Health Care



Medical Research and R&D

Congresswoman Speier is a strong and vocal proponent of robust funding for medical research and research and development (R&D).  Instead of funding one of the most dynamic and important sectors of our economy, we are starving it.  We are killing the goose that laid the golden egg.  In fact, this goose lays multiple eggs – good jobs, longer and healthier lives, and lower health care spending. 

The US medical innovation sector employs 1 million Americans, generates $84 billion in salaries annually, and exports $90 billion in goods and services.  The economic value of gains in US life expectancy has been estimated at roughly $95 Trillion from 1970-2000. Since 1990, our nation has gained about one year of longevity every six years with the help of NIH research.

Unfortunately, funding for the National Institutes of Health (NIH) has declined by 25% in real dollars over the last 10 years.  And while the United States still leads the world in patents and overall research, China is gaining fast, having recently passed Japan in total R&D investment for the number two spot — and they have no intention of stopping there. Chinese investment more than quintupled from 2000 to 2010 while America’s spending only rose by 22% over that same period.   Should current trends continue, China could surpass our investment in R&D within a decade.   

Congresswoman Speier:

·         Is a Co-Chair of the Congressional Biomedical Research Caucus, a forum to highlight some of the essential – and incredible—work being done at our leading research institutions, with funding from NIH and other critical federal programs;

·         Is a member of the Congressional Research and Development Caucus that increases awareness and supporting the economic, societal, and security benefits derived from federal R&D investment; and

·         Sponsored a special order hour on the House floor last December to highlight why this funding is so important;

·         Consistently advocates for funding for these crucial programs and agencies during the annual appropriations process.

Affordable Care Act (ACA)

At the close of the extended enrollment on April 15, 2014, at least 8 million Americans had signed up for the ACA.  California lead the way with over 1.39 million signed up for private health insurance through the exchange, greatly surpassing both the baseline projection of 580,000 and the enhanced projection of 830,000.  Medi-Cal enrolled approximately 1.9 million through the end of March bringing the total number of Californians enrolled through Medi-Cal and the exchange to over 3 million. 

As implementation of the ACA continues, there is no doubt that improvements will need to be made.  For example, Congresswoman Speier is an original cosponsor of the Fair Access to Health Care Act that would adjust the current phase-out of premium tax credits for geographic areas with high costs-of-living, ensuring parity and affordable access to health coverage regardless of where individuals live.  However, we should not revert to a time where insurers could rescind your coverage if you got sick and deny it if you had a preexisting condition. 

Congress seems trapped in a dysfunctional box of its own making, fighting many of the same battles while avoiding some of the issues we could actually address in a bipartisan way. 

For example, the House Oversight and Government Reform Committee, on which Speier serves, recently held its 26th hearing on the Affordable Care Act.  And on the House floor, there have been more than 50 votes to repeal or dismantle the law.  These were not actions to perfect or improve the law.

Although there are some in Congress who are compelled to continue to undermine the law, the latest enrollment numbers prove that there is a genuine need and demand amongst the American people for affordable health care.

 

If I do not purchase health insurance in 2014, will I have to pay a fine?

Yes.  Beginning in 2014, if you do not purchase health insurance coverage for yourself and your dependents or qualify for a hardship exemption, you will have to pay a penalty.  Here’s how to figure out how much you’ll have to pay.

For 2014, the amount of the penalty is:

·         The greater of either:

o    1% of your household income that is above the tax return filing threshold for your filing status, or

o    You family’s flat dollar amount, which is $95 per adult and $47.50 per child, limited to a family maximum of $285,

 

·         But capped at the cost of the national average premium for a bronze level health plan available through the Marketplace in 2014. 

Any penalty that you owe must be paid when you file your 2014 income tax return, which is due April 2015.

