Progress Report
Friday, June 12, 2009
In the past month, my focus has been on finalizing a proposal detailing exactly what Medicare benefits should be provided to eligible seniors living in Mexico; what rules must enrollees, providers, and intermediaries adhere to in order for the Demonstration Project to provide the data that Medicare administrators will need to judge the success (or failure) of the Project; and what issues should Medicare administrators look at in developing a program tailored to the Mexican healthcare market and the beneficiaries the Project is intended to serve.
There are many stakeholders to consider as this project moves forward, including beneficiaries living in Mexico either full or part-time; Medicare administrators charged with developing and implementing Program improvements; potential Medicare contract intermediaries (insurers with operations in the Mexican market); and Mexican health services providers (doctors, diagnostic laboratories and hospitals in Mexico). Accomplishing the goal of drafting a proposal that can be supported by all of these stakeholders is a considerable challenge. To meet this challenge, I have studied the relevant portions of existing Medicare legislation. I have met with and discussed hurdles to be overcome with representatives from the stakeholder communities. I have consulted health policy experts with specific knowledge of Medicare, and Medicare Demonstration Projects. And I have attempted to develop credible population and demographic data (from limited available sources) needed to develop the political arguments and strategies required to get this proposal introduced, and ultimately passed, in Congress.
At the end of May 2009, I completed what I hope will be a legislative proposal that all stakeholders will support. That proposal is part of an informational booklet I prepared for Members of Congress. The booklet provides explanatory and supporting information on Demonstration projects; the cost-savings potential of the proposed Project; the numbers of seniors living in Mexico (and from which states they vote); and other information aimed at building support for the proposal.
On June 12, I completed my third trip to Washington, DC to lobby for a Demonstration Project to Provide Medicare Benefits for Eligible Seniors Living in Mexico. My focus for this visit was hand delivering, to Congressional staffers involved in healthcare legislation, copies of my just completed proposal and booklet on the issue. Whenever possible, I also scheduled meetings with relevant staff members and Members of Congress.
I had high hopes of getting a commitment to introduce the proposal as legislation during this trip. Unfortunately, that did not happen, but the trip was by no means a failure. In legislation, success goes to the persistent and the well organized (funding doesn't hurt either). What you don't get today, you can win tomorrow if you keep trying.
Rep. Carolyn Maloney (D-NY), a longtime supporter of Americans living abroad, and founding member of the Americans Abroad caucus in Congress assured me that she strongly supports this proposal, but she just introduced legislation to cover the insurance and healthcare needs for life, for all of the first-responders to the 9/11 tragedy in her district. This could be a $1 billion proposal, and she felt it would be impossible for her to introduce another piece of health care related legislation this year. She did promise to sign on as a co-sponsor if we get the proposal introduced.
The Legislative Assistant to Senate Majority Leader, Harry Reid (D-NV) also expressed strong support, but as Majority Leader, Sen. Reid does not co-sponsor, or introduce, legislation.
A meeting with the Legislative Assistant to Rep. Javier Becerra (D-CA) was disappointing. She was interested, but clearly uninformed about Medicare and how it operates. She took notes, and hopefully will pass them along to someone on the Congressman's staff who is expert in this area.
A very productive meeting was held with Rep. Mike Honda (D-CA) and a very capable Senior Fellow for Social Security and Healthcare Issues, Bernadette Arellano, who is working in his office. Ms. Arellano was informed on the topic, asked relevant questions, and was ready to discuss political strategies and how we might deal with political opposition to the legislation. Rep. Honda promised to study the issue further, and to keep in touch. My strong sense is that he supports the idea, but wants to consult with colleagues to determine the best time to introduce the proposal.
Rep. Jim McDermott (D-WA) is also a strong candidate to introduce the proposal. I met him at an event on Friday evening, and introduced myself. I had visited his office previously, meeting with a staffer, but often, information doesn't trickle up to the boss in Congress. When I introduced myself, his response was, "Oh, you're that guy!" We had a good conversation, and the following Monday, I met with his Chief of Staff, Mike DeCesare. He, too was well informed, had clearly read my booklet. Congressman McDermott will be consulting with Congressman Honda as we proceed.
I also spoke briefly with staff from the House Hispanic Caucus. Many of the members of this Caucus are from U.S. Border States with populations that cross the border frequently, many to access health services in Mexico. My sense is that we can develop strong allies among the Caucus members on this issue.
