This
week Senate lawmakers continued to debate numerous proposed amendments
to Senate Majority Leader Harry Reid's (D-NV) health care reform bill.
An
updated analysis by our parent company shows that, with the proposed
health care reform legislation, across- the-board premiums will
increase significantly for younger and healthier people who purchase
insurance on the individual market or through small employer groups.
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Senate
Continues Debate on Health Care Reform Bill: As Senate lawmakers
continued to debate through the weekend and voted on proposed
amendments, President Barack Obama encouraged this effort by visiting
Capital Hill on Sunday and urging lawmakers to put aside their
differences and pass the historic legislation. While the President did
not mention abortion or the government-run option specifically, those
issues remain particularly divisive and at the center of debate on the
Senate floor:
* Abortion - On Tuesday the Senate rejected
(54-45) an amendment proposed by Sen. Ben Nelson (D-NE) that would have
imposed restrictions on coverage of abortion services for people who
received subsidies to buy insurance. Sen. Nelson has indicated that he
will not support a health care reform bill that does not include
language restricting abortion coverage. Tuesday's vote puts into
question whether Sen. Reid has the 60 votes necessary to pass the
reform package. * Government-Run Option - On Tuesday night a group
of 10 appointed Democratic Senate lawmakers announced a tentative
agreement in regards to the public option. In an effort to remove a
major hurdle to passing legislation this year, the group of negotiators
offered an alternative program to the government-run option that would
create several national insurance plans administered by private
companies but negotiated by the Office of Personnel Management, which
oversees health policies for federal workers. The negotiators said that
a government plan would only be created if private firms were unable to
deliver acceptable national policies.
The agreement would allow
individuals to buy into Medicare starting at age 55, and insurance
companies would face new regulations, including a requirement that they
spend at least 90 cents of every dollar collected in premiums on
medical services for customers.
In response to the agreement,
the American Hospital Association, the American Medical Association,
the American Federation of Hospitals - along with other health care
companies, including insurers and drug makers - expressed concerns over
the proposed Medicare expansion. Some also voiced concerns that the
agreement simply represents another form of a public option. Those in
opposition cite potential cost increases, low Medicare reimbursements
and greater government control over parts of the health care industry.
Hospital representatives said an expansion of Medicare would violate a
deal they reached with the White House this year to give up $155
billion in Medicare payments over the next decade. Furthermore, The
National Federation of Independent Business, a small-business
association, released a statement opposing the legislation as an
inadequate response to rising costs.
Currently Sen. Reid has
only released a few specific details about the agreement, and lawmakers
are hesitant to endorse the plan until it is better understood. Sen.
Joe Lieberman (I-CT) has indicated that the inclusion of a public
option trigger may be a possible deal breaker. Sen. Reid presented this
new agreement to the Congressional Budget Office (CBO) to be analyzed
and is currently waiting for the CBO costs estimates.
In
addition, on Wednesday Senate lawmakers debated an amendment offered by
Byron L. Dorgan (D-ND) that would allow for the importation of
prescription drugs from other countries. Should it pass, the measure
could threaten the pharmaceutical industry's support for President
Obama's health care reform. The pharmaceutical industry strongly
opposes allowing prescription drug imports, indicating that the risk
for counterfeit drugs would increase. While the amendment was supposed
to come to a vote on Wednesday, an agreement was not reached and debate
continued on Thursday.
Other Activities
Federal Insurers
Warn of Higher Premiums: The Association of Federal Health
Organizations , which includes federal employee-sponsored health
insurance companies and Associate Member Blue Cross and Blue Shield
Association, is starting to make waves on Capitol Hill with information
released in a November 25 report to the Office of Management and
Budget. The report indicates that health insurance premiums could go up
and benefits could be hurt due to impending fees on the insurance
industry and the excise tax on premiums above a certain amount.
Drug
Makers May See Increased Fees: Media reports indicate that the bill
emerging from the Senate may include fees on the pharmaceutical
industry that are greater than the $80 billion originally discussed in
June. Given that the House bill would cost drug makers about $140
billion, the eventual House-Senate bill is likely to include fees
exceeding $80 billion.
Public Opinion
Americans Oppose
Reform Plan: As special interest groups express concern over the latest
Senate proposal, polls continue to show that Americans are increasingly
worried about the impact of reform. The most recent Quinnipiac
University Poll indicates that Americans disapprove (52-38 percent) of
the health care reform proposal under consideration in Congress.
Furthermore, a Bloomberg National Poll indicates that 62 percent of
Americans say they are mostly pessimistic that they would benefit from
the bill.
Looking Ahead
Senate lawmakers will continue
working around the clock and weekends to debate and vote on the
proposed amendments. Sen. Reid is still pushing to have a final Senate
reform package put together by Christmas.
Senate Less
than two weeks after the debut of official legislative language, the
Senate began official debate on its $848 billion health care reform
bill “The Patient Protection and Affordable Care Act” (H.R. 3590) on
November 30. The bill, which is estimated to cover 94 percent of
Americans, passed its first hurdle before the Thanksgiving holiday when
Senate Democrats received the needed 60 votes on the “motion to
proceed” to debate.
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More
than 60 amendments have been filed to the Senate health care reform
legislation in its first week of debate. Some of the notable amendments
include one by Senator Barbara Mikulski (D-MD), which was adopted by a
vote of 61-39. The amendment would eliminate co-payments for many
preventive services for women – and would require that insurers provide
full coverage for breast and cervical cancer screenings. Senator David
Vitter (R-LA) also included a stipulation to the amendment that would
preclude the most recent controversial recommendations on breast cancer
screenings by the U.S. Preventive Services Task Force from being used
for insurance coverage determinations. Additionally, Senator Ben Nelson
(D-NE) and Senator Orrin Hatch (R-UT) are crafting an abortion-related
amendment that will mirror the one passed in the House version of the
bill last month. The amendment would prohibit the use of federal funds
for abortions.
Senator Thomas Carper (D-DE) is leading efforts
in the Democratic caucus on the creation of a public health insurance
option that is built around a state-by-state “trigger” option. Carper
has spent weeks working with members of the Democratic caucus, as well
as some moderate Republicans on the amendment that he is hoping will
appease a broad range of individuals concerned about the government-run
health insurance plan, also known as the “public option”.
Majority
Leader Harry Reid (D-NV) still has significant work to do in uniting
his divided Democratic caucus. Reid has stated that he will keep
Senators in Washington on weekends throughout December to ensure that
key legislative issues are worked out before a final bill can be
brought to the Senate floor. As detailed above, Reid will have to
balance trying to appease the progressive members of his party with a
robust government-run health insurance plan with corralling the
moderate and conservative Democrats who have been vocal on issues such
as abortion and cost-containment measures.
