm201350.htm) — Queso Fresco, Queso Panela y Requeson. Estos productos se venden en las tiendas y también son distribuidos a muchos restaurantes en el Noroeste del Pacífico (www.oregon.gov/DHS/news/2010news/2010-0219a-sp.pdf). El Departamento de Salud recomienda con urgencia que quien tenga estos productos no lo consuma.

Listeriosis (http://www.nia.nih.gov/Espanol/Publicaciones/FDA/listeria.htm) principalmente es una infección alimenticia causada por la bacteria Listeria monocytogenes. La listeria se encuentra muchas veces en los quesos blandos, que incluyen el queso tipo feta, Brie, Camembert, Roquefort, azul y los quesos al estilo Mexicano como el queso no pasteurizado fresco y queso blanco. Es común encontrarlo en la leche cruda y otros alimentos preparados listos para comer — como el pescado ahumado, verduras, ensaladas y en los productos que se compran en la sección Deli de las tiendas o supermercados. También se puede encontrar la bacteria en los perros calientes y otras carnes procesadas.

Hay algunas cosas que usted puede hacer para reducir el riesgo de infección por listeria:

Evite el consumo de leche no pasteurizada ó alimentos hechos con leche no pasteurizada (incluyendo el queso)

Lave las verduras crudas con suficiente agua antes de comerlas.

Cocine por completo los alimentos crudos de fuentes animales, tales como la carne, el cerdo o el pollo.

Mantenga las carnes no cocidas separadas de las verduras y alimentos cocidos o listos para comer.

Lávese las manos, los cuchillos y los utensilios para cortar después de que haya tocado alimentos no cocidos.

Consuma los alimentos que se dañan rápido y los alimentos listos para comer lo antes posible.

El Departamento de Salud recomienda http://www.oregon.gov/DHS/news/2010news/2010-0219a.pdf (www.doh.wa.gov/Publicat/2010_news/QuesBendList-sp.pdf) que las personas eviten el consumo de ciertos alimentos y practiquen medidas seguras en la manipulación de los alimentos. La información acerca de la seguridad de los alimentos en food safety (www.doh.wa.gov/ehp/food/safetytips.html) se encuentra en la red de la página del Departamento de Salud. En la red se encuentra más información sobre formas de como evitar la infección por listeriosis how to avoid listeriosis (www.kingcounty.gov/healthservices/health/communicable/diseases/listeriosis.aspx).

###

Republican Weekly Address

Rep. Dave Camp of Michigan

Feb. 20, 2010

Hello, I’m Congressman Dave Camp from Michigan, and I serve as the lead Republican on the House Ways & Means Committee.

This is a time of economic uncertainty. Tens of millions of Americans are either looking for work or have just given up entirely. They’re looking to Washington for solutions. But instead it seems Washington keeps adding to their problems.

That’s why Americans are demanding that President Obama and the Democrats in control of Congress scrap their misguided plan of a government takeover of health care.

They don’t want a 2,000-page bill that threatens jobs and drives up health premiums; they already have enough challenges to deal with in their daily lives.

They want Washington to start over with a step-by-step approach to health care reform that begins with reducing costs and ensures they can keep their current plan if they like it.

For those families and small businesses looking for a sign that Washington is ready to wake up and find common sense on this issue, next week’s White House health care summit may not be it.

In fact, right now, Democrats are continuing to work behind closed doors, putting the finishing touches on yet another massive health care bill Americans can’t afford and don’t want.

If it is like Democrats’ other health care bills, this one will drive up premiums, destroy jobs, raise taxes, slash Medicare benefits, and add to our already-skyrocketing debt.

But this won’t be just another bill written in secret and signed off on by special interests. Democrats have admitted they are working on an undemocratic plan to jam this bill through Congress and subvert the will of the American people.

Democrats themselves are describing this latest maneuver as a ‘trick.’ If the starting point for this summit is more of the same backroom deals and partisan bills, then this meeting will likely be a charade.

From the beginning, Republicans have listened to the American people and offered reforms that lower health care premiums for families and small businesses.

The bill I and House Republicans proposed last fall implements common sense solutions focused on lowering costs. Our bill ensures nobody will be denied coverage on the basis of a pre-existing condition.

