[Federal Register Volume 71, Number 114 (Wednesday, June 14, 2006)]
[Notices]
[Pages 34369-34373]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 06-5379]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Citizen's Health Care Working Group Interim Recommendations
AGENCY: Agency for Healthcare Research and Quality (AHRQ), HHS.
ACTION: Publication of Interim Recommendations of the Citizens' Health
Care Working Group, Request for Public Comment.
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SUMMARY: The Citizens' Health Care Working Group (the Working Group),
authorized by section 1014 of the Medicare Modernization Act, is
publishing interim recommendations and requesting public comment on
them.
DATES: Comments should be received on or before August 31, 2006.
ADDRESSES: Comments may be submitted either electronically or on paper.
Electronic Statements
Send comments online to the Work Group's Web site using this
address: http://www.citizenshealthcare.gov. or by e-mail to
Citzenshealth@ahrq.gov
Paper Comments
Send paper comments in duplicate to: George Grob, Executive
Director, Citizens' Health Care Working Group, Suite 575, 7201
Wisconsin Avenue, Bethesda, Maryland 20814. You may also fax comments
to (301) 480-3095.
To help us review your comments efficiently please use only one
method of commenting.
All comments will be made available on the Working Group's Web
site. All comments will be posted without change. You should submit
only information that you wish to make available publicly. Comments
will also be available for public inspection and copying at the Working
Group's Bethesda office during normal business hours.
FOR FURTHER INFORMATION CONTACT: George Grob, Executive Director,
Citizens' Health Care Working Group, (301) 443-1530,
george.grob@ahrq.hhs.gov or Caroline Taplin, Senior Program Analyst,
(301) 443-1514, caroline.taplin@ahrq.hhs.gov
SUPPLEMENTARY INFORMATION: Section 1014 of Pub. L. 108-173, (known as
the Medicare Modernization Act) directs the Secretary of the Department
of Health and Human Services (DHHS), acting through the Agency for
Healthcare Research and Quality, to establish a
[[Page 34370]]
Citizens' Health Care Working Group (Citizen Group). This statutory
provision, codified at 42 U.S.C. 299 n., directs the Working Group to
provide for a nationwide public debate about improving the health care
system; develop and seek public comment on interim recommendations
arising from this debate; and submit its final recommendations to the
President and Congress.
The Citizens' Health Care Working Group is composed of 15 members:
The Secretary of DHHS is designated as a member by statute and the
remaining 14 members were appointed to the Working Group by Comptroller
General of the U.S. Government Accountability Office and announced on
February 28, 2005.
The statute requires that interim recommendations be made available
on the internet for a ninety day public comment period and also made
available through other public channels. Interim recommendations were
posted on the Working Group's Web site on June 2, 2006. This notice
constitutes an additional public channel.
These recommendations outline a vision and a plan for achieving
broad-based change in health care in America, to which members of the
Working Group have agreed. Over the next three months, the Working
Group intends to further refine these proposals, using the public input
it actively seeks.
Review Text
The text of the interim recommendations and related materials
follow:
Preamble
The Charge to the Citizens' Health Care Working Group
Values and Principles
Interim Recommendations
Interim Recommendations of the Citizens' Health Care Working Group
June 1, 2006
Preamble
The health care system that captures vast amounts of America's
resources, employs many of its most talented citizens and promises to
relieve the burdens of dread disease badly needs to be fixed. Health
care costs strain individual, household, employer and public budgets.
Often our citizens forego needed treatment because they are pried out
of the market. At the same time, public budgets are bucking under the
burden of public health care programs.
We spend nearly $2 trillion on health care each year, yet
geography, race, ethnicity, language and money impeded Americans from
getting appropriate care when they need it. People in Utah recently
spoke for tens of millions of Americans when they noted.
``[the] inability to navigate the health care system without luck, a
relationship, money and perseverance''.
Far too often sick Americans lack one or more of these factors needed
to get health care.
Given the breaktaking advances in medical science--American health
care sadly under achieves. The health care system gets Americans the
right care, and only the right care, about 50% of the time. As many as
98,000 Americans die because of medical errors each year. Polls of
American households reveal that about one third of Americans report
that they or a family member have experience a medical error at some
point in their life. While no system can ever eliminate all error, we
can do better. While most Americans are generally satisfied with their
health care, too many Americans are being let down by their health care
institutions. Many people are afraid of the health care system, they
are bewildered by its complexity and are suspicious about who it aims
to serve.
Addressing the problems of U.S. health care involves considering
the perspectives, interests and circumstances of providers, payers,
health plans and consumers. We have spent 15 months reading, listening
and learning about U.S. health care from a wide range of perspectives.