House The House
of Representatives remains quiet on health care reform legislation
after passing its portion of the bill in November. Its main focus
during the next few weeks before the holiday recess will be on a
financial regulation package to be brought up by the House Committee on
Ways and Means.
The Senate began to slog its way
through amendments (see below) last week in a process that promises to
get harder, not easier. In the meantime, the debate continues as to
whether the Senate bill would do anything significant to slow rising
health care costs, and a Bloomberg story points out that a number of
economists and analysts are doubtful that it will. The White House
defends the bill's ability to slow costs, but some analysts predict
that Congress will need to make many more tough decisions to have a
real impact. According to Bloomberg, a group of Senators that includes
Joe Lieberman (I-CT) and Susan Collins (R-ME) is taking aim at rising
costs with an amendment that would include new requirements on
providers to try to wring more costs out of the system. Anyone
concerned about the rising cost of health care should be engaged in the
process by reaching out to their Senators to urge a greater focus on
bending the cost curve.
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Federal The
Senate debate on health care reform actually consists of three
simultaneous debates. The first is public on C-SPAN, and it's going
slowly as Republicans are pressing for 60 votes as often as they can
while Democrats try to speed things up. Nothing of any great moment has
been passed or decided. The second debate is the one Majority Leader
Harry Reid is conducting behind closed doors as he tries to garner 60
Democratic votes for some acceptable form of a public option. Once this
is accomplished, most observers believe Reid will immediately file
cloture to cut off debate on the bill itself. If successful at getting
60 votes, he will go straight to final passage, which would require 51
votes. This could happen before Christmas. The third debate is the one
Reid is having with House Speaker Nancy Pelosi over whether to have a
conference at all. If the Senate can pass a bill the House can accept
"as is," then there will be no need for a time-consuming conference
that could unravel the bill. Thus, Reid is checking in with Pelosi
frequently to see what he needs to be able to pass a bill and avoid a
conference.
Since returning from its Thanksgiving break last
week, the Senate has slowly been making its way through a number of
amendments. Key votes so far include: approved an amendment that would
require first-dollar coverage (no cost sharing) for certain preventive
services; approved an amendment stating that nothing in the bill reduce
guaranteed benefits under Medicare; defeated a motion that would have
sent the bill back to the Finance Committee for the purpose of removing
proposed cuts to Medicare; defeated an amendment that would have
removed the CLASS Act provisions from the bill; defeated a motion that
would have sent the bill back to the Finance Committee to eliminate the
proposed Medicare Advantage funding cuts; approved an amendment
requiring that nothing in the bill shall eliminate benefits “guaranteed
by law” to Medicare Advantage enrollees (protects only benefits also
covered by traditional Medicare and does not protect extra benefits and
services provided by MA plans); and defeated an amendment that would
have placed limits on how much attorneys can earn from medical
malpractice lawsuits.
States ALL STATES: The National
Governors Association (NGA) has announced an initiative outlining
preparations for federal health care reform. Titled "Rx for Health
Reform - Affordable, Accessible, Accountable," the 2009-2010 initiative
is led by Vermont Governor and NGA Chair James Douglas. It will focus
on: providing governors with the information needed to transition to a
new health care system; developing state-based system improvements and
cost containment measures, including tools necessary to develop
delivery system enhancements, looking at what is required under federal
legislation, and highlighting other reforms the states could undertake
to create a more efficient and effective health care system; and
preparing states for implementing insurance market reforms, state-based
exchanges, new mechanisms to support delivery system reform, and other
national health reforms. The NGA's Health Care Task Force includes
Governor Douglas and West Virginia Governor Joe Manchin, both serving
as co-chairs, as well as Indiana Governor Mitch Daniels, Mississippi
Governor Haley Barbour, New Hampshire Governor John Lynch, and Oregon
Governor Ted Kulongoski.
CALIFORNIA: The California Medical
Association (CMA), the second largest medical association after Texas,
has announced its opposition to the “Patient Protection and Affordable
Care Act,” the health care reform bill being debated in the Senate. The
CMA also opposed Governor Arnold Schwarzenegger’s comprehensive health
care reform proposal in 2007. In other news, Republican Governor
Schwarzenegger has appointed State Senator Abel Maldonado to serve as
Lieutenant Governor, but Democrats in the legislature have vowed not to
confirm the Republican Senator because they view him as a viable
state-wide candidate who could be elected easily to the position.
Maldonado still must be confirmed by the legislature, which has 90 days
to act.
COLORADO: The Colorado Medical Society (CMS) continues
to seek support for a bill that would define the practice of medicine
as including medical necessity determinations and utilization reviews
performed by health plan medical directors. As currently drafted, the
proposal would potentially expose medical directors to disciplinary
action by the state Board of Medicine when medical necessity or
utilization review decisions are challenged. Several discussions have
been held with the executive director of CMS to ascertain the nature of
the problem the association is trying to address, particularly since
the organization as a whole may not be supporting the bill.
ILLINOIS:
Illinois' fiscal situation is "grim and getting worse." Illinois has a
reported $12 billion structural budget deficit. Comptroller Hynes said
Illinois had nearly $4.6 billion in unpaid bills at the end of
September, a record development for the first quarter of any fiscal
year. This, despite the state having borrowed $2.25 billion in
short-term loans, which must be repaid before the end of FY2010. Hynes
identified two factors that have had a major impact on the
deteriorating fiscal position: the steep decline in economy-driven
revenues, such as personal and corporate income taxes and sales taxes,
and record lapse-period spending. Hynes predicted fiscal pressures
would continue well into FY2011 and warned of record and prolonged
payment delays for most categories of state programs and operations,
including health care and social services. There will be increasing
pressure on health care programs as the economic stimulus funds expire
and the amount of money demanded by utilization increases continue to
be realized. There are already significant payment cycle delays on
portions of the State employee health plan. The budget situation will
dominate discussions in the General Assembly, which reconvenes in
January.
KANSAS: At the request of Kansas Congresswoman Lynn
Jenkins, the Kansas Health Policy Authority recently announced that it
estimates the health reform bill passed by the U.S. House would provide
health insurance for 240,000 Kansans without coverage and possibly save
the state treasury up to $25 million a year. It estimated the U.S.
Senate Finance Committee bill would insure an estimated 190,000 Kansans
and reduce state costs by $25 million to $50 million a year. The
Authority also concluded that the House bill would provide more federal
matching dollars for Medicaid and likely would allow a reduced package
of benefits for Medicaid beneficiaries added to the state rolls as a
result of health reform. Current Kansas Medicaid eligibility is among
the strictest in the nation, with benefits generally available only to
the oldest and youngest of the state’s poor. Childless adults of
working age are not eligible and parents are enrolled only if they earn
less than about 27 percent of poverty guidelines. Exceptions are made
for pregnant women.
