President Obama Signs Anti-Smoking Law

President Obama knows all too well how difficult it is to quit smoking, and today he addressed his struggle to kick the habit just before signing a law he hopes will help other people put out their cigarettes too.

"Each day, 1,000 young people under the age of 18 become new, regular, daily smokers, and almost 90 percent of all smokers began at or before their 18th birthday," Obama said today. "I know. I was one of these teenagers. And so I know how difficult it can be to break this habit when it's been with you for a long time."

The new tobacco law gives the Food and Drug Administration authority to regulate tobacco in the same way the government regulates breakfast cereals and pharmaceuticals.

"This legislation is a victory for bipartisanship, and it was passed overwhelmingly in both houses of Congress," Obama said today. "It's a victory for health care reform, as it will reduce some of the billions we spend on tobacco-related health care costs in this country."

Public health organizations and many lawmakers, several of whom joined Obama today for the signing, have been fighting for regulation for nearly a decade in hopes of helping an estimated 45 million adult smokers in the United States to kick their habit.

The law means the government will have the power to decide how cigarettes are advertised and monitor how they're promoted to young people. It means cigarette makers will be required to include new, larger warning graphics with more health information on their products and will be prohibited from using words like "light" and "low tar" in their marketing.

While the law does not have the power to ban cigarettes and nicotine outright, it does allow the FDA to reduce nicotine levels and harmful chemicals in tobacco products.

"Forty-five years after the first U.S. surgeon general's report linking cigarette smoking to lung cancer, the most deadly product sold in America will no longer be the least-regulated product sold in America," said Matthew Myers, president of Campaign for Tobacco-Free Kids, in a statement earlier this month when Congress passed the bill.

Within the year, a rule will also be reinstated that prohibits outdoor tobacco ads within 1,000 feet of schools and playgrounds, and bans tobacco brands from sponsoring sports and entertainment events, according to the law.

At the American Cancer Society Cancer Action Network, CEO John R. Seffrin said the changes "will finally put an end to Big Tobacco's despicable marketing practices that are designed to addict children to its deadly products."

Health and Human Services Secretary Kathleen Sebelius also pinned high hopes on the effort.

"This legislation is a key part of our plans to cut health care costs and reduce the number of Americans who smoke," Sebelius said in a June 11 statement.

According to the Centers for Disease Control and Prevention, 440,000 people die prematurely from smoking each year, with an estimated 49,000 of those deaths due to secondhand smoke exposure.

"This legislation provides a tremendous opportunity to finally hold tobacco companies accountable and restrict efforts to addict more children and adults," American Heart Association CEO Nancy Brown said in a June 11 statement. "It has been a long and challenging process to move the bill through Congress but the determination of many concerned parents and supporters has never wavered."

Federal Tobacco Law Signals Changing Times

Twenty years ago, the Senate passed a measure -- by just one vote -- that banned smoking on airplanes. Today even tobacco-producing states have smoking bans in bars and restaurants.

But giving the FDA power to regulate tobacco is a huge move that's been in the works for a long time. In 2000, the Supreme Court ruled the FDA could not regulate tobacco according to current law, and many lawmakers and anti-smoking groups have been trying to change the law since.

"Tobacco products are unlike any other products on the market in that they are unusually lethal, but yet not highly regulated," FDA Commissioner Margaret "Peggy" Hamburg told a Senate panel last month as lawmakers considered her nomination for the job.

"We have tried for 10 years and we have failed," Sen. Chris Dodd, D-Conn., said in a speech on the Senate floor earlier this month. "Think what kind of a difference we could have made. How many lives we would have saved if we passed this 10 years ago."

The measure cleared its final hurdles earlier this month on Capitol Hill when the House and the Senate finally passed the bill and sent it to the president to sign.

Obama quickly expressed his support for the measure -- marking a departure from President Bush, who had suggested he would veto legislation that gave the FDA authority over tobacco.

To fund the regulatory effort, the FDA will collect user fees from the tobacco industry.

Not surprisingly, much of the tobacco industry opposed the bill, but there were some major exceptions to that rule. The giant Altria, parent company of Philip Morris, took an "if you can't beat 'em, join 'em" approach and supported the measure, although some complained the company contributed to a watering down of the bill.

Altria called the measure "not perfect" in a June 11 statement after the Senate voted on the measure.

