Special to the Independent from the Journal of New Ulm

MANKATO - In a telephone conference call with up to 1,000 constituents, Rep. Tim Walz and Health and Human Services Secretary Kathleen Sebelius tackled questions about the health care reform legislation in Washington.

Listeners were on listen-only status unless they signaled their wish to ask a question. Questions were prescreened by the moderator, Walz's Communications Director Meredith Salsbery. There were no raised voices, though some questions were contentious.

Walz will be holding a regular town hall meeting at 6 p.m.. Thursday at Mankato East High School.

Walz and Sebelius opened with brief statements, talking about the need for reform in the nation's health care system. Walz spoke of the skyrocketing costs of health care and medical coverage, and how it affects families. He said costs would only go higher if the nation does nothing.

Sebelius pointed out that the discussion about health care reform has been going on for decades. She credited President Barack Obama with making great progress in the seven months since his inauguration. She said some basic reforms that are needed include new rules for insurance companies.

"Insurance companies will no longer pick and choose gets coverage or be able to price people out of the market or drop people when they get sick," she said.

The changes would protect the choice of doctors and plans that provide high quality health care, and insuring coverage for all Americans.

"There's been a lot of talk about bits and pieces of this discussion where people disagree but I have to tell you, I, like the congressman, travel around and talk to a lot of people, and what I hear over and over again is basic points of agreement that the system is broken, costs are too high, folks in Minnesota and elsewhere who have coverage are worried about what happens tomorrow, worried about when their child leaves college and goes off your health plan, worried about what happens when someone develops a health condition, or when you quit your job or lose your job. They are concerned about what's happening in the market, and with the costs swings that they can't afford."

The new plan, she said, will make insurance affordable for all. Families will get tax credits, as will small businesses, to buy insurance. The hidden cost of uninsured patients will no longer be included in premiums, and there will be no co-pay for preventive care, she said.

Sebelius scoffed at news reports from Sunday that she or President Obama were weakening in their support for a public option, a government-run health plan that would compete with private insurers. "It must have been a slow news day Sunday," she said.

"I basically said on the talk shows what I have said for months, which is the key principles in a new marketplace are giving consumers some choices. They need more than one plan to choose from, everyplace in the country, and also some competition which holds costs down."

Sebelius said she and the president "continue to believe that a public option is the best way to hold down costs and to provide choice for consumers."

She said the Senate Finance Committee is talking about a coop strategy. "No one is really sure how that would work because no language has come out of the committee yet. The three House versions of the bill have a public option. The Senate Health Committee version has a public option, so we're waiting to see what the Finance Committee ultimately decides."

One questioner from Rochester asked about the end of life discussions in the bill. He thought it was an important issue for himself and his spouse.

Walz said the issue of end of life discussions and advance directives has been the source of much hurtful misinformation.

"The bill says nothing about forcing consultations on this. What it does say is that if a person wants to - giving choice back to the individual and their physician to have a conversation about what kind of things you can talk about - hospice care or what kind of procedures you would like to see done, so that your wishes are honored."

"The only end of life language in bill," said Sebelius, "would be to provide payment for that kind of consultation. Currently, is not covered."

A physician in Winona asked, "How can you support this bill on the pretense of containing health care costs when the bipartisan Congressional Budget Office acknowledges that this bill will cause health care costs to continue to soar while cutting Medicare reimbursements and impairing our doctors ability to even provide health care for seniors?"

Walz responded that the bill will not cut Medicare reimbursement. Walz said he agreed with the questioner that there is a need to find the "systemic change, the root cause of many of the costs."

Walz said Minnesota physicians, who treat patients more efficiently, lose out from Medicare reimbursements that are based on volume of care instead of quality of care.

Walz added that doing nothing is what will cause costs to rise, double premiums and raise costs to families and businesses.

Sebelius added that not passing bill will result in a 21 percent cut in physician reimbursements, a policy left over from the Bush Administration that has not been fixed. Without legislation to fix this, physicians would be forced into the choice that they would not accept more patients, or they would refuse to treat Medicare patients at all.

A woman in Owatonna asked if she would lose her health and dental coverage she receives as part of her retirement benefit from the telephone company she worked at.

Sebelius and Walz assured her she would not lose it under the president's plan. What does threaten her benefit is the rising cost to the company if nothing is done to stabilize the costs.

Walz and Sebelius assured a Mankato veteran that Tricare insurance coverage for soldiers and veterans would not be affected. In fact, said Walz, language has been inserted into the House legislation to make this protection very plain.

They also assured listeners that the plan would benefit young people just out of college in need of insurance, would prevent insurance companies from rejecting people for pre-existing conditions, and would help small businesses who are struggling to provide coverage for their employees.

Walz was asked why Congress isn't being forced to participate in this plan instead of its own plan. Walz replied that the new plan would provide many of the features and choices available in his congressional coverage.

An Eagle Lake man asked why the system isn't simplified by allowing everyone to buy into Medicare?

Sebelius said that idea has been talked about, but the administration doesn't want to dismantle the current employer based system.

Finally, the two assured listeners that the health care reform plan is not going to extend benefits to people who are in the country illegally.