We have held 6 hearings with experts, stakeholders, scholars, public
officials and advocates. We have conducted 31 community meetings, as
well as special topic meetings and sponsored meetings in 30 states and
the District of Columbia. We have reviewed all the major public opinion
polls focused on health care conducted between 2002 and 2006. Citizen
responses to the Working Group's internet polls (over 10,000 as of May
15) were studied. Finally, we have read close to 5,000 individuals'
commentaries on health care matters submitted by residents of this
country.
A picture has been sketched for us of a health care system that is
unintelligible to most people. They see a rigid system with a set of
ingrained operating procedures that long ago become disconnected from
the mission of providing people with humane, respectful and technically
excellent health care.
The legislation that created the Citizens Health Care Working Group
emphasizes the need to bring the views of everyday Americans to the job
of creating a better health care system. In previous health care reform
efforts, too little has been heard from the public about several key
issues, including:
The overarching values and aspirations that are at the
heart of the mission of health care, and
How they see the key elements of solutions to health care
financing and delivery.
It is in the spirit of giving a greater voice to everyday people
that we deliver these recommendations on how to make health care work
for all Americans
Table of Contents
Preamble
The Charge to the Citizens' Health Care Working Group
Values and Principles
Interim Recommendations
Members of the Citizens' Health Care Working Group
The Charge to the Citizens' Health Care Working Group
The Citizens' Health Care Working Group was created by the Medicare
Prescription Drug, Improvement and Modernization Act of 2003, Sec. 1014
to provide for the American public to ``engage in an informed national
public debate to make choices about the services they want covered,
what health care coverage they want, and how they are willing to pay
for coverage.'' Appointed by the Comptroller General of the United
States, the Working Group consists of 14 individuals from diverse
backgrounds, representing consumers, the uninsured, those with
disabilities, individuals with expertise in financing benefits,
business and labor perspectives, and health care providers. The
Secretary of Health and Human Services also serves as a member of the
Working Group. Because the Working Group's final recommendations will
be submitted to the Department of Health and Human Services, the
Secretary of Health and Human Services has neither participated in the
development of these recommendations nor has he endorsed them. He will
carefully consider them and take appropriate action.
The legislation charged the working group with holding hearings on
various health care issues before issuing The Health Report to the
American People. This report, completed in October 2005, provides an
overview of health care in the United States for the general public,
enabling them to be informed participants in the national discussion
organized by the Working Group.
The law specifies that this national discussion take place through
a series of Community Meetings, which as a minimum, address the
following four questions:
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--What health care benefits and services should be provided?
--How does the American public want health care delivered?
--How should health care coverage be financed?
--What trade-offs are the American public willing to make in either
benefits or financing to ensure access to affordable, high quality
health care coverage and services?
As noted in the Preamble of this document, we held 6 hearings with
experts, stakeholders, scholars, public officials and advocates. We
conducted 312 community meetings, as well as special topic meetings and
sponsored events, in more than 50 communities across the nation.
Members attended meetings in 30 states and the District of Columbia. We
reviewed all the major public opinion polls focused on health care
conducted between 2002 and 2006. Citizen responses to the Working
Group's internet polls (over 10,000 as of May 15) were studied.
Finally, we have read close to 5,000 individuals' commentaries on
health care matters submitted by residents of this country.
Following this nationwide citizen engagement, the Working Group is
required to prepare and make available to the public this interim set
of recommendations on ``health care coverage and ways to improve and
strengthen the health care system based on the information and
preferences expressed at the community meetings.'' Following a 90-day
public comment period on these recommendations, the Working Group will
submit to Congress and the President a final set of recommendations.
The law specifies that the President shall submit a report to congress
on the recommendations within 45 days of receiving them, and designates
five congressional committees that will hold hearings on that report
and the recommendations: the Committee on Finance of the Senate, the
Committee on Health, Education, Labor and Pensions of the Senate, the
Committee on Ways and Means of the House of Representatives, the
Committee on Energy and Commerce of the House of Representatives, and
the Committee on Education and the Workforce of the House of
Representatives.
Following are the interim recommendations of the Citizens' Health
Care Working Group, along with descriptions of how we conducted our
work and what we heard from participants in community meetings,
respondents to our Web polls, and citizens who wrote in to tell us
their views.
These recommendations outline a vision and a plan for achieving
broad-based change in health care in America. We recognize that the
issues involved are complex and challenging, and that it will take time
and a great deal of technical expertise, as well as political will, to
make the changes we think are necessary. Over the next three months, we
will continue to actively pursue public input as we deliberate and
further refine these proposals. During this process, we will provide
greater detail and explanation of our recommendations, as well as
further analysis of what we are hearing from the American people before
issuing the final recommendations to the Congress and the President.
