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Citizens' Health Care Working Group

Health Care that Works for All Americans

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Draft Budget

July 21, 2005

Salt Lake City, Utah

Citizens’ Health Care Working Group
Budget Justification

  FY 2005 FY 2006 FY 2007
($ Thousands)
BUDGET ALLOWANCE $2,976 $3,000 (requested)  
EXPENDITURES $2,976 $2,733 $267
Program Management 816 1,468 267
Personnel 305 822 189
Travel 150 166 10
Rent 110 190 32
Equipment and supplies 74 71 8
Contract support 176 220 28
Hearings (included in Program Management)
The Health Report to the American People
Drafting and analysis (included in Program Management)
Distribution   200  
Citizen Engagement 2,160 1,065 0
Community meetings 1934 467  
Webcasts 40 200  
Interactive website 35 10  
Self initiated meetings 50 100  
Citizen feedback analysis 40 140  
Public Awareness 50 160  
Recommendations (included in Program Management)
Presidential and Congressional Review (included in Program Management)


The Citizens’ Health Care Working Group was established by Section 1014 of the Medicare Modernization Act to “provide for a nationwide public debate about improving the health care system to provide every American with the ability to obtain quality, affordable health care coverage and to provide for a vote by the Congress on the recommendations that result form the debate.”

In order to accomplish this purpose, the statute provides for a 15 member Working Group. One member is the Secretary. The Comptroller General appoints the remaining 14 members, consisting of consumers of health care that represent individuals with chronic illnesses and receive insurance coverage through Medicare and Medicaid; and individuals who have expertise in financing and paying for benefits, have business and labor perspectives, and reflect a broad geographic representation.

The law prescribes a process whereby citizens will be engaged in informed discussions of the health care system and the Working Group will make recommendations that take into account feedback from citizens. The exact steps established by the law for this process are: hearings to examine all aspects of the health care system; widespread dissemination to consumers through the Internet and by other means of “The Health Report to the American People,” which provides a description of health services and the health care delivery and financing mechanisms; community meetings to facilitate citizen discussion and feedback on health care benefits and services, delivery mechanisms, financing methods, and trade-offs in benefits or financing to ensure affordable high quality health care coverage and services; publication of preliminary recommendations for public comment; publication of final recommendations; Presidential review and comment on the recommendations; and hearings by 5 congressional committees with jurisdiction over health care policy.

The members of the Working Group were appointed on February 28, 2005. The Working Group is planning to issue its final recommendations by September 30, 2006. A small staff will remain, and Members will be available to answer questions until the Working Group terminates.

The statue authorizes up to $3 million per year for FY’s 2005 and 2006 as well as “such sums as may be necessary” for preparation and dissemination of the report. Funds have been disbursed to the Working Group in such a way as to allow carry over of funds from one fiscal year to the next.

Following is a description of how the key products and events of the mandated process will be produced or carried out, along with comments regarding the amounts needed for each.


This element comprises all activities to administer the mandated process, including payment of Members salaries, staff salaries and benefits, travel costs for Working Group meetings and hearings, rent, equipment and supplies, financial management, and IT and other contract support. (Working Group Members’ pay and both Working Group Members’ and staff travel for community meetings are included in the community meetings line item of the Citizen Engagement activity.)

Working Group Members are paid when engaged in the business of the project, including their travel expenses. In order to minimize expenses, whenever possible Working Group meetings are held in conjunction with other required activities involving travel and pay. For example, to date meetings have been scheduled the day before or after hearings.

The budget for Working Group Members’ pay and travel includes funds to cover 6 meetings through fiscal year 2006 (October 1, 2005 through September 30, 2006.) The exact schedule for such meetings is not assumed; the cost is spread across each month in equal amounts purely as a placeholder for this expense.)

A small professional staff manage carries out the planning and day to day management of the Working Group’s activities. This consists of an SES member on reimbursable detail to serve as Executive Director, an Administrative Officer, one program analyst, and one person who serves as a meeting coordinator and administrative assistant. Two senior program analysts have been detailed from the department to serve on a non-reimbursable basis to plan and coordinate major events and product development. The need for staff support will vary across the life of the project and will be supported by temporary staff, including paid and unpaid interns and temporary employees with special skills necessary for each stage of the project. To date, the services of 3 paid summer interns and a temporary senior research director have been used. The budget allows for hiring 1.5 additional years of senior staff time or the equivalent amount of money for a greater number of junior and mid-level staff.

Support services are provided to the Working Group by the Administration for Healthcare Research and Quality (AHRQ), either directly or through contracts. A senior policy advisor in AHRQ has been assigned to coordinate this support and provide advice on the overall management and execution of the project.


These aspects of the project are carried out by Working Group members and professional staff , and their costs are for all practical purposes indistinguishable from program management discussed above. For example, as noted earlier, Working Group meetings have been planned and carried out coincidently with hearings, thus making distinctions in the cost of travel and member pay irrelevant. However, the following details provide some insight into the nature and magnitude of these activities.