Other positive responses:
* Tammy Baldwin (D-WI) "has heard about this and is very interested," according to her LA for Health & Medicare Issues, Elizabeth Lee. We plan to meet on my next trip.
* Debbie Wasserman-Schultz (D-FL). I had spoken with her directly at an event in early April, and she was glad to see I was following up... Mexico has a large number of voters from Florida, and she's seen the numbers. As a cancer survivor, she's in favor of making sure everyone has the coverage they deserve.
* Massachusetts is another large sending state for seniors living in Mexico, and Rep. Barney Frank's LA is studying the issue.
* Sen. Barbara Mikulski (D-MD) was "most impressed with the well-thought-out and detailed proposal. Sen. Mikulski is a lifelong champion of seniors' issues, and will certainly support this legislation," according to her LA for Health & Medicare, Julia Frifield. We will meet to discuss the proposal on my next trip.
* Many other positive comments and promises to give the proposal serious consideration.
I have not encountered any opposition to this proposal in Congress. No doubt, once introduced, there will be some. There will be Members who oppose "sending U.S. taxpayer dollars to Mexican doctors." There will be those who say, "Those people chose to leave the U.S., so why should the government pay for their health care?" And there will be stereotypical arguments citing the corruption in Mexico and thus the "inability to control fraud." I believe there are strong and convincing arguments to counter such opposition.
In the end, this is an issue about fairness (eligible beneficiaries, wherever they live, have paid into the Medicare Trust Fund throughout their working lives); and cost savings for the Medicare Program. I believe this could be the biggest per-beneficiary cost-saving Demonstration project that Medicare has ever undertaken, according to the cost calculations I have done.
In fact, because the U.S. currently spends at least 1/3 more than the next-most-expensive country for healthcare, this program could be implemented ANYWHERE (not just Mexico) and realize savings to the Medicare system. And ultimately, that is the aim of this project. Medicare can prove that it is administratively feasible to provide benefits to seniors wherever they live, can gain valuable administrative experience by starting in Mexico, working out any difficulties encountered, and gradually extend benefits ANYWHERE.
Please stay tuned as I will be providing details of the next steps planned for this campaign in the very near future.
Friday, June 12, 2009
In the past month, my focus has been on finalizing a proposal detailing exactly what Medicare benefits should be provided to eligible seniors living in Mexico; what rules must enrollees, providers, and intermediaries adhere to in order for the Demonstration Project to provide the data that Medicare administrators will need to judge the success (or failure) of the Project; and what issues should Medicare administrators look at in developing a program tailored to the Mexican healthcare market and the beneficiaries the Project is intended to serve.
There are many stakeholders to consider as this project moves forward, including beneficiaries living in Mexico either full or part-time; Medicare administrators charged with developing and implementing Program improvements; potential Medicare contract intermediaries (insurers with operations in the Mexican market); and Mexican health services providers (doctors, diagnostic laboratories and hospitals in Mexico). Accomplishing the goal of drafting a proposal that can be supported by all of these stakeholders is a considerable challenge. To meet this challenge, I have studied the relevant portions of existing Medicare legislation. I have met with and discussed hurdles to be overcome with representatives from the stakeholder communities. I have consulted health policy experts with specific knowledge of Medicare, and Medicare Demonstration Projects. And I have attempted to develop credible population and demographic data (from limited available sources) needed to develop the political arguments and strategies required to get this proposal introduced, and ultimately passed, in Congress.
At the end of May 2009, I completed what I hope will be a legislative proposal that all stakeholders will support. That proposal is part of an informational booklet I prepared for Members of Congress. The booklet provides explanatory and supporting information on Demonstration projects; the cost-savings potential of the proposed Project; the numbers of seniors living in Mexico (and from which states they vote); and other information aimed at building support for the proposal.
On June 12, I completed my third trip to Washington, DC to lobby for a Demonstration Project to Provide Medicare Benefits for Eligible Seniors Living in Mexico. My focus for this visit was hand delivering, to Congressional staffers involved in healthcare legislation, copies of my just completed proposal and booklet on the issue. Whenever possible, I also scheduled meetings with relevant staff members and Members of Congress.
I had high hopes of getting a commitment to introduce the proposal as legislation during this trip. Unfortunately, that did not happen, but the trip was by no means a failure. In legislation, success goes to the persistent and the well organized (funding doesn't hurt either). What you don't get today, you can win tomorrow if you keep trying.