It gives states the tools to implement their own innovative reforms. And we put an end to the junk lawsuits that are forcing doctors to practice defensive medicine and drive up the cost of health insurance for all Americans.

The non-partisan Congressional Budget Office projects that the Republican health care bill would actually lower health insurance premiums across the board by up to 10 percent – about $2,000 per year. The Democrat bills do just the opposite – they increase the cost of health care.

Just as important, Republicans get the job done without cutting Medicare, without raising taxes, and without piling more debt on our kids and grandkids. All the details of our plan are available at healthcare.gop.gov.

Republicans remain ready to discuss these ideas with President Obama and move forward in a bipartisan way to lower health care costs.

But Americans’ health care is way too important to risk on a rushed backroom deal that puts federal bureaucrats in charge of your personal health care decisions.

Instead of hurting small businesses by forcing them to pay new taxes and meet new regulations, our focus should be on lowering their health care costs so that they can expand and hire more workers.

So in order to have a productive bipartisan conversation on health care, Democrats must first listen to the American people and scrap their massive government takeover of health care. We must go into the summit with a clean slate focused on making healthcare affordable.

That is what Americans are asking for, and that is what Republicans will continue to work for.

Thanks for listening.

Under the agreement, announced Wednesday, the neighborhood group will withdraw its appeal of Children’s Master Plan and agrees to support the Master Plan under the terms of the settlement..

The compromise ends a long battle between the hospital and the residents of the surrounding residential area over the hospital’s 1.5 million square-foot expansion plan.

The plan had met a setback last fall when the city’s hearing examiner concluded the plan was inappropriate for the surrounding residential neighborhood and “inconsistent with the City’s urban village strategy.”

Seattle Children’s has argued that the expansion was necessary to provide needed services and has suggested that without the expansion the hospital might have to move out of the city.

The plan is now before the Seattle City Council.

The provisions of the agreement include:

• Development square footage reduction: Children’s proposal to add 1.5 million square feet of development is reduced by 275,000 square feet.

• No expansion of Children’s campus across Sand Point Way: Children’s Hartmann property, located across Sand Point Way, is removed from the Major Institution Master Plan. It may be re-developed separately under more limited non-institutional zoning.

• Children’s is still committed to implementing community benefits for Hartmann such as retaining the Sequoia grove, providing landscaping screen, and building a pedestrian/bicycle access to the Burke-Gilman trail.

• Fifty-year restriction on campus expansion into residential areas: For a period of 50 years, Children’s agrees not to expand its boundaries into specified residential areas to the south, east, and north.

• Height limits: No more than 20 percent of the campus land area will be over 90 feet in height and no more than 10 percent will be over 125 feet in height in the new major institution boundary area. No structure will be above 140 feet in height.

• Added Setback: The minimum structure setback/garden edge setback along the entire NE 45th Street frontage must be 75 feet, increased from 40 feet for a portion of that area.

• Southwest Parking Garage underground: The Southwest parking garage will be constructed underground.

• 40th Ave. NE mitigation: The traffic signal at this location will be installed before occupancy of Children’s Phase 1 development. Children’s and LCC will work with the City on technology and design features to minimize cut-through traffic and queuing.
• Seattle Children’s and the LCC will establish a permanent committee to maintain a good working relationship and resolve any issues that surface in a timely manner.

This is an updated version of a story originally published Sept. 21, 2009. It was produced in collaboration with KaiserHealthNews partner NPR.

As Democrats have pushed for a comprehensive overhaul of the country’s health system, much of their plans and rhetoric have focused on providing coverage for America’s uninsured.

Although that effort stalled following Massachusetts Republican Scott Brown’s election to the Senate, President Barack Obama reiterated that imperative in his State of the Union address last month. “By the time I’m finished speaking tonight,” Obama said, “more Americans will have lost their health insurance. Millions will lose it this year.” He continued, “I will not walk away from these Americans.”

Here’s a look at who those Americans are.

How many Americans are uninsured?

According to the Census Bureau, in 2008, more than 46 million Americans, about 15 percent of the population, did not have health insurance. Some experts believe the number is now larger because of the recession.

Who are the uninsured?

Low income is a strong factor in identifying the uninsured. About two-thirds of Americans without coverage earn less than twice the federal poverty level, which is $22,050 for a family of four. Almost 25 percent of the uninsured are eligible for Medicaid, the federal-state program to cover the poor, but are not enrolled.