"We have expressed First Amendment reservations about certain provisions, including those that could restrict a manufacturer's ability to communicate truthful information to adult consumers about tobacco products," the statement said. "We also believe that the resolution of certain issues would best be handled by rulemaking processes that involve sound scientific data and public participation."

Still, the company added, "On balance, however, the legislation is an important step forward to achieve the goal we share with others to provide federal regulation of tobacco products."

The tobacco industry has already been readying itself for a tougher U.S. regulatory environment by expanding its overseas marketing and developing new smokeless products.
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Health Care Roundtable: Public Option Hot Button Issue in Debate

With the health care debate taking center stage in the White House and on both sides of Congress, Democrats have stepped up their efforts to defend a government-sponsored health insurance program, saying the reforms they are proposing are greatly needed.

"What we know is that cost currently is crushing families and businesses," Health and Human Services Secretary Kathleen Sebelius told "Good Morning America" today. "Unless we do something, we won't be able to afford the health care we have, the health care we need."

The main point of contention between Democrats and Republicans is the idea of a "public option" -- a government-sponsored health insurance plan that would compete with private insurance.

Democrats say it will give people, especially those who are not able to afford insurance or cannot qualify for private care because of pre-existing conditions, another option. Republicans claim it will stifle the private health insurance industry.

The Congressional Budget Office estimates that 23 million Americans would migrate from employer-based health care plans or other plans to a government public health care plan if one were offered. A study by health consulting firm the Lewin Group found that if a government-run plan paid at the same rate as Medicare, 70 percent of consumers currently with private insurers would jump ship for the public program.

"A government plan, no matter what you call it, will increase costs. It will reduce choices and essentially it will not allow you to keep what you have, and that is the essence of what the health care system in this country is about," said Rep. Eric Cantor, R-Va., echoing the sentiment of his fellow Republican congress members. "We ought to allow for more competition so that people can have choice."

A CBS/New York Times poll found that 72 percent of Americans support a public option, and 50 percent think government would do a better job providing medical coverage than private insurers do. Only 30 percent of those polled said they did not think providing health insurance for all Americans was the government's responsibility.

According to recent estimates, 59 percent of Americans get health insurance through an employer. But 45.7 million people in the United States, including 8 million children, have no health insurance at all.

Who Pays for It?

Cost has also become a hot button issue -- namely, how will any new plan be funded?

Republicans have seized on a CBO report that estimates the plan proposed by Sen. Edward Kennedy, D-Mass., and Senate Democrats will cost upward of $1 trillion over 10 years and still leave 36 million uninsured. Democrats on the Senate Health Education Labor and Pensions Committee say they are revising the plan to cut that high price tag, and other committees of the Senate are also working on different bills.

Former majority leaders of the Senate, Tom Daschle, Howard Baker and Bob Dole, who have offered their own bipartisan solution, say that at least half of the costs to pay for health care reform would have to come from new revenue and taxes. White House officials say that's not true.

"I think people are thinking that this is brand new money that's being printed," said President Obama's domestic policy adviser Melody Barnes. "There's already $2 trillion worth of health care that's being spent already. This is redirecting that money so it's more efficiently and effectively used and so people are getting better quality health care."

Cantor and other House Republicans unveiled their own version of a health care bill last week, which they say will make quality health care more affordable and accessible, ensure that medical decisions are made by doctors and improve lives through effective prevention. But they did not give an estimate of cost or the specifics of what the plan would entail.

"What the Republican plan will do is, it will look more toward the individual and will say, if you have a plan, your insurer and you are going to determine the length of that coverage," Cantor said on "GMA." "But also if somehow you lose your job and that's how you get your coverage, we're going to make sure that you have the flexibility under that plan to take that coverage with you."

Health Care Debate on Preventive Measures

Officials say one way to cut health care industry costs in the long run is to put procedures in the plan that would reduce unnecessary tests that doctors conduct.

"Right now, we pay doctors based on how many times they touch a patient, how many tests are given, how many procedures are run. Not how well the patient is at the end of the day," Sebelius said.

Officials cite reports such as those in a recent Dartmouth University study that found that up to 30 percent of medical spending -- $700 billion a year -- does nothing to improve health.

But who will decide what tests are necessary?

