Health IT near top of Democrats' agenda for 2009

Washington -- A consensus is developing among some key Democrats to use a portion of an economic stimulus package to help physicians, hospitals and others pay for health information technology.

President-elect Barack Obama said in his weekly video address on Dec. 6, 2008, that he wants health IT to be part of an economic recovery bill congressional leaders hope to adopt early in his administration. "We will make sure that every doctor's office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes and help save billions of dollars each year," he said. Additional stimulus spending would go to other priorities, such as modernizing schools, government buildings and roads.

Sen. Max Baucus (D, Mont.) aligned with Obama on Dec. 10 by linking the need for wider health IT adoption with the push for stimulus spending. "I strongly believe that health IT has to be clear and present in any economic recovery bill," said Baucus, chair of the Senate Finance Committee.

Baucus also said he would pursue quick action on comprehensive health system reform legislation that includes a short-term extension of the State Children's Health Insurance Program rather than seek a separate, five-year SCHIP reauthorization. SCHIP, which covers about 6 million children, will expire on March 31 without legislative action.

John McDonough, DrPH, national health reform adviser to Sen. Edward Kennedy (D, Mass), said the U.S. lags behind most of the developed world in using health IT. Other reforms, such as improving the value of health spending, creating medical homes, better managing chronic illnesses and implementing quality-based payments, can't be completed in isolation. "All fundamentally are based on having a health information technology infrastructure," McDonough said.

Neither Obama nor Baucus specified a target dollar figure for health IT funding, but during his campaign Obama called for spending $50 billion over five years. They also did not offer many details, such as a time frame for implementing legislation and a plan for how health IT spending would be prioritized. The House and Senate considered at least three health IT bills in the last Congress, but none received a floor vote in either chamber.

Senate Republican staff reacted cautiously to the proposals at a Dec. 11 Alliance for Health Reform event on the future of health reform. Lawmakers agree on the need for federal investment in health IT, said a senior Republican health policy director for the Senate Health, Education, Labor and Pensions Committee, speaking on condition of anonymity to discuss the issue openly. But the details of health IT legislation, such as how patients' privacy will be maintained, are important.

"That frankly has been one of the biggest hang-ups and one of the biggest reasons we haven't gotten [a health IT] bill done to date," he said.

Mark Hayes, Republican health policy adviser for the Senate Finance Committee, said health IT alone will not solve the U.S. health system's problems. If policymakers don't better align payment and incentives to reward quality and value instead of service volume, "health IT could just help everyone do the wrong thing faster," he said.

Dual roles for Daschle

On Dec. 11, Obama officially named former Democratic Senate Majority Leader Tom Daschle as both his nominee for Health and Human Services secretary and as the head of the Obama White House Office of Health Reform. The HHS position requires Senate approval.

Daschle, who endorsed Obama for president, said one of his first conversations with Obama was about the need for health reform, an issue "that is so close to my heart." America has the most expensive health system in the world but is far from being the healthiest nation, he said.

Obama also named Jeanne Lambrew, PhD, as deputy director of the Office of Health Reform. Lambrew -- who wrote a book on health system reform with Daschle -- is an associate professor at the Lyndon B. Johnson School of Public Affairs at the University of Texas and a senior fellow at the Center for American Progress, a liberal think tank.

Many health care leaders, including AMA President Nancy H. Nielsen, MD, PhD, welcomed Daschle back to a leadership position. Daschle led Senate Democrats from 1994 to 2003. "As we work to reform the health care system, former Sen. Daschle has a firm grasp of the complex issues and has demonstrated a commitment to working with physicians and other stakeholders to strengthen the system," she said.

Daschle's appointment signals that Obama is serious about health reform, said Karen Ignagni, America's Health Insurance Plans' president and CEO. "Daschle is exceptionally well-qualified to bring people together in support of universal coverage, cost-containment and improved quality," she said.

Daschle said creating and adopting health reform legislation must be a transparent process and must involve all Americans. "We have to involve people who have personal stories to tell, who have ideas to share, who have real experiences that they can relate to," he said. "That is the essence of good legislating."

Still, the level of urgency is high, Obama said at the press conference, adding that policymakers can't delay acting on the health system's problems because of the economic crisis. "This is part of the emergency."