Congress Approves $787B Economic Stimulus Package; Obama To Sign Bill Into Law Today

The House and Senate on Friday approved a $787 billion economic stimulus package that includes a number of health care provisions, the Washington Post reports (Murray/Kane, Washington Post, 2/14). The House passed the stimulus package by a 246-183 margin with no Republican support, and the Senate approved the package by a 60-38 margin with the support of three Republicans (Hitt/Weisman, Wall Street Journal, 2/14). Obama plans to sign the economic stimulus package into law on Tuesday in Denver (Feller, AP/Houston Chronicle, 2/17).

According to the Post, the enactment of the stimulus package would mark the "start of a new ideological era that places the federal government at the center of the nation's economic recovery" and provide a "down payment on much of President Obama's domestic agenda," such as health care reform (Washington Post, 2/14). The enactment of the stimulus package also would result in a "big victory for Democratic priorities," such as health care reform, the New York Times reports (Herszenhorn, New York Times, 2/14).

Effect on Prospects for Health Care Reform
The Obama administration has said that the economic stimulus package would take steps toward health care reform, "perhaps softening the blow if Congress fails to comprehensively address the issue this year," the AP/Boston Herald reports. Jenny Backus, a spokesperson for HHS, said that the health care provisions in the stimulus package represent the "beginning of the president's health reform vision." She added, "It's designed to get relief to people who need it most and to do everything we can to bring down the cost of health care and improve access and quality" (AP/Boston Herald, 2/14).

Meanwhile, "liberals are debating how to ensure that the stimulus outcome does not define the outer boundaries" of the Obama agenda on health care and other issues, "so that future legislation is not limited, as the stimulus was, by the demands of centrist senators," according to the Post. Theda Skocpol, a political scientist at Harvard University, said, "We have to be out there explaining in the most elementary ways why something like universal health care is good for America." According to Jacob Hacker, a political scientist at the University of California-Berkeley, Obama might have the ability to obtain more support from Republicans for health care reform legislation than he received for the economic stimulus package, as Republicans have expressed some support for his health care proposals (MacGillis, Washington Post, 2/17).

Effect for States, Cities
State officials likely will face issues with "managing competing pressures from communities, watchdog groups and federal regulators over how the money is allocated" from the economic stimulus package, the AP/Hartford Courant reports (Fouhy, AP/Hartford Courant, 2/16). For example, some states have considered reductions in eligibility for Medicaid and other health care programs to address budget deficits, but "such cuts now could jeopardize any extra financing for Medicaid under the stimulus plan because the bill penalizes states that change their Medicaid eligibility to save money," according to the New York Times (Davey, New York Times, 2/16).

Meanwhile, although cities likely will "benefit once the money trickles down" from state governments, city officials "predict it will take longer for them to see funding" for health care and other programs, the AP/Miami Herald reports. In response, the National League of Cities has launched a campaign to help city officials obtain funds from the stimulus package for such programs (Walters, AP/Miami Herald, 2/17).

Provisions
Several newspapers recently examined health care provisions in the economic stimulus package. Summaries appear below.

• COBRA/Medicaid: The stimulus package includes federal subsidies for health insurance premiums under COBRA and additional funds for state Medicaid programs, but House and Senate negotiators eliminated provisions included in earlier versions of the package that would have expanded the programs, the Los Angeles Times reports. Under the stimulus package, states will receive $87 billion in additional federal Medicaid funds (Levey, Los Angeles Times, 2/17). The stimulus package also includes $24.7 billion for federal subsidies to cover 65% of the cost of health insurance premiums under COBRA for as long as nine months for lower-income workers who have lost their jobs as a result of the current economic recession (Vitez, Philadelphia Inquirer, 2/17). However, earlier versions of the stimulus package included provisions that would have allowed low-income workers who lost jobs that did not include health insurance to apply for Medicaid through 2010 and allowed recently unemployed workers ages 55 and older or those with at least 10 years of tenure at their jobs to continue to receive health insurance through COBRA until they find a new job that offers coverage or reach age 65, when they can enroll in Medicare (Los Angeles Times, 2/17).
  