MICHIGAN: State House Democrats announced a
plan last week to cut auto insurance rates through tighter restrictions
on auto insurance companies and the medical portion of those claims,
affecting subrogation and coordination of benefits for Aetna and
Cofinity®. Generally, the proposal requires auto insurance companies to
offer low-cost auto insurance to low-income drivers with good driving
records. The bill also would: allow the state insurance commissioner to
deny rate changes by auto insurance companies before they take effect;
prohibit auto insurance rate increases for those with good driving
records; prohibit auto insurers from using certain types of rating
factors; and limit fees paid to doctors and hospitals for treating auto
accident injuries. Michigan is the only state that requires all auto
insurance policies to give unlimited medical coverage for injuries
suffered in auto accidents. The proposal would change that requirement
and allow motorists to buy maximum medical coverage as low as $50,000.
This means that rate-regulated provider groups would likely have group
policies pay auto claims rather than wait for adjudication of the claim
in court, as they would not want their fees limited. In addition, the
allowance of low medical coverage on auto claims would affect Aetna's
subrogation and coordination of benefit activities with both auto
carriers and Aetna enrollees.
MISSOURI: The Department of
Insurance recently released its 2008 HMO Annual Report showing that the
entire managed care market is declining. The report shows that the
number of people enrolled in either an HMO or a major medical health
insurance plan decreased 15 percent since 2006. PPO plans are gaining
the most enrollment, and POS plans remain more popular in certain areas
than HMO plans. Total premiums for managed care coverage continue to
rise with the industry reporting a 7.5 percent increase from 2004 to
2008. The medical cost ratio for all HMOs operating in Missouri,
covering only Missouri business, was 82 percent in 2008, compared to
the nationwide industry number of 83.6 percent.
NEW JERSEY: The
legislature returned from its extended recess and took action on
legislation to establish a medical home demonstration project for the
Medicaid population. Upon federal approval, the state Medicaid program
would set out a three-year demonstration project with an annual
evaluation and reporting requirement by the Division of Medicaid
Assistance Services to the Governor and legislature. On the Senate
side, Aetna offered support for legislation requiring chain restaurants
to provide nutritional information for food and beverages on their
menus. Similar legislation is currently making its way through the
Assembly and will likely receive a full vote in both chambers prior to
the end of the session.
NEW YORK: The legislature passed
another deficit reduction plan, trimming spending and using unspent
funds to plug a $2.7 billion dollar budget deficit. A large percentage
of the revenue used to fill the gap came from federal stimulus money
that was originally designated for the 2010 budget and cuts to the
Medicaid trend factor. After intense lobbying and coalition efforts,
the legislature did not pass the Governor's proposed 0.25 percent
increase to the patient services assessment or "sick tax". In addition,
the Senate did not pass the Marriage Equality Act, effectively
defeating the bill for the year. The legislature will return to face a
multi-billion dollar deficit again in January, and it is likely that
increases to health insurance taxes will be back on the table.
UTAH:
The Department of Insurance remains committed to pursuing legislation
to expand the Utah Health Exchange Network Portal to include a master
patient index that providers could access to obtain coverage
eligibility information. The bill contains a number of troubling
provisions, including a monthly batch reporting requirement on health
plans. The proposal also includes a July 1, 2010 effective date
allowing no time to update and test affected internal systems.
On
November 21st Senate lawmakers voted along party lines to move ahead
with a floor debate over Senate Majority Leader Harry Reid's (D-NV)
proposed health care reform legislation. Negotiations began in the
Senate this week following the Thanksgiving recess.
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WellPoint
believes the Senate legislation will have a significant, negative
impact on the cost and nature of coverage for our customers. We believe
it will cause more problems and have outlined several reasons why
employers, employees, and consumers should be concerned about this
legislation.
If these points concern you as well, we encourage you to engage your Senators thru visiting the Health Action Network.
House and Senate Negotiations
Senate
Debates Health Care Reform Bill: As the debate began Monday,
discussions highlighted many contentious issues including
cost-containment, the public option, illegal immigrants, Medicare cuts
and abortion funding. In the coming weeks each side will be offering
dozens of amendments that will be debated and voted on. On Wednesday,
lawmakers agreed to vote on amendments addressing two of this week's
main issues , centering on women and seniors:
* One proposed
amendment, co-sponsored by Sens. Barbara Mikulski (D-MD) and Olympia
Snowe (R-ME), would increase insurance benefits for women, mandating
that policies include an annual health screening. While the amendment
does not specifically lay out what preventive services will be covered,
the measure gives the Health and Human Services Secretary authority to
make these determinations. Debate on the amendment in part focused on
the controversial recommendations last month that women undergo fewer
mammograms and Pap smears to test for cervical cancer. The
Congressional Budget Office said the amendment would cost $940 million
over a decade. This amendment passed by a vote of 61-39. * Another
proposed amendment was filed by Sen. John McCain (R-AZ) and would
remove from the bill $400 million in Medicare cuts to home health
providers, hospitals and private providers of Medicare Advantage plans.
This motion failed by a vote of 58 to 42.
AARP Backs Medicare
Cuts: As Senate lawmakers prepare to vote on controversial Medicare
funding amendments to the reform legislation, AARP said in a letter on
Wednesday that the organization supports Medicare cuts.
Medical
Groups Oppose Senate Bill: A coalition of the American College of
Surgeons and 18 other medical societies representing surgeon
specialists indicated Wednesday that they could not support the
proposed Senate bill given that it inadequately addresses Medicare's
doctor payment system. In addition, the California Medical Association
joined a number of other state medical associations , including
Florida, Georgia and Texas, in opposition to the bill being discussed
in the Senate. The California Medical Association cites increases in
costs of services and restrictions in access to care for elderly and
low-income people as reason for the opposition.
CBO: Premiums
Could Rise for Individuals: According to a new analysis from the
Congressional Budget Office (CBO) released Monday, the Senate's health
care reform bill may increase premiums for individuals purchasing
insurance, unless they qualify for government subsidies. The report
also indicates that employees from large companies would see premiums
decrease, while those from small firms would see premiums remain
largely unchanged. On Tuesday, The Wall Street Journal editorial page
made the case that, according to the CBO, employer-sponsored insurance
costs would remain roughly in line with the status quo; a result
tantamount to failure, considering the overall cost-cutting goals of
reform.
Abortion Continues to Take Center Stage: Abortion-rights
groups held a lobby day on Wednesday as part of a national "week of
action" to fight language in the House health care bill, which would
impose greater restrictions on access to the controversial procedure.
The Senate's reform bill currently does not include the same level of
restrictions. However, the language from the House bill is expected to
come up during the debate.