"Clinicians will make those decisions," said Nancy-Ann DeParle, director of White House Office of Health Reform. "What we're trying to do and the president is trying to get is a system where we can have lower costs for all families and businesses."

"No one's going to tell your doctor that he or she can't do a procedure, but there will be a set of protocols that we know at the end of the day actually produce a better result for you and are less intrusive," Sebelius said. "Do what works best for me, and that's really what we're talking about. Not cheaper medicine, better medicine each and every time."

Doctors say they need more protection against medical malpractice lawsuits if they are to cut the number of tests they prescribe.

But in a speech to the American Medical Association last week, Obama was noncommittal on that end, saying only that his administration wants to work with doctors to cut back "excessive defensive medicine.

"I recognize that it will be hard to make some of these changes if doctors feel like they're constantly looking over their shoulders for fear of lawsuits. ... I understand some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That's a real issue," Obama said. "I'm not advocating caps on malpractice awards, which I personally believe can be unfair to people who've been wrongfully harmed."

The Healthy Life

Another component of the White House health reform plan, officials say, is to encourage Americans to live healthier lives. Health and Human Services estimates that 54 percent of all U.S. health care costs are due to three mostly preventable conditions: heart disease, diabetes and obesity. Eighty percent of heart disease, obesity and cardiovascular disease is preventable.

"Some of that is about personal responsibility but it's also making sure that there are incentives for businesses. We're working with CEOs recently who came in and said, 'We're working with our staff to make sure that we're reducing obesity rates and working on tobacco cessation,'" Barnes said.

Doctors say the government needs to create a grassroots effort simply to get Americans to walk a little bit every day.

"If I could pick one single thing for all Americans to do, it would be walking, because I know it would cut into the rates of diabetes, hypertension, obesity and cardiovascular disease," said Dr. Mehmet Oz. "Just 30 minutes a day is the magic number. It would be a national policy that's easy to follow and would have a dramatic impact."
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Public Favors Obama's Health-Care Plan

Despite public support for an optional public health insurance plan, President Obama's plan to include one in his health-care bill is facing intensified opposition on Capitol Hill.

The president has insisted on a government-run insurance program that would compete with private companies.

"You will have your choice of a number of plans that offer a few different packages, but every plan would offer an affordable, basic package," the president said in an address to the American Medical Association in Chicago last week. "And one of these options needs to be a public option that will give a broader range of choices and inject competition into the health-care market so that forces waste out of the system and keep the insurance companies honest," he said.

His repeated efforts to pitch that option have met a receptive audience. A New York Times poll released today said that a striking 72 percent of Americans support a public health-care plan, and 57 percent are willing to pay higher taxes to cover all Americans.

Nevertheless, the president's chances for an optional health care plan that would be run by the government may be fading. Republicans and some Democrats have expressed skepticism.

That scrutiny intensified this week after a Congressional Budget Office report found a Democratic plan in the Senate would cost at least $1 trillion over 10 years and cover just one-third of the uninsured.

"The CBO estimates were a death blow to a government-run health-care plan," Sen. Lindsey Graham, R-S.C., said today on ABC's "This Week With George Stephanopoulos."

Republicans have repeatedly hammered the president on the proposal. Sen. Mitch McConnell has taken to the Senate floor daily to lament what Republicans consistently describes as "a government takeover of health care."

Sen. Chris Dodd, D-Conn., who is shepherding a bill through the Senate Health, Education, Labor and Pensions Committee as chief deputy to committee chairman Edward Kennedy, D-Mass., said he still prefers a public option. But Democrats are clearly on the defensive.

"We're not done with this at all," Dodd said today on "This Week." "If this were easy, it would have been done decades ago."

This week, Dodd's committee continues its markup of their version of health-care reform and is expected to consider a proposal for a public health insurance option and a mandate for employers to contribute.

The Senate Finance Committee, which is pursuing its own, private bipartisan health-care effort, has slowed the pace of its closed-door negotiations. It remains unclear if the panel can agree on a plan that covers everyone and pares down the $1.6 trillion price tag, with or without a public option.

Democrats are scrambling to muster support for the president's plan, but even some of them are skeptical.

