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Public Hearing on Private Insurance Readability-TOMORROW!
Emergency Rule Rolls Back Consumer Initiatives in Private InsuranceThe Commissioner of Insurance will hold a public hearing to consider the permanent adoption of an emergency rule that repeals readability improvements and access to insurance policies. Let your voice be heard! Valuable consumer protections are needed in insurance policies. You can share your thoughts on private health insurance accessibility:
Public Hearing on "the Repeal of Policy Simplification Provisions"
Tuesday, May 3, 2011, 10:00am
OCI Building, 125 South Webster Street, 2nd Floor, Room 227
Background: On February 9, Wisconsin's Commissioner of Insurance implemented an emergency rule repealing the requirements that improve access to and readability of insurance policies. The repeal eliminates the "policy simplification provisions" implemented in the Wisconsin Administrative Code (Section 6.07) in 2010 that requires insurers make available an insured's complete insurance policy electronically and sets a timeline for that production. In addition, the rule returns the "readability score" of policies to their prior levels--a level determined too difficult for consumers to understand (based on an evaluated Flesch score). There are additional measures being rolled back as well, including the requirement that all policy "exclusion and limitation" language appear in the same section of the policy, not scattered throughout. Read more in on this topic in the last edition of the HealthWatch Reporter.
Still Time to Weigh In with DHSThe Department of Health Services has recently concluded what appears to have been the last Town Hall meeting in Kimberly, Wisconsin, with stops in Eau Claire, Fennimore, and Milwaukee. While an announcement has not been made of any future hearings, the Department of Health Services (DHS) is still accepting public comment! A "Virtual Town Hall Meeting" has been posted on the DHS website. Take advantage of this opportunity to weigh in on the impact of BadgerCare and Medicaid programs on the people of Wisconsin. Survey questions specifically ask for input on what DHS can improve, and "cost saving suggestions."
Update on State Budget TimelineOn Thursday, April 21, Joint Finance Committee Co-chairs Senator Alberta Darling (R-River Hills) and Representative Robin Vos (R-Racine) mapped out the process for the state budget. Members of the Joint Finance Committee were briefed in a memo dated April 20 on how to make amendments to the budget and submit them to the Legislative Fiscal Bureau. The first Joint Finance Executive Session was Tuesday, April 26, when the Committee began voting on 14 agencies and programs. That included Insurance, the Public Defender’s Office and the DNR. The Joint Finance Committee Co-Chairs said this budget process will be ruled by three guiding principles: no increases in taxes to working families, reducing spending, and delivering core services. Representative Vos said in a statement to the press, however, that despite these principles, not all programs will be funded at the levels seen in the past. Senator Alberta Darling said she is expecting bipartisan efforts to make changes to education, shared revenue and Medicaid programs. The State Assembly will take up the budget once the Joint Finance Committee finishes its work. The assembly is currently adjourned until May 10.
Joint Finance Committee's Schedule This Week:
Tuesday May 3, 11:00am: The Agenda includes the Department of Health Services, four areas in Transportation, and the Office of the Commissioner of Insurance.
Thursday, May 5 at 11:00am: The Agenda includes Military Affairs, Tourism, the Government Accountability Board, Building Commission and the Arts Board.
Medical Transportation in Wisconsin: LogistiCare
Update on the New State ContractOn April 15, the HealthWatch Update staff reported in its Grapevine Section that new questions were emerging about the new state Medicaid transportation contract awarded to LogistiCare, a Georgia-owned business. Initially, we thought that HMOs in southeastern Wisconsin were included in the new contract. However, the original proposal did not include the six southeast counties, and those regional HMOs will maintain responsibility for the non-emergency transportation of their members. However, the new contract will affect the rest of Wisconsin.
The contract is effective as of July 1, though members can begin calling LogistiCare's general phone line for appointments that are scheduled July 1 or later on June 17. DHS and LogistiCare held a series of provider meetings across the state; the most recent one, held in Madison, included this PowerPoint that covers a lot of general questions, but also raises some important issues. For example, what about confidentiality of a member’s medical information and exactly what questions a member must answer to qualify for a ride? In addition, members must call for their ride before noon, two days in advance of their appointment. As we understand the proposed process, when members call LogistiCare for the first time, they must answer a series of questions to determine if they qualify for a ride or if they could take alternate means of transportation. For example, LogistiCare will ask: can the member take a bus or get a ride from a friend or relative? If they are within a quarter mile of a bus route and determined, by phone, physically and mentally capable of getting there, LogistiCare would issue a bus pass to get to the member to subsequent appointments. But what if people cannot get through before noon to request a ride? What if they do qualify for a bus pass but can’t actually make it to the bus stop? These and other questions remain.