Other Activities
Pfizer CEO
Backs Reform: Pfizer, Inc . CEO, Jeffery Kindler, said Tuesday that he
supports Congress' efforts to reform the health care system. However,
he is specifically opposed to anything that could lead to price
controls - such as giving the government the ability to directly
negotiate with drug makers for products under the Medicare Part D drug
benefit program. Mr. Kindler also stated that the $80 billion that the
pharmaceutical industry has agreed to contribute to help pay for the
health care system overhaul exceeds any benefit that the industry would
receive from additional patients due to extended coverage.
Public Opinion
Americans
Lean Against Health Care Reform: The latest USA Today/Gallup Poll
released Monday shows that Americans currently skew against passing
health care reform legislation. Forty-nine percent of Americans say
they would advise their member of Congress to vote against the bill,
while 44 percent say they would support it. A Robert Wood Johnson
Foundation poll conducted just before Thanksgiving indicates that most
Americans do not expect health care reform to affect their lives
directly. However, for those who do expect a change, a larger number
believe that there will be more negative affects than positive ones.
Interestingly, however, another poll released Monday by the Robert Wood
Johnson Foundation Center for Health Policy (UNM-RWJF Center), Latino
Decisions and impreMedia shows widespread consensus among the
Latino/Hispanic electorate about the importance of health care reform,
indicating significant support for expansion of coverage.
Americans
Support Malpractice Reform: An Associated Press poll released just
before Thanksgiving shows that 54 percent of Americans favor making it
harder to sue doctors and hospitals for medical errors, while 32
percent are opposed to the idea.
Looking Ahead
Negotiations
on proposed amendments to Sen. Reid's reform bill will continue in the
coming weeks. Sen. Reid hopes to have a health care reform bill passed
by Christmas but has warned Senators to plan on working weekends to get
this done.
Senate Former President Bill Clinton visited Senate Democrats on
Capitol Hill this week, urging them to quickly pass health care reform
by the end of the year. Senate Leadership continues to work pulling its
final merged bill together and Majority Leader Harry Reid (D-NV) says
that he will introduce the legislation on the Senate floor the week of
November 16th.
Under Senate rules, a 60-vote majority is
required to move the bill forward before official debate can begin. It
is likely that Democrats will receive the 60-votes needed to move the
bill to the Senate floor, but it remains to be seen whether Reid has
the full 60 votes to overcome a filibuster for bill’s official passage.
Reid is still aiming to pass the legislation by the Christmas holiday.
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House After
passing its health care reform legislation, the “Affordable Health Care
for America Act” (H.R. 3962), the House of Representatives was quiet
this week.
Overview: Medicare Payroll in Senate Health Care Reform Legislation
The
Senate’s health care reform legislation has still not yet been
unveiled, but there are reports that an analysis from the Congressional
Budget Office has found the bill to be more costly than expected, so
Senate Democrats are already considering new ways to pay for the bill.
One
of the options is an increase to the Medicare portion of the payroll
tax on individuals making $250,000 per year or more. Currently, workers
and employers each pay a 1.45 percent payroll tax for Medicare and the
new proposal would increase that to 2.5 percent payroll tax bracket for
those making $250,000 per year or more.
By including this new
approach, it would allow the Senate to either reduce or eliminate
altogether the controversial excise tax on “Cadillac” or high-cost
insurance plans, passed in the Senate Finance Committee’s bill last
month. Under legislation (S 1796) approved by the Senate Finance
Committee, individual insurance plans costing more than $8,000 and
family plans costing more than $21,000 would face a 40 percent excise
tax on any amount above that level.
Reid
Unveils Senate Bill: Senate Majority Leader Harry Reid unveiled his
version of health care reform legislation on Wednesday night after
receiving cost estimates from the Congressional Budget Office (CBO).
With a price tag of $849 billion over ten years, the bill will reduce
the deficit by $127 billion over a decade and cut Medicare spending by
$500 billion, while increasing taxes by $500 billion. In addition, the
bill will:
* Provide coverage for 31 million Americans who
currently lack health insurance - accounting for 94 percent of eligible
Americans * Offer a government-run option of which states can opt out * Expand Medicaid
* Require most Americans to carry health insurance, providing subsidies
for those who cannot afford it and imposing weak penalties for
violations * Bar insurance companies from denying coverage based on
pre-existing conditions or dropping coverage for those who become sick * Impose penalties on medium and large sized employers for not providing health insurance to employees * Increase the Medicare payroll tax on higher-income workers * Imposes fees totaling $101.9 billion on insurance companies, drug makers, and medical device manufacturers over ten years * Impose a tax on high-cost health insurance plans provided by employers to their employees.
While
Democrats remain committed to passing the legislation, it is not
certain that Reid has the 60 votes needed to bring the measure to the
floor for debate. Several moderate democrats, including Sens. Mary L.
Landrieu of Louisiana, Blanche Lincoln of Arkansas and Ben Nelson of
Nebraska have expressed concerns over the inclusion of a government-run
plan. Sen. Sherrod Brown (D-OH), however, expressed in a meeting Monday
night with Reid that liberal lawmakers had conceded enough ground on
the government-run plan and that he should push forward with the bill.
Members
of the Senate will convene on Saturday for a rare weekend session to
hold a procedural vote, deciding whether or not to bring the
legislation to the Senate floor for debate.
Immigration and
Abortion Remain Central to the Debate: Access to care for illegal
immigrants will continue to be contentious as lawmakers work to
reconcile the health care legislation passed by the House and pending
in the Senate. Under the bill approved by the House, illegal immigrants
would not be barred from using their own money in the newly-created
insurance exchanges. White House officials and members of the Senate
Finance Committee, however, pledged that undocumented workers be barred
not only from receiving subsidies but also from buying insurance
through federally sponsored exchanges - even with their own money.
As
Senate Majority Leader Harry Reid works to finalize the legislation, he
will also need to address the question of federal funding for
abortions, an issue that has proved starkly divisive. Because of
pressure from the Catholic Church and anti-abortion groups, the
House-approved bill restricts the use of taxpayer funds for abortions,
a decision that has sparked a heated debate among pro-choice and
pro-life advocacy organizations. In contrast, the Senate's proposed
bill would allow the use of federal funds for abortion in cases of rape
and incest, requiring insurers that cover elective abortions to
segregate money from Americans who get government subsidies.
Public Opinion
Polls
Continue to Show Deep Divisions: A new Washington Post-ABC News poll
shows that Americans are deeply divided over the current health care
proposals and that the majority believes costs will rise. Forty-eight
percent say they support the proposed changes to overhaul the health
care system, whereas 49 percent are opposed. In addition, 52 percent
say an altered system would probably make their own care more
expensive, and 56 percent see the overall cost of health care in the
country going up as a result of the reform.
