Raul Grijalva on Health Care
Democratic Representative (AZ-7)
Voted NO on the Ryan Budget: Medicare choice, tax & spending cuts.
Proponent's Arguments for voting Yes:
[Sen. DeMint, R-SC]: The Democrats have Medicare on a course of bankruptcy. Republicans are trying to save Medicare & make sure there are options for seniors in the future. Medicare will not be there 5 or 10 years from now. Doctors will not see Medicare patients at the rate [Congress will] pay.
[Sen. Ayotte, R-NH]: We have 3 choices when it comes to addressing rising health care costs in Medicare. We can do nothing & watch the program go bankrupt in 2024. We can go forward with the President's proposal to ration care through an unelected board of 15 bureaucrats. Or we can show real leadership & strengthen the program to make it solvent for current beneficiaries, and allow future beneficiaries to make choices.
Opponent's Arguments for voting No:
[Sen. Conrad, D-ND]: In the House Republican budget plan, the first thing they do is cut $4 trillion in revenue over the next 10 years. For the wealthiest among us, they
give them an additional $1 trillion in tax reductions. To offset these massive new tax cuts, they have decided to shred the social safety net. They have decided to shred Medicare. They have decided to shred program after program so they can give more tax cuts to those who are the wealthiest among us.
[Sen. Merkley, D-OR]: The Republicans chose to end Medicare as we know it. The Republican plan reopens the doughnut hole. That is the hole into which seniors fall when, after they have some assistance with the first drugs they need, they get no assistance until they reach a catastrophic level. It is in that hole that seniors have had their finances devastated. We fixed it. Republicans want to unfix it and throw seniors back into the abyss. Then, instead of guaranteeing Medicare coverage for a fixed set of benefits for every senior--as Medicare does now--the Republican plan gives seniors a coupon and says: Good luck. Go buy your insurance. If the insurance goes up, too bad.
Reference: Ryan Budget Plan;
; vote number 11-HV277
on Apr 15, 2011
Voted NO on repealing the "Prevention and Public Health" slush fund.
Congressional Summary:Amends the Patient Protection and Affordable Care Act (PPACA) to repeal provisions establishing and appropriating funds to the Prevention and Public Health Fund (a Fund to provide for expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs). Rescinds any unobligated balanced appropriated to such Fund.
Proponent's Argument for voting Yes:
[Rep. Pitts, R-PA]: Section 4002 of PPACA establishes a Prevention and Public Health Fund, which my bill, H.R. 1217, would repeal. The PPACA section authorizes the appropriation of and appropriates to the fund from the Treasury the following amounts:
We have created a slush fund from which the Secretary of HHS can spend without any congressional oversight or approval. I would suggest to my colleagues that, if you wanted more funding to go towards smoking cessation or to any other program, the health care law should have contained an explicit authorization. By eliminating this fund, we are not cutting any specific program. This is about reclaiming our oversight role of how Federal tax dollars should be used.
- $500 million for FY 2010
- $750 million for FY11
- $1 billion for FY12
- $1.25 billion for FY13
- $1.5 billion for FY14
- and for FY15 and every fiscal year thereafter, $2 billion.
Opponent's Argument for voting No:
Reference: To repeal the Prevention and Public Health Fund;
; vote number 11-HV264
on Apr 13, 2011
[Rep. Waxman, D-CA]: This bill represents the Republicans' newest line of attack to disrupt, dismantle, and to ultimately destroy the Affordable Care Act. For many years, Republicans have joined with Democrats in supporting programs to prevent disease, to promote health and, in turn, to cut health care costs. But today, the House will vote to end funding for the first and only Federal program with dedicated, ongoing resources designed to make us a healthier Nation.
Voted YES on expanding the Children's Health Insurance Program.
Proponent's argument to vote Yes:
- Reauthorizes State Children's Health Insurance Program (SCHIP) through FY2013 at increased levels.
- Gives states the option to cover targeted low-income pregnant women
- Phases out coverage for nonpregnant childless adults.
Rep. FRANK PALLONE (D, NJ-6): In the last Congress, we passed legislation that enjoyed bipartisan support as well as the support of the American people. Unfortunately, it did not enjoy the support of the President, who vetoed our bill twice, and went on to proclaim that uninsured children can simply go to the emergency room to have their medical needs met. As the Nation moves deeper into a recession and unemployment rates continue to rise, millions of Americans are joining the ranks of the uninsured, many of whom are children. We can't delay. We must enact this legislation now.
