Udall and Heinrich vow to fight for Indian health care in second session

"If we have health care reform it should include our first Americans," Rep. Martin Heinrich says.

While health care is snarled in Washington, two of New Mexico's congressional members say they're committed to getting the Indian Health Care Improvement Reauthorization and Extension Act passed during the second session of the 111th Congress. But, reaching an agreement on the act could be complicated after the election of Scott Brown to the senate last week.

"People don't know what's going to happen," Rep. Martin Heinrich said on Wednesday as he prepared to attend the president's State of the Union address. "There's a lot of uncertainty until we know exactly what the process is moving forward."

While there does not appear to be a clear path for the IHCIA, which expired eight years ago, both Heinrich and Sen. Tom Udall said that they are "ready to go at it again."

"The fact that the House and Senate have passed it in previous sessions -- I think -- means there's some good bi-partisan support for this," Udall said in a telephone interview. "We should be able to get it in the next version of health care [reform] as a freestanding bill or joined with something else -- depending on what other legislation comes up this year."

Indeed, the act, which was last reauthorized in 1992, appears to have support from people on both sides of the aisle.

"If we have health care reform it should include our first Americans," Heinrich said. "This is important to people from places like Alaska where their delegation is Republican, and it's important to people from places like New Mexico where we've got a Democratic delegation."

Living up to treaty obligations


Udall, a co-sponsor of the senate amendment that placed the IHCIA into health care reform package, has said it would allow the United States to “live up to its treaty obligations.”

“We can’t truly address the health care crisis in our country without improving health care for all of our citizens, and that includes the 1.9 million American Indians and Alaska Natives whose health care is coordinated through this act,” Udall said last Fall.

In October, when it appeared the Democrats had the votes to pass health care, Heinrich sent this letter to house leaders and urged them to include the reauthorization act as part of comprehensive health insurance reform.

At the time, Heinrich wrote, "Our country desperately needs health insurance reform — but our pursuit of reform cannot leave Native Americans behind,” Heinrich said. “I represent tens of thousands of Native Americans in central New Mexico, and my constituents have made it clear that they cannot wait any longer for health care reform in Indian country.”

Photo: SoyJames

Still optimistic

Today, nothing has changed in Heinrich's mind, and he said he's "optimistic if there is a package that comes out of the house and senate that it [IHCIA] will be a part of it. That's certainly what I've been advocating to the leadership of the House."

Heinrich insists he does not regret tying the measure to the comprehensive reform bill, because the House Natural Resources Committee, where he is a standing member, has already passed the IHCIA as a stand alone piece of legislation.

Udall said the IHCIA would be included in the senate's next version of health care -- either as a freestanding bill or joined with "something else of a health care nature depending on what other legislation comes up this year."

As a last resort, Udall said it could be attached to bills at the end of the year to "get things done that we all know need to be done."

Fixing health care disparities

"There's no doubt if you ask all 22 New Mexico tribes they'd say this is their top priority," Udall said. "There are very severe health care disparities on natives lands."

Remedying those disparities is why Udall insists the act needs to be reauthorized this year.

"The important thing is that the health care delivery system is underfunded," Udall said. "In the last 10 years there's been a rapid of health care technology. In this case we have outdated technology in place in many of these institutions. The update moves us forward in terms of prevention. It moves us forward on the diabetes and obesity epidemic. There are many things that move the health agenda forward for native Americans in this reauthorization and we need to get this done."

In fact, last December, on the senate floor, Udall said health care for Native Americans was in dismal shape and quoted from a Civil Rights Commission study that showed annual health care spending on Federal prison inmates was double the amount spent on American Indians.

"Inmates have better health care than the population with whom we signed treaties and made a promise to provide health services," Udall said. "Right now in Indian Country, the health care situation is dire. Native Americans are diagnosed with diabetes at almost three times the rate of any other ethnic group, they often don't have access to preventive care, and Native youth are attempting and committing suicide at alarming rates

Better chance for passage this year

The originial amendment authored by Natural Resources Committee Chairman Nick Rahall, D-W.V., would reauthorize the program until 2025 and make the most urgent reforms to the program.

After attending the President Barack Obama's first State of the Union speech both Udall and Heinrich could feel a little better about their chances to get the act through congress this year after
Obama appeared to breath new life back into the health care debate during his speech on Wednesday night.