Furthermore, a
recent Associated Press (AP) poll shows that Americans are split (43
percent opposed; 41 percent support) over the health care plans being
discussed in Congress. The AP poll also suggests that the public is
becoming more attuned to the details of the proposals, including the
cost implications and the public option. And, according to a Quinnipiac
University poll released Thursday, 53 percent of voters disapprove of
President Barack Obama's handling of health care reform.
However,
a new CBS News poll shows that only one in four Americans prefer to
have no health care legislation at all, while 51 percent support a bill
with a public option.
Other Activities
CMS Report
Indicates Costs Would Rise Under House Bill: According to a report
issued by Richard Foster, the chief actuary at the Centers for Medicare
and Medicaid (CMS), overall spending on health care would rise as a
result of the legislation approved by the House. Specifically, the
measure to reduce more than $500 billion from future Medicare spending
would sharply reduce benefits for some seniors and may jeopardize
access to care for millions of others.
Drug Makers Increase
Price, Anticipating Health Reform: The media has reported that the drug
industry has been raising prices at its fastest rate in years, in
anticipation of the costs associated with health care reform. These
costs include the $80 billion in fees over the next decade that the
industry agreed to in order to help pay for coverage of the
uninsured.On Wednesday, Democrats in Congress asked for two separate
investigations of drug industry pricing.
Economists Endorse
Health Care Reform Bill: Twenty-three high profile economists from
universities and think tanks sent a letter to President Obama on
Tuesday to support four important elements of health reform legislation
critical to its success: deficit neutrality, an excise tax on high-cost
insurance plans, an independent Medicare commission, and delivery
system reforms.
Looking Ahead
The Senate will convene on
Saturday for a procedural vote, deciding whether or not to bring the
legislation to the Senate floor for debate. Debate could continue
throughout the weekend.
The Business Roundtable released a
report late last week that found key components of existing health care
reform legislation could slow the growth of health care costs and offer
real savings for companies and their employees. The results were
immediately welcomed by the White House. Yet, the report goes on to
warn that certain provisions within the legislation could actually
accelerate costs. "The report also shows that reform done wrong won't
work and could make a bad situation much worse," said Antonio M. Perez,
Chair of Business Roundtable's Consumer Health and Retirement
Initiative. Aetna, a supporter of bipartisan health care reform, has
expressed similar concerns. Specifically, the report notes changes that
threaten to increase health care spending include failure to implement
a strong individual mandate, increases in the cost of health care to
individuals from changes to consumer spending accounts, and increased
cost shifting to the private sector from reduced reimbursements to
providers and the public plan option.
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The
Democratic leadership continues to play an "inch-by-inch" game on
health care reform. In the House, Speaker Pelosi is fully aware of the
fact that the very bill she managed through the House would very likely
not pass a second time because of the abortion issue. But she succeeded
in inching the bill forward, which was the plan all along. In the
Senate, Majority Leader Harry Reid continues weaving policy substance
with political reality in order to create a mosaic that can inch
forward to the next milestone, which is getting the 60 votes needed to
allow the Senate to proceed to debate. He has yet to release the final
"merged" bill; Senator Reid is going one-on-one with the Senate to sort
out the combination of provisions that will allow him to get past the
next hurdle. The abortion issue is the latest stumbling block, as at
least one Senator is saying "no" to proceeding without this very
provision. To jump start the process, Senator Reid is using the first
of myriad procedural tactics to get the bill to the Senate floor. But
if Republicans stand their ground, Senator Reid probably can't get to
that next step (the "motion to proceed") until Friday. That would leave
only enough time to make a few introductory speeches and go home for
Thanksgiving.
On Thursday, the House is expected to proceed to
debate and possibly pass a permanent "fix" to the perennial problem of
what to do about scheduled cuts to physician reimbursement in Medicare.
The House leadership wants to spend $210 billion (with no good funding
source) to eliminate the upcoming 21 percent cut in 2010, along with
all future cuts. The Speaker needs to make the gesture, given the AMA's
support for her health care reform bill. It is unclear whether this
measure will pass in the House; however, it is clear that such a
measure will have a more difficult time in the Senate. For one, the
Finance Committee reform bill already contains a one-year "fix" costing
$10.9 billion, which is the best Chairman Max Baucus thinks is
currently possible. The Senate already tried two weeks ago to pass a
permanent fix, and Senator Reid was soundly rebuffed in the effort.
States
ILLINOIS:
A leader in the Senate has prefiled a bill to amend Illinois' HIPAA law
with a proposal that group and individual health insurance carriers be
prohibited from imposing any pre-existing condition exclusions. Current
limitations imposed by state law would be deleted. While the issue is
being discussed on the federal level, this issue has had a lot of
traction with both House and Senate Insurance Committee members for the
past six months. As amended, the current proposal may not meet current
federal HIPAA requirements. The bill will not be considered until
January 2010.
MICHIGAN: The Office of Financial and Insurance
Regulation (OFIR) has scheduled a hearing on November 23 to review Blue
Care Network's proposal to buy Physicians Health Plan. In late
September, Blue Care Network, a Michigan nonprofit HMO, filed a
statement with OFIR regarding its intention to acquire control or merge
with Physicians Health Plan of Mid-Michigan-Family Care and PHPMM
Insurance Company. OFIR has 90 days to review the statement. Various
parties have requested that OFIR conduct public hearings before making
a decision on the sale, due to concerns raised regarding the size of
the Blue Cross Blue Shield of Michigan.
NEW JERSEY: The governor
has directed state departments and agencies to collectively cut $400
million from the state budget due to state revenue collection falling
well short of budget projections. Furthermore, the Governor requested
that the legislature not pass any spending bills during the upcoming
"lame duck" session. This nearly half-a-billion dollar shortfall,
coupled with a projected $8 billion budget deficit for next fiscal
year, puts the state in dire fiscal straits. With options limited for
making up the lost revenue, businesses operating in the state will be
closely monitoring this developing situation.
NEW YORK: The
legislature has passed a bill that prohibits all subrogation
(collateral source or third party) recoveries by an insurer for medical
expenses. The former collateral source rule eliminated the potential
windfall of double recoveries by plaintiffs who receive medical
benefits and win recoveries from defendant payments. The old rule of
law allowed insurance companies to offset potential premium increases
to consumers by authorizing them to recover medical costs from payments
made to an injured plaintiff from a jury award or settlement. With that
option no longer available, insurance premiums in New York will be
further stressed. In addition, Governor Paterson and the hospital
sector are proposing that the current Patient Services Assessment (PSA)
of 9.63 percent be increased by 0.25 percent to generate an additional
$54 million as part of the Governor's second Deficit Reduction plan
(DRP) for 2009. The hospitals are advocating for this insurance tax
increase to offset some of the governor’s proposed Medicaid cuts on
hospitals. The $800 in insurance taxes adopted this year already
includes an increase in the PSA, and the new proposal would make the
latest increase retroactive to November 1, clearly not included in
premium increases for 2010. The legislature is set to return to the
Capitol for two more special session days to address the DRP.