Opponent's argument to vote No:Rep. ROY BLUNT (R, MI-7):
This bill doesn't require the States to meet any kind of threshold standard that would ensure that States were doing everything they could to find kids who needed insurance before they begin to spend money to find kids who may not have the same need. Under the bill several thousands of American families would be poor enough to qualify for SCHIP and have the government pay for their health care, but they'd be rich enough to still be required to pay the alternative minimum tax. The bill changes welfare participation laws by eliminating the 5-year waiting period for legal immigrants to lawfully reside in the country before they can participate in this program. In the final bill, we assume that 65% of the children receiving the benefit wouldn't get the benefit anymore. It seems to me this bill needs more work, would have benefited from a committee hearing. It doesn't prioritize poor kids to ensure that they get health care first.
Reference: SCHIP Reauthorization Act;
; vote number 2009-H016
on Jan 14, 2009
Voted YES on overriding veto on expansion of Medicare.
Pres. GEORGE W. BUSH's veto message (argument to vote No):
- Extends Medicare to cover additional preventive services.
- Includes body mass index and end-of-life planning among initial preventive physical examinations.
- Eliminates by 2014 [the currently higher] copayment rates for Medicare psychiatric services.
I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it because:In addition, H.R. 6331 would delay important reforms like the Durable Medical
Equipment, Prosthetics, Orthotics, and Supplies competitive bidding program. Changing policy in mid-stream is also confusing to beneficiaries who are receiving services from quality suppliers at lower prices. In order to slow the growth in Medicare spending, competition within the program should be expanded, not diminished.
- It would harm beneficiaries by taking private health plan options away from them.
- It would undermine the Medicare prescription drug program.
- It is fiscally irresponsible, and it would imperil the long-term fiscal soundness of Medicare by using short-term budget gimmicks that do not solve the problem.
Proponent's argument to vote Yes: Sen. PATTY MURRAY (D, WA): President Bush vetoed a bill that would make vital improvements to the program that has helped ensure that millions of seniors and the disabled can get the care they need. This bill puts an emphasis on preventive care that will help our seniors stay healthy, and it will help to keep costs down by enabling those patients to get care before they get seriously ill. This bill will improve coverage for low-income seniors who need expert help to afford basic care. It will help make sure our seniors get mental health care.
Reference: Medicare Improvements for Patients and Providers Act;
; vote number 2008-H491
on Jul 15, 2008
Voted YES on giving mental health full equity with physical health.
- Paul Wellstone Mental Health and Addiction Equity Act of 2008: Requires group health plans to apply the same treatment limits on mental health or substance-related disorder benefits as they do for medical and surgical benefits (parity requirement).
- Genetic Information Nondiscrimination Act of 2008: Prohibits a group health plan from adjusting premium or contribution amounts for a group on the basis of genetic information.
SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. PALLONE. This is a comprehensive bill which will establish full mental health and addiction care parity. The Mental Health Parity Act of 1996 authorized for 5 years partial parity by mandating that the annual and lifetime dollar limit for mental health treatment under group health plans offering mental health coverage be no less than that for physical illnesses. This bill requires full parity and also protects against discrimination by diagnosis.
OPPONENT'S ARGUMENT FOR VOTING NO:Rep. DEAL of Georgia: I am a supporter of the concept of mental health parity, but this bill before us today is not the correct approach. This path will raise the price of health insurance, and would cause some to lose their health insurance benefits and some employers to terminate mental health benefits altogether.
The bill's focus is also overly broad. Our legislation should focus on serious biologically-based mental disorders like schizophrenia and bipolar disorder, not on jet lag and caffeine addiction, as this bill would include. There are no criteria for judicial review, required notice and comment, or congressional review of future decisions.
I would ask my colleagues to vote "no" today so that we can take up the Senate bill and avoid a possible stalemate in a House-Senate conference on an issue that should be signed into law this Congress.
LEGISLATIVE OUTCOME:Bill passed House, 268-148
Reference: Mental Health and Addiction Equity Act;
; vote number 08-HR1424
on Mar 5, 2008
Voted YES on Veto override: Extend SCHIP to cover 6M more kids.
