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With Liberty and Access for All


The latest estimates from the National Coalition on Health Care ( show that 46 million Americans—nearly 16% of the population—have no health insurance, and those numbers are increasing. The federal government has been flirting with addressing this growing problem for years, but 2007 may be the turning point, when key legislation may help turn the rising tide of uninsured and underinsured patients.

“A couple of things create a more favorable milieu for this,” explains Eric Siegal, MD, regional medical director, Cogent Healthcare, Madison, Wis., and chair of SHM’s Public Policy Committee. “The first is that Massachusetts did it on their own—states are no longer waiting for Congress to do something. The second is that, with every passing year, there’s increased pressure to do something.”

Regardless of why this is happening now, some promising legislation has been introduced in Congress that may provide the beginnings of a solution.

Policy Points

Deadline Approaching for Obtaining Your NPI

The deadline for obtaining a National Provider Identifier (NPI) is May 23. An NPI is required for use in standard health transactions, as mandated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA-covered entities, such as providers completing electronic transactions, healthcare clearinghouses, and large health plans, must use only the NPI to identify covered healthcare providers in standard transactions. For more information on the NPI, visit the Centers for Medicare and Medicaid Services NPI page at You can apply for an NPI online at, or you can call the NPI enumerator at (800) 465-3203.

Get the Facts with CMS Medicare Physician Fee Schedule Fact Sheet

The latest Medicare Physician Fee Schedule Fact Sheet is available online from the Centers for Medicare and Medicaid Services. It includes information about how payment rates for individual services are calculated. Factors influencing 2007 payment rates, including the effects of the Five Year Review of physician work relative value units (RVUs) and other refinements, and specifies that the new conversion factor for 2007 is $37.8975 as a result of the SHM-supported Tax Relief and Health Care Act of 2006.

To download the fact sheet, visit

Get a Tdap Vaccine

Have you gotten a Tdap vaccine yet? The CDC now recommends that all hospital and ambulatory care workers who have direct contact with patients should consider receiving a single dose of the tetanus, diphtheria, and pertussis (Tdap) vaccine, which was licensed in 2005. A survey of infection-control practitioners in pediatric hospitals shows that 90% of them had been exposed to pertussis over a five-year period.

The Health Partnership Act

Perhaps the most promising legislation on healthcare access is an innovative, bipartisan, bicameral effort known as the Health Partnership Act, which proposes a federal-state partnership to address the issue.

Identical bills have been introduced in each house. The Health Partnership Act (S. 325) was introduced in the Senate by Jeff Bingaman (D-N.M.) and George Voinovich (R-Ohio), and the Health Partnership Act through Creative Federalism (HR 506) was introduced in the House by Tammy Baldwin (D-Wis.), Tom Price (R-Ga.), and John Tierney (D-Mass.). Similar legislation was introduced by some of these same parties in the last Congress; though the bill died before action was taken, it was immediately reintroduced in the new Congress this January.

If enacted, the Health Partnership Act would give state and local governments the opportunity to implement their own solutions for providing coverage to uninsured populations, allowing them to address the unique needs that exist within their boundaries. Interested states, groups of states, or even parts of states would apply for five-year federal grants by submitting proposals that demonstrate how their plans would reduce the number of uninsured and improve healthcare quality. Each plan would include information on the appropriate use of information technology to improve the availability of evidence-based medical and outcomes data to providers and patients.

The act would establish a new bipartisan State Health Innovation Commission (SHIC), which would be part of the Department of Health and Human Services. This commission would review the state proposals and submit to Congress a list of recommended applications. It would also work with an established organization—possibly the Institute of Medicine—to develop performance measures and goals regarding coverage, quality, and cost of state programs.

Participating states would eventually report their progress to the SHIC, which would then report to Congress on whether each state was meeting the goals of the act and would then recommend further action.

Giving individual states the flexibility to create their own programs could generate new ideas and would ultimately reveal which programs work best. “We’re not expecting states to hit the ball out of the park the first time, but it’s a start,” says Dr. Siegal. “It’s a step in the right direction.”

SHM supports the Health Partnership Act and has sent a letter of support to Senate sponsors. “This [legislation] may or may not be the most expedient way to get it done,” says Dr. Siegal. “But SHM supports this legislation and is currently drafting a letter of support for the House version.”

The Healthy Americans Act

Another, more comprehensive, bill was introduced in the Senate by Ron Wyden (D-Ore.) in December 2006.

The Healthy Americans Act would require businesses to replace their current health benefits with an increase in wages equal to the amount spent on health insurance premiums. It would require all employees to use these increased wages to purchase their own health plans and would provide subsidies to low-income workers to help pay their premiums.

Those employers not currently providing any health benefits would be required to begin making phased-in “Employer Shared Responsibility Payments,” which would be used to ensure that everyone is able to afford their health plans by funding premium reductions.

Wyden’s bill would have each state establish a Health Help Agency to educate residents about private health plans, to administer enrollment, and to assist income-eligible enrollees with sliding scale premium reductions. These agencies would be funded by the federal government and insurance companies.

Finally, insurance companies would be required to cover every individual who chooses to enroll and would not be allowed to raise prices or deny coverage if individuals are sick.

Some State-Level Solutions

Some states—Massachusetts, for one—have already taken action, implementing their own innovative policies and programs to expand coverage for their populations. Maine, Massachusetts, and Vermont have instituted comprehensive healthcare reform; Arkansas, Montana, New Mexico, Oklahoma, Rhode Island, Tennessee, and Utah have all implemented some form of public-private partnerships; and Illinois and Pennsylvania have initiatives that cover all children.

Maine, Massachusetts, and Vermont all use Medicaid funds to partially subsidize healthcare coverage for families with annual incomes as high as $53,000.

For details on all current state initiatives for healthcare coverage, download the report “State of the States 2007: Building Hope, Raising Expectations” from the Web site of the State Coverage Initiatives at

Why Hospitalists Should Care

Providing healthcare coverage to the uninsured is one of SHM’s public policy priorities. “There really is a crisis out there, and hospitalists are on the front line of it every day,” says Dr. Siegal.

As former SHM President Mary Jo Gorman states in SHM’s letter of support for the Senate’s Health Partnership Act: “Many hospitalist programs exist to manage the burgeoning population of uninsured and underinsured patients who require hospitalization. These patients are more likely to delay seeking care until their illnesses deteriorate to the point that they need emergency care. In many communities, hospitalists have become the safety net for this vulnerable patient population.”

For further information about federal legislation for improved access and to see if your representatives are cosponsors, visit SHM’s Legislative Action Center at TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

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