Veterans Affairs Secretary Eric Shinseki confirmed Tuesday that the Obama administration is considering a controversial plan to make veterans pay for treatment of service-related injuries with private insurance.

But the proposal would be “dead on arrival” if it’s sent to Congress, Sen. Patty Murray, D-Washington, said.

Murray used that blunt terminology when she told Shinseki that the idea would not be acceptable and would be rejected if formally proposed. Her remarks came during a hearing before the Senate Committee on Veterans Affairs about the 2010 budget.

I am not a health care wonk but some of my good friends are, so I’ll refrain from pretending I can construct a health care argument whereby this makes sense (or doesn’t, for that matter). Instead, as a moral matter, veterans deserve free, government-provided health care. As a political matter, why the Obama administration would want to squander its good will in the military community is completely beyond me. Murray calls the plan DOA, as she should. But why should it be considered seriously in the first place?

Influence comes in many forms. Often, influencing the influencers is a smart strategy. Free food never hurts, either.

The head of public relations for the pharmaceutical giant Pfizer makes free food a centerpiece of his “tips for managing journalists” an industry conference, Advertising Age reports.

In this video clip, Pfizer’s global public relations chief Ray Kerins explains his strategy for working with journalists, whose coverage, in the words of Advertising Age,”so heavily impacts the pharmaceutical giant’s reputation.” Kerins says:

“…[T]omorrow, we’re hosting a lunch with the communications team for Linda Johnson, who’s one of the top health care folks at the Associated Press. She’s outstanding, she’s brilliant we love her to death. But we’re bringing her into our home and we’re saying, look, here’s who we are and here’s what we’re talking about. She’s not meeting with executives, she’s meeting with communications, with my folks on the media team. We do this about every other week.”

Johnson won’t be the first journalist to be feted at Pfizer. Kerins estimates that his team met with about 115 journalists in 2008, on and off-site.

No doubt it’s a good investment for Pfizer. Critical media coverage can cost a drug company billions in lost sales, diminished good will, and even legal and political scrutiny. Stories with headlines like “Maker of Vioxx Accused of Deception” hurt Merck’s bottom line.

Kerins claims that that his team has “no agenda” when journalists are made honored guests at corporate headquarters. But, as someone who has worked in the pharmaceutical industry, writing ad copy for various well-known brands including some of Pfizer’s products, I can categorically say “Yeah, right.” He may not be pitching specific stories, but he’s almost certainly mounting a charm offensive.

The pharmaceutical industry is perhaps second only to Hollywood in the economic emphasis placed on lunch. A couple advertising agencies where I worked did a brisk business designing customized boxes for bagels served at so-called “Lunch and Learns”–promotional events where company representatives, or scientists hand-picked by the company, tried to woo doctors into prescribing the latest ACE inhibitor or antidepressant. We’d get memos from the marketing teams explaining how our colorful bagel boxes, emblazoned with company logos and drug tag lines, reinforced the key sales messages of the lecture.

When big pharma reaches out to influencers, such as doctors and journalists, its always couched in terms of education — but Merck is not an educational institution. It sells drugs.

Ironically, a lot of the worst press big pharma has gotten in recent years centered on the companies’ shameless attempts to ingratiate themselves with physicians through free food, conveniently-packaged information, and flattery. Apparently, Pfizer has decided that the cure for bad press is to offer journalists similar perks.

Speaker of the House Nancy Pelosi (D-Calif.) (WDCpix)

The new regulation — unveiled by the Dept. of Health and Human Services (HHS) earlier this month — expands the rights of some healthcare workers to withhold treatments and counseling services, possibly including contraception, based on their moral or religious sentiments. The White House argues that the change — known as the “right of conscience” rule — is necessary to clarify similar worker protections surrounding abortion and sterilization procedures that already exist as law. But many Democrats have joined women’s health advocates, healthcare providers and some state officials in blasting the rule as a sweeping expansion of existing statute that threatens women’s access to reproductive health services.

Illustration by: Matt Mahurin

“Congress,” House Speaker Nancy Pelosi (D-Cal.) said in a terse Dec. 18 statement, “will work with President-elect [Barack] Obama to reverse this rule.”