"Well to be candid with you, I don't know that he has the votes right now," Sen. Dianne Feinstein, D-Calif., told CNN, referring to the president. "I think there's a lot of concern in the Democratic Caucus."
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Obama Fast-Tracks Health Care Reform

President Obama, with a strong assist from Congress's budget watchdog, is moving healthcare reform to the fast track on Capitol Hill -- with or without Republican support.

The next two months are a "make or break period" for getting healthcare done, the president told Senate Democrats at a White House meeting on Tuesday. Mr. Obama says he still wants a bipartisan plan, but Republicans worry that Tuesday's Democrats-only meeting signals a new tack that may leave them behind.

Call it un-HillaryCare. The president's rush to closure, even before details of the plan are in place, is in sharp contrast to the White House-driven healthcare reform effort in the first two years of the Clinton administration.

Obama is leaving the drafting of the plan largely to Congress, where competing plans are emerging on both sides of the aisle this week. Meanwhile, the White House is making the overall case for reform and generating a sense of inevitability that a plan will clear Congress this year.

At the same time, some elements that sunk the Clinton-era healthcare plan appear less of a factor this time.

In a little-noted but significant development last week, the Congressional Budget Office (CBO), which played a key role in derailing support for the Clinton plan, unveiled the approach it will take in judging the cost of Obama's healthcare reform.

"This is a political land mine. The CBO ruling, which went pretty much under the radar, is very important in making sure that healthcare reform can be successful," says Maya MacGuineas, president of the bipartisan Committee for a Responsible Federal Budget in Washington.

The critical element in CBO scoring is what counts as a part of the federal budget. In 1994, the CBO described President Clinton's proposed health alliances as government activities financed by government funds -- a move that supporters say derailed the plan by assigning it unacceptably high costs.

Typically, the CBO scores legislation only after it has been finalized. But in a May 27 issue brief, the CBO took a proactive stance on budgetary treatment of proposals to change the nation's health insurance system. A federal mandate requiring individuals to have a minimum amount of health insurance would not be counted as a government expense "because the federal government imposes a variety of mandates on private entities whose associated costs are not included in the budget," said CBO director Douglas Elmendorf in a blog explaining the brief.

President Obama Pushing Healthcare Reform

"Had the CBO said we will count [the plan] as a tax or government expenditure no matter what, you would have had a huge hurdle to overcome, even insurmountable. Instead, healthcare reform is moving on a really fast track," says Ms. MacGuineas.

In another boost, the budget procedures for fiscal year 2010 allow the Senate to shield healthcare reform from a Republican filibuster under a process called reconciliation. It means that the plan can pass by a simple majority instead of the 60 votes typically required in the Senate for legislation that the minority party opposes.

"What the CBO said back in 1994 killed the Clinton plan. Last week, CBO came with a ruling that said the opposite," says Stanley Collender, a budget expert at Qorvis Communications in Washington.

"You add this wonky thing to the fact that healthcare is going to be included in reconciliation, and you can't avoid coming to the conclusion that healthcare has a pretty good chance this year," he adds. "Impediments are going by the wayside."

Until this week, top Senate Republicans said they had assurances that the president wanted a bipartisan solution. They now say they are troubled by reports that Obama at Tuesday's meeting appeared open to a strong public insurance plan -- a move that would scuttle most GOP support.

"If they try to insist that there be a public plan, that's very counterproductive," says Sen. Judd Gregg of New Hampshire, the top Republican on the Senate Budget Committee, who released his own health plan his week.

"I don't think Americans want to put government between themselves and their doctor."

Senate Finance Committee Chairman Max Baucus (D) of Montana and Sen. Charles Grassley of Iowa, the top Republican on the panel, met privately with Obama a month ago to discuss progress in drafting healthcare reform.

At that meeting, "the president said he'd rather have a bipartisan plan that gets 80 percent of what he wants than a partisan plan that passes by 51 votes," recalled Senator Grassley Tuesday. He added, "If Democrats come away from the White House set on a partisan measure, it can't be done."

Hurdles Remain for Bipartisan Healthcare Plan

"The only way I can bargain in good faith representing Republicans is if we don't have a public option," he said.

Senators on the finance panel are meeting privately Thursday to discuss prospects for moving forward on a bipartisan plan.

Without reform, healthcare costs are projected to reach 34 percent of gross domestic product and 72 million Americans will be without health coverage by 2040, according to a report released Tuesday by the Council of Economic Advisers to the president.
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