"Let us find a way to come together and finish the job for the American people," Obama said. "Let's get it done. Let's get it done," he repeated.

Health Department announces cost containment plan

Health Secretary Alfredo Vigil, MD, announced today that the New Mexico Department of Health will make changes to the Developmental Disabilities Waiver Program to help control costs and maintain quality services for clients.

The DD Waiver Program is an optional Medicaid program that provides services to more than 4,000 people with developmental disabilities in New Mexico so they can live as independently as possible.

“These tough choices are absolutely necessary for us to maintain a strong and viable program,” Dr. Vigil said. “Our clients and people who support them will have to reprioritize how they spend their annual budget. We will help people make the necessary adjustments so we can minimize the impact of the changes. People will continue to receive the same quality of services.”

The Department of Health expects to save $9 million a year and will work with clients and providers to roll out the following changes this month. All changes will be in effect by June 30.

The changes include:

• A 2% cut to annual budgets for non-residential services, such as therapies, skill building and care during the day, and to provider rates for these services.
• Families or caregivers paid to provide services in their homes will receive up to 1,000 hours of relief from care giving, instead of up to 1,750 hours.
• Restructuring Family Living Services so providers get paid based on an individual’s needs instead of a set amount.
• Stricter criteria for approving extra services for people who have high-risk medical or behavioral needs.

The immediate changes are necessary because of rising costs to operate the program and the current economic crisis. The cost to operate the DD Waiver program has been increasing over the past few years. The average cost per client has increased from approximately $67,000 in 2006 to a projected $75,300 in 2011. The total cost each year for the DD Waiver program has increased from $252 million in 2006 to a projected $307 million in 2011.

Dr. Vigil said one reason for the increased cost is more people are receiving the most expensive level of care, but some do not need all of those services. The Department is working on long-term solutions to curb those costs and ensure people only get the services they need.

“While we are developing long-term solutions for the program, we have to take these cost saving steps now to protect the program and the people who rely on these services,” Dr. Vigil said. “We are also working with providers to see how we can reduce the cost of doing business with the State, such as limiting the amount or frequency of required reporting.”

The Department expects to make long-term changes to the DD Waiver redesign in 2011. The Department is working with clients, people on the waiting list and providers in planning changes that will make the program operate more efficiently and continue to improve the quality of life for people who have developmental disabilities. Before making long-term changes, the Department will solicit input from the public, the Department’s stakeholder advisory councils and provider associations.

The Department already included these groups to craft the immediate changes. The cost savings the Department is implementing now will help maintain the program but will not allow the Department to take people off the waiting list.

“We would like nothing more than to provide care to all the New Mexicans who need it, but we must balance our desire to serve more individuals with fiscal realities,” Dr. Vigil said. “We will always look at ways to serve as many people as we can.”

The Department of Health assists clients on the waiting list to find and receive a variety of public support from several agencies while waiting for the DD Waiver. Services include special therapy for children who are eligible for Medicaid, special education classes and personal care services for Medicaid-eligible adults such as assistance with grooming, bathing and eating.

Heinrich won't predict Senate action on health care bill

U.S. Rep. Martin Heinrich, who cast his vote for the new House health care reform bill, is back in New Mexico. During the lunch hour, on Monday, he met with doctors, nurses and medical providers at the University of New Mexico Medical school.

While, he won't predict what the U.S. Senate will do with the bill when it moves to the upper chamber, he told reporters that he won a office pool with his staffers -- accurately predicting the measure would get 220 votes on the House floor on Saturday.



Heinrich also talked about how hard it was to get to consensus, what impact the bill will have on Medicare Advantage, and how it may help small businesses and the self employed.

We have two other videos from the news conference that we will post later tonight - so look for the updates and join our video channel on YouTube.

Udall: Native Americans struggling to get affordable access to health care.

U.S. Senator Tom Udall, D-NM, joined 15 Senate colleagues today in introducing major legislation to improve health care for 1.9 million American Indians and Alaska Natives across the country – the Indian Health Care Improvement Reauthorization and Extension Act of 2009.

The federal government has treaty obligations to provide health care to American Indians and Alaska Natives, but Udall noted Indian health care programs haven’t been updated in more than ten years and have been chronically underfunded for decades.

