Archive for the ‘Health disparities’ Category

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Federal money well spent: grants to save money by promoting community health

Wednesday, September 28th, 2011

All across the country, health officials are boasting about new federal grants, awarded yesterday, that will help them save money by improving the health of Americans. More than $100 million in Community Transformation Grants went to projects in 36 states to address the underlying causes of chronic diseases that drive the bulk of national health costs. The projects promote active living, healthy eating, smoking cessation and preventive services and focus on addressing the higher rates of disease among communities of color.

Funding comes from the crucial Prevention and Public Health Fund, authorized in the Affordable Care Act, to help slow the persistent growth of health costs by preventing disease. Since its creation, the $17 billion fund has been under attack from Congressional Republicans who oppose the ACA. Earlier this month, President Obama himself targeted the fund for $3.5 billion in cuts as part of his deficit reduction plan. The grants show why the fund is so important: it will reach into communities nationwide to improve the lives and health of everyday people.

Even some of those most opposed to the ACA scored some of the money. For example, the administration of Iowa Governor Terry Branstad, who has joined a federal lawsuit challenging the ACA, won $3 million. News reports quoted his administration talking about the grants helping to save money. Similar comments came from leaders in other states. “The best way to reduce health care costs is by living healthier lives,” said Live Well Omaha Executive Director Kerri Peterson of a grant to Douglas County, Nebraska.

California and Texas drew the most money — $22 million and $11 million respectively. Most of the money went to public health departments. One of the few community-based organizations to win a grant was My Brother’s Keeper in Mississippi, which works to improve the health of African-Americans.

Thirty-five grants support proven interventions, while 26 support communities seeking to build the capacity to undertake wellness projects. Those 26 provide a great opportunity for advocates and community members to get involved as project leaders organize an assessment of community needs, build coalitions, and devise a plan to be submitted for more funding.

Officially, project success will be measured through improvements in weight, nutrition, physical activity, smoking cessation and emotional well-being, according to Ursula Bauer, director of the CDC’s National Center for Chronic Disease Prevention and Health Promotion. But look also for a drop in long-term health costs over time.

Examples of specific initiatives include a South Dakota project to expand smoke-free, multi-unit housing and make streets and trails more suitable for walking and biking. They also include Texas plans to expand access to fresh produce in cities and towns.

A separate set of grants went earlier this month to seven national organizations to help expand the reach of the grants. Among those receiving money was the National REACH Coalition, a Community Catalyst partner that works in communities to address racial and ethnic disparities in health.

– Alice Dembner, Deputy Policy Director

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Following the Leaders: How Some Hospitals Use Community Benefit Programs to Address Health Equity

Monday, September 26th, 2011

We’ve used this space to talk at some length about the shortcomings that follow from our “patchwork quilt” of state and federal standards for community benefit. Today, we’re taking a detour to talk about what’s right with community benefit—specifically, steps some hospitals are taking to address disparities in health through community benefit programs.

Naming the Problem
The face and voice of America is changing. Racial and ethnic minorities currently comprise one-third of the U.S. population; nearly 47 million people—18 percent of the population—speak a language other than English at home. With this change in demography, the health of the United States as a whole is becoming increasingly dependent on the health of minority populations. Yet disparities in health are widespread, well-documented, and present in every factor that impacts how long and how well people live: from healthy behaviors to clinical care access and quality, and from social and economic factors (like income, housing, and education) to physical factors such as environmental quality. Each year, an estimated 83,000 deaths are attributable to racial and ethnic health disparities.

Fortunately, some hospitals are responding to factors contributing to disparities in health by creating community benefit programs that address all of the factors impacting health in their communities, including access.

Creating Solutions through Community Benefit
Last week, hospital community benefit officers and consumer advocates shared their experiences with partnering to address health disparities.

First, we shared Community Catalyst’s vision for “community benefit” as goods, services and resources provided without reimbursement (or with partial reimbursement) to address community-identified needs and concerns, particularly those of groups who are underserved. Community benefit implies a partnership—a social contract, of sorts—between hospitals and their communities. This vision sees an active role for community partners in identifying community needs and assets and shaping the priorities hospitals choose to address. These programs can focus on a variety of issues impacting health equity—health care access through financial assistance or funding for free clinics, for example, or programs to increase access to healthy foods.