But party leaders aren’t saying how they’ll try to do it. Representing one option, Sens. Hillary Clinton (N.Y.) and Patty Murray (Wash.) introduced legislation last month that would simply prevent HHS from implementing the new rule. Reps. Diana DeGette (D-Col.) and Louis Slaughter (D-N.Y.) have vowed to introduce similar legislation in the House next year.

“The Bush Administration continues to pursue its extreme ideology over sound public health policies,” DeGette said in a statement earlier this month.

Congress could also simply refuse to fund the new rule, which is estimated to cost $44 million.

Or they could nix it altogether by invoking an obscure law — known as the Congressional Review Act (CRA) — which allows Congress to reject White House regulations passed within 60 legislative days of Congress’s adjournment. The law would leave Democrats several months next year to kill the rule.

An advantage of the CRA route is that the vote would be exempt from the dreaded Senate filibuster, which has snuffed dozens of Democratic bills over the past two years. The disadvantage is that the measure would have to stand alone and couldn’t be buried in another bill as a rider.

Jessica Arons, director of the Center for American Progress’ Women’s Health and Rights Program, said that invoking the CRA is not as easy as it sounds, particularly when the issue relates to abortion. Conservative-leaning Democrats might not support it, she said, and party leaders might not have the political will to bring it up to begin with.

The Congressional fight could shift to the White House. The HHS under Obama could simply propose a new regulation. Obama has already criticized the rule, issuing a statement in August saying the change “complicates, rather than clarifies the law.”

“It raises troubling issues about access to basic health care for women, particularly access to contraceptives,” Obama said. “We need to restore integrity to our public health programs, not create backdoor efforts to weaken them.”

Yet the issue could be a thorny one for Obama, who ran on a platform of reaching across the aisle to Republicans. Despite his early opposition to the rule, he might not want to make an abortion-related issue one of his first battles, if only because it might threaten that message of bipartisan healing.

Health care advocates point out that crafting a new White House regulation would also be time-consuming, calling for periods of public comment that could extend the process to six months or longer. The legislative options, advocates say, could happen much more quickly.

Spokespersons in the offices of Pelosi and Senate Majority Leader Harry Reid (D-Nev.) said that discussions over how to reverse the regulation are underway, but no final decision has been made.

Plenty of laws on the books — both federal and state — already protect health care workers from having to participate in abortion and sterilization procedures based on moral or religious objections. The new rule would expand those laws by forcing any healthcare entity receiving federal dollars to attest that employees aren’t forced to assist in practices and procedures they deem to be “morally coercive or discriminatory.”

“A trend that isolates and excludes some among various religious, cultural, and ethnic groups from participating in the delivery of health care is especially troublesome,” the rule states, “when considering current and anticipated shortages of health care professionals in many medical disciplines and regions of the country.”

Yet the rule doesn’t specifically define which practices and policies would be covered, leaving many lawmakers and women’s health advocates to fear that contraception and other family-planning services would apply. Additionally, the rule will apply to anyone who “assists in the performance of a procedure,” a group defined broadly as anyone who participates in “any activity with a reasonable connection to the objectionable procedure, including referrals, training, and other arrangements for the procedure, health service, or research activity.”

“It goes well beyond doctors and nurses to include almost anyone who works in the health care sector,” said Arons of the Center for American Progress. “It allows people to withhold relevant medical information and not inform patients about all their options.”

HHS estimates the new regulation will affect roughly 572,000 health-related facilities, including hospitals, pharmacies, laboratories and medical schools. The rule was published in the Federal Register Dec. 18 and will take effect 30 days afterwards — just 48 hours before Obama takes office.

HHS did not return calls for comment.

There is also worry that the new rule will allow healthcare workers to take jobs in certain facilities – a family planning clinic, for example – for the sole purpose of withholding certain information, counseling services or treatments they find objectionable. Tait Sye, a spokesman for the Planned Parenthood Federation of America, pointed out that, under the new rule, it would be difficult to identify such a saboteur.

“Your boss doesn’t know,” Sye said. “The patient doesn’t know. The hospital doesn’t know … No one knows. And it creates an enormous potential for chaos.”

Meanwhile, states aren’t waiting around for Washington lawmakers to act. In Connecticut, for example, state Attorney General Richard Blumenthal is considering legal action to prevent the new regulation from taking hold. Blumenthal says he’s worried that the change could prevent victims of rape from receiving emergency contraception.

“We went through a very lengthy, painstaking, contentious process to reach our statute in Connecticut which has worked well for everyone,” Blumenthal told The Associated Press earlier this month.