Udall said:

The United States has an obligation to provide quality, accessible health services for our country’s First Americans, but right now, the federal government isn’t living up to that responsibility,” said Udall, a member of the Senate Committee on Indian Affairs. “This legislation would bring much-needed reforms to the Indian health care system to begin addressing the dramatic health disparities that face Native Americans, including skyrocketing diabetes rates, lack of preventive care, and an epidemic of teen suicide.

For Pete's Sake

Health care for the first Americans is a pledge the country made. Udall is correct. It's a pledge that must be honored.

Nearly a third of New Mexicans have no health care insurance

More than 31% of non-elderly adults in New Mexico are being left out in the cold with out any private coverage for medical care.

That percentage translates into 468,000 adults without health care insurance in 2008, and that's up from 363,000 in 2001 according to a U.S. Census Bureau report released last week. And, those numbers do not even include people who've lost their insurance after being laid off this year due to the economy.

Today, Health and Human Services Secretary Kathleen Sebelius released a new analysis of last week’s U.S. Census numbers regarding the uninsured. Sebelius warned the U.S. health care system has reached a breaking point. She said:

The status quo is unsustainable, and continuing to delay reform is not an option. These numbers only serve to further confirm a reality that far too many American families live with every day.

The percentage of people with employer-based coverage also decreased, from 57.3% of the population in 2001 to 53.4% in 2008. The report also reveals more and more workers, some 281,000 people employed both full and part time, in New Mexico are not receiving any health insurance at the workplace. That's a jump from 26.9% in 2001 to 31.4%. Those numbers include 9,000 people from high-income households who are now uninsured.

Those sobering numbers seem to confirm that health insurance reform cannot wait another year. Nationwide, the number of uninsured increased from 39.8 million in 2001 to 46.3 million in 2008.

SIMPLE MATH

The Henry J. Kaiser Family Foundation issued a report showing the cost of private health care premiums are far outpacing the growth in employeewages:

Over the last ten years premiums have increased by 131%, while wages have grown 38% and inflation has grown 28%.

Sebelius notes, “In states across the country we’ve seen the health care coverage situation go from bad to worse. And, it’s clear that losing insurance isn’t a problem that plagues only the poor or the unemployed – it could happen to anyone.”

10 Excellent Reasons for National Healthcare

Consumer advocate Ralph Nader sent me a compelling letter this morning. He's going to be holding Democrats feet to the fire on their pledge for health care reform.

In our opinion that's a good thing. The time to act on this issue has passed.

Recently, I not only had a medical insurance claim denied, but the provider dropped me completely. As a part-time employee my provider does not offer benefits and I obtained a "worthless" private policy.

Nader says there are no more excuses for Democrats to take action in Congress.

With the Democrats in power in Washington, Nader believes they can pass whatever health care reform they want despite intense lobbying from the health care, insurance and phramaceutical industries. Nader then wants President Barack Obama to sign legislation allowing Americans to get the treatments they need.

Everybody in. Nobody out.

Nader suggests Democrats pass a single payer system:

1. For prevention and treatment.
2. For free choice of doctors and hospitals.
3. No more premiums, deductibles, exclusions, co-pays, in-network, out-of-network rigamarole.
4. No more family medical bankruptcies.
5. No more pay or die.
6. No more pay or become sicker.
7. Single payer is the only system that will work.
8. It's the most efficient.
9. Single payer will cut out literally hundreds of billions in administrative fat, billing fraud and unconscionable profits.
10. These savings will be used instead to insure the 50 million uninsured and the millions more underinsured.

Saving Lives!

More than 21,000 Americans die every year from lack of health insurance.

Really, no matter where you stand on the health insurance issue that's too many people dying for being poor and uncovered. According to recent polls, the majority of the American people want single payer. So do the majority of doctors, nurses, and health economists.

Nader asks:

So, what will the Democrat leadership do?

He suggests, "they will keep single payer off the table because they fear the insurance industry and the pharmaceutical industry - and want their campaign money - more than they fear the American people.

Or as Speaker of the House Pelosi told reporters last week:

Over and over again, we hear single payer, single payer, single payer. Well, it's not going to be a single payer.

Along with Nader, we wonder who Pelosi is speaking for here. Certainly not for the American you are getting sicker and sicker and dying month after month.

Turning Up the Heat.

There is support in Congress for single payer and it appears to gain some traction before being stalled over and over again.