Then, hospital community benefit officers shared how hospitals are addressing health disparities:

• Vondie Woodbury of Trinity Health System, Mercy Health Partners and the Muskegon Community Health Project in Michigan shared how initial community efforts to increase access to care for the uninsured led to the creation of the Access Health Program, a community-based, non-profit cooperative that now partners with Mercy Health to provide access to a full range of services for small business employees who were previously priced out of the commercial insurance market. The program focuses significantly on educating members about healthy living and prevention. “First and foremost, we learned we had to democratize the [community benefit] system so that all of the voices in the community have a chance to shape what is happening. That’s been key to our success,” she said. Trinity hospitals also use a common enrollment form that asks questions to determine if patients are presumptively eligible for financial assistance, prescription drug help, food stamps, and a free vision program offered by a community partner. Trinity also sends outreach workers to visit patients who are behind on their bills and enroll them in financials assistance or Medicaid, rather than allowing their accounts to proceed to collections erroneously.

• In Sonoma County, California, the community benefit arm of Saint Joseph Health System takes a broad, comprehensive approach to address the social determinants of health, according to Dory Magasis Escobar. It deploys health promoters from the communities it serves to educate their friends and neighbors about healthy behaviors and available services, as well as sponsoring free services through community clinics. But it also teaches community members how to relate to systems of power in order to effect change. For example, the health system trains community leaders to respond to neighborhood concerns; participates in community coalitions; and engages in advocacy at the local, state, and federal level on issues that impact vulnerable members of its community.

While these hospitals are stellar examples, advocates can still make progress when local hospitals aren’t as inclined to partner with the community. “Be persistent,” said Claudia Lennhoff of Champaign County Health Care Consumers, an Illinois organization that first approached hospitals about improving financial assistance and debt collection policies. “We started out as adversaries because they wouldn’t meet with us. We were able to move that to a very different place and recently worked together to increase dental access in our community.”

Good News Is (Potentially) on the Way
While hospital leadership plays a major role in determining community benefit programs, the Affordable Care Act also includes some new requirements that can help public health and community advocates raise their concerns. Starting in 2012, all tax-exempt hospitals will have to engage in a “community health needs assessment” and plan implementation strategies that take input from public health experts and community representatives. And while the final rules are still being written, the most recent document put out for comment by the IRS includes a substantial role for grassroots leaders and community members. (Community Catalyst submitted comments on this document.)

While it pays to understand the issues policymakers will be wrestling with in the coming months, community benefit planning processes should be underway in most hospitals. Health equity advocates should ask for a seat at the table, no matter where their hospitals are in the planning process. After all, we share a common vision for communities that promote the health of everyone.

- Jessica Curtis, Project Director, Hospital Accountability Project

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New National Legislation to Advance Health Equity

Friday, September 16th, 2011

A bill filed in Congress yesterday provides hundreds of tools to address the disgraceful health disparities that plague our communities and deprive so many people of color of long, healthy lives.

The Health Equity and Accountability Act of 2011 (HEAA) was introduced by leaders of the Congressional Tri-Caucus – the Congressional Asian Pacific American Caucus, Congressional Black Caucus, and the Congressional Hispanic Caucus. It builds on the expansions of coverage in the Affordable Care Act, the health equity initiatives of the US Department of Health and Human Services, and activities to enhance community health underway across the country. In fact, many ideas from a version of the bill introduced in a previous Congress were incorporated into the ACA.

The new bill, HR 2954, includes creative measures to improve the health of families of all backgrounds by eliminating barriers to care, promoting better ways to provide care, expanding and diversifying the health workforce, and addressing factors that deeply affect our health, such as the environment in which we live, work and play. It also includes steps to improve cultural and linguistic competency of care and enhancements to collection and analysis of data about health disparities. Advocates for health equity, including Community Catalyst and many other organizations, contributed ideas for the new legislation.

Our hope is that these ideas can be translated into initiatives that help reduce the disproportionate number of black infants dying in their first year of life, the disproportionate number of Hispanics suffering from high blood pressure and diabetes, and similar disparities. Studies show that reducing racial and ethnic health disparities not only saves lives but could save billions of dollars a year in medical costs .

Community Catalyst applauds the filing of the bill and encourages advocates and lawmakers to support its provisions. We will draw on the bill as we work with our partners nationwide to enhance health equity.

– Alice Dembner, Deputy Policy Director

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Help Shape Health Equity Work

Wednesday, July 13th, 2011

Consumer advocates have a new opportunity to influence regional work to strengthen health equity. This is your chance to make a difference!