LogistiCare's services could be very valuable for rural Wisconsin, where members may notice an increase in service. But in Dane County, where providers and HMOs currently handle most non-emergency medical transportation, the new system looks disruptive to certain members who have not had trouble getting to appointments.
It is also important to note that there is at least one discrepancy between the PowerPoint and what's being sent out to people who use ForwardHealth. The ForwardHealth Update on these transportation issues lists an incorrect number for TTY/hearing impaired services. The correct number is 866-288-3133. LogistiCare's general phone line for routine appointments is 866-907-1493.
The ForwardHealth update will be sent around to members as early as June 1, though many providers are taking it upon themselves to educate members on the changes to transportation under LogistiCare. HealthWatch Wisconsin will definitely be following up with its members and friends, looking for potential increases in no-shows for appointments and at the grievance process.
Center for Medicare and Medicaid Proposes New RuleThe Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that will create a "standardized, transparent process" for states when they set Medicaid reimbursement rates and help ensure access, according to AHA News Now. CMS is getting out in front of a controversy over disparate state Medicaid payment rates, proposing a rule change instead of leaving the issue to be settled by the US Supreme Court. Under the rule, states must adopt a process to monitor Medicaid beneficiaries' access to health care service by service type. States with proposed reimbursement cuts would be required to review the new rates compared to: usual and customary changes, Medicare payments, commercial payments or Medicaid costs; and the composite average reduction from proposed rate changes.
Administration's SeniorCare BackpedalingWhen speaking at the 4th Annual HealthWatch Wisconsin Conference, Department of Health Services Secretary Dennis Smith insisted that Medicare Part D was a much more economical way for Wisconsin seniors to secure needed pharmaceuticals. The comments came after the Administration's budget included a rule that if a senior qualifies for Medicare Part D, they would have to enroll in it as their primary health coverage. SeniorCare could then be "secondary coverage." This past Saturday, however, the Governor stated in an interview he'd be willing to compromise on the SeniorCare budget provisions. The Governor actually said that his willingness to compromise is echoing earlier remarks made by his health secretary. The about face follows the recent Senate Democrat-authored SeniorCare Protection Bill and very vocal senior advocates.
Contraceptive Equity Repeal, but Women's Health Still Under AttackIn the April 15 edition of the HealthWatch Update,we brought you a look at the federal budget maneuvering around Planned Parenthood, where Speaker of the House John Boehner finally "traded" the language barring federal funding of Planned Parenthood for an extra $500 million in spending cuts from other programs. More locally, bargaining with women's health continues. The budget provision repealing Wisconsin's contraceptive equity law has been removed from the state budget proposal, which means birth control can still be covered under prescription drug plans just like all other prescriptions. The repeal of the Contraceptive Equity law, however, exists now as a stand-alone bill in the state legislature. As is, the budget proposal would eliminate Wisconsin’s only women’s health and family planning program, which provides funding for Planned Parenthood of Wisconsin and dozens of other women’s health providers across the state.
May is "Mental Health Awareness Month"Advocates and health care professionals are celebrating and raising awareness around mental health this May. Starting Monday, Mental Health America is celebrating its annual campaign of “May is Mental Health Month” with two major themes, including: “Do more for 1 in 4” and “Live well! It’s essential for your potential.” The first theme addresses that one in every four adults lives with a treatable mental health disease in the United States. It encourages professionals, friends and family to take action and support those suffering. We can do more! The second theme for the month is focused on improving personal well-being and steps that can be taken to avoid stress. The Mental Health America website offers the ten steps in the "Live Your Life Well" program to get started. In a press release, Mental Health America of Wisconsin urges Wisconsinites to weigh in on the state budget, especially cuts to Medicaid and county services. "This puts our fragile mental health system at risk."