Attorneys general from at least a dozen other states have joined Blumenthal in their vocal condemnation of the new rule. More recently, health officials and lawmakers in New Mexico, Iowa and Colorado are also weighing in with concerns.

The right-of-conscience rule is not the only regulation to be ushered from the White House in recent weeks. Rules to ease restrictions on mountaintop mining, expand oil shale development and allow commercial fisheries to police their own polluting have all emerged from the White House in the final moments of President George W. Bush’s lame-duck term. Still, none has inspired the outcry of the “right to conscience” rule.

“On its way out the door,” DeGette said, “the Bush Administration has, once again, stubbornly and irresponsibly attacked Americans’ access to health care.”

Suffering the recession’s painful squeeze, more states are eying cuts to low-income health care programs to salvage their budgets.

At least 19 states have already proposed or installed cuts to public health programs, including Medicaid and the State Children’s Health Insurance Program (SCHIP), according to a report updated this week by the Center on Budget and Policy Priorities, a liberal policy analysis group. Those programs provide health coverage to the states’ most vulnerable residents, leaving state officials and health care advocates worried that affected patients will be left dangling without access to treatment.

Illustration by: Matt Mahurin

“It’s adding enormous hardships for those who rely on Medicaid for their health care needs,” Ron Pollack, executive director of Families USA, a consumer health care advocacy group, said of the trouble facing state budgets. Families USA released a report earlier this month finding that 1 million people would lose their health coverage if the cuts were realized in just eight of the 19 states that have proposed or enacted them.

Pollack said the problems will only get worse if the recession deepens, as many expect it will next year. “With each passing week we’re hearing of more states [proposing health cuts],” he said, “and I expect we’re going to see that accelerate in January.”

The threat to these public health programs arrives as most states are caught in an ugly economic cycle. Unemployment is up, creating greater demand for expensive social programs like food stamps and Medicaid, while home values and consumer spending are down, leaving less revenue from sales and property taxes for states to fund those programs. And the fiscal gaps are growing.

At least 41 states and the District of Columbia face 2009 budget shortfalls totaling $42 billion, CBPP has found. Looking ahead to 2010 and 2011, the number of struggling states rises to 44, while the shortfall figure skyrockets to $350 billion.

Compounding these troubles, almost every state in the country has some form of legal balanced budget requirement, meaning that, unlike the federal government, they can’t simply fall back on deficit spending to survive the recession. Instead, legislators have been forced to hike taxes, lay off state employees and cut back on services. Medicaid and SCHIP, because they represent one of the largest chunks of state budgets, have been early targets for cuts.

Indeed, California is increasing co-payments and reducing dental services under SCHIP, CBPP found. In Maine, some patients will be hit with a $25 Medicaid enrollment fee, which will likely discourage participation. In South Carolina, new income-eligibility rules are expected to push 3,700 folks out of Medicaid, CBPP reports. Arizona is forcing some Medicaid patients to reapply more frequently, which is expected to reduce the rolls, even among those eligible for the program, CBPP said.

Ann Kohler, director of the National Association of State Medicaid Directors, said states that are traditionally reliant on the finance industry for revenue — New York, New Jersey, Rhode Island and Connecticut — have had a particularly tough time balancing their budgets as that industry has collapsed. “It’s become very dire,” said Kohler, who once headed the Medicaid programs in New York and New Jersey.

There are many other examples. In Michigan, another state that’s been crushed by the downturn, Medicaid enrollment is up 70,000 in the last year, said James McCurtis Jr., spokesman for the state health department. In Colorado, Medicaid enrollment is increasing by 2,000 each month, said Joanne Lindsay, spokeswoman for the Dept. of Health Care Policy and Financing.

In New Mexico, where Medicaid enrollment jumped from 408,000 in August 2007 to 450,000 a year later, the legislature has plans to meet next month to weigh potential cuts to the program. As options, officials will consider benefit cuts, rate hikes and reduced outreach efforts, according to Betina Gonzales McCracken, spokeswoman for the state’s Health and Human Services Dept. “We’re seeing the need to reduce our budget across the state,” she said.

Some state officials say the recession’s effects on Medicaid and SCHIP aren’t tangible just yet. Karen Smigielski, spokeswoman for Minnesota’s Dept. of Human Services, said it’s “too soon” to gauge the ultimate impact of the recession on low-income health programs. “It takes awhile for people to get poor enough to become eligible,” she said.

