One of the greatest challenges we face as a nation is meeting our health care needs. There are 46.6 million Americans without health insurance and 16 million Americans who are underinsured. These numbers are more than statistics; they are a grim reality for many Americans. Throughout my tenure in Congress, I have worked to provide affordable and comprehensive health care services for all Americans. I understand that rising costs, job insecurity, and cuts in federal funding have made it harder to ensure that all individuals have access to the health services they need. That is why I have introduced legislation to help workers afford health care while between jobs, and support successful programs to ensure that older Americans, working families, and small businesses have access to affordable health coverage. Furthermore, in an effort to ensure comprehensive coverage, I introduced legislation that would require prescription drug managers and other private health insurers to pay health care claims in a timely fashion. Local providers fulfill their commitment to care for patients everyday, and my legislation will ensure that providers can spend more time focusing on patient care, not cumbersome red tape that threatens their ability to provide care. This is just one example of how I am dedicated to providing more affordable health options for New Jersey families and ensuring that all Americans have access to quality health care at a reasonable cost.

2. For several years, Medicare Part B spending has risen more than the average rate of economic growth in the U.S., while physicians and other Part B providers under current law have to absorb these costs in the form of reimbursement cuts calculated by a Sustainable Growth Rate (SGR) formula. Congress has intervened and temporarily suspended the mandated reimbursement cuts for 2003 through 2006, which has been followed by continued growth in utilization and intensity of health care services, in Medicare Part B spending, and in beneficiary premiums for Part B services – a dynamic which CMS Administrator Mark B. McClellan, M.D., Ph.D. has called a "vicious circle of rapid growth in utilization and spending." There are currently two legislative proposals [HR 5866 and HR 5916] to replace the SGR formula. What do you think should be done to address this problem?

To ensure access to quality health care for families, we need to make sure doctors are paid fairly to treat Medicare patients. As you may know, the SGR formula was established to provide Medicare reimbursement to physicians for their work and services. Unfortunately, it has become apparent that the formula is flawed, and as it stands, does an inadequate job of reimbursing physicians. I have heard from many physicians all over the state who have told me how the SGR is threatening their ability to provide care to Medicare patients. I know our doctors are willing and want to help, but they need and deserve the appropriate compensation to do so. That is why I recently joined my colleagues in sending a letter to Senate Majority Leader Frist and Senate Minority Leader Reid that urges the Senate to address this issue before October. Immediate action must be taken to prevent a dramatic cut in payment to physicians, and it is the least we can do for doctors who are providing important health care to our nation’s citizens.

3. Consumer-driven health care – in the form of high deductible health plans and price and quality transparency initiatives – is being touted as a movement to hold down health care costs, provide more choice and autonomy to health care consumers, and lead to more competition on price and quality. What is your view on consumer-directed health care, and what role do you think the federal government should play in supporting it?

As I mentioned above, I believe that we have a responsibility to provide affordable and accessible health care to all Americans. Consumer-driven health care, as you know, is an undefined term that can encompass many different types of health plans. In terms of high deductible plans and price and quality transparency initiatives, I have some concerns, but I also believe that all options should be fully explored and considered. With high deductible plans, my serious concern is that people with chronic health conditions will have to pay more for their health care. Thus, those who need the most access to affordable care, those who are sick and have low-incomes, will be worse off under this system. I am not willing to support a plan that will hurt older and sicker individuals. My vision for our health care system is one that aims at prevention. That is why I introduced the Patient Navigator, Outreach and Chronic Disease Prevention Act, which creates "navigators" – individuals who help patients understand and navigate our complex health care system, and moves our health care system away from a disease-based system to one focused on prevention. I am pleased to report that this legislation was signed into law this past June. We should not be working on a plan that harms our most vulnerable individuals, but rather one that encourages comprehensive and affordable care.

4. Many in government and the private sector have talked about the importance of interoperable health information technology products – such as electronic health records and electronic prescribing systems that can communicate and share data with each other – in fostering networks so that consumers and health care organizations have secure and widespread access to that information. Studies have shown that it is not cost-effective for most physician practices to purchase those systems on their own. What role do you think the federal government should play in facilitating the adoption of this technology?