Nader says:

Already, 76 House members support HR 676 - the single payer bill in the House. But the Democratic leadership in Washington has taken single payer off the table. They meet regularly behind closed doors with insurance and drug industry lobbyists - to thwart single payer.

Nader is asking for financial support to help him keep the focus on Single Payer. You can help him with a donation here.

This is Democrat Terry Riley. For years he's helped his wife struggle with medical issues at home. He's also advocated for Bill Richardson's Health Care Solutions program. This year he testified in Santa Fe at the Senate Rules Committee.

When I saw him late last month he told me about his website What If You Knew NM . It's loaded with additional information on the single payer insurance model.

Riley says it time for health care. Not health insurance.

Photo: MG Bralley

UDALL ADDRESSES N.M. LEGISLATURE ABOUT JOBS, CLEAN ENERGY AND HEALTH CARE

Earlier today in Santa Fe, U.S. Senator Tom Udall, D-N.M., spoke to a joint session of the New Mexico Legislature about plans to address the country’s economic crisis, create clean energy jobs and fix America’s health care system. Read his remarks below:

Udall 322009

Publish at Scribd or explore others: economy clean energy

NM Senate Schedules Floor Debate on Health Care Reform.

HEATHCARE TRANSPERANCY BILL EXPECTED TO BE DEBATED ON SENATE FLOOR TODAY.

from Sen. Tim Keller:

Santa Fe , NM – SB259 offers a free market solution to help consumers and business make better decisions with their medical insurance.

“It is clear purchases of medical insurance would benefit from more information about how their premiums are being spent, this is about helping consumer decision making and fostering more competition in the healthcare system,” said bill sponsor Senator Tim Keller (D-Bernalillo-17).

SB259 would require insurance providers to disclose the medical loss ration, historical premiums and any third party commissions when consumers and small business request a medical insurance quote. “I believe true healthcare reform has to connect the cost of services and to the fees we pay, without allowing supply and demand to set an accurate price the public will never get a fair shake and healthy competition in the industry won’t occur,” said Keller after the bill passed out of the corporations committee.

A 2007 study of healthcare financing conducted by UNM’s Institute for Public Health reported a need for greater transparency about information that would help consumers evaluate the costs and performance histories across the various medical insurance plans; including the percent of premium that actually goes to pay for medical services and broker commission and fees.

The survey voiced skepticism around the accuracy information that typically was made available and reported difficulty in comparing competing plans because lack of clear, interpretable information on costs and performance.

While medical insurance providers and brokers have remained neutral on the bill, strong opposition from national home & life insurance brokers who are concerned the bill could eventually open the door for similar rules in there industry. The Public Regulatory Commission, members of the small business community and executive departments have come out in support of the bill.

Former NM Health Secretary Rebukes John McCain's Plan to Tax Healthcare!

With all the talk about economic bailout plans, falling stock prices, and rising energy costs it is easy to lose site of some of the other top issues in this year's election.

One that we've focused on is health care for all Americans. We thought we'd re-visit this important issue before the election.

Last week jobless claims rose 15,000 to 478,000 according to government reports. While the number of people collecting regular state unemployment benefits fell by 6,000 to a seasonally adjusted 3.72 million in the week ended Oct. 11, the four-week average of continuing claims rose by 44,250 to 3.68 million, the highest in more than five years.

The government's October employment survey was conducted last week, with the results to be released on Nov. 7. Compared with September's survey week, initial claims are up about 8%, while continuing claims are up about 6%.

While states may increase the length of their wage benefits, these hard-working Americans, many who oppose national or universal health care, are about to find out what many people have been talking about for years, and they won't be able to afford the short-term Cobra benefits. Once they land a new job, if economic conditions improve, they'll find out any of their pre-existing conditions won't be covered.

Last Monday, we attended a health care townhall meeting with U.S. Senator Jeff Bingaman, former NM Health Secretary Michelle Lujan Grisham, and UNM Doctor Don Dirkson. They talked to a crowd of about 50 people about exactly what they can expect if Barack Obama is elected president next week.

Essentially, all three VIP's advocated for more access. Each one said that health care isn't about insurance it's about access to quality health care.

Grisham tells us she's been busy since losing to Martin Heinrick in the first congressional district primary in June. In August, she formerd a consulting group with Deborah Armstrong (another former Health Secretary). Grisham told me their new group, Delta Consulting Group, incorpated this summer. We invited her to write a guest column and she responded with this thoughtful piece.