  
• Comparative-effectiveness research: The stimulus package includes $1.1 billion in funds for comparative-effectiveness research, and enactment of the package would mark the first time that the federal government has spent "substantial amounts" for such research, the New York Times reports. Under the stimulus package, HHS would receive the funds immediately and allocate them over several years. The provision also would establish a council of as many as 15 federal employees to coordinate such research and advise Obama on use of the funds. Supporters hope that the results of such research "will eventually save money by discouraging the use of costly, ineffective treatments," the Times reports. However, pharmaceutical and medical device companies have raised concerns that the "findings will be used by insurers or the government to deny coverage for more expensive treatments and, thus, to ration care," and some Republicans have "complained that the legislation would allow the federal government to intrude in a person's health care by enforcing clinical guidelines and treatment protocols," according to the Times (Pear, New York Times, 2/16).
  
  
• Health care IT: The stimulus package includes $19 billion for health information technology as part of an effort to make all U.S. health records electronic by 2014, McClatchy/Kansas City Star reports (Douglas, McClatchy/Kansas City Star, 2/13). According to the Washington Post, the effort to switch to electronic health records has "lagged for several reasons," such as "concerns over lack of universal protocols for collecting data, as well as rules that establish how, with whom and under what circumstances the data can be shared." Many health care providers have raised concerns about "liability if private information gets into the wrong hands," the Post reports (Huslin, Washington Post, 2/16).
  
  
• NIH: Sen. Arlen Specter (R-Pa.), one of only three Senate Republicans to vote for the stimulus package, agreed to support the package in large part because of additional funds for NIH included in the legislation, the Times reports. Under the stimulus package, the NIH budget would increase by 34%, from $29 billion to $39 billion. Specter, the "most ardent champion on Capitol Hill" for NIH, used "backroom" procedures to add funds for the agency in the stimulus package, the Times reports (Harris, New York Times, 2/14).

USA Today Editorial, Opinion Piece
USA Today on Monday published an editorial and an opinion piece on privacy protections for health care IT included in the economic stimulus package. Summaries appear below.

• USA Today: "In the digital age, switching patients' medical records from unwieldy paper to computerized data is a no-brainer," but the "very things that make digital records so appealing -- easy access, sharing and speed of transmission -- make them vulnerable to everyone from snoopers and thieves to businesses that want to use your medical records for their profit," a USA Today editorial states. According to the editorial, the stimulus package includes "some strong privacy safeguards," but the "fierce, down-to-the-wire battle between health care industry players who opposed many safeguards and privacy advocates shows how difficult it is to make patient privacy a priority." The editorial states, "Failing to do so will leave patients vulnerable to many abuses," adding, "Medical data in the hands of businesses outside strict privacy laws could be turned into health scores, which would follow an individual through life, leading to discrimination by employers or other punitive actions" (USA Today, 2/16).
  
  
• Mary Grealy, USA Today: "Creating an electronic health information network carries breathtaking potential to save lives, prevent disease and bring greater cost-efficiency to our health care system," and failure to implement such a system should not occur because of "excessive, unnecessary regulations aimed at combating hypothetical problems," Grealy, president of the Healthcare Leadership Council, writes in a USA Today opinion piece. "It is not only possible but necessary to ensure confidentiality while also enabling the essential, unimpeded flow of information for quality health care, patient safety and medical research," according to Grealy. "We need to bring real-world common sense to this issue," she writes, adding, "Yes, let's maintain strong privacy protections, but let's do so without sacrificing the health care benefits that the digital revolution can bring to millions of Americans" (Grealy, USA Today, 2/16).

Additional Opinion Pieces

• David Broder, Washington Post: "The daunting thing for Obama is that the next issues will be even tougher in Congress," as the economic stimulus package was "relatively speaking, easy pickings," because it "is always simpler to assemble a majority for spending money than for saving it," Post columnist Border writes. He adds, "When Obama turns to health care, he will have to ask someone to pay for the millions of people he wants to add to the insurance rolls" (Broder, Washington Post, 2/15).
  
