Warner, Webb speak out on health-care reform

About 23,000 of Virginia's uninsured are getting continuous medical care through a program run out of Virginia Commonwealth University's Health System.

It's designed to fill a gap in which uninsured people who lack continuous care often rely on emergency rooms for treatment.

The program is an example of the right kind of health-care reform as it relates to service delivery, cost and compensation, says Sen. Mark R. Warner, D-Va., who recently took to the Senate floor to tout the program.

"Between 2000 and 2005 emergency-room visits dropped 14 percent by having this kind of continuity of care," he said. "As well, thesepatients didn't show up at other emergency rooms, they were treated earlier in the prognosis of their illness," he said.

It's one topic of the wide-ranging debate over health-care reform that has shifted to the Senate after a $1.2 trillion overhaul narrowly cleared the U.S. House of Representatives last week.

Senate Majority Leader Harry Reid, D-Nev., is expected to introduce his Senate bill this week after the Congressional Budget Office releases its estimate of the measure's cost.

In 2006, the last time the U.S. census counted, more than 1 million Virginians under the age of 65 lacked health insurance.

Virginia's two senators are expressing concerns about costs -- in the expense of individuals' premiums and the rising federal deficit. While both are open to the idea of a public option, it's not their priority.

Sen. Jim Webb, D-Va., is taking aim at the profit margins in private insurance. "They've been really off the charts," Webb said Oct. 25 on the CNN program "State of the Union." Webb said his ideal approach is not-for-profit insurance companies.

Aside from that, according to Webb spokeswoman Jessica Smith, the senator wants a plan that is deficit-neutral and pays for itself, provides affordable insurance and care for people at "an acceptable percentage of their income" and addresses dropped insurance coverage and refusals to cover pre-existing conditions.

Webb wants a plan under which the Medicare program would create incentives to value the quality, rather than the quantity, of provider services. But he does not want an "overly cumbersome, bureaucratic system."

"He believes strongly that we need to streamline the health-care system and get costs under control," Smith said.

Warner is focusing on reducing the federal deficit long term and ultimately reducing health-care costs for families, businesses and the government.

He does not feel strongly about whether the final version should allow states to opt out or whether it should include a co-op or an exchange.

"The public option is not his priority," said Kevin Hall, Warner's spokesman. "The cost curve is his priority in health-care reform."

Warner, Virginia's junior senator, has been working with other freshman senators and some moderate Democrats on a series of potential floor amendments targeted to better use of data to drive down costs and increase transparency, Hall said.

He has led nine other Senate freshmen in weekly floor speeches on health care for about five weeks.

In his latest, on Nov. 5, he said readjusting the financial incentives must be a key component of any health-care reform.

"We have a health-care system right now that rewards bad practices," he said. "We have a health-care system that rewards hospitals for multiple readmissions, rather than a low readmission rate. We have a health-care system that rewards volume of care rather than quality of care."

He spoke about three programs aimed at reforming the delivery system in Virginia, including Virginia Commonwealth University's Virginia Coordinated Care.

The program assigns a primary-care physician to oversee each uninsured patient's health with the goal of increasing coordination between doctors and hospitals and, as a result, increase accountability, improve quality of care, and lower costs, he said.

The majority of patients are assigned to a community doctor who contracts with VCU. The physicians are reimbursed per patient visit and receive a monthly management fee for participating in the program, which started in 2000.

Webb, Virginia's senior senator, has taken issue with the process of trying to overhaul health care. He said the White House should have clearly expressed its expectations at the outset.

"From that, we should have had hearings, and then the Congress should have legislated," Webb said in an appearance on the CNN program in late October.

"Having done it the reverse way, with these five different bills percolating up through committees, it's really difficult to see even what we're voting for," he said.

He has called for greater transparency and sent a letter to Reid, calling for health-care legislation to be posted on a public Web site for review at least 72 hours before the first and final votes in the Senate, Smith said.

Still, in the CNN interview, Webb said he has told Reid that "I will vote to proceed forward to debate."

"That doesn't mean that I will necessarily at this time commit myself to voting for the result of that debate, but . . . we need to have the debate," he said.

Contact Olympia Meola at (804) 649-6812 or .