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Posts Tagged ‘Reform’

The federal health care reform legislation, known as the Patient Protection and Affordable Care Act, signed by the President on March 23, 2010, and the Health Care and Education Reconciliation Act approved by Congress, signed by the President today, will expand the availability of health care coverage to millions of Americans. While some of the measures will be implemented this year, many do not take effect until 2014 and some extend out to 2020.

Below is a high-level overview of the timeline.   It is important to note that many of these reforms and their effective dates are subject to the rules and regulations process both at the state and federal levels – which could alter the intended timing of implementation.

2010

New Programs:
* Temporary retiree reinsurance program is established
* National risk pool is created, small business tax credit is established
* $250 rebate for Medicare members who reach the “doughnut hole”

Insurance Reforms:
* Prohibits lifetime benefit limits – based on dollar amounts
* Allows restricted annual limits on the dollar value of certain benefits
* Coverage rescissions/cancellations are prohibited (except for fraud or intentional misrepresentation)
* Cost-sharing obligations for preventive services are prohibited
* Dependent coverage up to age 26 is mandated
* Internal and external appeal processes must be established
* Pre-existing condition exclusions for dependent children (under 19 years of age) are prohibited
* New health plan disclosure and transparency requirements are created

2011

Insurance Reforms:
* Uniform coverage documents and standard definitions are developed
* Minimum medical loss ratios are mandated

Medicare Reforms:
* Medicare Advantage cost sharing limits effective
* Medicare beneficiaries who reach the doughnut hole will receive a 50% discount on brand name drugs
* A 10% Medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.
* Medicare Advantage plans would begin to have their payments frozen.

Other:
* Employers are required to report the value of health care benefits on employees’ W2 tax statements.
* Annual industry fee for pharmaceutical manufacturers of brand name drugs.
* Voluntary long term care insurance program would be made available to provide cash benefit for assisting disabled individuals to stay in their homes or cover nursing home costs. Benefits would start five years after people begin paying a fee for coverage.
* Funding for community health centers would be increased to provide care for many low income and uninsured people.

2012

* Hospitals, physicians, and payers would be encouraged to band together in “accountable care organizations. “
* Hospitals with high rates of preventable readmissions would face reduced Medicare payments.

2013

* Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2. 35% on earned income —up from the current 1. 45%. A new tax of 3. 8% on unearned income, such as dividends and interest, is also added.
* Medical expense contributions to flexible spending accounts (FSAs) limited to $2,500 a year—indexed for inflation. In addition, the thresholds for claiming itemized tax deduction for medical expenses rise from 7. 5% to 10% of income.
* Medical device manufacturers would have a 2. 9% sales tax on medical devices; devices such as eyeglasses, contact lenses, and hearing aids would be exempt.
* Eliminates deduction for expenses allocable to Medicare Part D subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.

2014

Coverage Mandates & Subsidies:
* Individual and employer coverage responsibilities are effective.  
* Individual affordability tax credits are created and small business tax credits are expanded.

Health Insurance Exchange & Insurance Reforms:
* State individual and small group health insurance exchanges operational.
* Guaranteed issue, guaranteed renewability, modified community rating and minimum benefit standards (“essential benefits” plan) effective.  
* Lifetime and annual dollar limits are prohibited for essential benefits.
* Pre-existing condition exclusions are prohibited.

Taxes & Fees:
* Addition of new taxes on health insurers

Medicaid and Medicare Reform:
* Medicaid expanded to cover low income individuals under age 65 up to 133% of the federal poverty level—about $28,300 for a family of four.
* Minimum medical loss ratio of 85% required for Medicare Advantage plans

2018

Taxes & Fees:
* Tax (“Cadillac tax”) imposed on employer sponsored health insurance plans that offer policies with generous levels of coverage.

2020

Medicare Reform:
* Doughnut hole coverage gap in Medicare prescription benefit is fully phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

Author  Resource: Easy To Insure ME http://www. easytoinsureme. com/

Week of January 25, 2010

The sudden halt to health care reform’s steady march forward came as a shock to many who saw an upset win by Republican Senator-elect Scott Brown in Massachusetts as all but impossible. But if many took delight in the election outcome’s impact on health reform legislation, Aetna Chairman Ronald A. Williams made it clear in a New York Times story last week that the country still needs meaningful health care reform – reform that addresses access as well as affordability. Everyone benefits by health reform that gets at the factors driving soaring health care costs and the loss of coverage for so many Americans. While Congress thinks carefully about its next steps, Aetna will continue to support meaningful health care reform and continue to offer responsible solutions to legislative leaders.

Federal

The election of Republican Scott Brown as the new senator from Massachusetts has derailed the Congressional health care reform train, less because Brown denies Democrats the 60th filibuster-proof vote, though that is certainly a major result, and more because it collapsed the Democratic political house of cards by highlighting the power of independent voters and the frustrated anti-incumbent mood of the electorate. Whether Democrats can regroup from this wake-up call will consume their leadership from now until the November off-year elections. How Democrats handle, and how Republicans respond to, health care reform in the short term and other key priorities – such as jobs, the economy, energy and security – over the rest of the session will underscore all Congressional decisions from now until the first Tuesday in November. In short, the 2010 elections started in earnest with Brown’s victory.

Once Democrats get past the shock of losing Kennedy’s seat, they will have to grapple with health care reform, one way or the other. The early favorites, including passing the Senate bill “as is” in the House, have been dropped for now as Democrats recognize the political cost of ramming through something unpopular propelled by political muscle only. Passing a smaller, less invasive and mostly Democratic bill has only a slightly better chance, as Republicans are not too likely to “crossover” quite yet. There is a growing interest in using reconciliation (the 51-vote tactic) down the road to pass a Democratic-only bill, once the House and Senate Democratic leadership can agree to a single bill. And, there is the outside chance that Democrats will see the Massachusetts election as an imperative to craft a bipartisan bill with Republicans that can secure 70-plus votes in the Senate. Wednesday’s State of the Union speech, followed by the party issues retreats later in the week, will go a long way toward determining which path will be pursued.