The Office of Minority Health in the federal Department of Health and Human Services is seeking nominations for 10 regional health equity councils – one in each of the 10 HHS regions. The councils are being established to help shape and spur action on the National Stakeholder Strategy for Achieving Health Equity, which was released in April by the federal government. The strategy contains lots of good ideas for community engagement, but no new government funding. A strong council could help push the work forward, and facilitate fund-raising. Each council will contain up to 35 members from the public and private sectors. Let’s ensure that consumer and community voices are heard.

OMH is accepting nominations through midnight on July 18 at RHECnomination@minorityhealth.hhs.gov. Qualifications needed include leadership skill and experience working on health disparities. At a minimum, nominations must include the name, title, address, phone and email for both the nominee and the nominator. For more information, refer to the full description from HHS.

– Alice Dembner, Deputy Policy Director

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Cross-Post: A Disappointing Rollback of Consumer Protections on Appeals

Friday, June 24th, 2011

June 23, 2011

The Affordable Care Act (ACA) established many consumer protections, but it was only the first step.  As decisions are made about implementation and regulations, the need for consumer engagement is critical. As an example of where protections could have been stronger, the Department of Health and Human Services just released regulations that relax a number of requirements on health plans and insurers, making it more difficult for consumers to successfully pursue appeals against them.

This is just a reminder that there will be many opportunities in the coming months and years to weigh in on federal regulations as the ACA is implemented – and it’s important for consumers to respond.  Community Catalyst will continue to provide updates about these opportunities and to work with consumer advocates to ensure consumer voices are heard, and state experiences inform the federal debate.

This blog was originally posted on Georgetown Center for Children and Families’ Say Ahh!

Imagine you’re a parent and your child has been diagnosed with cancer and is going through painful, debilitating treatment. You can imagine the sleepless nights, the worry, the exhaustion, the fear. Now imagine that your insurance company denies some of the claims for your child’s treatment – treatment that the doctors assure you are essential to saving your child’s life. If not paid by the insurer, the bills amount to tens of thousands of dollars – putting you at risk of bankruptcy. At a time when your sole focus should be – has to be – your child’s health, you are forced to spend hours on the phone, fighting with health plan bureaucrats.

For President Obama, it was exactly this type of situation that sparked his passion for health care reform. He watched his mother, dying of ovarian and uterine cancer, battle the insurance company from her hospital bed to get insurance coverage for which she’d faithfully been paying premiums. As he said in a 2009 speech to AARP: “That happens all across the country. We are going to put a stop to that.”

And he did. With passage of the Affordable Care Act, for the first time consumers across the country, no matter what plan they’re in, are empowered to appeal their health plans’ decisions to an independent, external review panel. This critical consumer protection is designed to stop the worst of insurance company abuses and was a great win for consumers. In fact, a recent study by the General Accounting Office found that when consumers appeal denied claims, the health plan has to reverse its decision as much as 50% of the time.

Yet, as with everything health reform related, the devil is in the details. And how the appeals provision is implemented matters just as much – if not more – than having the right in the first place. Unfortunately, in a regulation quietly released late yesterday, the Administration relaxed a number of requirements on health plans and insurers, making it more difficult for consumers to successfully pursue appeals. Here are a few specifics:

• Scope of Review. The Administration has significantly narrowed the range of issues consumers can appeal. Originally the rules allowed consumers to seek external review of any adverse benefit decision (except eligibility for the plan). In the new version, consumers can only seek review for claims that involve “medical judgment” or a rescission of coverage. This means that any decision that’s considered “contractual” cannot be appealed to the external reviewer. For example, a plan’s determination that a particular service, drug, or supply is not covered would probably be considered contractual. Unfortunately, according to a recent AMA study, that’s one of the top reason patients’ claims are denied.
•Urgent Care Claims. Originally insurers were required to make a decision on an emergency care claim within in 24 hours of receiving it. In this latest rule, in response to complaints from industry that the time frame was too “burdensome,” the Administration is giving plans up to 72 hours to make a decision. This, in spite of many comments from consumer groups and providers highlighting the need for fast turnaround in emergency situations.
•Translations for Patients with Limited English. The law is clear: plans must provide enrollees with information about their appeal rights in a “culturally and linguistically appropriate manner.” Yet the Administration has significantly weakened this requirement. First, in only 6 counties in the country will plans be required to translate materials into any language other than Spanish. Second, plans only need to provide translations orally. If an enrollee wants translated materials in writing (kind of important if you’re going through the legalistic process of pursuing an appeal), they must proactively request them. Third, the Administration eliminated a requirement that plans keep a record of an enrollee’s language preference. That was, you guessed it, deemed too “burdensome” for the plans.
•Allowing Plans to Forum Shop. Perhaps the craziest part of the new rules is that they allow plans to choose their own judge and jury. Thankfully, this won’t be true in all states. State laws that already have strong laws that ensure an independent, impartial review will not be preempted by the federal rules However, a significant number of states do not have adequate external review laws, and will be preempted by a federal process. The problem is, under the new rules, plans in states subject to the federal process will be allowed to choose their own external reviewer. This is at odds with the recommendations of the National Association of Insurance Commissioners (NAIC), whose model state law on external review requires that external reviewers be randomly assigned (not handpicked by plans) to ensure and independent, impartial process.
•Giving Patients Less Time to File an Appeal. The earlier rule allowed consumers to have 120 days before filing the appeal. In response to complaints from insurance companies that this was too long, the new rule gives consumers only 60 days. Yet for someone struggling with pain, a recent surgery, rehabilitation, or other after-effects of an injury or illness, this time can pass in the blink of an eye. Many patients are likely to miss the deadline, and thereby miss their opportunity to correct an insurer’s bad decision.
•Delaying Implementation. Finally, many of the new appeals protections were to have gone into effect next week.  But in March new rules gave plans until January 1, 2012 (some even later), to comply. For consumers, these delays effectively deny them access to an impartial, fair review of their claim.

Sadly, all of these changes add up to some unfortunate administrative hurdles that will prove challenging for those parents fighting with their health plan to pay for the care essential to cure their child’s illness. Or for sons who must watch their mother battle cancer and her insurance company at the same time. On the other hand, the health reform law provides many of these same families with rights they didn’t have before. I hope that as we transition to 2014, and people gain more experience with their new appeal rights, we can convince policymakers to enact the necessary rules to make them real.

- Sabrina Corlette, Research Professor
Health Policy Institute, Georgetown University

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Protecting Prevention Funding Is Key to Controlling Health Costs

Thursday, April 14th, 2011

As House Republicans hammered away this week at federal spending, they took another whack at the Prevention and Public Health Fund. But if their goal is really saving money, they just hit their thumb instead of the proverbial nail.

The Affordable Care Act established the Prevention Fund and allocated $15 billion over the next decade to help shift the focus of our health system from treating diseases to preventing illness. The ultimate goal is improving the health of Americans and reducing long-term health costs. Already, the Fund is supporting state and local initiatives to reduce obesity, cut tobacco use, prevent HIV/AIDS and train more public health workers.

This year, it will also fund the Community Transformation Grants, an innovative program to support local efforts to reduce chronic disease and health disparities. Expanding prevention initiatives is one third of the package needed to control health care spending, along with reducing waste and occasional bad care in Medicaid and Medicare, and cutting prices and high administrative costs in the private sector.

But Republicans in Congress have repeatedly targeted the fund for repeal, or attempted to take its funding for other purposes. Yesterday, amid claims that the money provides a “slush fund” for Health and Human Services Secretary Kathleen Sebelius, the Republican-controlled House voted 236 to 183 to repeal the fund and rescind all money not already spent. This struck a political blow against the Affordable Care Act, but if the repeal were to pass the Senate and get signed by the president, it would leave the country sicker – from both diseases and rising health costs.

Fortunately, President Obama and Senate Democratic leaders understand that prevention can both save lives and save money.  Senate President Harry Reid and Senator Tom Harkin, chairman of the Senate Health, Education, Labor and Pensions Committee and the father of the fund, are not likely to bring the repeal bill to the Senate floor for a vote. Also yesterday, the White House issued a statement  indicating that the President would likely veto any attempt to eliminate the Fund.  The “statement of administrative policy” said repeal “could worsen the nation’s health and increase system costs.” Indeed. The prevention funding is also key to expanding jobs and improving the health and productivity of America’s workers.

There continues to be some risk that money from the Fund will be used to pay for existing prevention efforts, rather than the new initiatives envisioned by Harkin and others. The Fund escaped a direct cut in the compromise plan to fund the federal government for the rest of this fiscal year, despite $38 billion taken from other programs. However, there remains the unfortunate possibility that the Obama administration may tap the Fund to replace some of the $730 million cut from the Centers for Disease Control and Prevention.