OKLAHOMA:
Two Republican State Senators are sounding the alarm bell regarding
both U.S. House and Senate versions of health care reform, charging
that either would devastate at least one new health care facility in
Oklahoma City and cost Oklahoma County and surrounding environs more
than 500 jobs. State Sen. Jim Reynolds and Sen. Harry Coates say both
bills would financially devastate many top-quality health care
facilities, including Oklahoma Heart Hospital’s $98 million South
Campus, which is set to open soon. The bills would financially
undermine the facility by denying the facility federal reimbursement
for services such as Medicare and Medicaid. A joint venture of Mercy
Hospital, Midwest City Regional and a group of local physicians, the
facility will serve much of southeast Oklahoma County along with
hundreds of active-duty military and veterans. Both Sen. Coates and
Sen. Reynolds say they will ask Gov. Brad Henry to intercede quickly to
remove the onerous provisions.
UTAH: The Department of Insurance
is circulating a draft bill to amend the state's uniform electronic
standards law to require insurers to provide coverage eligibility and
detailed coordination of benefits information to physicians. Aetna will
be submitting comments, including the fact that an insurer is not the
repository of each member's applicable insurance coverage information
and that a July 1, 2010, effective date does not allow sufficient time
for implementation.
This week's debate
focused on last Saturday's approval of health care reform legislation
by the House of Representatives. Some members of the media have raised
concerns over the costs associated with the Democrat version of health
care reform, highlighting the challenges Democrats might face
politically as health care reform legislation evolves in Congress.
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House
Passes Health Care Reform Legislation: Late last Saturday, the House
narrowly passed its health care reform package with a 220-215 vote,
which included opposition from 39 Democrats. One Republican, Rep.
Joseph Cao (R-LA), voted in favor of the bill. President Barack Obama
visited Capitol Hill on Saturday morning to encourage House Democrats
to pass the legislation.
The $1.1 trillion legislation passed by
the House would extend coverage to an estimated 36 million Americans,
vastly expand Medicaid, establish a government-run option, and create
individual and employer mandates. It would also bar insurers from
denying coverage based on pre-existing conditions or from dropping
coverage for those who become sick. To pay for the expansion, the House
passed measures including a $400 billion cut in Medicare spending over
the next 10 years and new taxes on the wealthy. While the Congressional
Budget Office (CBO) estimates that the bill will reduce the federal
deficit by about $104 billion over a decade, the bill's longer term
impact remains unclear, and some Democrats are still raising concerns
over its costs.
In order to secure enough votes for passage,
House Speaker Nancy Pelosi (D-CA) agreed to hold a vote on an amendment
that would specifically bar the public plan from covering abortion and
prohibit those who receive insurance subsidies from using the subsidy
to purchase private plan options that cover abortion. The amendment was
approved 240 to 194, with 64 Democrats in favor. Abortion rights
supporters, however, vowed to oppose the final legislation if it
remains in the amendment, highlighting the difficult road ahead.
AARP
and AMA Back House Bill: The House reform legislation received a boost
last Thursday, winning the support of two highly influential lobbies -
AARP and the American Medical Association (AMA). The announcements came
at a critical time as the House Speaker was working to shore up the
last votes needed to pass the reform legislation.
Small
Businesses Voice Concern: Groups and coalitions representing small
businesses showed their opposition to the health care reform late last
week, sending letters to lawmakers urging them to vote against the
House health care reform bill. In a statement Saturday, Susan Eckerly,
Senior Vice President of the National Federation of Independent
Business, said, "With unemployment at a 26-year high, the punitive
employer mandates and atrocious new taxes will force small business
owners to eliminate jobs and freeze expansion plans at a time when our
nation's economy needs small business to thrive."
Obstacles
Remain for Senate: While Senate Majority Leader Harry Reid (D-NV) waits
for the CBO to review the Senate's health care proposal, many hurdles
remain before securing the 60 votes needed for it to pass. These
obstacles include the incorporation of a public option, issues
associated with federal funding for abortion, and how to pay for the
health care overhaul. Recent reports indicate that Sen. Reid is
favoring an increase in payroll tax on the wealthy to help pay for
reform. In addition, U.S. drug makers, medical-device manufacturers and
insurers are gearing up for another opportunity to reduce proposed
industry fees in the Senate version of reform legislation.
With
continuing pressure from White House officials to pass health care
reform legislation by the end of the year, Sen. Reid has indicated that
he will bring the reform package to the Senate floor for debate as
early as Monday. However, Senators have indicated that, more
realistically, voting will take place before Christmas, with the final
passage in mid-January. In an effort to spur on Senate Democrats,
Former President Bill Clinton - whose health care reform efforts failed
15 years ago - told the senators over lunch last Tuesday that "passing
health care reform is not only a moral issue but also an economic
imperative."
Public Opinion
American Support Slips for
Passing a Health Care Reform Bill: A new Gallup Poll released last
Monday shows that Americans have moved in a more negative direction on
whether or not a new bill should be passed into law. Thirty-eight
percent of Americans now say they would advise their member of Congress
to vote against a new health care bill this year, while 29 percent
would advise their member to vote for it. In addition, 41 percent say a
new health care bill would make the U.S. health care system better in
the long run, while 40 percent say it would make things worse.
Other Activities
Republicans
Mobilize to Increase Opposition: In an effort to drum up opposition to
the Democratic health care reform bills, Senate Republican Conference
Chairman Lamar Alexander (R-TN) indicated that Republicans are
"quietly" planning approximately 50 in-person and telephone town hall
gatherings over the next three weeks.
Looking Ahead
CBO
estimates of the cost of the Senate health care reform package are
expected late this week or early next week, which will clear the way
for Senate Majority Leader Harry Reid to bring the legislation to the
Senate floor for debate as early as Monday.
Given that the Senate is expected to
require much more time than the House to vote on a health care bill
(see below), it is likely there is not enough legislative time left in
2009 to wrap up a bill for Christmas delivery to the White House.
Senate Majority Leader Harry Reid fueled concerns about the schedule
last week when he refused to commit publicly to passing an overhaul
bill this year. This makes a "conference" between the House and Senate
MORE likely in January 2010 THAN IN 2009, and that could require some
time since the current House and Senate versions are vastly different
on several key provisions. If the Conference pathway proves too
contentious, House Speaker Nancy Pelosi and Reid could play legislative
"ping-pong," whereby each Chamber makes a modest change and ships if
off to the other, back and forth, until they both approve the same
language.
