[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]


-----------------------------------------------------------------------

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.

-----------------------------------------------------------------------

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:


[[Page 34371]]


--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.

[[Page 34372]]

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.

[[Page 34373]]

     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