I strongly believe that if we increase the use of health information technology products, we have the potential to improve the quality of care, reduce medical costs and medical errors. However, unless we provide the resources and funding to implement this technology, it will be too much of a financial burden for most health professionals to implement. That is why I recently joined my colleagues in sending Senators Specter and Harkin, Chairman and Ranking Member on the Senate’s Labor, Health, and Human Services Appropriations Subcommittee, a letter requesting full funding of the administration’s request for health information technology plus a 50 percent increase above the president’s request for the Office of the National Coordinator for Health Information Technology. In addition, I co-sponsored the National Health Information Incentive Act of 2005, which would provide grants and assistance to small health care providers and entities to implement a national health information infrastructure. With financial support and important input from doctors, health care entities, patients and technology experts, I am confident our nation will be able to develop and implement interoperable health information technology products that will save lives and in the end, decrease health care costs.

5. A 1999 report by the Institute of Medicine, "To Err is Human: Building a Safer Health System," put the subject of medical errors on the map and made patient safety a public issue. What do you think is the best approach to reducing medical errors and compensating victims of medical errors, while reducing the strain of skyrocketing medical malpractice insurance premiums on the health care system?

As I mention in question 4 and question 6, I believe that we can reduce medical errors and reduce the strain of skyrocketing medical malpractice insurance premiums through the implementation of interoperable health information technology as well as reasonable and bipartisan malpractice reforms.

6. On the subject of medical malpractice reform, the American Medical Association and many physician groups support a cap on noneconomic damage awards (e.g., pain and suffering jury awards in malpractice trials) as a key ingredient to controlling skyrocketing medical malpractice insurance premiums, while also preserving patient access to high-risk medical procedures performed by physicians who are saddled with the highest insurance premiums (e.g., obstetricians, neurosurgeons, orthopedic surgeons, and general surgeons). The U.S. House of Representatives has passed such a bill several times, while it has repeatedly been defeated in the Senate. What is your position on the issue?

I recognize that medical malpractice is a serious and daunting problem for New Jersey and our nation. It is imperative to ensure that good doctors serving communities all across America can afford to practice medicine, and I believe that with comprehensive medical malpractice reform we can ensure just that. To protect our doctors and patients, I believe we must weed out frivolous lawsuits; require insurance companies to pass along premium savings from the legislation directly to health care providers; provide targeted assistance to the physicians and communities that need it most; create an independent commission to examine every aspect of the current insurance crisis, propose additional solutions, and make recommendations to avoid any future malpractice insurance crisis. Unfortunately, the Senate leadership recently let another opportunity for real malpractice reform slip by. Instead of working to get bipartisan legislation through Congress, they chose to bypass the Committee, to limit debate on the Senate floor, and to prohibit amendments – all options which could have helped to resolve this national problem. It is my hope that we will not let other opportunities slip by and instead work together to effect true change for all Americans. It is the duty of the House and Senate to work in a bipartisan manner to ensure access to quality health care for all. We owe it to our nation’s doctors and patients.

7. Medicare has several demonstration projects looking at paying providers more for measurably higher quality care. What role do you think pay-for-performance reimbursement has in improving the quality of health care, and what role do you see the federal government having on the matter in the future?

We are lucky to have internationally recognized physicians in America as well as physicians who are renowned in their local communities. Both are equally commendable and important to our overall health care system. I believe that our nation’s doctors providing the most efficient care should be rewarded for their work, and ideally, that will create a more affordable health care system, which is the goal of pay-for-performance. However, to implement a successful pay-for-performance program, I believe it must be driven by clinical data that takes into account all aspects of a patients’ ability to recover. With the existence of health disparities among minorities and low-income communities, and the difficulty in measuring environmental and socio-economic factors, I am very concerned that this type of system could create disincentives for caregivers to enter into underserved communities. Instead, I fear doctors would be drawn to practice in communities where they are more likely to see positive health outcomes in their patients because these patients have access to preventative care, a healthy home, nutritious diet, and comprehensive support system. In the end, I want to ensure that all physicians are recognized for their high level of care, and hope that a pay-for-performance program is one that encourages doctors to care for all patients.

8. New Jersey and many other states are struggling to fund burgeoning Medicaid expenses, in part because of shrinking federal dollars. What can, and should, the federal government do to help states meet their Medicaid obligations?