The bottom line: It remains important to educate all members of Congress about the long-term savings that result from reducing chronic diseases, and the important role the Prevention Fund plays in our nation’s long-term financial health. 

- Alice Dembner, Deputy Policy Director

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Toward Better Health for People of Color

Friday, April 8th, 2011

Focusing unprecedented federal attention on the barriers to good health for people of color, the US Department of Health and Human Services unveiled a two-part plan today of federal and community strategies designed to move the nation toward health equity. The plans mark an important step forward. The impact will depend on how strategies are implemented on the ground.

The goal is to reduce health disparities such as the fact that black babies are twice as likely to die in their first year as white babies, Hispanics die of diabetes at 1.4 times the rate of whites, and Asian-Americans are far more likely to contract Hepatitis A than whites. The causes of these problems run deep, far beyond access to insurance coverage or health care. They include the jobs we get, the places we live and the quality of schools for our children.

Part one is HHS Action Plan to Reduce Racial and Ethnic Health Disparities , which coordinates health equity measures in the Affordable Care Act, Healthy People 2020 and other existing federal initiatives. It sets out five broad goals, ranging from expanding access to health care to diversifying the health workforce. Specific steps include implementing the long-awaited Community Transformation Grants, creating an online registry of medical interpreters for patients who don’t speak English, expanding the use of community health workers in the Medicaid program, and expanding preventive dental care for children.

HHS Assistant Secretary Howard Koh called it “the most comprehensive federal effort ever to address racial and ethnic disparities.”

Part 2 is the National Stakeholder Strategy for Achieving Health Equity, which provides a second set of goals and strategies for initiatives and partnerships designed to foster community-level engagement. This strategy was developed over several years through local, regional and national meetings called the National Partnership for Action. The document details 20 strategies ranging from training youth to be health leaders to ensuring the availability of health data on underserved populations. It calls for the formation of 10 regional health equity councils to coordinate and galvanize the work, and promises to provide local communities with technical assistance and tool kits to move forward.

Given the bruising budget battles underway in Washington, no new money is attached to the plans. The federal work will draw on existing funding, including money currently under siege from the Affordable Care Act – another reason to defend that funding. For the most part, the local initiatives will need to find their own resources. Fortunately, the stakeholder strategy lays out hundreds of objectives which could be the basis for local organizing and could be attractive to local funders.

– Alice Dembner, Deputy Policy Director

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The grants are coming! The grants are coming!

Monday, January 31st, 2011

Word came last week from the Obama administration that the Community Transformation Grant program will begin “very soon,” despite the discussion of federal budget freezes. Speaking at the Families USA Health Action conference, an official said the administration is committed to the grants. The program, authorized in the Affordable Care Act, is designed to promote innovative community strategies to prevent chronic diseases and address health disparities. Grants will be awarded on a competitive basis to state and local agencies, state and local nonprofits, tribes, and networks of community-based organizations.

The administration said the federal Centers for Disease Control and Prevention is putting the final touches on a request for grant applications. No word yet on how big the program – or the individual grants – will be. Money for the grants is coming from the national Prevention Fund, established and funded with $15 billion over 10 years in the ACA. Because the Prevention Fund was already appropriated by Congress, it will not be subject to the spending freeze that the President announced on Tuesday night. However, the Fund could still be targeted for cuts by Republican members of Congress, who have previously tried to use it to pay for other priorities.

Other news you can use: keep your eye out for state-by-state fact sheets on Healthcare.gov detailing what the Prevention Fund is already paying for. These will be helpful in talking to Members of Congress about the importance of the Fund.

– Alice Dembner, Deputy Policy Director

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Prevention Fund Saved!

Wednesday, September 15th, 2010

Through the collective efforts of advocates of many different stripes across the country, we staved off an attempt yesterday to gut the new Prevention and Public Health Fund, a critical part of national health reform.

An amendment from U.S. Senator Mike Johanns, a Nebraska Republican, was defeated 46-52 in a procedural vote on the Senate floor. That amendment to the Small Business Jobs and Credit Act would have used the bulk of the $15 billion Prevention Fund to pay for a change in business tax-reporting rules.