Those wishing to comment on the interim recommendations may do so
by August 31, 2006 in any of three ways:
online at www.CitizensHealthCare.gov;
by e-mail to citizenshealth@ahrq.gov; or
by mail to the following address:
Citizens' Health Care Working Group, Attn: Interim Recommendations,
7201 Wisconsin Ave, Rm. 575, Bethesda, MD 20814.
Values & Principles
The Citizens Health Care Working Group believes that reform of our
health care system should be guided by principles that reflect values
of the American people:
Health and health care are fundamental to the well-being
and security of the American people.
It should be public policy, established in law, that all
Americans have affordable health care coverage.
Assuring health care is a shared social responsibility.
This includes, on the one hand, a public responsibility for the health
and security of its people, and on the other hand, the responsibility
of everyone to contribute.
[cir] A defined set of benefits is guaranteed, by law, for all,
across their lifespan, in a simple and seamless manner; the benefits
are portable and independent of health status, working status, age,
income, or other categorical factors that might otherwise affect
insurance status.
[cir] Individuals' security is assured: as defined in law, changes
in circumstances cannot be used to limit full access to benefits.
All Americans will have access to set of core health care
services across the continuum of care throughout the lifespan.
[cir] Access to care means that everyone should be able to get the
right care at the right time and at the right place. Appropriate health
care must be available and affordable, as well as convenient and
accessible for people in their communities. People's ability to get
services and be treated appropriately and in a respectful manner are
also essential aspects of access to care.
[cir] Health care encompasses wellness, preventive services, and
treatment and management of health problems.
Core benefits/services will be selected through an
independent, fair, transparent, and scientific process which gives
priority to the consumer-health care provider relationship:
[cir] Identification of core benefits will be made and updated by a
public/private entity whose members are appointed through a process
defined in law which
--Includes citizens representing a broad spectrum of the population
--Will specify core benefits taking into account evidence-based science
and expert consensus regarding the effectiveness of treatments.
[cir] Additional coverage for services beyond the core package can
be purchased.
Shared social responsibility implies consideration of
health care costs.
[cir] Health care spending needs to be considered in the context of
other social needs and responsibilities. Because resources for health
care spending are not unlimited, the efficient use of public and
private resources is critical.
[cir] Individuals should be responsible, to the extent possible, to
be good stewards of their health and health care resources.
Interim Recommendations
Core Benefits: Americans will have access to a set of
affordable and appropriate core health care services by the year 2012.
Recommendation 1: It should be public policy that all Americans have
affordable health care
All Americans will have access to set of core health care services.
Financial assistance will be available to those who need it.
Across every venue we explored, we heard a common message:
Americans should have a health care system where everyone participates,
regardless of their financial resources or health status, with benefits
that are sufficiently comprehensive to provide access to appropriate,
high-quality care without endangering individual or family financial
security.
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Financing Health Care That Works for All Americans
This and other of the recommendations contained here call for
actions that will require new revenues to provide some health care
security for Americans who are now at great risk. The opinion polls we
examined, the community meetings we held, and the web based surveys and
comments we received, all showed large majorities of people willing to
make additional financial investments in the service of expanding the
protection against the costs of illness and the expansion of access to
quality care.
We recommend adopting financing strategies for these
recommendations that are based on principles of fairness, efficiency,
and shared responsibility. These strategies should draw on dedicated
revenue streams such as enrollee contributions, income taxes or
surcharges, ``sin taxes'', business or payroll taxes, or value-added
taxes that are targeted at supporting these new health care
initiatives.
We note that improvements in efficiency through a variety of
mechanisms such as investments in health information technology, public
reporting, and quality improvement may be realized over time. To the
extent that such efficiency gains are obtained they would be used to
assist in paying for new protections such as those against catastrophic
health care expenditures and the impoverishment of individuals as a
result of getting the health care they need.
No specific health care financing mechanism is optimal. We
understand that the transition from the current system to a system that
includes all Americans will take time and that multiple financing
sources will need to coexist during the move to universal coverage.
However, the disparate parts must be brought together in a way that
ensures a seamless and smooth transition.
Recommendation 2: Define a ``Core'' Benefit Package for All Americans
Establish an independent non-partisan private-public group to
identify and update recommendations for what would be covered under
high-cost protection and core benefits.
Members will be appointed through a process defined in law
that includes citizens representing a broad spectrum of the population
including, but not limited to, patients, providers, and payers, and
staffed by experts.
Identification of high cost and core benefits will be made
through an independent, fair, transparent and scientific process.
The set of core health services will go across the continuum of
care throughout the lifespan.
Health care encompasses wellness, preventived services,
primary care, acute care, prescription drugs, patient education and
treatment and management of health problems provided across a full
range of inpatient and outpatient settings.
Health is defined to include physical, mental and dental
health.
Core benefits will be specified by taking into account
evidence-based science and expert consensus regarding the medical
effectiveness of treatments.