Republican Scott Brown, fresh off his victory in the Massachusetts race for U. S. Senate, called on the secretary of state to send him to Washington immediately, saying Wednesday that he wants to send health insurance reform “back to the drawing board. ”

Though the state typically waits at least 10 days to collect absentee ballots before certifying, the senator-elect said he’s “confident” his margin of victory — 5 points and nearly 110,000 votes — was greater than the number of outstanding ballots.

Brown is champing at the bit to be sworn in since he would become the 41st Republican in the Senate, breaking the Democrats’ 60-vote supermajority and potentially scuttling health care reform if it returns to the chamber for a final vote.

“Since the election is not in doubt, I’m hopeful that the Senate will seat me on the basis of those unofficial returns,” Brown said, adding that he’s already spoken to members of the state’s congressional delegation, including Sen. John Kerry, and will travel to Washington Thursday. “I think it’s important that we hit the ground running because there’s some very important issues facing our country. ”

On health care reform, he said he wants “everyone” to have some form of health care coverage, but questioned plans to slash Medicare and raise taxes to do it.
video
Brown Ready to Hit Ground Running

Brown ready to hit ground running

“I think we can do it better,” he said.

The Republican senator-elect said he was focused on moving to Washington as soon as possible to try to free up some of the political gridlock there.

“I have always just wanted to go down and solve the problem regardless of party,” Brown told NBC’s “Today” Show.

“While they’re in Washington talking about what someone said in a book and what this happened, we have some very serious problems when it comes to over-taxation, overspending and Al Qaeda who are trying to kill us. So we need to get back to the basics and start solving problems that affect every person in this country,” he said.

Brown’s insurgent candidacy has forced Democrats to rethink the basics on several matters, including the massive health insurance reform bill that is tagged to cost nearly $1 trillion over 10 years. They are also reconsidering agenda items they plan to use in November’s midterm election campaigns.

By winning the Senate seat in Massachusetts by nearly the same margin that President Obama defeated Sen. John McCain in November 2008, Brown takes away Democrats’ filibuster-proof majority and can pull a reverse-Obama — claiming a mandate to defeat the health care legislation now stuck in Congress.

Despite the upset, Obama adviser David Axelrod said administration officials will take into account the message voters delivered Tuesday but declined to go further.

“It’s not an option simply to walk away from a problem that’s only going to get worse,” Axelrod said of the health care bill.

Sen. Susan Collins, R-Maine, said one of the many messages coming out of the Massachusetts election is that Americans are sick of partisan gridlock, but voters also had a much more expansive recommendation.

“They want better performance out of Washington, they want us focusing on the troubled economy and the need for more jobs and . . . they’re tired of sweetheart deals that were sneaked into the health care bill. They want that kind of bill to be negotiated in the open. And they’re tired of politics as usual and they also want controls. They don’t want unfettered, one-party control,” Collins told Fox News.

Collins said she cannot support a bill “that imposes billions of dollars for new taxes, slashes Medicare by $500 billion and would actually cause insurance rates to go up. ”

“We really should start from scratch and do a completely bipartisan bill,” she added

But Pennsylvania Gov. Ed Rendell said that Americans oppose the health insurance changes because “the administration and its supporters, myself included, haven’t done a good enough job explaining to people what’s in this bill. ”

Rendell said he wants to go back to the drawing board in order to better communicate the message. If that fails, and a filibuster is threatened, then Democrats shouldn’t “just cave” but should make the other side “explain why they’re trying to block the bill with this type of political chicanery. ”

“I haven’t heard one good alternative offered by any Republican except let’s start at the beginning, let’s start all over. Start all over to do what?” he asked.

Rendell added that he wants to call the GOP’s bluff.

“Let them filibuster, let them take to the floor and speak endlessly and endlessly about why this is bad for the American people and what the alternative is,” he said.

As the debate continues over whether to scrap the year-long health insurance reform effort, some are also looking at whether Republicans can repeat the feat in Massachusetts in other states.

Seven Senate seats now held by Democrats are now considered toss-ups in November — Nevada, Colorado, Arkansas, Illinois, Pennsylvania, Delaware and Connecticut. Four Republican seats are in the same situation — Missouri, Kentucky, Ohio and New Hampshire.

“I think anybody who’s up for election this November ought to take seriously what the people of Massachusetts had to say in that special Senate election,” said Sen. Joe Lieberman. D-Conn.
Sen. John Cornyn, R-Texas, head of the National Republican Senatorial Committee, said Democrats nationwide should be on notice

“Americans are ready to hold the party in power accountable for their irresponsible spending and out-of-touch agenda. ”

But Democratic Senatorial Campaign Committee Chairman Robert Menendez cautioned against “taking a single unique election and extrapolating what it means for the midterms 10 months away. ”

Still, Menendez said he doesn’t want to sugarcoat what happened and Democrats will be sorting through the lessons in the days ahead.

February 17, 2010

The Week in Health Reform–Federal Legislative Overview

House and Senate
Things were quiet last week in Washington due to the 30 plus inches of snow the area received.   On Feb. 9 House leaders announced that due to the heavy snow in the area they would suspend votes in the House for the remainder of the week. Congress will not be in session this week due to the President’s Day recess and will reconvene the week of Feb. 22.

As a result of the congressional schedule, the timeframe for a floor vote on the McCarran-Ferguson antitrust legislation will be pushed back until the week of Feb. 22 at the earliest.   Reports have stated that the antitrust bill is part of House Speaker Nancy Pelosi’s (D-CA) strategy of moving smaller pieces of health care legislation quickly to help build momentum for a comprehensive health care reform bill. The Speaker also continues to urge House Democrats to pass the Senate bill as long as it is accompanied by a separate “reconciliation” bill that would “fix” key provisions in the Senate bill (e. g. , raising the threshold for the Cadillac tax and dropping the Nebraska Medicaid provisions) to satisfy some members of her caucus.

The Senate remained in session last week, despite the weather, although Majority Leader Harry Reid (D-NV) stated that the Senate would not conduct any votes.   On Feb. 11, Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released the highly anticipated “jobs bill” – The Hiring Incentives to Restore Employment (HIRE) Act.