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Late
Saturday night the House of Representatives approved its version of
health care reform by the slim margin of 220 to 215 (218 was the
minimum needed). The core of the approved House bill remained unchanged
from the version the Speaker introduced a few weeks ago and includes:
an employer mandate to provide and pay for coverage; a fairly strong
individual coverage requirement; a public plan option set up by
government that would pay "negotiated" rates to providers; and
insurance reforms, including guaranteed issue and modified community
rating. It does not include the "Cadillac" plan tax or the insurer tax
provisions currently in the Senate bill. The House bill would be paid
for in part with cuts to Medicare Advantage and a surcharge on the
"wealthy."
On the Senate side, Majority Leader Reid is waiting
for the revenue score from CBO on several different Senate Bill
scenarios, given that several Senators have publicly stated opposition
to going forward without a hard and fast number on both cost and impact
on bending the spending curve. He also needs this time to win over the
60 votes needed to even proceed with consideration of the bill, let
alone the 60 needed to cut off debate once the debate begins; he may
not have either right now. The earliest the Senate could start debate
would be the week of November 16, but a date in December seems more
likely. Approval of the House bill will surely put increased pressure
on the Senate to move forward but to do so cautiously, given the slim
voting margin in the House, as the issue moves closer to the finish
line.
Bills to extend and expand COBRA have been introduced in
both the House and Senate and could well be part of the final push on
health care reform. Both versions extend the Special COBRA subsidy
program from end of 2009 to June 30, 2010 and maintain the government's
65 percent subsidy. The Senate version increases this subsidy to 75
percent, and the House extends basic COBRA eligibility from 18 to 24
months. Given the unemployment numbers, it seems likely that, whether
as part of health reform or on its own, a COBRA extension (including
the subsidy) will be enacted in 2009.
States
ARIZONA:
Governor Jan Brewer and legislative leaders have reached a tentative
agreement to reconvene to address the projected 2010 budget shortfall,
which ballooned from $1 billion in early September to $2 billion by the
end of October. Although the governor favors a temporary tax increase
to boost revenue, she is unlikely to float that idea this time around
to help limit the length of the session. Governor Brewer is expected to
announce her candidacy for re-election. Although the former lieutenant
governor is now the incumbent and has never lost an election, she is
viewed as vulnerable by some Republicans because of budget concerns and
her continued focus on obtaining additional revenue through taxation.
CALIFORNIA:
California’s state budget deficit could reach $7 billion for the
current fiscal year in part because of recent court decisions blocking
state funding cuts. For example, a federal judge recently blocked the
state's plans to cut $80 million from its budget for In-Home Supportive
Services, and Insurance Commissioner Steve Poizner has filed a suit to
block the sale of part of the State Compensation Insurance Fund, which
was projected to generate $1 billion. Some analysts project that the
state’s budget deficit will range from $10 billion to $20 billion in
the upcoming fiscal year. In other developments, Lt. Governor John
Garamendi won a special election to fill the Congressional seat vacated
by U.S. Representative Ellen Tauscher (D). Garamendi was elected
lieutenant governor in 2006 after 16 years in the legislature and two
terms as insurance commissioner.
COLORADO: Senator Betty Boyd,
President Pro Tem and Chair of the Health and Human Services Committee,
met with insurer representatives to highlight the issues likely to get
attention in the upcoming session. A proposal to prohibit the use of
gender in rating individual policies has a high likelihood of passing,
she said. Senator Boyd also advised that efforts will be made to ensure
that the Cover Colorado program remains solvent, as it has potential to
be used as the state’s public plan option. Speculation has it that
Colorado could become one of the first states to act on federal health
care reform if it is enacted. Finally, she expressed a strong interest
in authorizing the DOI to establish standardized policy forms.
DELAWARE:
Department of Health and Social Services Secretary Rita M. Landgraf has
issued an update to existing statutes adding virtual colonoscopy as an
approved colorectal screening modality. Delaware law requires coverage
for colorectal screening modalities and empowers the Secretary to add
modalities as recommended by the Delaware Cancer Consortium.
Accordingly, all contracts for health insurance issued, delivered or
renewed after December 1, 2009 must include coverage for virtual
colonoscopy for colorectal cancer screening.
DISTRICT OF
COLUMBIA: Newly passed legislation requires individual and group health
plans to provide coverage for orally administered chemotherapy
medication in a manner no more restrictive than intravenously
administered treatment or injected cancer medications. In other
business, the Council of the District of Columbia confirmed Acting
Commissioner Gennet Purcell as Commissioner for the District of
Columbia Department of Insurance, Securities and Banking (DISB).
Commissioner Purcell, who served as DISB’s Deputy Commissioner since
2008, is an attorney and member of both the State of Maryland Bar and
the Commonwealth of Virginia Bar. As deputy, her primary
responsibilities included oversight of the agency’s core functional
areas, including the divisions of Insurance, Securities, Banking, Fraud
Enforcement and Investigation, and Risk Finance.
GEORGIA: A
meeting was held last week between health insurance representatives and
the Chairman of the Senate Insurance Committee to discuss legislation
for 2010 that would restrict rental networks. The Medical Association
of Georgia also was represented. Aetna has committed to work with all
interested parties on the legislation.
ILLINOIS: A fall veto
session concluded at the end of October, and three health insurance
bills of import passed both chambers. The first bill creates external
review requirements for all commercial insurance products, rather than
just HMOs, effective July 1, 2010. The bill also establishes committees
to create a uniform small-employer group health status questionnaire
and an individual health statement for use on January 1, 2011. The
legislation also requires insurers to semi-annually prepare and provide
the Department of Insurance a statement on aggregate administrative
expenses and other information. It is a good compromise versus what was
originally proposed. In addition, both chambers passed an orthotics and
prosthetics mandate on health carriers and HMOs for policies amended,
delivered, issued, or renewed six months after the effective date of
the amendatory act. The third bill changed the requirements to obtain a
producer license. The Illinois General Assembly is not expected to
reconvene until January 2010.
MISSOURI: The Secretary of the
State recently approved a ballot initiative proposal for the November
2010 ballot that would essentially eliminate network-based health care
delivery in Missouri. The move follows unsuccessful efforts to enact an
any-willing-provider bill in past legislative sessions.The petition
effort behind the ballot initiative appears to have been spearheaded by
a local surgical practice that has been excluded from the medical
staffs of local hospitals. Any willing provider is only one portion of
the proposal. It would apply to health carriers and health benefit
plans, including Medicare and Medicaid, and facilities. It would, for
example, prohibit carriers from: Imposing on a beneficiary any
co-payment, fee, or condition that is not equally imposed on all other
beneficiaries in the same benefit category, co-payment level, or class;
prohibiting or limiting a provider from the opportunity to participate
in the network if that provider is willing to accept the carrier’s
operating terms and conditions, fee schedule, covered expenses,
utilization and quality standards. The State Auditor is preparing an
assessment of the fiscal impact of the proposed measure as well as a
brief summary of the fiscal impact for the petition. Legal challenges
to the ballot initiative are permitted. A group of stakeholders,
including Aetna, are discussing strategy.