OnTheIssues Explanation: This vote is a veto override of the SCHIP extension (State Children's Health Insurance Program). The bill passed the House 265-142 on 10/25/07, and was vetoed by Pres. Bush on 12/12/07.
CONGRESSIONAL SUMMARY: This Act would enroll all 6 million uninsured children who are eligible, but not enrolled, for coverage under existing programs.
PRESIDENT'S VETO MESSAGE: Our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. My Administration strongly supports reauthorization of SCHIP. [But this bill, even with changes, does not meet the requirements I outlined].
It would still shift SCHIP away from its original purpose by covering adults. It would still include coverage of many individuals with incomes higher than the median income. It would still result in government health care for approximately
2 million children who already have private health care coverage.
SUPPORTER'S ARGUMENT FOR VOTING YES:Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill protects health insurance coverage for some 6 million children who now depend on SCHIP. It provides health coverage for 3.9 million children who are eligible, yet remain uninsured. Together, this is a total of better than 10 million young Americans who, without this legislation, would not have health insurance.
The bill makes changes to accommodate the President's stated concerns.
LEGISLATIVE OUTCOME:Veto override failed, 260-152 (2/3rds required)
Reference: SCHIP Extension;
Bill Veto override on H.R.3963
; vote number 08-HR3963
on Jan 23, 2008
- It terminates the coverage of childless adults in 1 year.
- It prohibits States from covering children in families with incomes above $51,000.
- It contains adequate enforcement to ensure that only US citizens are covered.
- It encourages securing health insurance provided through private employer.
Voted YES on adding 2 to 4 million children to SCHIP eligibility.
Allows State Children's Health Insurance Programs (SCHIP), that require state legislation to meet additional requirements imposed by this Act, additional time to make required plan changes. Pres. Bush vetoed this bill on Dec. 12, 2007, as well as a version (HR976) from Feb. 2007.
Proponents support voting YES because:
Rep. DINGELL: This is not a perfect bill, but it is an excellent bipartisan compromise. The bill provides health coverage for 3.9 million children who are eligible, yet remain uninsured. It meets the concerns expressed in the President's veto message [from HR976]:
- It terminates the coverage of childless adults.
- It targets bonus payments only to States that increase enrollments of the poorest uninsured children, and it prohibits States from covering families with incomes above $51,000.
- It contains adequate enforcement to ensure that only US citizens are covered.
Opponents recommend voting NO because:
Rep. DEAL: This bill
[fails to] fix the previous legislation that has been vetoed:
- On illegal immigration: Would the verification system prevent an illegal alien from fraudulently using another person's name to obtain SCHIP benefits? No.
- On adults in SCHIP: Up to 10% of the enrollees in SCHIP will be adults, not children, in the next 5 years, and money for poor children shouldn't go to cover adults.
- On crowd-out: The CBO still estimates there will be some 2 million people who will lose their private health insurance coverage and become enrolled in a government-run program.
Veto message from President Bush:
Like its predecessor, HR976, this bill does not put poor children first and it moves our country's health care system in the wrong direction. Ultimately, our goal should be to move children who have no health insurance to private coverage--not to move children who already have private health insurance to government coverage. As a result, I cannot sign this legislation.
Reference: Children's Health Insurance Program Reauthorization Act;
Bill H.R. 3963
; vote number 2007-1009
on Oct 25, 2007
Voted YES on requiring negotiated Rx prices for Medicare part D.
Would require negotiating with pharmaceutical manufacturers the prices that may be charged to prescription drug plan sponsors for covered Medicare part D drugs.
Proponents support voting YES because:
This legislation is an overdue step to improve part D drug benefits. The bipartisan bill is simple and straightforward. It removes the prohibition from negotiating discounts with pharmaceutical manufacturers, and requires the Secretary of Health & Human Services to negotiate. This legislation will deliver lower premiums to the seniors, lower prices at the pharmacy and savings for all taxpayers.
It is equally important to understand that this legislation does not do certain things. HR4 does not preclude private plans from getting additional discounts on medicines they offer seniors and people with disabilities. HR4 does not establish a national formulary. HR4 does not require price controls. HR4 does not hamstring research and development by pharmaceutical houses.
HR4 does not require using the Department of Veterans Affairs' price schedule.