Senators Baucus and Grassley issued a joint statement, emphasizing that this bill was drafted with bipartisan input.   They further stated:  “We also agree that, once properly reviewed, the package should be considered in a deliberate, but expeditious manner.   Any efforts to needlessly delay Senate completion of consideration of this package through partisan means will undermine our goal of timely action in the current economic climate.   Action on the expired provisions is long overdue.   Timely action on incentives for economic activity and job creation also is needed. ”
Hours after details of the “HIRE” legislation were released, Majority Leader Reid publicly stated that he was scrapping the bill.   Reid told reporters that when the Senate returns from its recess on Feb. 22, “we will move to a smaller package than has been talked about in the press. ”  Reid went on to state that some of the tax provisions included in the legislation – key to garnering Republican support for the deal – “confuse” the bill.   Reid went on to say that, “we don’t have a jobs bill. We have a jobs agenda. ”

The draft “HIRE” legislation addresses a number of key health care issues:

* The bill extends, by three months, the eligibility period for premium subsidies for state continuation coverage and COBRA continuation coverage to include persons who are unemployed on or before May 31, 2010.   The bill also clarifies that these subsidies are available to persons who are involuntarily terminated from their jobs after previously losing their employer-sponsored coverage due to a reduction in hours.   The premium subsidies originally were enacted as part of the American Recovery and Reinvestment Act of 2009, also known as the “stimulus bill. ”

* The bill provides for a seven-month Medicare physician payment fix (sometimes known as the “doc-fix”), maintaining physician payment rates at their current levels through Sept. 30, 2010.   Under current law, in the absence of congressional action, physicians are scheduled to face a steep rate reduction on March 1.

* The bill provides for a one-year extension of both Medicare Advantage Special Needs Plans (section 626) and Medicare Cost Plans (section 627).

* The bill includes numerous provisions addressing Medicare fee-for-service reimbursement issues.
White House Health Care Reform Summit
In a pre-Super Bowl interview on CBS, President Obama said that he would like to host a televised health care summit with Republican and Democratic congressional leaders on Feb. 25.   While specific details are not yet available, the summit represents the Obama Administration’s latest strategy to jumpstart the health care reform debate and seeks bipartisan cooperation following the loss of the Democrats’ supermajority in the Senate.   Republican leaders expressed interest in the summit, and House Republican Leader John Boehner (OH) issued a statement saying that, “The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access. “  In response, White House officials insisted that the President is not interested in starting from scratch on health reform.

This week Democratic and Republican congressional leaders also met with President Obama at the White House to discuss the jobs bill, health reform, energy, trade and other legislative priorities.

Following the meeting, the President spoke with reporters and he made the following comments about health reform:  “I’m going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals.   What I will not do, what I don’t think makes sense and I don’t think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there’s a lot of posturing.   Let’s get the relevant parties together; let’s put the best ideas on the table.   My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don’t get every single thing that I want.

The health care reform bills being debated in Congress threaten to shut out millions of immigrants. But Congress’ exclusionary policies toward immigrants will not simply leave immigrants worse off. They will inevitably jeopardize the nation’s economy and the health of all of us.

President Obama has prioritized health care reform to ensure that millions of Americans have a fair, affordable and efficient health care system. For immigrants, this vision is far from a reality. First, the current health care reform bill treats legal immigrants unfairly. Individuals who have waited years to come to the United States will be required to wait years in order to obtain affordable health care.

Immigrants are generally younger and healthier than the U. S. population at large. However, no one is immune to falling ill or having an accident. The current health care bill would require recently arrived, legal immigrants to wait five years to obtain the only option for affordable health care coverage, Medicaid. While low-income citizens will have access to Medicaid, the most vulnerable among us will continue to wait for affordable health care despite the fact that they pay taxes for the very programs from which they are excluded. There is no sound reason for Congress to discriminate against these individuals and prevent them from receiving basic medical care.

Congress and the White House also took an unprecedented step to prohibit individuals from buying — with their own hard-earned money — an American good that could help their families. The Senate version of the health care bill forbids undocumented immigrants from purchasing private insurance at full cost in the newly created insurance marketplaces. As a result, undocumented immigrants as well as their family members, who are often U. S. citizens or legal immigrants, will likely remain uninsured and will be forced to seek care in the emergency room.

The costs of providing health care for undocumented immigrants will not disappear after passing health care reform. It is unlikely that millions of immigrants, whose contributions keep up our standard of living and our economy functioning, will be deported. Instead, the cost of care will become the financial responsibility of the patient, the provider, the local and state governments, and every single taxpayer. Moreover, in order to exclude a few, there will be additional forms, documents, and bureaucrats that the rest of us will be subjected to. Buying the mandated health insurance could feel like a trip to the Department of Motor Vehicles. Taxpayers will have to pay millions for this additional red tape and delay, all to keep a few people from buying health insurance with their own money.

Providers, employers, consumers, religious leaders, and state and local governments recognize that these policies are short-sighted and will cost all of us more in the long-run. Policies that attempt to exclude and ostracize immigrants also disproportionately harm all communities of color and immigrant-rich states like California and New York, further widening existing inequities in our nation. Yet because immigrants live in all 50 states, the intended and unintended consequences and costs of these restrictions will be far-reaching.

Ending discriminatory and exclusionary policies in this final round of negotiations is not only a matter of fundamental fairness and sound economics. It is required in order to not leave all of us worse off. Congress has a short window of opportunity to remove the restrictions on legal and undocumented immigrants in the health care reform bill. Doing so will not jeopardize the passage of the bill. Failing to doing so, however, will leave all of us, immigrant or not, worse off and wondering what happened to the promise of health care reform.

JANUARY 22, 2010

This Week in Health Care Reform

After months of public debate and private negotiations, health care reform discussions stalled following Tuesday’s Senate vote in Massachusetts. The Democratic Senate lost its 60th vote supermajority when Republican Scott Brown was elected to the United States Senate in the Massachusetts special election.