President-elect Barack Obama is piecing together an enormous spending package designed to boost the economy and tamper rising unemployment. Early reports indicate that the package could be in the range of  $800 billion, with roughly $100 billion of that earmarked to help states cover their Medicaid costs.

Many experts warn that the budget problems — and their effects on public health — will only get much worse if that stimulus funding is held up for any reason.

“The longer we go without it,” said Kohler, of NASMD, “the more we’re going to need.”

Unlike the vast majority of Americans, her husband and children had a good chance of qualifying for free, federally funded, comprehensive health care under a program of the Dept. of Health and Human Services’ Indian Health Service.

The governor’s husband, Todd Palin, traces his Yup’ik ancestry to his maternal grandmother. Sarah Palin routinely mentions her husband’s background at public appearances, and did this regularly when she ran for governor in 2006. At the time, the issue painted her in a positive light with the Native Alaskan voting bloc.

Todd is a lifelong fisherman. Bristol Bay fishing rights must be bought or inherited in Alaska. In Palin’s case, he says he bought his fishing spot from his grandfather in the 1970s. He also inherited shares in two native Alaska corporations. These shares can only be passed from one blood relative to another. Private citizens cannot purchase them.

Todd Palin’s ancestry grants another plus — it makes him and his children eligible to apply for free government health care.

To qualify for the state-based, federally funded program, Alaska Area Native Health Service, residents must provide proof of ancestry. Cecile Wesley, the director of eligibility at the Alaska Native Medical Center in Anchorage, told me in an interview that one way of establishing ancestry requirements is to present a shareholder card for one of four Alaska native corporations that list “blood quantum” — the carrier’s percentage of “Indian blood.”

“[Alaska Native Medical Center] does not have a blood quantum requirement,” said Wesley, when I asked what percentage of native blood a resident must have in order to receive the healthcare.

One corporation that issues cards with the blood quantum requirement is the Bristol Bay Native Corp. According to public disclosure forms Sarah Palin filed with the state of Alaska, her husband and their children are BBNC shareholders. Palin’s disclosure form is available here.

Todd Palin and the Palin children are also a shareholders in another Native corporation, Choggiung Ltd.

Wesley said that the Bristol Bay cards have been updated in recent years to include the blood quantum. Older cards would not have been accepted. In that case, the Palins would have had to establish proof of ancestry through the federal Bureau of Indian Affairs, or by presenting a membership card in a federally approved tribe.

Like Alaska, the Bureau of Indian Affairs does not set a blood quantum requirement for establishing native ancestry.

Multiple requests for comment from the McCain-Palin campaign were not immediately answered.

It’s unclear whether the Palin’s ever used the native health-service program. But, it’s likely that the family had a better option than “paying out-of-pocket” for health-care coverage.

*Note: This post was originally published at 5:00am Eastern. The time stamp was changed so it would remain on the TWI homepage.

Sen. John McCain (Photo by: Lauren Victoria Burke)

PHOENIX — Sen. John McCain, the Republican presidential nominee, continues to hold a substantial lead over his Democratic opponent, Sen. Barack Obama, among military veterans — despite the fact that Obama has consistently voted for higher increases in veterans’ health-care spending and advocated sweeping reforms at the Depart. of Veteran Affairs.

The most recent Gallup poll of registered voters, conducted in mid-August shortly before the Republican National Convention, showed that among those who had served in the military, 56 percent backed McCain, compared to 34 percent for Obama. Among all registered voters, Obama led McCain 46 percent to 43 percent.

Illustration by: Matt Mahurin

The poll found that veterans favored McCain not because he is considered a war hero after his almost six years as a POW in North Vietnam. Rather, Gallup emphasized that because most veterans tend to be Republican–47 percent said they were Republican or leaned toward being so– they were simply backing their party’s presidential nominee.

Obama has certainly worked hard for veterans issues. As a member of the Senate Veterans Affairs Committee, the Illinois senator has pushed to end benefit disparities between veterans with combat and noncombat experience; get homeless vets off the streets; improve their mental health-care benefits; increase Depart. of Veteran Affairs funding and overhaul the administration of all vet benefits.