Advocates are celebrating this week as: "Children's Mental Health Awareness Week." Tune into a webcast on Tuesday, May 3, at 1:00pm to learn, "Connect the Dots: Understanding Children's Mental Health. Additional events this week include:
- Communities in Action to Prevent Suicide, May 4
- The Many Faces of Depression: Hope and Health, May 13
- Medication Effects: The Good, the Bad and the Ugly, May 23
Complete HealthWatch Public Hearing Footage Now Online!HealthWatch Wisconsin has posted the complete video footage of public testimony on the impact of proposed BadgerCare and Medicaid cuts that will affect 1.2 million Wisconsinites covered by these programs. In March, HealthWatch Wisconsin sponsored two days of public hearings during the HealthWatch Wisconsin Annual Conference, drawing hundreds of people to listen, learn, and for some, to share their stories and the stories of loved ones. HealthWatch Wisconsin staff was on hand to record participants' testimony.
View the public testimony footage here.
HIRSP Premiums Increase July 1First reported in "Wisconsin Health News," the state's HIRSP Authority is said to be increasing premiums by 15%, effective July 1, 2011. The increase is necessitated by an almost 40% jump in medical expenses in recent months and a state law that requires HIRSP members to carry 60% of the plan costs. One of the key factors impacting plan costs is the increased prices of top-selling brand name drugs. To see current rates for HIRSP state plans, visit the HIRSP Premium Rate Table and the Plan Subsidy Discount Tables:
HIRSP will be sending a letter to its policyholders explaining the changes this month. In the meantime, if you have any questions, the general phone number for HIRSP is 1-800-828-4777.
Case Tip Two-Self Funded Insurance Plans Walk into a Bar...
Every so often you may encounter a patient or client who has health coverage under two self-funded ERISA (Employee Retirement Income Security Act) health insurance plans, through work and through a spouse's work, for example. If that patient receives a medical bill, which insurance company pays first?
Self-funded ERISA plans are only governed by federal law - hence the confusion. The particulars of self-funded ERISA plans vary from firm to firm, plan to plan. The National Association of Insurance Commissioners published its own model coordination of benefits (COB) guidelines for states to follow. This model, introduced in 1971 and amended to keep up with the times, was to serve as an example for employers and state legislatures to adopt as a consistent set of rules for coordinating benefits. Of course, model rules do not carry the force of law. Most COB provisions include the following:
- General rules for employees and spouses covered by two group health plans: the plan that covers the individual as an employee will generally pay as the primary payer, and the plan that covers the individual as a dependent will generally be the secondary payer.
- The “birthday rule” is common for children covered by two employer group health plans. In this situation, the plan covering the parent whose birthday falls first in the year will pay primary on the children, the other parent’s plan becomes the secondary payer. The plans consider only the parent’s birth date, not the parent’s birth year (NOTE: This is the rule Wisconsin has adopted. It is based on the 1986 NAIC Rules model and is found at: Wisconsin Admin. Code Ins. 3.40).
- If the parents are divorced, payment order may be affected. If the divorce decree does not specify health insurance responsibility and the parents have joint custody, the birthday rule applies. If a court order specifies the parent responsible for providing health care coverage, that group health plan is primary.
- If a person has COBRA continuation coverage or any state mandated continuation coverage, the continuation coverage is secondary.
- If a plan does not spell out coordination of benefit rules, the plan that covered the person for the longer period of time is primary.
by Katie Foran-McHale
As Special Projects Manager, Patricia plays a significant number of roles at Public Health Madison and Dane County (PHMDC). Her official title doesn’t do justice to everything she’s involved with at Public Health: She currently serves as Data Abstractor for PHMDC’s Fetal and Infant Mortality Review process, one of eight Intake Nurses, first point of contact for students and volunteers looking to work with Public Health, an agency representative to the Dane County Coalition to Reduce Alcohol Abuse and the Dane County HealthWatch Coalition, planner for the Annual Breastfeeding Symposium fundraiser and occasionally a preceptor or mentor for student workers.
“It’s a variety of interesting and challenging work,” she said.
Her primary responsibility is now spent as Data Abstractor. She collects records and reports, abstracts specific data and adds it to a national database. She and a team of staff members are reviewing cases to analyze trends in infant mortality, looking for disparities. “Maybe there are gaps in resources, maybe we find that people don’t know about available resources and don’t seek help, or maybe they have difficulty sustaining seeking help,” she said.
It is a quarterly review process that will eventually lead them to make recommendations that would improve health systems in Dane County judging by trends they find occurring throughout the year. “Everybody in Dane County needs to work together to gather data, to analyze it, and to look how we can prevent more babies from dying in the future,” Patricia said.