The vast majority of the uninsured – 80 percent – are in working families. And, a higher percentage of minorities are uninsured than whites. Nearly 80 percent are U.S. citizens, and 15 percent are undocumented immigrants.

The uninsured rate for people between the ages of 19 and 29 is 30 percent, the highest rate of any age group. Although many of these young people are working, their wages are often low, and they may find coverage unaffordable.

People whose employers don’t offer health benefits may also find more costly individual insurance plans too expensive. For others, prior medical conditions can restrict their access to coverage. And still others, believing that they are in good health and will not need it, opt not to buy insurance.

The uninsured are less healthy than the rest of the population. While about 60 percent report they are in excellent or very good health, 10 percent say they are in poor or fair health. That’s twice as many as those with coverage. The Centers for Disease Control and Prevention’s latest National Health Interview Survey, released in December, found that 7.2 percent of Americans put off “needed medical care” in the first six months of last year.

Even though the latest Census Bureau figures indicate that more children slipped into poverty in 2008, their uninsured rate dropped from 11 percent in 2007 to 9.9 percent in 2008. The decline reflected the expansion of two government programs: the Children’s Health Insurance Program and Medicaid.

Who pays the medical bills of the uninsured?

A 2008 study in the journal Health Affairs estimated that uninsured patients received about $86 billion in care in 2008. Of that amount, $30 billion came out of their pockets, leaving more than $56 billion in uncompensated care: $35 billion for hospitals; nearly $14 billion for community-based providers and close to $8 billion for private physicians.

Some of those uncompensated costs are recouped by hospitals and providers through government programs established to help subsidize care for the poor.

Charities also provide some support, such as funding free clinics. The remainder is shifted to insurers and their customers in the form of higher charges for health care. The Health Affairs study estimated that insurers and customers paid $14.1 billion toward the uninsured, although other groups, including the liberal health advocacy group Families USA, argue that insurers and customers bear even more of the burden.

How could Congressional health overhaul proposals affect the uninsured?

The Democratic proposals passed by the House and Senate – in limbo for now – would require most people to buy coverage. Those earning less than the poverty level, members of Indian tribes and people with religious objections to health insurance are among those who would not have to carry insurance. The House bill would also require many employers to offer coverage, and the Senate version would levy penalties on large employers that choose not to do so.

Both proposals would establish insurance “exchanges” with standardized benefits to enable individuals or businesses to compare and buy plans.

The bills would expand Medicaid coverage to include some people who don’t qualify now for various reasons, including their incomes, and would provide subsidies to help people (some earning up to four times the poverty level) buy insurance. At least 9 percent of uninsured Americans make too much money to get subsidies under the bills. And some people who receive subsidies may still find that the total cost of insurance, including co-payments and deductibles, to be either unaffordable or undesirable.

Illegal immigrants would not be eligible for the expanded Medicaid programs and would not receive subsidies. The Senate plan would bar illegal immigrants from buying insurance through the exchanges.

The bills also seek to reduce the number of uninsured by barring private insurers from rejecting applicants who have pre-existing conditions.

Republican proposals would make access more available to uninsured by promoting state-run high-risk pools and health exchanges to help consumers choose affordable plans. The GOP would also allow individuals to buy policies across state lines and provide refundable tax credits to buy insurance.

The CBO estimates that the Senate bill would reduce the number of uninsured by about 31 million, the main GOP plan would reduce the number by about 3 million.

Sources:

• The Census Bureau: Health Insurance Coverage 2008

• The Congressional Budget Office analysis of the Republican House plan, Nov. 4, 2009

• The Congressional Budget Office analysis of the Senate bill, Dec. 19, 2009

• CDC: January-June 2009 National Health Interview Survey

• Economic Policy Institute Report

• Families USA: Hidden Health Tax

• Health Affairs: Covering The Uninsured In 2008

• Kaiser Family Foundation: Side-By-Side Analysis of Major Health Care Reform Proposals

• Kaiser Family Foundation: The Uninsured: A Primer

• Kaiser Health News: Caught In The Middle: Making Too Much – And Too Little – To Benefit From Health Care Changes

• Urban Institute: How Will the Uninsured be Affected by Health Reform?

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.