Rep. Carolyn Maloney (D-NY), a longtime supporter of Americans living abroad, and founding member of the Americans Abroad caucus in Congress assured me that she strongly supports this proposal, but she just introduced legislation to cover the insurance and healthcare needs for life, for all of the first-responders to the 9/11 tragedy in her district. This could be a $1 billion proposal, and she felt it would be impossible for her to introduce another piece of health care related legislation this year. She did promise to sign on as a co-sponsor if we get the proposal introduced.
The Legislative Assistant to Senate Majority Leader, Harry Reid (D-NV) also expressed strong support, but as Majority Leader, Sen. Reid does not co-sponsor, or introduce, legislation.
A meeting with the Legislative Assistant to Rep. Javier Becerra (D-CA) was disappointing. She was interested, but clearly uninformed about Medicare and how it operates. She took notes, and hopefully will pass them along to someone on the Congressman's staff who is expert in this area.
A very productive meeting was held with Rep. Mike Honda (D-CA) and a very capable Senior Fellow for Social Security and Healthcare Issues, Bernadette Arellano, who is working in his office. Ms. Arellano was informed on the topic, asked relevant questions, and was ready to discuss political strategies and how we might deal with political opposition to the legislation. Rep. Honda promised to study the issue further, and to keep in touch. My strong sense is that he supports the idea, but wants to consult with colleagues to determine the best time to introduce the proposal.
Rep. Jim McDermott (D-WA) is also a strong candidate to introduce the proposal. I met him at an event on Friday evening, and introduced myself. I had visited his office previously, meeting with a staffer, but often, information doesn't trickle up to the boss in Congress. When I introduced myself, his response was, "Oh, you're that guy!" We had a good conversation, and the following Monday, I met with his Chief of Staff, Mike DeCesare. He, too was well informed, had clearly read my booklet. Congressman McDermott will be consulting with Congressman Honda as we proceed.
I also spoke briefly with staff from the House Hispanic Caucus. Many of the members of this Caucus are from U.S. Border States with populations that cross the border frequently, many to access health services in Mexico. My sense is that we can develop strong allies among the Caucus members on this issue.
Other positive responses:
* Tammy Baldwin (D-WI) "has heard about this and is very interested," according to her LA for Health & Medicare Issues, Elizabeth Lee. We plan to meet on my next trip.
* Debbie Wasserman-Schultz (D-FL). I had spoken with her directly at an event in early April, and she was glad to see I was following up... Mexico has a large number of voters from Florida, and she's seen the numbers. As a cancer survivor, she's in favor of making sure everyone has the coverage they deserve.
* Massachusetts is another large sending state for seniors living in Mexico, and Rep. Barney Frank's LA is studying the issue.
* Sen. Barbara Mikulski (D-MD) was "most impressed with the well-thought-out and detailed proposal. Sen. Mikulski is a lifelong champion of seniors' issues, and will certainly support this legislation," according to her LA for Health & Medicare, Julia Frifield. We will meet to discuss the proposal on my next trip.
* Many other positive comments and promises to give the proposal serious consideration.
I have not encountered any opposition to this proposal in Congress. No doubt, once introduced, there will be some. There will be Members who oppose "sending U.S. taxpayer dollars to Mexican doctors." There will be those who say, "Those people chose to leave the U.S., so why should the government pay for their health care?" And there will be stereotypical arguments citing the corruption in Mexico and thus the "inability to control fraud." I believe there are strong and convincing arguments to counter such opposition.
In the end, this is an issue about fairness (eligible beneficiaries, wherever they live, have paid into the Medicare Trust Fund throughout their working lives); and cost savings for the Medicare Program. I believe this could be the biggest per-beneficiary cost-saving Demonstration project that Medicare has ever undertaken, according to the cost calculations I have done.
In fact, because the U.S. currently spends at least 1/3 more than the next-most-expensive country for healthcare, this program could be implemented ANYWHERE (not just Mexico) and realize savings to the Medicare system. And ultimately, that is the aim of this project. Medicare can prove that it is administratively feasible to provide benefits to seniors wherever they live, can gain valuable administrative experience by starting in Mexico, working out any difficulties encountered, and gradually extend benefits ANYWHERE.
Please stay tuned as I will be providing details of the next steps planned for this campaign in the very near future.