She also hears from people every day who don’t have health insurance and need to access health care. In these cases, knowledge is power – Patricia is able to refer patients to places they can go for help through connections she’s made and information she’s learned through her work with HealthWatch, with which she has been a member for the last two years.
“Advocacy organizations fight for individual rights that I can’t always do myself, but I’m able to tell people about these organizations that can help them,” she said. In turn, she’s able to offer information about Public Health and provide knowledge of her work—she will be giving a presentation on fetal and infant mortality at this week’s Dane County HealthWatch Coalition meeting.
Through her many involvements, Patricia stays informed about health-related legislation, issues, resources, programs, services and strategies. “Because of what I learn, I can collaborate in activities that help us have a competent and coordinated public health workforce,” she said. “And the information that I have doesn’t just help me, it helps my whole organization to serve the public.”
Click here for a list of upcoming coalition meetings. Dane County HealthWatch met this morning at the Hawthorne Branch of the Madison Public Library. A big thank you to Patricia Frazak (member profile above) to organizing the meeting location, providing refreshments, and presenting! She presented on Public Health Madison & Dane County's (PHMDC) new Fetal and Infant Mortality Review (FIMR), along with Dan Stattelman-Scanlan, also from PHMDC. Jon Peacock of the Wisconsin Council on Children and Families also attended and spoke on the issue of centralization and potential privatization of income maintenance services in Wisconsin. Finally, Dane County HealthWatch members discussed at length the new provider contracts for non-emergency medical transportation through LogistiCare. The next Dane County HealthWatch meeting will be June 6, back at the usual location at the Waisman Community Outreach Center on East Olin Ave, and the speaker, confirmed for now, will be Amy Mendel-Clemens, the Economic Support Division Administrator for Dane County. For more information about the Dane County HealthWatch Coalition, please contact Adam VanSpankeren.
The Dunn County HealthWatch Coalition’s last luncheon meeting on Thursday, April 7 was a success. Chris Kruse, an EMT and Chief Medical Examiner for Dunn County, came to speak to the group about causes of death in Dunn County. The group's next meeting has not been formally announced yet - Dunn County coalition members, stay tuned for the invitation to be sent around via email. For more information about the Dunn County HealthWatch Coalition, please contact Wendy MacDougall or Sandy Nevin.
The Eau Claire County HealthWatch Coalition has their next meeting scheduled for Thursday, May 5 at the Luther Hospital Cafeteria from 12:00-1:30pm. Speakers include Paula Gibson, Community Relations Director for Harbor House Memory Care speaking about Harbor’s services and new websites and Pat Perkins of the Eau Claire City-County Health Department, giving an update from the annual statewide HealthWatch Wisconsin conference. For more information, please contact Lou Kelsey or Pat Perkins.
The Milwaukee HealthWatch Coalition will meet May 11 to welcome Barb Wesson to give an overview of CORE/El Centro, a non-profit grassroots volunteer-driven organization that offers individuals of all income levels access to natural healing therapies. For more information about the Milwaukee HealthWatch Coalition, please contact Nora Foshager.
The Pierce County HealthWatch Coalition Steering Committee has been busy! The steering committee has another strategic planning call on May 9 to prepare for its kickoff meeting, which has been scheduled for May 12 at Crossroad Community Church in Ellsworth, Wisconsin. Mike Rust, of ABC for Rural Health and the Polk and Barron County HealthWatch Coalitions, will be the group’s first speaker and will be discussing changes to the BadgerCare programs. For more information about the Pierce County HealthWatch Coalition, please contact Lisa Raethke.
The Tri-County HealthWatch Coalition had their most recent meeting on Tuesday, April 26 at the Goodwill Community Center in Menasha. They continued to address issues raised in the March 31 draft of their strategic plan and will soon begin implementation of some of their strategies to address health concerns in the Tri-County area. For more information about the Tri-County HealthWatch Coalition, contact Susan Garcia Franz or Connie Raether.
CKSN Corner Covering Kids with Special Needs
The National Youth Leadership Network announces their new curriculum: Reap What You Sow: Harvesting Support Systems Curriculum Training Packages. Reap What You Sow brings youth and adults together to build support systems. For more information, click here.
May 7. Regional Special Education Conference: Child and Adolescent Mental Health Issues. 8:30 a.m., Madison College, Madison. Register free at 877-374-0511 or by emailing firstname.lastname@example.org. For more information, click here.