Photo from: MG Bralley

Guest Opinion - John McCain's Plan to Tax our Healthcare!

Our health care system is broken. Barack Obama has a plan to fix it and ensure that every New Mexican has access to quality, affordable healthcare. John McCain will only make it worse by pursuing his policy of deregulation.

New Mexico has one of the highest uninsured rates in the country with an uninsured population of more than 400,000, including about 64,000 children. Currently, one out of every four people in New Mexico does not have the ability to regularly visit a doctor or a health care provider due to lack of health insurance. This is unacceptable.

Since President Bush has taken office, health care costs have risen 4.6 times faster than average wages in New Mexico. And, rather than standing up to health insurance companies to reduce health care costs, John McCain's plan will tax your health care benefits for the first time in history, and lead 20 million workers to lose the coverage they get from their employers, including 98,000 New Mexicans. McCain will pay for his health care plan with a massive tax increase on middle class families, and with costs skyrocketing, that'll mean even more pain and even worse access for your family down the road.

Under New Mexico state law, insurance providers must provide coverage of diabetes care, mammograms, home health care, and immunizations, to name a few. However, the McCain plan will put these services at risk by deregulating the insurance industry and removing the protections state legislatures pass for their constituents. Additionally, the McCain plan won't do anything to stop insurance companies from discriminating against you if you've got a pre-existing condition like asthma or diabetes and require the provision of preventive health care.

McCain's plan to deregulate the health care industry – just like he and his allies have done with our financial markets – would be catastrophic for New Mexicans. We can't afford four more years of deregulation and New Mexicans to fend for themselves.

In an Obama administration, we're going to finally stand up to the big drug and insurance companies and provide affordable, accessible health care for every single New Mexican. Obama will work with employers who are providing health care for their employees and lower premiums by up to $2,500 per family per year, and he'll reduce costs for business and their workers by picking up the tab for some of the most expensive illnesses and conditions. He will create a Small Business Health Tax Credit to provide small businesses with a refundable tax credit of up to 50% on premiums paid by small businesses on behalf of their employees.

Obama will make sure no American is turned away from any insurance plan because of illness or pre-existing conditions. And he will have Medicare negotiate drug prices with pharmaceutical companies so that prescription drugs are not cost prohibitive for those seniors.

Taxing middle class families to receive health care is not the answer. Senator Obama will fight for middle class families so that all New Mexicans have a health plan that's as good as the one he has as a Member of Congress.

Michelle Lujan Grisham, J.D.

Former Secretary NM Department of Health

Barack Obama and Joe Biden's Health Care Plan is Available for Review here.

or watch this video.

Last August, Charlie Rose interviewed John McCain on his health care ideas.

Governor Bill Richardson Pushes for Fiscally Responsible Rebates, Health Care Coverage for Kids Before Friday's Special Session.

Governor Bill Richardson announced today that he will move ahead with a fiscally responsible CARE package of tax rebates for New Mexico families to reflect an updated revenue picture for the state.

“The bottom line is the state still expects $225 million in extra money – money that should go back to New Mexico families who are struggling to make ends meet,” Governor Bill Richardson said. “I am confident we can put money in people’s pockets in a fiscally responsible way.”

Governor Richardson, working with legislative leaders, directed state economists representing the administration and the Legislature to prepare an updated consensus-revenue forecast this week to get a more accurate picture of the state’s economy before the special session that is scheduled to start on Friday.

Today’s forecast reduced the amount of new, one-time money available in the current FY 2009 budget year from $392 million to $225 million – reflecting lower oil and natural gas prices. That means $225 million will be on the table during the special session for one-time tax rebates and other relief for New Mexico families.

Governor Richardson is revamping his CARE package to reflect the new revenue figures. The new package will be presented to legislators before the special session starts on Friday.

Today’s revenue forecast also reduced the amount of new, on-going, or recurring, money that will be available starting July 2010. Economists agreed that the Governor and the Legislature can count on $351 million being available starting next year to pay for priorities like health care reform. Economists will meet two more times before the start of the 2009 legislative session.

Governor Richardson has proposed carving out $58 million from that $351 million in new, recurring money to pay for his health coverage plan, which includes an aggressive effort to cover all children under the age of 19.