But Obama never served in the military. For some veterans, like many who attended the American Legion’s annual convention last month in Phoenix, that is what counts, not their allegiance to the GOP.

One was Vietnam veteran Bernard Randall, 63. He told me that he supports McCain because “he’s a veteran” with “more experience than Obama.” Randall, an Apache who served in the Marines in 1967-68, said health care is his top issue, and that McCain is more likely to do something about it. Randall’s views were echoed by a dozen other conventioneers, even after they watched a video of Obama addressing the gathering.

But is Randall’s and the other vets’ faith in McCain justified?

Not according to several veterans’ organizations that have given McCain low marks for his overall voting record on vet issues.

Iraq and Afghanistan Veterans of America, a non-partisan advocacy group, gave McCain a “D” in 2006, while Obama earned a “B+.” The Vietnam Veterans of America reported that on 31 “key votes” between 2001 and 2008 on issues including veterans’ health-care funding and the Foreign Intelligence Surveillance Act, McCain opposed its positions 15 times, while supporting it eight times. In contrast, Obama, since elected to the Senate in 2004, backed the group’s stands 12 out of 13 times. The Disabled Veterans of America said McCain supported its positions 20 percent of the time in 2006, compared to Obama’s 80 percent.

There are several examples of the conflicting McCain and Obama votes, including McCain’s opposition to five bills that would increase funding for veteran healthcare programs and related facilities. A full list of those bills is available here.
Before Obama came to the Senate, McCain also cast votes against obtaining better equipment for troops. In 2003, for example, he voted to table an amendment that called for an additional $322 million for safety equipment for military forces in Iraq. The measure would have reduced reconstruction funds for Iraq by the same amount. In April 2003, he voted to table an amendment, that passed 52-47, to provide more than $1 billion in equipment for the National Guard and reserves to reduce a shortage of helmets, bullet-proof armor and other gear

McCain said that while the National Guard spending amendment included items “nice to have,” he condemned it because it was presented as an emergency measure and had not gone through the normal process with open debate. “This is neither the appropriate nor, I believe, fiscially the responsible thing to do at this time,” McCain said, “I urge a ‘no’ vote.”

Whether McCain’s relatively low rankings by veterans’ groups will drive a substantial number of vets to vote for Obama remains to be seen. For now, McCain enjoys strong support from veterans who hold his military service and experience as a POW in high regard. “He gets a lot of veteran support because most veterans have extreme respect for what he went through in the military,” retired Navy Capt. Mike Lumpkin, a Democrat who is running for a congressional seat in eastern San Diego County, told me. Lumpkin is a member of Obama’s veterans advisory group, Next Generation Veterans for Obama, and appeared on stage at the Democratic National Convention in Denver.

Lumpkin, who served 21 years as a Navy SEAL, said that he knows how powerful a record of military service can be in attracting voters. He told me he’s attracting strong crossover support from Republicans with military backgrounds in his congressional race. “There is an inherent bond and respect, especially for a career military officer,” he said.

In fact, McCain is also attracting significant cross-over support among veterans who are or lean Democrat — about 17 percent, according to the Gallup poll. Overall, McCain is the choice of 89 percent of vets who say they are Republican, while Obama wins 75 percent of veterans who say they are Democratic.

McCain’s support among veterans is comparable to that of President George W. Bush in 2004, who drew the support of 55 percent of veterans, against Sen. John Kerry’s 39 percent, in the last Gallup poll before the presidential election. Bush served stateside in the Texas Air National Guard during the Vietnam War, while Kerry saw action in Vietnam and was wounded. Vets’ strong support for Bush, despite Kerry’s military record, is an another indication of their affinity for the Republican Party, according to Gallup.

Other polls echo Gallup’s August findings that McCain enjoys an advantage among veterans. Rasmussen Reports’ national telephone survey, conducted July 21-22, of 3,000 likely voters, which included 588 respondents who served in the military, found that veterans supported the GOP presidential nominee over Obama, 56 percent to 37 percent. By contrast, non-military respondents favored Obama 50 percent to 43 percent.

Yet, despite McCain’s support among veterans, he cannot take their backing for granted. One reason is Obama’s strong legislative record of supporting veterans now. The other is McCain’s checkered legislative record on vet issues.

The challenge for Obama is whether he can convince millions of veterans who historically vote for the Republican presidential nominee that he has their back covered far more than the former Navy POW.