May 9. Did You Know? Now You Know! 5:30-8:30 pm.m, Jefferson County Health/Human Services Department, 1541 Annex Road. Training for parents, grandparents, caregivers and providers on health care, community services and support for children and youth with special health care needs and/or disabilities. Register free by calling 800-234-5437 or emailing Brad Holman.
May 14. Workshop on employment for youth with special health care needs, 8:30 a.m. to 12 p.m., Children’s Hospital of Wisconsin Corporate Center, Suite 220. Sponsored by the Southeast Regional Center for Children & Youth with Special Health Care Needs and Children’s Hospital of Wisconsin Social Work Program. Call 414-266-3188 to RSVP and for more information. Space is limited.
On April 4, the DHS released a new BadgerCare Plus Handbook. The new handbook is available here. For a PDF version with highlighted changes, click here.
Ops Memo 11-21: Administrative Renewals
Released April 28
New Policy: Current policy requires an individual or household to conduct a renewal every 12 months. Effective May 1, 2011 certain households and individuals will be able to meet this requirement through the administrative renewal process described here. Cases selected for administrative renewal will not receive an eligibility renewal notice. The extension of program eligibility under an administrative renewal is based on the information in CWW as of the month prior to the month a full renewal would otherwise have been due. An administrative renewal case is not required to provide the IM agency with any additional information in order to have program eligibility continued. Administrative renewal cases remain subject to change reporting requirements. The administrative renewal notice identifies program specific change reporting requirements, as well as the potential consequences for not reporting changes timely. Changes reported for a case that has undergone an administrative renewal should be processed under existing policy.
State & National News
Analysis and Comment
Wisconsin’s new “Office of Free Market Health Care” is Governor Scott Walker’s version of the office formerly known as the “Office of Health Care Reform.” The main duty of the office has become setting up the health insurance exchange required by the Affordable Care Act. Yet, the version of the exchange planned by the “Free Market” office is very different than the exchange previewed by advocates and providers on October 28, 2010 at the HealthWatch Wisconsin-sponsored “The Changing Landscape of Private Health Insurance in Wisconsin After Reform.” The new Administration is considering moving Medicaid recipients into private plans offered on the exchange, a move proposed to “reduce state costs while expanding options for Medicaid recipients.”
In Matt Hrodey’s article, “State Weighing Medicaid Shift,” Milwaukee News Buzz, April 29, he explores the idea of the state buying Medicaid-eligible individuals into commercial plans. Matt’s comments stem from a Health Coverage Purchasing Exchange Survey on the “Free Market” website, where individuals are encouraged to provide input on a variety of issues, including whether the state should buy Medicaid recipients into plans on the exchange. ABC for Health’s Bobby Peterson provides some perspective, “What type of coverage is available? What type of oversight would be available to people that currently have solid protection under state and federal law as Medicaid enrollees?” Bobby continues, “Keep in mind, there are legislative proposals to strip away state mandates and let out-of-state companies sell policies in Wisconsin. Medicaid under federal law provides comprehensive coverage that in many cases is better than most private insurance available now and certainly better than the policies that could be available from out of state.” This survey question sounds like its leading people to conclude that we should fully privatize Medicaid coverage. “I would argue that the program currently operates as a public/private partnership and that we should continue on this path. The Medicaid program can be improved, but this has been the case since 1965 and the program has evolved over time.”
By the questions posed, it seems like the office of Free Market Health Care wants to convince people that they can save money by using the private marketplace; but if they fail to maintain insurance or purchase inferior coverage they end up in the emergency room. If that happens the debt is socialized to us all in the form of more expensive health care when these bills are unpaid and shifted to people and plans that are paying. Peterson concludes, “Some people call this cost shifting or a hidden tax---I call it the redistribution and socialization of medical debt.” With this short preview of what the “Free Market” office plans, we see barriers being created to the accessible health care coverage under the proposed health care reforms slated for 2014.
Insurance companies use language of profit in policies
Chris Rickert, Wisconsin State Journal, 30 Apr. 2011
"I've long believed insurers, banks, credit card companies and moneyed service providers in general use language — purposely or not — to flummox customers and protect their financial interests."
Some wary about Atlanta firm's contract to give rides to Medicaid patients
David Wahlberg, Wisconsin State Journal, 28 Apr. 2011
"A new state contract with an Atlanta-based company to arrange rides to medical care for Medicaid patients is raising concern among transportation providers and patient advocates."