Opponents support voting NO because:
Does ideological purity trump sound public policy? It shouldn't, but, unfortunately, it appears that ideology would profoundly change the Medicare part D prescription drug program, a program that is working well, a program that has arrived on time and under budget. The changes are not being proposed because of any weakness or defect in the program, but because of ideological opposition to market-based prices. Since the inception of the part D program, America's seniors have had access to greater coverage at a lower cost than at any time under Medicare.
Under the guise of negotiation, this bill proposes to enact draconian price controls on pharmaceutical products. Competition has brought significant cost savings to the program. The current system trusts the marketplace, with some guidance, to be the most efficient arbiter of distribution.
Reference: Medicare Prescription Drug Price Negotiation Act;
Bill HR 4 ("First 100 hours")
; vote number 2007-023
on Jan 12, 2007
Voted NO on denying non-emergency treatment for lack of Medicare co-pay.
Vote to pass a resolution, agreeing to S. AMDT. 2691 that removes the following provisions from S 1932:
Reference: Reconciliation resolution on the FY06 budget;
Bill H Res 653 on S. AMDT. 2691
; vote number 2006-004
on Feb 1, 2006
- Allows hospitals to refuse treatment to Medicaid patients when they are unable to pay their co-pay if the hospital deems the situation to be a non-emergency
- Excludes payment to grandparents for foster care
Voted NO on limiting medical malpractice lawsuits to $250,000 damages.
Vote to pass a bill that would limit the awards that plaintiffs and their attorneys could be given in medical malpractice cases. The bill would limit non-economic damages, including physical and emotional pain to $250,000. The bill would also limit punitive damages to $250,000 or double economic damages, whichever amount is greater. Punitive damages would be banned against makers and distributors of medical products if the Food and Drug Administration approved those products. The bill would call for all states to set damage caps but would not block existing state statutory limits. The bill would cap attorneys' contingency fees to 40% of the first $50,000 in damages; 33.3% of the next $50,000; 25% of the next $500,000; and 15% of any amount in excess of $600,000.
Reference: Medical Malpractice Liability Limitation bill;
Bill HR 4280
; vote number 2004-166
on May 12, 2004
Voted NO on limited prescription drug benefit for Medicare recipients.
Medicare Prescription Drug and Modernization Act of 2003: Vote to adopt the conference report on the bill that would create a prescription drug benefit for Medicare recipients. Starting in 2006, prescription coverage would be made available through private insurers to seniors. Seniors would pay a monthly premium of an estimated $35 in 2006. Individuals enrolled in the plan would cover the first $250 of annual drug costs themselves, and 25 percent of all drug costs up to $2,250. The government would offer a fallback prescription drug plan in regions were no private plans had made a bid.Over a 10 year time period medicare payments to managed care plans would increase by $14.2 billion. A pilot project would begin in 2010 in which Medicare would compete with private insurers to provide coverage for doctors and hospitals costs in six metropolitan areas for six years. The importation of drugs from Canada would be approved only if HHS determines there is no safety risks and that consumers would be saving money.
Reference: Bill sponsored by Hastert, R-IL;
; vote number 2003-669
on Nov 22, 2003
Voted YES on allowing reimportation of prescription drugs.
Pharmaceutical Market Access Act of 2003: Vote to pass a bill that would call for the Food and Drug Administration to begin a program that would permit the importation of FDA-approved prescription drugs from Australia, Canada, the European Union, Iceland, Israel, Japan, Lichtenstein, New Zealand, Norway, Switzerland and South Africa.
Reference: Bill sponsored by Gutknecht, R-MN;
; vote number 2003-445
on Jul 24, 2003
Voted NO on small business associations for buying health insurance.
Vote to pass a bill that would permit the creation of association health plans through which small companies could group together to buy insurance for their employees. Association health plans that cover employees in several states would be excused from many individual state insurance regulations but would be regulated by the Labor Department.
Reference: Small Business Health Fairness Act;
Bill HR 660
; vote number 2003-296
on Jun 19, 2003
Voted NO on capping damages & setting time limits in medical lawsuits.
Help Efficient, Accessible, Low Cost, Timely Healthcare (HEALTH) Act of 2003: To improve patient access to health care services and provide improved medical care by reducing the excessive burden the liability system places on the health care delivery system. Limits the availability of punitive damages, and sets a 3-year limit for suing.