  
• Jeffrey Kuhner, Washington Times: "America is heading down the road to socialism -- and ruin" -- as the stimulus package "is primarily designed not to stimulate the economy, but the size and scope of government," Times columnist and Edmund Burke Institute President Kuhner writes. According to Kuhner, Obama "is shrewdly erecting an enduring majority electoral coalition" with provisions in the stimulus package for "every important Democratic special interest group," such as "expanding Medicaid and unemployment insurance, and more money for strapped states and localities" (Kuhner, Washington Times, 2/15).
  
  
• Alastair Wood, Washington Times: The stimulus package "provides an opportunity to invest in 'infrastructure' to allow the country to emerge from this economic crisis with rejuvenated support systems to support robust future economic growth," Wood -- a former assistant vice chancellor for clinical research and associate dean of Vanderbilt Medical school, an author and managing director of Symphony Capital -- writes in a Times opinion piece. He writes, "We need to achieve the most appropriate care, always striving for better quality while understanding the cost impact." According to Wood, because "we lack the infrastructure to obtain the data needed to understand what needs to be done to fix our nation's health and provide optimal cost effective care, we need to immediately increase the research budget" for the Agency for Health Care Research and Quality and "build up our schools of public health to train and fund the epidemiologists and health care economists needed to find the solutions to the nation's health crisis." In addition, the stimulus package should provide funds for the biotechnology industry and academic medical centers because the "future will depend not so much on 'shovels' but on education, research and the discovery and innovation that comes from prepared minds," he writes. Wood concludes, "We must not squander this opportunity to secure our nation's economic future by not investing in the industries of the future. Our children expect it of us" (Wood, Washington Times, 2/15).

Broadcast Coverage

• ABC's "This Week" on Sunday featured a roundtable discussion on the economic stimulus package with Sens. Chuck Schumer (D-N.Y) and Lindsey Graham (R-S.C.) and Reps. Maxine Waters (D-Calif.) and Peter King (R-N.Y.) (Stephanopoulos, "This Week," ABC, 2/15).
  
  
• NBC's "Meet The Press" on Sunday included an interview with David Axelrod, a senior adviser to Obama, in which he discussed health care and other provisions in the stimulus package, as well as a roundtable discussion with Ron Brownstein of National Journal; Washington Post columnist Eugene Robinson; Roger Simon of The Politico; and Kimberly Strassel of the Wall Street Journal on health care and other provisions in the package (Gregory, "Meet The Press, NBC, 2/15). A transcript is available online.
  
  
• NBC's "Nightly News" on Monday examined the potential effects of the health care provisions in the stimulus package on the U.S. health care system (Bazell, "Nightly News," NBC, 2/16).
  
  
• NPR's "All Things Considered" on Monday reported on concerns raised by Republicans about funds for comparative-effectiveness research included in the stimulus package. The segment includes comments from Gail Wilensky, a health care economist; David Nexon of the Advanced Medical Technology Association; Rep. John Shadegg (R-Ariz.); conservative radio host Rush Limbaugh; and Robert Blendon, a professor and health care policy expert at the Harvard School of Public Health (Rovner, "All Things Considered," NPR, 2/16).
  
  
• NPR's "Day to Day" on Monday examined how funds provided in the stimulus package to expand adoption of EHRs could improve patient care and reduce costs. The segment includes comments from Michael Randolph, a primary care physician at Union Memorial Hospital in Baltimore; Peter Basch of MedStar Health; and Mark Levitt, chair of the Certification Commission for Healthcare Information Technology (Levitt, "Day To Day," NPR, 2/16).
  
  
• WAMU's "Diane Rehm Show" on Tuesday included a discussion on the stimulus package with Jared Bernstein, chief economist and economic policy adviser for Vice President Biden; Alice Rivlin, a senior fellow at the Brookings Institution; Jonathan Weisman of the Wall Street Journal; and Rea Hederman, a senior policy analyst at The Heritage Foundation (Rehm, "Diane Rehm Show," WAMU, 2/17).