Photo: MG Bralley

McCain Pledges Easier Access to Quality Health Programs for Rural New Mexican Vets

Thousands of rural New Mexican vets now have to travel to Albuquerque for access to care, but things might get better for them if Republican Presidential Candidate John McCain gets his way. On Saturday in Las Vegas, Republican Presidential Candidate John McCain told disabled vets, like himself, that he'll create a Veterans' Care Access Card. The card, McCain said, will provide those without timely access to VA facilities the option of using high-quality health-care providers near their homes.


Here's the text from his speech:

Though victory in Iraq is finally in sight, a great deal still depends on the decisions and good judgment of the next president. The hard-won gains of our troops hang in the balance. The lasting advantage of a peaceful and democratic ally in the heart of the Middle East could still be squandered by hasty withdrawal and arbitrary timelines. And this is one of many problems in the shifting positions of my opponent, Senator Obama.

To read the rest of the remarks click here.

Photo from Memorial Day Speech in ABQ - MG Bralley

White: I'm Back on the Trail.

He may be slowed down a bit while recovering from a back injury and week long hospital stay, but Darren White says he’s ready to campaign.

On Thursday he squelched rumors that he was quitting the campaign for the 1^s Congressional District. He says bloggers who claimed NM Republicans might replace him on the ballot at a meeting next Thursday with Heather Wilson are “absolutely false.”

In this PRESS CONFERENCE AUDIO White says he’s prepared to earn every single vote and eager to talk about important issues in the campaign, including health care.

"America has the highest quality health care in the world, but too many Americans (44 million) are without basic health coverage. We must enact common-sense reforms and market-based solution that will make quality health care more affordable and more accessible for every American."

4 Point Health Care Program:

Making Health Care More Affordable:

• White wants common-sense tort reform measures. He says they are necessary to reduce frivolous lawsuits that are driving up the cost of health care through unnecessary litigation, forcing doctors and other specialists to practice defensive medicine.
• He also wants to provide individual tax credits to purchase health care, and promote Health Savings Accounts, so more Americans can purchase their own health insurance.

Improving Accessibility and Increasing Choices:

• Allow people to shop for health insurance across state lines so they can find the plan that is best for them and their families at a cost they can afford.
• Make it easier for small business to pool together so they can provide their employees with the same quality health coverage as larger companies.
• Ensure people are able to keep their health insurance when they change jobs.

Keeping Patients and Doctors in Charge:

• Darren White says he believes that patients and doctors, not Washington bureaucrats, should be in charge of health care.
• Darren opposes government-run health care schemes that would increase costs, limit patient choice, and reduce the quality and efficiency of health care in America.

Providing More Coverage for Uninsured Children in America:

• In a country with as much wealth as America, it is morally unacceptable for children to go without basic health coverage. White says he’ll support a program to provide more children with basic health coverage through expanding the S-Chip Program.
• In case you missed it, Congressional Candidate Darren White released his 7 point plan for energy independence this week.

Here are the key provisions:

Innovate to find the next generation of energy sources:
We must continue research and development into promising new, clean, and reliable energy sources, including solar power, hydroelectric power, wind power, and biofuels.

Expand the use of clean energy sources now:
We need to expand the use of proven alternative energy sources, including nuclear power, natural gas, and clean coal technology.

Increase the production of American-made energy in an environmentally-safe way :
Today, about 70% of the oil consumed in the United States is imported, a significant amount from countries that are not friendly to the U.S. That is unacceptable when America has a vast reservoir of untapped resources. We must increase domestic production to increase supply, and lower the price of gas.

End bureaucratic red tape:
We have to bring new, modern oil refineries on-line to increase supply. Bureaucracy and regulations have held up the construction process long enough.

Encourage conservation:
Americans want to be active partners. We need to reward Americans who make their home, car, or business more energy-efficient through conservation tax incentives. We should help more businesses allow their employees to telecommute by providing incentives.

Corporate responsibility:
American corporations need to be partners in this process as well. I support increased fuel efficiency standards for automobiles. And there must be serious accountability tied to any tax credits for energy companies.

More oversight on speculators:
Some estimate 25% of the cost of a barrel of oil is due to speculation. The trading of oil futures should be transparent and subject to strict oversight. We must close loopholes, reform the system, and aggressively investigate cases of potential abuse and price manipulation.

Photo: MG Bralley