Reference: Bill sponsored by Greenwood, R-PA;
Bill HR 5
; vote number 2003-64
on Mar 13, 2003
MEDS Plan: Cover senior Rx under Medicare.
Grijalva adopted the Progressive Caucus Position Paper:
Summary of the Medicare Extention of Drugs To Seniors Act (Meds) MEDS establishes an 80/20 outpatient prescription drug benefit under a new Medicare Part D that will be administered by the Health Care Financing Administration. The plan will cost similar to figures for the Bush prescription drug plan due to this plan’s emphasis on lowering the price of pharmaceuticals.
- First-dollar 80%/20% benefit (may charge beneficiary less for generics)
- Catastrophic coverage begins at $2000 out-of-pocket.
- No beneficiary would have to spend more than $2288 for prescription drugs (including premium)
Prescription Drug Prices:
- (Reimportation) Beginning 2003, all FDA-approved prescription would be allowed for importation at world market prices after being tested for safety. Once fully implemented, Medicare could set fee schedules based on imported drug prices.
- (Allen Bill) To eliminate price discrimination, manufacturers would charge
Medicare and its beneficiaries the price equal to the lower of either the lowest price paid for the drug by other Federal Government agencies or the manufacturer’s best price for the drug.
- (Reasonable Prices) Drugs developed with taxpayer funds would be subject to “reasonable price” agreements when patents are transferred to pharmaceutical companies.
Premiums and Low-income Assistance: Premiums would be $24/month in the first year and indexed to a pharmaceutical Sustainable Growth Rate, which will ensure that premiums or drug costs do not increase arbitrarily.
The Government would subsidize low-income beneficiaries to the following levels:
- 100% of the premium and cost sharing for beneficiaries below 135% of poverty.
- Partial subsidy on a sliding scale for those between 135% and 150%
Employer Incentive Program: Employers providing drug coverage equal to or better than the Medicare coverage receive an incentive payment to maintain such coverage.
Source: CPC Press Release, MEDS Plan 01-CPC3 on Jan 31, 2001
Rated 100% by APHA, indicating a pro-public health record.
Grijalva scores 100% by APHA on health issues
The American Public Health Association (APHA) is the oldest and largest organization of public health professionals in the world, representing more than 50,000 members from over 50 occupations of public health. APHA is concerned with a broad set of issues affecting personal and environmental health, including federal and state funding for health programs, pollution control, programs and policies related to chronic and infectious diseases, a smoke-free society, and professional education in public health.
The following ratings are based on the votes the organization considered most important; the numbers reflect the percentage of time the representative voted the organization's preferred position.
Source: APHA website 03n-APHA on Dec 31, 2003
Improve services for people with autism & their families.
Grijalva co-sponsored improving services for people with autism & their families
Amends the Public Health Service Act to require the Secretary of Health and Human Services to:
Source: Promise for Individuals With Autism Act (S.937 & HR.1881) 07-HR1881 on Apr 17, 2007
- convene, on behalf of the Interagency Autism Coordinating Committee, a Treatments, Interventions, and Services Evaluation Task Force to evaluate evidence-based biomedical and behavioral treatments and services for individuals with autism;
- establish a multi-year demonstration grant program for states to provide evidence-based autism treatments, interventions, and services.
- establish planning and demonstration grant programs for adults with autism;
- award grants to states for access to autism services following diagnosis;
- award grants to
University Centers of Excellence for Developmental Disabilities to provide services and address the unmet needs of individuals with autism and their families;
- make grants to protection and advocacy systems to address the needs of individuals with autism and other emerging populations of individuals with disabilities; and
- award a grant to a national nonprofit organization for the establishment and maintenance of a national technical assistance center for autism services and information dissemination.
- Directs the Comptroller General to issue a report on the financing of autism services and treatments.
Establish a national childhood cancer database.
Grijalva co-sponsored establishing a national childhood cancer database
Conquer Childhood Cancer Act of 2007 - A bill to advance medical research and treatments into pediatric cancers, ensure patients and families have access to the current treatments and information regarding pediatric cancers, establish a population-based national childhood cancer database, and promote public awareness of pediatric cancers.
Authorizes the Secretary to award grants to childhood cancer professional and direct service organizations for the expansion and widespread implementation of: Legislative Outcome: House version H.R.1553; became Public Law 110-285 on 7/29/2008.