Simple checklist may spot signs of autism by age 1
Associated Press, 28 Apr. 2011
"It's not ready for routine use, as more work is needed to verify its accuracy. But it also may prove valuable in finding more at-risk babies to study what causes the developmental disorder."
Walker plan brings warning from USDA
Jason Stein, the Milwaukee Journal Sentinel, 28 Apr. 2011
"Gov. Scott Walker's proposal to privatize work determining who is eligible for food assistance in the state would violate federal law and could expose the state to a loss of more than $20 million in federal money, federal officials say."
Blog: Should your doctor be on Facebook?
Danielle Ofri, The New York Times, 28 Apr. 2011
"But now that any patient can Google a medical team, doctors — like teachers and lawyers — need to consider issues of professionalism before sharing their private lives."
What's behind seniors' fears of GOP Medicare plan?
Associated Press, 28 Apr. 2011
"Some experts say GOP policymakers may have overlooked a defining trait among older people: concern for the welfare of the next generations."
Family Care audit raises concerns about oversight
Scott Bauer, Associated Press, 28 Apr. 2011
"The report by the nonpartisan Legislative Audit Bureau praised the program for improving access to long-term care, but said its cost effectiveness is difficult to assess because the type and quality of services offered may be luring some people to enroll in the program who otherwise wouldn't seek public assistance."
Blog: How the GOP stopped worrying and learned to love Obamacare
Ezra Klein, The Washington Post, 27 Apr. 2011
"The goal is to increase competition by requiring health plans to provide a minimum set of benefits, enabling consumer to make apples-to-apples comparisons and simplifying the task of buying health insurance."
Court questions limits on use of prescription data
Associated Press, 26 Apr. 2011
"Several justices said the so-called data mining law raised troubling constitutional concerns because it appeared to make it harder for brand-name drug makers to state their case, while placing no similar restrictions on the state, insurance companies and others who favor the increased use of cheaper generic medicines."
Hospital report card reveals faults at local facilities
David Wahlberg, The Wisconsin State Journal, 26 Apr. 2011
"At least 17 patients at Meriter Hospital got urinary tract infections from catheters during a recent 21-month period, and 20 patients at UW Hospital had the same problem."
State seeks opinions on health care exchanges
Guy Boulton, The Milwaukee Journal Sentinel, 25 Apr. 2011
"The goal is to increase competition by requiring health plans to provide a minimum set of benefits, enabling consumer to make apples-to-apples comparisons and simplifying the task of buying health insurance."
Insurance policy readability may not get better
David Wahlberg, The Wisconsin State Journal, 22 Apr. 2011
"Wisconsin's new insurance commissioner wants to end a rule that required health insurers to make their policies more understandable."
State's mental health system braces for cuts
Lauren Hasler, The Fond du Lac Reporter, 20 Apr. 2011
"Wisconsin's public mental health system — once viewed as a national model — has become fragmented and underfunded."
Editorial: Patients are not consumers
Paul Krugman, The New York Times, 21 Apr. 2011
"Now politicians and supposed reformers talk about the act of receiving care as if it were no different from a commercial transaction, like buying a car — and their only complaint is that it isn’t commercial enough. What has gone wrong with us?"
Column: What happened to compassionate conservatism?
Shawn Doherty, The Cap Times, 20 Apr. 2011
"Unlike the country bumpkin portrayed by actor Jimmy Stewart, this Mr. Smith comes from Washington with an agenda that some people worry could spell the end of the state’s Medicaid programs and of the moderate Republican approach toward government that helped create them."
State's mental health system braces for cuts
Lauren Hasler, Wisconsin Center for Investigative Journalism, 20 Apr. 2011
"What saved Donovan from suicide or another tragic fate was a mother's perseverance and taxpayer-funded mental health services."
Editorial: Preserving the Medicare contract
Rep. Tammy Baldwin, The Cap Times, 20 Apr. 2011
"Medicare is a contract we make with our seniors that if you work hard, play by the rules, and contribute a fair share in your earning years, then you will have medical care in your senior years. For decades, Medicare has kept millions of our senior citizens from living out their days in poverty."
Obama calls GOP Medicare, spending plan 'radical'
Associated Press, 20 Apr. 2011
"The president has proposed cutting spending, raising taxes and squeezing federal health care programs. The Republican plan rules out tax cuts and would achieve nearly $6 trillion in savings from spending cuts and overhauling Medicare and Medicaid."