Health Care Reform Negotiations Post-Massachusetts Special Election

Massachusetts Election of Senate Republican Recasts Debate: Following the election of Republican Scott Brown to the Massachusetts Senate seat Tuesday night, Democratic leaders have been scrambling to revive what could now be a dying bill. The loss of the Democrat’s 60th vote in the Senate opens up the legislation to a Republican filibuster – something the Democrats have managed to avoid thus far in the debate.

House and Senate Democrats met this week to discuss how to move forward with the reform legislation in light of this election and promised Wednesday that they would push ahead. There are a number of options that Democrats are considering, but at this point they have not charted their course.

On Wednesday, Speaker of the House Nancy Pelosi (D-CA) attempted to rally House Democrats around a strategy to push the Senate bill through the House and onto President Barack Obama’s desk so as to avoid the need to again secure 60 Senate votes. However, the Speaker indicated on Thursday morning that she did not believe she has the needed 218 House votes necessary to move forward. This option would have allowed lawmakersto then propose additional modifications to the approved legislation through a process called “reconciliation,” which only requires 51 votes in the Senate.

Other remaining options:

1.
House and Senate Democrats could also quickly complete the merging of the two bills and vote on the combined package before Mr. Brown is sworn in.
2.
Democratic leaders could attempt to re-engage Sen. Olympia Snowe (R-ME), the only Republican who voted for the Senate Finance Committee’s bill passed in October. Democrats would need to allow her to amend the bill so that she could support its passage and give Democrats the needed 60th vote; or,
3. House and Senate Democrats could essentially start over in their respective chambers and propose scaled-back versions of the bill under “reconciliation” procedures or regular order. Reconciliation procedures would greatly limit the scope of the legislation to issues only related to raising or spending federal funds; therefore, many provisions, such as creating new insurance exchanges and an individual mandate, might be excluded.

President Obama seemed to indicate that he favors having House and Senate lawmakers start over again and produce a scaled-back bill. In addition, more moderate Senate Democrats – hesitant to push through such a huge partisan bill in light of the Massachusetts election – urged leaders to slow down.
Sen. Jim Webb (D-VA) has called on Senate leaders to suspend voting on health care reform until Mr. Brown is sworn into office. President Obama and Senate Majority Leader Harry Reid (D-NV) have iterated this same message. Further, Sen. Joe Lieberman (D-CT) called for a bipartisan effort as the best way to achieve health care reform legislation.

Health Care Reform Negotiations Prior to Massachusetts Special Election

Senators Urge Guarantee of Government Savings: In a letter sent last Thursday to Sen. Reid, five Democratic Senators asked for the inclusion of a “fail-safe mechanism” in the final bill. This mechanism would give Congress “the tools to keep costs under control should the current savings estimates fail to materialize. “

Both the Senate and House versions of the bill rely heavily on reductions in government spending, particularly around Medicare, to help pay for reform. Republicans and some nonpartisan analysts believe the government will not follow through on these spending reductions, which will lead to soaring costs.

President Obama Pushes for Less Protection for Biologic Drugs: Last Thursday President Obama pushed for a change in the health care reform legislation that would reduce the number of years that biologic drugs were patent protected from generic competition, previously set at 12 years. White House officials and Rep. Henry Waxman (D-CA) were negotiating for 10 years protection or less.

Members of the news media speculated that the move to reduce biologic drug protections could be a leverage point for President Obama to pressure the drug industry to increase contributions to pay for health care reform. In fact, the Wall Street Journal reported that Congressional Democrats had already asked drug companies to contribute an additional $10 billion or more, over and above the $80 billion which the industry agreed to early on in the reform negotiations.

President Obama Strikes Deal with Unions: Last week Democratic negotiators struck a deal with union officials and conceded to union demands to scale back a tax on high-end insurance plans. The deal would exempt union workers from having to pay the tax until 2018, five years after the tax would apply to other workers. While the deal would help gain union support for the bill, it would also reduce the amount of tax revenue generated by about 40 percent, to $90 billion. As such, Democratic leaders would need to find other sources of revenue to make up the difference.

Public Opinion

Exit Poll Indicates Health Care Reform as Hot Button Issue: As the ballot polls closed on Tuesday night’s Massachusetts Senate election, an exit poll conducted by Frabrizio, McLaughlin & Associates indicated that 52 percent of voters said that they oppose the federal health care reform measure and 42 percent said they cast their ballot to help stop President Obama from passing this legislation. In addition, 48 percent said that health care was the single issue driving their vote.

Polls Show Discontent: The latest Wall Street Journal/NBC News poll indicated that almost half of Americans believe the health care reform bill in Congress is a bad idea (46 percent). This figure is up dramatically from April when only 26 percent believed the plan was a bad idea. Further, just 33 percent say the plan is a good idea. Nearly half of those surveyed (48 percent) believe that passing the current legislation would be a “step backward. “

In addition, a new Quinnipiac University poll showed that public support for health care reform continues to decline. Thirty-four percent mostly approve, while 54 percent mostly disapprove. At the end of December, 53 percent of Americans mostly approved, while 36 mostly disapproved.

Looking Ahead

Currently, the path to health care reform is unclear. Democrats seek a way to secure the necessary votes to pass the legislation, and some now question the value of pushing such a large bill. President Obama had hoped to see a final bill prior to his State of the Union address, which has been scheduled for January 27; however, it appears this goal is likely out of reach.

FEBRUARY 5, 2010

This Week in Health Care Reform EasyToInsureME FEBRUARY 5 2010   

Despite proclaiming to focus on other issues, such as the economy and jobs, President Barack Obama injected new energy into the health care reform debate this week.

On Monday, President Obama held a Q&A session via YouTube in which he responded to questions submitted during his State of the Union address. He commented that “it is my greatest hope” to have health care reform legislation “not just a year from now, but soon. ” He also responded to criticisms regarding the lack of transparency around the reform negotiations.

On Tuesday, at a town-hall-style meeting in New Hampshire, President Obama rejected the notion that health care reform was dead, saying “we’ve got to punch it through. ” Further, on Wednesday, he met with Senate Democrats reiterating his commitment to reform and encouraging lawmakers to press forward. He also suggested that Republicans play at least some role in negotiating a final bill.