The below table can help you figure out your tax return filing threshold:

2014 Federal Tax Filing Requirement Thresholds

Filing Status

Age

Must File a Return If Gross Income Exceeds

Single

Under 65

$10,150

 

65 or older

$11,700

Head of Household

Under 65

$13,050

 

65 or older

$14,600

Married Filing Jointly 

Under 65 (both spouses)

$20,300

 

65 or older (one spouse)

$21,500

 

65 or older (both spouses)

$22,700

Married Filing Separately 

Any age

$3,950

Qualifying Widow(er) with Dependent Children

Under 65

$16,350

 

65 or older

$17,550

 

Examples of How to Calculate Your Penalty:

Example 1: Single individual with $40,000 income

George, an unmarried individual with no dependents, does not have health insurance coverage for any month during 2014 and does not qualify for an exemption.  For 2014, George’s household income is $40,000 and his filing threshold is $10,150.

·         To determine his payment using the income formula, subtract $10,150 (filing threshold) from $40,0000 (2014 household income).  The result is $29,850.  One percent of $29,850 equals $298.50.

o    Because $298.50 is greater than the $95 flat fee, George’s penalty for 2014 is $298.50.

Example 2: Married couple with 2 children, $70,000 income

Stephanie and Jonathan are married and have two children under 18. They do not have health insurance coverage for any family member for any month during 2014 and no one in the family qualifies for an exemption. For 2014, their household income is $70,000 and their filing threshold is $20,300.

·         To determine their payment using the income formula, subtract $20,300 (filing threshold) from $70,000 (2014 household income). The result is $49,700. One percent of $49,700 equals $497.

o    Because $497 is greater than that flat dollar amount of $285, Stephanie and Jonathan’s penalty is penalty is $497.

 

Do I qualify for a hardship exemption from purchasing health insurance in 2014?

Instructions on how to report health care coverage exemptions will be available closer to the start of the 2015 tax filing season.

·         When it becomes available, the IRS will first release draft forms and instructions here: Draft forms and instructions

·         You may also submit comments on draft forms and instructions here: Form for commenting on draft forms and instructions

 

Here are the current categories of hardship exemptions:

1)      an individual experiences financial, domestic, or other circumstances that prevent him/her from obtaining coverage or the expense of purchasing coverage would have caused him/her to experience serious deprivation of food, shelter, clothing, or other necessities;

2)     an individual is unable to afford coverage based on projected household income, where coverage would exceed 8% of projected household income;

3)     an individual whose income is below the filing threshold (and therefore eligible for the filing threshold exemption), except that the individual claimed a dependent with a filing requirement and had household income exceeding the filing threshold as a result;

4)     an individual is ineligible for Medicaid based on a state's decision not to carry out the ACA expansion;

5)     an individual is identified eligible for affordable self-only employer-sponsored insurance (ESI), but the aggregate cost of the ESI for all the employed members of the family exceeds 8% of household income;

6)     an individual is an Indian eligible for services through an Indian health care provider, but is not eligible for an exemption based on being a member of an Indian tribe, or is eligible for services through the Indian Health Service;

7)     an individual who enrolls in a plan offered through an exchange prior to the close of the open enrollment period (March 31, 2014) will be able to claim a hardship exemption for the months prior to the effective date of the individual's coverage; or

8)     an individual has been notified that his/her plan will not be renewed and believes that the available plan options are more expensive than the plan that was not renewed.

For more information, please visit the IRS’s website at: http://www.irs.gov/uac/ACA-Individual-Shared-Responsibility-Provision-Exemptions

 

Medicare

More than forty years ago, our nation created the Medicare system and entered into an agreement with every single American - if you work hard and pay into the system, you are entitled to Medicare benefits when you turn 65 or become disabled. Today, more than 47 million people receive Medicare benefits - nearly 50% of who earn less than $23,000 each year. Congresswoman Speier considers this system to be absolutely sacred and is committed to doing all she can to ensure that it is here for decades to come. That said, Medicare is certainly in the line of fire these days.