Source: Conquer Childhood Cancer Act (S911/HR1553) 07-S911 on Mar 19, 2007
- activities that provide information on treatment protocols to ensure early access to the best available therapies and clinical trials for pediatric cancers;
- activities that provide available information on the late effects of pediatric cancer treatment to ensure access to necessary long-term medical and psychological care; and
- direct resource services such as educational outreach for parents, information on school reentry and postsecondary education, and resource directories or referral services for financial assistance, psychological counseling, and other support services.
Remove restrictions on estriol (menopause medication).
Grijalva co-sponsored removing restrictions on estriol (menopause medication)
A concurrent resolution expressing the sense of Congress that the Food and Drug Administration's (FDA) new policy restricting women's access to medications containing estriol does not serve the public interest.
- Whereas menopause is often a challenging transition for millions of women that requires specialized medications and medical treatments;
- Whereas physicians prescribe a variety of pharmaceutical treatment options to treat women experiencing the symptoms of menopause;
- Whereas individual women respond differently to different treatment options;
- Whereas women's physicians determine on a case-by-case basis which treatment option is optimal for each woman;
- Whereas many physicians prescribe compounded estrogen and other bioidentical hormone treatments for patients for a variety of reasons;
- Whereas many physicians prescribe compounded estrogen treatments that contain estriol to treat menopausal and perimenopausal women;
- Whereas estriol is one of three
estrogens produced by the human body;
- Whereas estriol has been prescribed and used for decades in the United States;
- Whereas the Food and Drug Administration (FDA) has announced that it will no longer permit compounding pharmacists to prepare medications containing estriol pursuant to a doctor's prescription;
- Whereas insurers are now denying women reimbursement for compounded medications containing estriol as a result of the FDA's announcement; and
- Whereas the FDA has acknowledged that it is unaware of any adverse events associated with use of compounded medications containing estriol:
Now, therefore, be it Resolved, That it is the sense of the Congress that--
Source: SCR88/HCR342 08-SCR88 on Jun 10, 2008
- physicians are in the best position to determine which medications are most appropriate for their patients;
- the FDA should respect the physician-patient relationship; and
- the FDA should reverse its policy that aims to eliminate patients' access to compounded medications containing estriol.
Require insurers to cover breast cancer treatment.
Grijalva co-sponsored Breast Cancer Patient Protection Act
Congressional Summary: Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require coverage and radiation therapy for breast cancer treatment.
- Prohibits restricting benefits for any hospital length of stay to less than 48 hours in connection with a mastectomy or breast conserving surgery or 24 hours in connection with a lymph node dissection; or
- Prohibits requiring that a provider obtain authorization from the plan for prescribing any such length of stay.
- According to the American Cancer Society, excluding cancers of the skin, breast cancer is the most frequently diagnosed cancer in women.
- An estimated 40,480 women and 450 men died from breast cancer in
2008, and an estimated 182,460 new cases of invasive breast cancer were diagnosed in women, plus 1,990 cases in men.
- Most breast cancer patients undergo some type of surgical treatment.
- Treatment for breast cancer varies according to type of insurance coverage and State of residence.
- Currently, 20 States mandate minimum inpatient coverage after a patient undergoes a mastectomy.
- Breast cancer patients have reported adverse outcomes, including infection and inadequately controlled pain, resulting from premature hospital discharge following breast cancer surgery.
Source: H.R.111 11-HR111 on Jan 5, 2011
Increase funding for occupational & physical therapy.
Grijalva signed Medicare Access to Rehabilitation Services Act (MARS)
Medicare Access to Rehabilitation Services Act of 2011 - Amends title XVIII (Medicare) of the Social Security Act to repeal the cap on outpatient physical therapy, speech-language pathology, and occupational therapy services of the type furnished by a physician or as an incident to physicians' services.
SEC. 2. OUTPATIENT THERAPY CAP REPEAL.
Section 1833 of the Social Security Act (42 U.S.C. 1395(l)) is amended by striking subsection (g).