Hearings. So far, the Working Group has conducted hearings in Crystal City, Virginia, and Jackson, Mississippi. Additional hearings are planned for Salt Lake City, Utah; Houston, Texas; Boston, Massachusetts; and possibly for Portland, Oregon, and Indianapolis, Indiana. These hearings have, or will, cover all the subjects prescribed by the statute, including: cost of care; access; insurance; private and public initiatives to expand access and reduce costs; rural health, disparities; medial technology; IT for managing health care; and State and local government programs and initiatives. The last hearings will be conducted by the end of September.

Report. Initial analytic work needed for the “The Health Report to the American People” essentially overlaps that needed to support the citizen engagement discussed below. Publication of the report is planned for early FY 2006. The report will be made available electronically and, to some extent, also in printed and disk formats. Some copies will be available upon request. $200,000 is reserved for printing and distribution in FY 2006. We hope that printing may be done gratis by some outside organizations interested in promoting the work of our initiative.

Recommendations. This stage of the project will follow the citizen engagement discussed below, and will be carried out by Working Group members and professional staff.


This part of the project will command the single largest block of time and resources for the project. Several different strategies will be used.

Community meetings. These will be carried out as envisioned by the statute and comprise the core of this initiative. We are currently planning to host approximately 36 meetings throughout the country. Approximately 24 will be spread throughout the nation, with participants broadly representative of the areas in which they are held. Approximately 8 additional meetings will be held specifically to reach audiences that, despite our best efforts, may not be adequately represented in the broader community meetings. These groups would include, for example, individuals in remote areas, underserved rural or central city areas, Native Americans, minorities, disabled persons, and younger and older citizens.

These community meetings will each include approximately 150 individuals. They will each last approximately one half day and will be modeled on citizen engagement strategies that have emerged recently and used effectively to obtain informed feedback from citizens. They will be guided by professional facilitators following a standard protocol, involving three segments—education, discussion, and feedback. Participant feedback will be obtained regarding the four issues specified in the statute: health services, delivery mechanisms, financing, and tradeoffs. This will be achieved though the facilitated discussions and the use of new technology that allows participants to register their feed back in real time through handheld electronic devices. Their feedback will be summarized and disseminated widely to citizens nationwide through the internet, news outlets, and other means. At least one Working Group Member will be physically present at each meeting as required by the law.

Based on our preliminary discussions with possible meeting facilitating contractors, the unit cost of each meeting will range from $50,000 to $80,000 including planning, audience recruitment, advertising, execution, analysis, and media relations. The budget assumes a unit cost of $75,000, including attendance by two working Group Members and 1 staff member at each meeting. The number of meetings held will be adjusted upward or downward depending on the actual unit cost.

Webcasts. We also plan to use offshoot products of these community meetings to reach a much broader national audience through webcasts and interactive website technologies. Edited video clips and slides based on the community meetings can be used to produce webcasts throughout broad regional areas. The cost of producing, advertising, and executing these meetings is expected to be relatively small compared to the community meetings described above and required by the statute. However, they cannot be produced without drawing on the materials prepared for the community meetings themselves. We believe that these webcasts meetings can be planned and executed for anywhere from no cost (for passive casts) to as much as $20,000 each to drive an audience to them. The budget includes $80 to develop the slide/video program and $160,000 to execute the webcasts.

Interactive Website. Our interactive website will also allow individual citizens to read educational materials, some modeled on the materials used for the community meetings, and provide their feedback using their personal computers. This can be done for minimum cost, but in conjunction with other activities described below can reach a wide audience.

Self initiated community meetings. We have already heard from consumer and stakeholder groups of their interest in conducting their own community meetings based on materials that we can make available to them. We plan to use the same materials prepared for webcast and our interactive website for this purpose. Interested parties will be able to download the materials from our website and provide feedback through the website, by mail, or through an 800 number telephone system. We will promote the use of this extremely economical outreach strategy through proactive engagement of consumer and stakeholder groups. This will also supplement out efforts to reach disadvantaged and hard to reach groups. Some will cost little more than $4,500 for 2 Working Group Members and one facilitator to attend conferences which would welcome them as a featured program. This item includes ($100,000 to hire two consultant to promote self initiated meetings and $50,000 for Working Member pay and their and staff travel costs.)

Ongoing analysis of Citizen Feedback. Professional staff, with expert consultant assistance, will monitor an analyze the feedback received from citizens in all modalities. This line item includes $50,000 for expert consultant services to design and monitor questions to the American people, $30,000 for a representative national random survey
In April, 2006, and $100,000 for development and implementation of a 1-800 number telephone service.

Public awareness. Periodic public awareness activities will be supported to keep citizens aware of the report and opportunities for providing feedback during the duration of the initiative. It includes $50,000 for expert editing services to prepare and edit various documents, and $160,000 for expert consultant services for media and external relations .

All of the budget estimates for these citizen engagement methods are based on preliminary research by our professional staff. They are thus subject to change. Our strategy is use a mix of these methods, and we plan to adjust the numbers of each method as necessary to stay within our budget and achieve the most cost-effective mix of approaches.


The presidential comments and congressional hearings required by the law will be carried out after the Working Group has issued its final recommendations. We plan to maintain a small professional staff and have Members available for consultation until the official termination of the Working Group.