NEW JERSEY: Health
insurance issues were front and center in a bitter battle for the
governor's office, which ended last week when Republican candidate
Chris Christie defeated Democratic Governor Jon Corzine. The
governor-elect has publicly supported greater flexibility for carriers
to make health coverage more affordable via mandate-free plan designs
and interstate sales of health policies. The Democrats remain in firm
control of the legislature, which will make the governor-elect's agenda
an uphill battle. Also, the Department of Banking and Insurance (DOBI)
adopted a regulation standardizing the information and format on health
identification cards. Additionally, DOBI initiated a meeting with the
state's major health plans seeking guidance as to how the state might
proceed in limiting plans,’ and members,’ exposure to exorbitant
out-of-network provider charges. This is one in a series of meetings
aimed at developing consensus on an appropriate fee schedule or other
mechanism for non-par provider charges. Lastly, the NJ Department of
Health & Senior Services (DHSS) has launched a six-month Hospital
Newborn Pilot Program. Nine hospitals throughout the state are
participating in a pilot to ensure no newborn leaves the hospital
without health insurance. The participating hospitals are expected to
submit data to the DHSS.
NEW YORK: Governor David Paterson is
calling for a special session to address the current state budget
deficit. The Governor’s two-year, $5.2 billion Deficit Reduction
Package would have a current-year impact of $3.2 billion in 2009-10 and
a recurring impact of $2 billion in 2010-11. The components include
across-the-board spending reductions and a tax penalty forgiveness
program. The Governor indicated that his agenda will include a bill
that would completely prohibit all subrogation (collateral source)
recoveries on any insured or self-insured plans. The existing
collateral source rule eliminates the potential windfall of double
recoveries to plaintiffs who receive benefits and make recoveries from
both their insurance coverage and defendant payments, while still
ensuring that uncompensated losses are fully compensated. This
subrogation legislation passed the Senate earlier this year, but it has
not passed the Assembly. In other business, State Sen. Eric
Schneiderman, chairman of the Codes Committee, and Sen. Neil Breslin,
chairman of the Insurance Committee, introduced a bill known as "Ian's
Law," which is named after a patient with muscular dystrophy. The
proposed legislation would prohibit non-renewal of group policies and
would require heath plans to get state Department of Insurance approval
before discontinuing a class of insurance. The bill also would require
plans to continue covering a totally disabled policyholder for 18
months, even if the plan gets state permission to cancel an entire
class of policies.
As we near the end
of a busy week in Congress, WellPoint sent a letter to Congressional
Members highlighting the detrimental impact of current legislation on
our health care system. The letter focuses on the potential impact of
the Affordable Health Care for America Act (HR 3962) currently being
debated in the House of Representatives.
WellPoint also provided
Congress with a point-by-point response to the White House Blog's
criticism of its actuarial analyses released late last week.
And,
earlier this week, The Wall Street Journal published alead editorial
highly critical of House Speaker Nancy Pelosi (D-CA) and the House
bill. In addition, House Republicans proposed their own health care
reform legislation.
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On
Saturday, November 7, the House of Representatives is scheduled to vote
on health care reform legislation that would force individuals to
purchase coverage through the government health care exchange. Section
202(c) of HR 3962 prohibits individual coverage from being sold outside
of the government health care exchange.
Forcing individuals to
purchase coverage through the exchange reflects a sharp departure from
the current system, and we believe Americans should have the choice of
not buying coverage through the government exchange if they choose not
to do so.
We encourage you to take action and contact your Congressional Member today.
House and Senate Negotiations
House
Republicans Offer Health Care Reform Plan: On Tuesday, House Republican
Leader John Boehner (R-OH) described key aspects of the newly proposed
health care reform bill that focus more on controlling health care
costs than on expanding coverage. The proposed bill will:
* cap medical malpractice damages; * increase incentives for people to open health savings accounts; * allow insurance companies to sell insurance across state lines; * allow trade associations and guild members to band together to purchase group insurance , and * create state-based, high-risk insurance pools for individuals who have difficulty obtaining health care coverage.
The
bill does not bar insurance providers from denying coverage based on
pre-existing conditions, nor does it create individual or employer
mandates. It also does not raise taxes. The media suggest that
Republicans may galvanize around their newly introduced bill. However,
the media also speculate that the proposed legislation may make
Republicans more vulnerable to criticism. Late Wednesday, the
Congressional Budget Office (CBO) indicated that the bill would only
cover 3 million additional people at a cost of $60 billion through 2019.
Biofuel
Tax Credit Restrictions Added to House Health Care Reform Legislation:
A measure introduced by Rep. Chris Van Hollen (D-MD), a member of the
House Democrat leadership, would save the federal government $24
billion in biofuel tax credits over 10 years.
The measure would
restrict the paper industry from claiming tax incentives for use of a
fuel known as "black liquor." The tax credit savings could be used to
offset costs of the health care bill, Van Hollen said.
Abortion
and Immigration Issues May Imperil House Legislation: As House Speaker
Nancy Pelosi works to shore up 218 votes for the House health care
reform legislation introduced last week, two key contentious issues
remain at the center of debate - funding for abortions and coverage for
illegal immigrants . This week, anti-abortion Democrats circulated
legislation to strengthen prohibitions in the bill against federal
funding of abortion. It is also still up for debate as to whether or
not illegal immigrants would be allowed to shop for insurance within
the new exchange.
Senate Leader Signals Delay: Senate Majority
Leader Harry Reid (D-NV) signaled Tuesday that Congress may fail to
meet the end-of-year deadline for health care reform imposed by
President Barack Obama. Senators are currently waiting for CBO cost
estimates on their health care reform proposal, which may not come
until late next week. Given this timeline and the upcoming Thanksgiving
holiday, a bill may not reach the Senate floor until December.
Public Option Developments
CBO
Indicates House Bill Would Attract Less Healthy: According to the CBO,
the House health care reform legislation would attract less healthy
enrollees in its version of the public option and would subsequently
result in higher health care costs. In addition, the CBO predicted that
of the 30 million Americans likely to purchase insurance through the
insurance exchanges, one fifth would purchase insurance from the public
option.
Looking Ahead
President Obama indicated that he
will visit Capitol Hill late this week to address House Democrats and
encourage a final push towards health care reform legislation. While
House leaders plan to hold a rare Saturday vote on their proposed
measure, Senate leaders still await a CBO cost estimate.