[Explanatory note from Wikipedia.com "Therapy Cap"]:
In 1997 Congress established per-person Medicare spending limits, or "therapy cap" for nonhospital outpatient therapy, but responding to concerns that some people with Medicare need extensive services, it has since placed temporary moratoriums on the caps. The therapy cap is a combined $1,810 Medicare cap for physical therapy and speech language pathology, and a separate $1,810 cap for occupational therapy ($1870 for 2011). Medicare patients requiring rehabilitation from disabilities, car accidents, hip injuries, stroke, and other ailments would be limited to roughly two months worth of treatments at an outpatient therapy clinic. Any patients that exceed the cap, whether they are healed or not, would have to stop therapy, or pay for the therapy services out of their own pocket.Several medical associations have lobbied against therapy caps because the bill inadvertently restricted disabled seniors, stroke patients, and other severe cases from receiving therapy treatments.
Source: HR.1546&S829 11-HR1546 on Apr 14, 2011
Establish a public insurance option via healthcare Exchanges.
Grijalva co-sponsored Public Option Deficit Reduction Act
Amends the Patient Protection and Affordable Care Act [PPACA, known as ObamaCare] to require Exchanges to offer a public health insurance option that ensures choice, competition, and stability of affordable, high-quality coverage throughout the United States. Declares that the primary responsibility is to create a low-cost plan without compromising quality or access to care. Sets forth provisions related to the establishment and governance of the public health insurance option, including that such plan:
- may be made available only through Exchanges;
- must comply with requirements applicable to other health benefits plans offered through such Exchanges; and
- must offer bronze, silver, and gold plan levels.
Requires the Secretary of Health and Human Services to: Requires repayment of start-up costs for the public health insurance option. Authorizes the Secretary to utilize innovative payment mechanisms and policies to determine payments for items and services under the public health insurance option.
Source: H.R.191 11-HR191 on Jan 5, 2011
- establish an office of the ombudsman for the public health insurance option;
- collect such data as may be required to establish premiums and payment rates;
- establish geographically adjusted premiums at a level sufficient to fully finance the costs of the health benefits provided and administrative costs related to the operation of the plan; and
- establish payment rates and provide for greater payment rates for the first three years.
Sponsored merging Alzheimers diagnosis and care benefit.
Grijalva co-sponsored HOPE for Alzheimer's Act
Congressional Summary:The purpose of this Act is to increase diagnosis of Alzheimer's disease and related dementias, leading to better care and outcomes for Americans living with Alzheimer's disease and related dementias. Congress makes the following findings:
- As many as half of the estimated 5.2 million Americans with Alzheimer's disease have never received a diagnosis.
- An early and documented diagnosis and access to care planning services leads to better outcomes for individuals with Alzheimer's disease.
- Combining the existing Medicare benefits of a diagnostic evaluation and care planning into a single package of services would help ensure that individuals receive an appropriate diagnosis as well as critical information about the disease and available care options.
Proponent's argument for bill: (The Alzheimer's Association, alz.org).
The "Health Outcomes, Planning, and Education (HOPE) for Alzheimer's Act" (S.709/H.R. 1507) is one of the Alzheimer's Association's top federal priorities for the 113th Congress. The HOPE for Alzheimer's Act would improve diagnosis of Alzheimer's disease and increase access to information on care and support for newly diagnosed individuals and their families. It would also ensure that an Alzheimer's or dementia diagnosis is documented in the individual's medical record.
Source: S.709/H.R. 1507 13-H1507 on Apr 11, 2013
GOP can't beat ObamaCare, so they pretend it's a "disaster".
Grijalva voted NAY Full Repeal of ObamaCare
Heritage Action Summary: This vote would fully repeal ObamaCare.
Heritage Foundation recommendation to vote YES: (2/3/2015): ObamaCare creates $1.8 trillion in new health care spending and uses cuts to Medicare spending to help pay for some of it. Millions of Americans already have lost, and more likely will lose, their coverage because of ObamaCare. Many Americans have not been able to keep their doctors as insurers try to offset the added costs of ObamaCare by limiting the number of providers in their networks. In spite of the promise, the law increases the cost of health coverage.
Secretary of Labor Robert Reich recommendation to vote NO: (robertreich.org 11/22/2013): Having failed to defeat the Affordable Care Act, Republicans are now hell-bent on destroying the ObamaCare in Americans' minds, using the word "disaster" whenever mentioning the Act, and demand its repeal. Democrats [should] meet the Republican barrage with
three larger truths:
- The wreck of private insurance: Ours has been the only healthcare system in the world designed to avoid sick people. For-profit insurers have spent billions finding and marketing their policies to healthy people--while rejecting people with preexisting conditions, or at high risk.