The Republicans, under the leadership of Paul Ryan, have proposed a Medicare plan which would replace traditional Medicare with a voucher system beginning in 2024. The voucher would grow more slowly than health care costs leaving seniors at the mercy of insurance companies and facing higher out of pocket costs.

This is not what seniors have worked for and deserve, nor what Congress envisioned when it created the program decades ago. That is why Speier has consistently voted against efforts to cut Medicare benefits or transfer it into a voucher system, and will continue to oppose these efforts.

Speier believes we must do more to protect the Medicare system, not undermine it. As the baby boomers age, there are fewer contributing workers for each eligible Medicare recipient. This is why Speier is committed to implementing common sense reforms that will ensure adequate access to care, increased efficiency and a Medicare system that is available for decades to come. She believes we must do more to eliminate Medicare fraud which costs our nation nearly $60 billion each year, reduce medical errors and infections which not only cost our system $45 billion annually but lead to 100,000 deaths each year, and build on the measures included within health reform which ensure that doctors operate more efficiently while continuing to make quality patient care their number one priority.

H.R. 2914, the Promoting Integrity in Medicare Act

One reform to Medicare Speier is championing is the end to physician self-referrals. Speier’s legislation H.R. 2914, the Promoting Integrity in Medicare Act, will cut wasteful Medicare spending on unneeded or even harmful CTs, MRIs, lab tests, radiation treatments, or physical therapy. Current law bars physicians from referring Medicare patients for certain health care services in which they have a financial interest, but the in-office ancillary services (IOAS) exception allows physicians to be reimbursed for some services, including CT, MRI and PET scans, anatomic pathology, radiation oncology and physical therapy that they provide within their own offices.  Today, many physicians purchase expensive advanced imaging machines or bring pathologists or physical therapists in house because with a fee for service payment system, they know that they are big profit drivers.  A recent Government Accountability Office report has confirmed that physician self-referral for advanced imaging services is costing Medicare more than $100 million in unnecessary spending each year.

The in-office exception was originally created so that physicians could continue to render non-complex services, like X-Rays, within their offices at the same time as the patient’s visit, and was never intended to include these complex and costly services.  Instead, this exception has created perverse incentives and led to overutilization:


·         Doctor-owned imaging machines have been used four times more than those used by radiologists since 2000.

 

·         Self-referring non-radiologist physicians perform up to eight times as many imaging studies as physicians who refer their patients to radiologists.


·         Between 1998 and 2005, the number of physicians referring patients for radiological testing within their own practices grew at triple the rate of the same exams in other settings.

·         Only 10% of advanced imaging services are performed on the same day as an office visit.

Closing the IOAS loophole in the Stark Law for anatomic pathology, radiation therapy, advancing imaging, and physical therapy services would produce over $6 billion in savings over 10 years according to the President’s Fiscal Year 2015 budget.  Enacting this legislation will save Medicare billions of dollars and will promote more efficient treatment without comprising a patient’s quality of care.

Childhood Cancer
Congresswoman Speier is a proud member of the Congressional Childhood Cancer Caucus.

For many cancer survivors and their families, geographic distance from cancer centers is a barrier to receiving appropriate specialized care. Her bill adopts many of the IOM recommendations for improving follow-up care for cancer survivors. It also expands cancer control programs, including surveillance and comprehensive control programs within the CDC that will support states’ efforts in this area. In addition, it establishes grants at the National Institutes of Health so that research can be conducted on disparities in survivorship and the development of systems to monitor and care for cancer survivors. Of particular importance, it creates grants to establish and operate childhood cancer clinics so that comprehensive long-term follow up services are available for a larger number of childhood cancer survivors.

While we are making progress towards the elimination and more effective treatment of children's cancer, we must also dedicate greater effort towards effectively addressing the long-term effects of these conditions. This bill would help ensure that those who have bravely struggled and conquered cancer as children have access to the resources and infrastructure they need as the longer term consequences of their illness surface, sometimes years down the road.