Health Care Reform Negotiations

Democrats Look for Path Forward: Recent statements made by Rep. Charles Rangel (D-NY) are the first concrete signs that Democrats have started working to revive comprehensive health care reform legislation. Rep. Rangel indicated to the media that lawmakers have begun writing a compromise bill based on the legislation passed by the Senate last December. The bill will incorporate changes agreed upon last month by White House negotiators and members of the House and Senate.

Senate Majority Leader Harry Reid (D-NV) did not commit to a timeline for reform, but hopes that Democrats can agree to a path forward by next week. So far, he has been unable to identify compromise language that will win the needed 51 Senate votes.

At the same time, Speaker of the House Nancy Pelosi (D-CA) indicated that the House would vote on a small piece of the overall health care reform package next week. The proposed bill would overturn the insurance industry’s exemption from federal antitrust laws. The Senate version of health care reform did not include this measure because Sen. Reid could not secure the 60 votes needed to include it; however, Sen. Reid indicated the Senate would reconsider the measure.

Additional Activities

President Obama’s Budget Assumes Health Care Reform: On Monday, White House officials released a proposed $3. 8 trillion 2011 budget including several measures aimed at improving health care:

·        Hiring more fraud detectives to root out waste in Medicare and Medicaid

·        Providing $25. 5 billion to help state Medicaid programs swelling with enrollment due to unemployment

·        Eliminating Congressional earmarks for building hospitals and other facilities, including $10 million for Alaska and $35 million for Mississippi

·        Initiating or increasing funds for the following research projects:

o       quality improvements for seniors with chronic conditions

o       effective medical treatments for the costliest conditions

o       expeditious ways to adopt electronic medical records

o       medical fields such as genetic medicine that may provide breakthrough treatments.

Further, the budget assumes that some form of health care reform legislation will pass Congress. It includes a “reserve fund for health care reform” totaling $634 billion as a “down payment” for the legislation and also assumes that the reform effort will generate $150 billion in savings over 10 years.

States Begin Initiatives to Expand Coverage: With the fate of national health care reform in question, state legislators are pushing their own bills to expand coverage. Last Thursday, California’s State Senate passed a measure to create a government-run health care system, ignoring a veto threat from Gov. Arnold Schwarzenegger. The measure is now with the State Assembly. Missouri legislators have introduced a similar bill to create a government-run plan whereas lawmakers in other states, including Virginia and New Jersey, are working to tweak existing state programs to expand coverage. Tight budgets in all of those states may hinder these efforts.

Virginia Senate Says No to Individual Mandates: On Monday, Virginia’s Democratic-controlled State Senate passed measures that would make it illegal to enforce an individual health care mandate. This decision comes in direct conflict with the House and the Senate health care reform bills, both of which require all individuals to purchase health insurance.

Public Opinion

Majority of Americans Doubt Passage of Health Care Reform, but Growing Optimism: A survey released by the Pew Research Center on Wednesday shows growing optimism around the passage of health care reform. While the poll indicates that the majority of Americans (60 percent) do not believe health care reform legislation will pass this year, the figure is down from the 67 percent who said – just after a special Senate election was held last month in Massachusetts – that such legislation would not pass.

Poll Indicates Damage Done On Health Care Reform: A poll released Tuesday by Public Policy Polling shows that Republicans currently have the advantage over Democrats in the ballot races for Congress, regardless of the final outcome of health care reform. In general, the poll shows that 43 percent of voters surveyed would vote for a Republican, whereas 40 percent would vote for a Democrat. When asked about the implications of the health care overhaul.

* If health care reform passes, 45 percent would likely vote Republican and 40 percent would likely vote Democrat.
* If health care reform does not pass, 43 percent would likely vote Republican and 38 percent would likely vote Democrat.

The poll also shows that 36 percent of respondents support the President’s health care reform effort, while 51 percent oppose it.

Looking Ahead

Currently there is no timeline for the development of a comprehensive health care reform package. However, Speaker Pelosi is moving forward with smaller pieces of the bill, starting next week with the repeal of the antitrust exemption for insurance companies.

The Week in Health Reform—Federal Legislative Overview

The White House
On March 3, President Obama continued his push for Members of Congress to complete health insurance reform legislation within the upcoming weeks.   He delivered a statement to a group of medical professionals in the East Room of the White House, in which he said that he has asked Senate and House leaders to finish work on health reform and schedule final votes in the next few weeks.   The President went on to say that the issues have been debated thoroughly and that now is the time to make a decision.   Although he did not specifically mention the budget reconciliation process, the President said that the American people deserve an “up or down” vote on health reform in the same way that welfare reform and tax cuts were approved by Congress in the past under reconciliation rules.

The President said that health insurance reform would change three things:

* End the “worst practices” of health insurance companies
* Give individuals and small businesses the same kind of choices members of Congress have
* Bring down health care costs for families, businesses and the government

The President made numerous references to the health insurance industry and stated that there is a fundamental disagreement between Republicans and Democrats about whether there should be more or less regulation of health insurance companies.   The President concluded by emphasizing that he will do everything in his power to make the case for health reform in the coming weeks, and he also urged the American people to make their voices heard.

In addition, the President said he is open to exploring policy priorities identified by Republicans at the bipartisan summit such as:

* Conducting undercover investigations of health care providers that receive reimbursement from federal programs.
* Appropriating funds for state-based demonstration programs to test alternative approaches, including health courts, to resolving medical malpractice suits.
* Linking Medicaid eligibility expansions to higher Medicaid reimbursement for physicians.

* Clarifying that Health Savings Accounts (HSAs) may be offered through the proposed health insurance exchanges.

On March 4, Health Care Service Corporation President and CEO Pat Hemingway Hall attended a meeting at the White House, along with CEOs from other leading health insurance companies and officials from the National Association of Insurance Commissioners.   The group met with Health and Human Services Secretary Kathleen Sebelius and President Obama to discuss premium issues in the individual market.