Immediate Protection for the Most Vulnerable: Action
should be taken now to better protect Americans from the high costs of
health care and to improve and expand access to health care services.
Recommendation 3: Guarantee financial protection against very high
health care costs.
No one in America should be impoverished by health care costs.
Establish a national program (private or public) that ensures
Coverage for all Americans,
Protection against very high out-of-pocket medical costs
for everyone, and
Financial protection for low income individuals and
families.
Recommendation 4: Support integrated community health networks
The Federal Government will lead a national initiative to develop
and expand integrated public/private community networks of health care
providers aimed at providing vulnerable populations, including low
income and uninsured people, and people living in rural and underserved
areas, with a source of high quality coordinated health care by:
Identifying within the federal government the unit with
specific responsibility for coordinating all federal efforts that
support the health care safety net;
Establishing a public-private group at the national level
that is responsible for advising the federal government on the nation's
health care safety net's performance and funding streams, conducting
research on safety net issues, and identifying and disseminating best
practices on an ongoing basis;
Expanding and modifying the Federal Qualified Health
Center concept to accommodate other community-based health centers and
practices serving vulnerable populations; and
Providing federal support for the development of
integrated community health networks to strengthen the health care
infrastructure at the local level, with a focus on populations and
localities where improved access to quality care is most needed.
Quality and Efficiency: Intensified efforts are central to
the successful transformation of health care in America.
Recommendation 5: Promote efforts to improve quality of care and
efficiency
The Federal Government will expand and accelerate its use of the
resources of its public programs for advancing the development and
implementation of strategies to improve quality and efficiency while
controlling costs across the entire health care system.
Using federally-funded health programs such as Medicare,
Medicaid, Community Health Centers, TRICARE, and the Veterans' Health
Administration, the Federal Government will promote:
[cir] Integrated health care systems built around evidence-based
best practices;
[cir] Health information technologies and electronic medical record
systems with special emphasis on their implementation in teaching
hospitals and clinics where medical residents are trained and who work
with underserved and uninsured populations;
[cir] Reduction of fraud and waste in administration and clinical
practice;
[cir] Consumer-usable information about health care services that
includes information on prices, cost-sharing, quality and efficiency,
and benefits; and
[cir] Health education, patient-provider communication, and
patient-centered care, disease prevention, and health promotion.
Recommendation 6: Fundamentally restructure the way that palliative
care, hospice care and other end-of-life services are financed and
provided, so that people living with advanced incurable conditions have
increased access to those services in the environment they choose
Individuals nearing the end of life and their families need support
from the health care system to understand their health care options,
make their choices about care delivery known, and have those choices
honored.
Public and private payers should integrate evidence based
science, expert consensus, and culturally sensitive end of life care
models so that health services and community-based care can better deal
with the clinical realities and actual needs of chronically and
seriously ill patients of any age and their families.
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Public and private programs should support training for
health professionals to emphasize proactive, individualized care
planning and clear communication between providers, patients and their
families.
At the community level, funding should be made available
for support services to assist individuals and families in accessing
the kind of care they want for last days.
Members of the Citizens' Health Care Working Group
Randall L. Johnson, Chair
Frank J. Baumeister, Jr.
Dorothy A. Bazos
Montye S. Conlan
Richard G. Frank
Joseph T. Hansen
Therese A. Hughes
Brent C. James
Catherine G. McLaughlin
Patricia A. Maryland
Rosario Perez
Aaron Shirley
Deborah R. Stehr
Christine L. Wright
Michael O. Leavitt, Secretary of Health and Human Services
Because the Working Group's final recommendations will be submitted
to the Department of Health and Human services, the Secretary of Health
and Human Services has neither participated in the development of these
recommendations nor has he endorsed them. He will carefully consider
them and take appropriate action.
End of Review Text
Additional materials including a description of how the Working
Group did its work, key findings from the dialogue with the American
people, stories from Americans, and background material on the
demographics and health resources of locations where Working Group
community meetings were held, findings from the Working Group's
internet poll and University town hall meeting, and a summary of
presentations made to the Working Group can be found on the Working
Group's Web site: www.citizenshealthcare.gov.
Authority: This notice is published in accordance with section
10(a) of the Federal Advisory Committee Act.
The Medicare Modernization Act charged AHRQ with administering the
funds provided by the Congress for the activities of the Citizens'
Health Care Working Group. However, AHRQ has not participated in the
development of these recommendations or supporting material, has had
not advance knowledge of their content, and publication of this notice
is not an endorsement of the Working Group's recommendations by AHRQ or
the Department of Health and Human Services.
Carolyn M. Clancy,
Director.
[FR Doc. 06-5379 Filed 6-13-06; 8:45 am]
BILLING CODE 4160-90-M