As a result, the Prevention Fund will be available to support national, state and local programs to make Americans healthier, reduce racial and ethnic health disparities, and to help control soaring health costs in the long run. President Obama has already allocated $500 million from the fund and another $750 million is slated to be spent in the 2011 fiscal year. The Community Transformation Grants, designed to help local communities address the social and economic causes of poor health, are one of the innovative programs slated to be supported through the Prevention Fund.

We thank the hundreds of national and state organizations that raised their voices in support of the Prevention Fund. We will likely need to remain vigilant to protect the fund from future attempts to grab it for other purposes. But for now, we can celebrate.

– Alice Dembner, Policy Manager

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Senate proposal would gut funding to make Americans healthier and reduce health disparities

Thursday, August 19th, 2010

Update: Due to response to this blog post, we would like to share additional information with those who are interested in signing-on to the letter. If you would like to sign-on, please contact Trust for America’s Health by e-mailing rhamburg@TFAH.org.

A short-sighted proposal from U.S. Senator Mike Johanns, a Nebraska Republican, would gut the brand-new $15 billion Prevention and Public Health Fund, created as part of the health reform law, to pay for a change in business tax-reporting rules. The Prevention Fund was established to support national, state and local programs to make Americans healthier and reduce racial and ethnic health disparities. President Obama has already allocated $500 million from the fund.

Johanns’ amendment is slated for a vote on Sept. 14, the day after Congress returns from August recess, and has some strong business backing. Learn more about this strike at a key component of health reform on a 1 p.m. call tomorrow hosted by Community Catalyst and three partner organizations.

The Prevention Fund is key to our long-term health, to controlling soaring health costs, and to advancing health equity. Among the programs Johanns’ proposed amendment would wipe out are the innovative Community Transformation Grants. These grants are designed to help local communities address health disparities and reduce chronic diseases by promoting healthy living and tackling the social and economic causes of poor health. They are also the main avenue in the health reform law for addressing the root causes of health disparities, such as poor availability of healthy food and exposure to environmental hazards.

The Johanns amendment could also threaten initiatives to increase vaccination against disease, as well as millions of dollars a year in state grants to reduce obesity and tackle other public health problems. Congress envisioned all of these being supported by the Prevention Fund, which dedicates $15 billion over 10 years to beef up the tiny portion of health spending now devoted to preventing illness.

Johanns proposed the amendment to a bill (H.R. 5292, the Small Business Jobs and Credit Act) that would create a loan fund and tax breaks for small businesses.  His amendment would overturn a portion of the health reform law that requires business to provide more detailed reporting to the Internal Revenue Service about services and materials they buy. Small businesses, in particular, are concerned that the new reporting would be a burden, and passage of the amendment is a real possibility.

To offset the loss of tax revenue created by his proposal, Johanns would tap $11 billion from the Prevention Fund – all of the money allocated for the fund from 2010 through 2017. He would also weaken another critical component of health reform – the requirement that everyone who can afford health insurance must obtain it, or pay a penalty. Our partners at the Center on Budget and Policy Priorities have written a detailed analysis of the proposal.

Community Catalyst is signing onto a letter to Congress opposing the gutting of the Prevention Fund, and we urge other organizations to do the same. We also recommend contacting Senators directly to let them know that the Prevention Fund should not be up for grabs. Two small business organizations, Small Business Majority and Main Street Alliance, are also speaking out against the attack on the Prevention Fund, with Main Street saying it would “seriously undermine the improved access and cost containment goals of health reform.”

Ironically, Johanns’ attempt to wipe out the Prevention Fund comes just as Congress is considering separate measures to allocate hundreds of millions of dollars from the fund to the Community Transformation Grants for fiscal year 2011. Rules for the competitive grant program are still being developed, but the health reform law says the grants should go to state and local governments and community-based organizations for changes in policies, programs, environment and infrastructure including increasing access to nutritious foods, creating parks, and creating healthier school environments.

Senator Bill Nelson, a Florida Democrat, is offering an alternative that helps small businesses without harming the Prevention Fund. It scales back, rather than eliminates, the new tax reporting requirement, and funds the change by ending a tax break for the nation’s five large oil companies.  Nelson’s amendment is also slated for a vote on Sept. 14. Both this and Johanns’ amendment need 60 votes to pass, and the votes could be close.

It’s crucial to the success of health reform to beat back the Johanns amendment and send a message to others who would try to hijack the Prevention Fund for other purposes.

– Alice Dembner, policy manager

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