House and Senate
Congressional leaders are now focused intensely on developing legislative language that could be supported by a majority of members in both chambers.   The President’s comments last week send a strong signal that such legislation, once finalized, would move through Congress under budget reconciliation procedures.

Under reconciliation rules, the House first would have to pass the Senate version of the health care reform bill, H. R. 3590, which passed on Christmas Eve last year.   After that, the House would then be required to pass a separate “corrections” bill incorporating specific changes to that bill that will likely be negotiated among White House officials and House and Senate leaders.   After the House passes the “corrections” bill, under budget reconciliation procedures, the Senate would need at least 50 senators to vote for the “corrections” bill.   Under reconciliation rules, only a simple-majority vote of 51 votes are needed for passage (Vice President Joe Biden would be the 51st vote if only 50 senators vote for the bill) and filibusters are banned.

In order to meet the goal of sending a final health reform bill to the President’s desk before the Easter recess (which is scheduled to begin on March 29), congressional leaders would need to send legislative language to the Congressional Budget Office (CBO) for cost analysis in the very near future. On March 4, White House Press Secretary Robert Gibbs said that President Obama hopes the House of Representatives will pass the health reform bill by March 18, so the rest of the process can move swiftly.
Speaker Nancy Pelosi (D-CA) is now tasked with trying to corral votes in the House, while trying to assure those who are wary that the Senate will be willing to support the same measures. Some House members are worried about being left “holding the bag,” if the Senate decides it will not support some of the same legislative language.

In order to ensure the Democrats have enough votes, President Obama invited two groups of the Democratic Caucus to the White House on March 4 to continue to push for health reform passage.   Members from the Congressional Progressive Caucus were:
Caucus Chairs Raúl Grijalva (AZ) and Lynn Woolsey (CA), Congressional Asian Pacific American Caucus Chairman Mike Honda (CA), Congressional Black Caucus Chairwoman Barbara Lee (CA), Congressional Hispanic Caucus Chairwoman Nydia Velázquez (NY), Reps. Dennis Kucinich (OH), Lucille Roybal-Allard (CA) and Jan Schakowsky (IL), as well as delegates Madeleine Bordallo (Guam) and Donna Christensen (Virgin Islands).

Afterward, Obama met with key members of the New Democrat Coalition.    The New Democrats, like the Blue Dogs, are a group of fiscally conservative Democrats.   Attendees of this meeting included:  Reps. Jason Altmire (PA), Melissa Bean (IL), Lois Capps (CA), Joe Crowley (NY), Ron Kind (WI), Allyson Schwartz (PA) and Adam Smith (WA).

Overview: Extension of Physician Payment “Fix” and COBRA Provisions
On March 2, the Senate passed H. R. 4691, the “Temporary Extensions Act of 2010″ and President Obama signed it into law.   This legislation includes a one-month extension of the Medicare physician payment “fix,” premium assistance for unemployed workers with COBRA and state continuation coverage, unemployment insurance and several other legislative provisions that expired on February 28.   Before voting on passage of the bill, the Senate first voted on an amendment by Senator Jim Bunning (R-KY) that would have offset the $10 billion cost of the “extenders” package.   This amendment was defeated and therefore no further legislative action was needed.   The bill was later signed by the President.

Overview:  The “Health Insurance Industry Fair Competition Act” – H. R. 4626
In a letter dated March 3, 22 Democratic Senators wrote to Majority Leader Harry Reid (D-NV) urging him to bring H. R. 4626, the “Health Insurance Industry Fair Competition Act, to the Senate floor at its earliest opportunity.   In the letter they state that “[this legislation] is an important step toward bringing competition to the health insurance market, and would ensure that anticompetitive abuses such as price fixing and monopolization are policed in the health insurance industry. “  America’s Health Insurance Plans (AHIP) CEO Karen Ignagni maintains the position on the legislation saying, “The rhetoric surrounding repeal [anti-trust exemptions] does not match the reality of the situation.   Health insurance is one of the most regulated industries in America at both the federal and the state levels. The Act is extremely limited in scope and has nothing to do with competition within the health insurance industry.   In fact, a wide range of insurer activities, including mergers and many types of business practices, are and always have been subject to federal antitrust laws and to enforcement by the Department of Justice. ”

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Week of March 15, 2010

The White House last week continued to rail against rising health insurance premiums to help build popular support for his health care reform package. But the effort to focus the blame for rising costs on insurers was questioned, in particular, by state insurance experts and economists quoted in a New York Times story last week. Insurance commissioners said that trying to hold down premiums before costs were under control would be very risky. This approach could mean solvency issues in some cases, they told the Times. To help educate Americans about the true drivers of rising health care costs, America’s Health Insurance Plans, the industry trade association, last week launched a new national ad campaign. The ad demonstrates that health insurance company costs represent a small slice of the overall health care cost pie.

Federal

With a cadre of staff operatives searching for the right health insurance reform provisions among those previously discarded from the House, Senate and the President’s proposals, Democratic leadership has been relentlessly pursuing every possible pathway to pass a final bill. The expected process would have: 1) the House pass the Senate-adopted reform bill (which most House members hate), 2) the House passing a bill to “fix” all the things it hates using a reconciliation legislative vehicle, followed by 3) the Senate passing the very same reconciliation bill — requiring only 51 votes in the Senate. The House Budget and Rules Committees are expected to start the review, hearing and mark-up process of the reconciliation bill this week. The Senate commitment to using reconciliation was made official in a scathing letter from Leader Harry Reid to the Minority Leader. Along the way the two Chambers will need to see the latest CBO “scores” on the bill before voting, and 216 House Democrats will have to resolve policy disagreements over abortion, federal health insurance rate review and authority, and other substantive issues. Additionally, the House will have to trust that the Senate can pass the reconciliation measure without changing one comma. Partisanship has blossomed into open hostility over health reform. Whether Congress can overcome these policy, process and political mine fields remains as murky as ever, but Democrats have chosen to try and will push for resolution by the Easter recess.