- We could not continue with this travesty of a healthcare system: ObamaCare is a modest solution. It still relies on private insurers--merely setting minimum standards and "exchanges" where customers can compare policies.
- The moral imperative: Even a clunky compromise like the ACA between a national system of health insurance and a for-profit insurance market depends, fundamentally, on a social compact in which those who are healthier and richer are willing to help those who are sicker and poorer. Such a social compact defines a society.
Legislative outcome: Passed House 239-186-8; never came to a vote in the Senate.
Source: Supreme Court case 15-H0132 argued on Feb 3, 2015
Expand the National Health Service Corps.
Grijalva signed Access for All America Act
A bill to achieve access to comprehensive primary health care services for all Americans and to reform the organization of primary care delivery through an expansion of the Community Health Center and National Health Service Corps programs. Amends the Public Health Service Act to:
Source: S.486&HR1296 2009-S486 on Mar 4, 2009
- increase and extend the authorization of appropriations for community health centers and for the National Health Service Corps scholarship and loan repayment program for FY2010-FY2015, and provide for increased funding for such programs in FY2016 and each subsequent fiscal year; and
- revise and expand provisions allowing a community health center to provide services at different locations, adjust its operating plan and budget, enter into arrangements with other centers to purchase supplies and services at reduced cost, and correct material failures in grant compliance.
Expedited licensing for biosimilar products.
Grijalva signed Promoting Innovation & Access to Life-Saving Medicine Act
Amends the Public Health Service Act to provide for the licensing of biosimilar and interchangeable biological products.
Source: S.726&HR.1427 2009-S726 on Mar 11, 2009
- Allows any person to file an abbreviated biological product application with the Secretary of Health and Human Services. Requires such applications to include information demonstrating a high degree of similarity or interchangeability between the biological product and the licensed biological product (reference product).
Requires the Secretary to:
- approve an application and issue a license for a biosimilar product unless the Secretary finds and informs the applicant that the information in the application fails to demonstrate biosimilarity between the biological product and the reference product or the safety, purity, and potency of the biological product; and
- establish requirements for the efficient review, approval, suspension, and revocation of abbreviated biological product applications.
Allows an applicant a determination as to the interchangeability of a product and its reference product based on whether a product can be expected to produce the same clinical result as the reference product in any given patient. Grants market exclusivity to any biological product that is determined to be interchangeable for a specified period.
- Sets forth provisions governing patent infringement claims involving comparable biological products and legal remedies to expedite the adjudication of patent infringement disputes.
- Extends the period for approval of biological products to allow for studies of the use of new biological products in the pediatric population.
Make health care a right, not a privilege.
Grijalva adopted the Progressive Caucus Position Paper:
The Progressive Caucus is united in its goal of making health care a right, not a privilege. Every person should have access to affordable, comprehensive and high-quality medical care. We must use our health care dollars efficiently and ensure public accountability in all medical decisions. Based on this goal, we support the following principles:
Source: CPC Position Paper: Health Care 99-CPC2 on Nov 11, 1999
- All Americans, including the 44 million currently without health insurance, deserve to have the health care they need, regardless of ability to pay.
- Medicare must remain solvent and available for the millions of seniors and individuals with disabilities who rely on the program. The Progressive Caucus supports expanding the program to cover prescription drugs and other needed products and services for beneficiaries. We support a Medicare buy-in for individuals age 55 and older. We support lowering out-of-pocket costs for seniors who currently pay, on average, 20% of their income for health care.
- Proposals should be rejected to
change traditional Medicare from a defined benefit to a defined contribution or voucher system.
- Balanced Budget Act cuts that are negatively affecting patient access to hospitals, nursing homes, and home health agencies must be restored.
- Medicaid must have the resources to continue to provide coverage and care for low-income individuals, including children in the CHIP program.
- Individuals with disabilities should retain their health benefits when they return to work and to have access to rehabilitative and other needed services.
- Funding and outreach and other programs serving low-income Americans should be expanded. Examples of such programs are the Children’s Health Insurance Program (CHIP); Qualified Medicare Beneficiary (QMB), Specified Low-income Medicare Beneficiary (SLMB), and Qualified Individuals programs; transitional funds for Medicaid recipients who are also welfare-to-work recipients; and for HHS for mental health outreach for the elderly.
Page last updated: Jun 09, 2020