The Senate has passed Jobs Bill II and shipped it off to the House, where passage is not certain. Within the bill are two health-related items of note. First, the COBRA eligibility and subsidy program will be extended to the end of 2010. (These provisions are set to expire at the end of March. ) Second, the bill contains a suspension until September 30, 2010 of the cut to physician Medicare reimbursements for the current calendar year. (This provision is also set to expire at the end of March. ) Aetna urged Congress to apply the “doc fix” to next year’s reimbursement as well, since insurers’ Medicare rates are based on what doctors are paid, but in the end Congress failed to make this change. Aetna and the industry will continue to find ways both to establish a more lasting, if not permanent, doc fix and to devise a legislative solution to the disconnect between doctor reimbursement and Medicare Advantage rates for 2011 and beyond.

States

ARIZONA: Budget issues remain front and center as the governor and Republican leadership proposed a plan they hope will close the $700 million deficit this year and reduce the anticipated $2. 6 billion deficit in 2011. Righting the state’s fiscal ship has become a very partisan exercise, with the Republicans supporting reductions in Medicaid and KidsCare, and the elimination of full-day kindergarten. As the special session on the budget is running concurrently with the regular session, no other bill hearings were held. The oral chemotherapy parity bill may be dead for this year as proponents did not meet the deadline for submitting amendatory language.

CALIFORNIA: The Assembly Accountability and Administrative Review Committee chaired by Assemblyman Hector De La Torre held a hearing last week to examine how the Department of Managed Health Care (DMHC) and the Department of Insurance (CDI) has handled issues surrounding the rescission of policies in the individual market. According to a report prepared for the committee by Bryan Liang, director of the Institute of Health Law Studies at the California Western School of Law, fewer than 300 of 6,000 former policyholders are participating in health insurers’ agreements to settle such cases. Republican committee members were highly critical of this witness, while De La Torre was critical of the Departments. The DMHC reported that since their settlements were completed there have only been nine rescissions over the past two years, proof that the DMHC and the health plans have revamped their processes for rescission and have worked to address the problem.

COLORADO: A bill mandating maternity and contraceptive coverage in individual policies continues to receive significant attention in the Senate. The most recent amendment proposes requiring maternity coverage in at least three of the plans marketed by an insurer. It would also allow a current member of a plan without maternity coverage to switch to a plan with maternity coverage from the same carrier during the first trimester. The other major bill would require that second level appeals be performed by physicians who are actively involved in clinical practice. This measure is counterintuitive in the current economy, since it would result in outsourcing appeals and drive up costs for plan sponsors and their employees.

CONNECTICUT: A proposal that would require health insurance plans to cover oral chemotherapy in the same way that intravenous chemotherapy is covered made it through the legislature’s Insurance and Real Estate Committee last week. Currently, many health plans treat the two kinds of cancer treatments differently. Chemotherapy treatments that come in pill form are often categorized as prescription drug benefits that can require patients to pay a larger share of the cost. Cancer patients, doctors and patient advocates spoke in favor of the bill, while insurers and the Connecticut Business and Industry Association opposed it, arguing that it would put a mandate on health plans that could raise costs and make it more difficult for employers to afford insurance.

GEORGIA: A bill restricting the use of rescissions in individual health insurance policies passed a Senate committee last week. Aetna continues to work with its trade organizations to educate legislators about the adverse effect of this type of legislation. Discussions also continue regarding legislation affecting the use of rental networks.

KANSAS: Roughly half way through the legislative session, several health care bills are still moving through the process. On the regulatory front, the Insurance Department has proposed a regulation that would mandate coverage of routine patient care costs while the insured is enrolled in a cancer clinical trial – a mandate that was rejected by the legislature in 2008. A hearing will be held on April 20, and Aetna will have an opportunity to present testimony on this issue. Bills still alive include mandates for autism and orally administered chemotherapy, legislation prohibiting dental contracts that require the dentist to follow a fee schedule for non-covered services, and a ban on “most favored nation” clauses by some insurers. Another bill would allow small employers to create individual HRAs to fund premium payments on individual policies, require administering insurers to offer employees the option of receiving health insurance coverage through a high-deductible health plan with an HSA, and requiring insurers who offer small group health plans to offer high-deductible health plans with HSAs, while authorizing tax deductions for health insurance premiums for individual insurance policies. Separate legislation would amend the definition of “eligible employee” to include part-time workers (currently less than 30 hours per week). Pending legislation concerning hospital charges would prohibit charging private-pay patients more than 25 percent of what the hospital’s highest volume private payer would pay for the same goods or services. Legislation that died includes a telemedicine mandate and creation of a health care insurance database for employers.

KENTUCKY: Health issues that are being hotly debated by the legislature right now include an autism mandate, a dental bill that would not allow insurers to hold dentists, optometrists or ophthalmologists to a fee schedule for non-covered services, and a bill setting a reimbursement floor for chiropractic services. The chiropractic services proposal would allow chiropractors to bill, and would require insurers to reimburse, an evaluation and management (E&M) CPT code on each and every visit. In addition to billing for follow-up services for manipulations and other therapies, the chiropractor would be allowed to submit, and the insurer required to pay, for another E&M code on each and every visit. The legislation would also add a new mandated benefit to the Kentucky statutes. Currently, reimbursement for chiropractor visits is required only if the chiropractor performs a service already covered by the health benefit plan. Under the proposal, any service within the scope of practice of a chiropractor that is billed would become a mandated benefit. Finally, the bill would require health benefit plans to provide reimbursement without the chiropractor having to provide any documentation that the services were medically necessary. Each of these bills has, or is expected to, pass at least one chamber.

SOUTH DAKOTA: Several important legislative deadlines are approaching, resulting in a flurry of activity. Bills or resolutions not passed by the second chamber by March 9 died. But the Governor has already signed a bill that amends the premium rate-setting procedure for the high-risk pool so that rates for a given classification are 150 percent of the average actively marketed premium. The pool will have to offer three or more plan designs, remove coverage requirements for the plans (such as disease management) and remove set cost-sharing values. The bill was signed by the Governor on March 1 and will become effective on July 1, 2010. The Governor has also signed a bill prohibiting rating based on injuries caused by domestic violence and legislation requiring refunds of premiums for partial months, in the case of mid-month cancellations. Both chambers have passed legislation prohibiting contract language requiring dentists to accept a fee schedule for non-covered services, and the bill awaits the Governor’s signature. Finally, the legislature passed a resolution opposing the federal health care reform proposals passed in the U. S. Senate and House.

JANUARY 29, 2010

This Week in Health Care Reform

Following the election of Republican Scott Brown to the Massachusetts State Senate last week and the resulting loss of Senate Democrats’ supermajority, lawmakers continue to pave the way for health care reform – with limited progress. In addition, polls indicate that the public would rather lawmakers focus more on the economy than on health care.

State of the Union Address

President Obama Gives State of the Union Address: On Wednesday evening, President Barack Obama delivered his first State of the Union address before a joint session of Congress. Having hoped to have a health care reform bill on his desk prior to his address, the President instead used his speech to encourage Congress to push forward on health care reform. Yet, he did not give specific guidance as to how to proceed with the legislation. Instead, he made it clear that his primary focus would be on jobs and the economy.

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Health Care Reform Negotiations

Democrats Still Seek Way Forward: While vowing not to give up, Democratic Senate leaders indicated Tuesday that they no longer felt pressure to move quickly on health care reform; and, in the wake of the Massachusetts election and in reaction to public opinion, they shifted focus to jobs and the economy. Senate Majority Leader Harry Reid (D-NV) commented that there is “no rush” on health care and said that he and Speaker of the House Nancy Pelosi (D-CA) were working to map out a way to complete health care reform in the coming months. On Wednesday, Sen. Pelosi floated a two-pronged strategy to pass incremental changes now and pursue comprehensive reform later.

Some lawmakers have considered breaking up the legislation into smaller pieces that have bipartisan support. However, this option will prove challenging given the complexities and interdependencies of the measures. For example, lawmakers would like to include a measure that requires all insurance companies to insure those with pre-existing conditions; however, premiums will most likely increase unless there is an individual mandate.

Earlier this week, Democrats appeared to be coalescing around a different strategy through which Senate lawmakers would make changes to their bill to appease members of the House. The Senate would then pass the revised bill via reconciliation, which only requires 51 votes. Following that, the House would approve the revised bill, giving it to President Obama for his review. However, movement on this strategy stalled Tuesday when two centrist Senators, Sens. Evan Bayh (D-IN) and Blanche Lincoln (D-AK), indicated that they would oppose using reconciliation to bypass Republican support. Others, including Sen. Joe Lieberman (I-CT) and Sen. Dianne Feinstein (D-CA), have suggested a “time out” on health care reform until there is a clear path forward.

In the GOP response to President Obama’s State of the Union address, Virginia Governor Robert McDonnell said that Republicans share the Democrats’ desire for health care reform, but do not agree with their proposed solutions. Republicans suggest that Democrats scrap the current proposals and start over with more Republican input on issues such as medical malpractice reform and selling insurance policies across state lines.

Republicans Call for Transparency: On Wednesday, the House Energy and Commerce Committee marked up a resolution presented by Rep. Michael Burgess (R-TX) which requested that the administration divulge documentation regarding the health care reform deals made with trade associations and a labor union. Committee Chairman Henry Waxman (D-CA) said that while details remained to be worked out, he would support a narrowed version of the Republican request for White House records.

President Obama to Speak with House Republicans: President Obama will meet with House Republicans on Friday in response to an invitation to speak at their annual retreat in Baltimore that begins Thursday and ends Saturday. The meeting comes just after the President’s State of the Union address, and members of the news media speculate that the meeting may spur more bipartisanship or potentially lead to even more tension between the two parties.

Interest Groups Call for Reform: With health care reform’s fate in jeopardy, interest groups have voiced their support, encouraging Democrats to push forward with legislation. The AARP, American Cancer Society Cancer Action Network, Consumers Union, Families USA and Service employees International Union sent a joint letter last Thursday urging Congress not to abandon comprehensive health care reform. Further, the United States Conference of Catholic Bishops also sent a letter to Congress urging a push for reform.

Public Opinion

Polls Show Concern with Health Care Reform; More Focus on Jobs and Economy: Several polls were released this week that highlight the public’s disenchantment with health care reform and anxiety around the struggling economy.

A new CNN/Opinion Research poll released Tuesday shows that only three in ten Americans say they want Congress to pass legislation similar to the bills currently being discussed in Congress. Forty-eight percent of Americans would like lawmakers to start again on a new bill, and 21 percent believe Congress should not work on bills that would change the current health care system. Further, a Wall Street Journal/NBC poll released Wednesday found that 51 percent of Americans believe President Obama has paid “too little attention” to the economy and that 44 percent feel he has paid “too much attention” to his proposed health care overall.

In addition, a new USA Today/Gallup poll released late last week finds that most Americans call for a more bipartisan effort in health reform. A 55 percent majority of Americans say that President Obama and Congressional Democrats should suspend movement on health care reform and consider alternatives that would increase Republican support.

A poll released last weekend by the Washington Post , Henry J. Kaiser Family Foundation and Harvard University’s School of Public Health indicated that dissatisfaction with the direction of the country, including the Democrats’ health care reform proposals, drove the outcome of the Massachusetts election. The post-election survey of Massachusetts state voters showed that overall 43 percent say they support the health care reform proposals advanced by President Obama and Congressional Democrats, while 48 percent oppose them.

A new poll released Monday from the Robert Wood Johnson Foundation found that fears regarding the health care reform package increased significantly in December as members of the Senate finalized their bill. Thirty-three percent of respondents said they believed their access to care would worsen if the legislation passed, up from 25 percent in November. Forty-two percent said the country’s finances would suffer under reform, compared with 34. 6 percent in November.

Looking Ahead

Next week, the President will present his Budget to Congress (which includes health programs), after which Congressional hearings will commence. We expect health reform to be discussed in these sessions. While there remains no clear path forward for health care reform, Congressional leaders will continue to work to find a solution.