This Week in Health Insurance Reform EasyToInsureME.com

January 27, 2010

This Week in Health Reform--Federal Legislative Overview

House and Senate
Republican
Scott Brown’s victory over Massachusetts Attorney General Martha
Coakley (D) in the January 19 special election to fill the seat of the
late Senator Edward Kennedy (D) is proving to be a game-changer for the
health care reform debate. It is now unclear what Democrats can do to
pass President Obama’s most important legislative agenda item. Even
though the Democrats held a majority in the House and Senate this year,
they failed to coalesce around a strategy to pass this legislation.
Initially after Brown’s win, there were two options under discussion
for moving forward on the current legislation.

1. Have
   the House take up the Senate-passed bill and use the "reconciliation"
   bill process to "fix" several of the provisions the House finds
   unacceptable (e.g., the “Cadillac” tax, etc.). If the House
   passes the Senate bill, it will go directly to the President for his
   signature, with no further action needed in the Senate. A
   "reconciliation" bill, which would need only 51 votes in the Senate,
   could be passed either in tandem with the Senate bill or follow soon
   after.
   .
2. Scale back the health care reform bill. A
   scaled-back bill could include health insurance reforms, exchanges, as
   well as several other provisions and possibly could attract bipartisan
   support. While many Democrats are likely to view this approach as a
   major lost opportunity, leadership may determine this is the most
   viable approach.

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However,
Speaker of the House Nancy Pelosi (D-CA) publicly stated on January 21
that the House does not have the 218 votes needed to pass the Senate
version of the health care reform bill, which takes option number one
(above) off the table.

While numerous
private discussions are reportedly being held on the matter, at the
outset it seems that Democrats’ only option for keeping the current
legislation alive is to reach across the aisle to their Republican
counterparts, most notably, moderate Senator Olympia Snow (R-ME). That
would mean a more conservative bill, which could anger rank and file
Democrats who are supportive of the legislation.

Although
no plans have emerged for how to move forward, it now looks like
Democrats will have to modify their plans. On the night of Scott
Brown’s win in Massachusetts, Rep. Anthony Weiner (D-NY) – one of the
biggest proponents for a single-payer health care system – said: "The
only way to go forward is to take a step back. If there isn't any
recognition that we got the message and we are trying to recalibrate
and do things differently, we are not only going to risk looking
ignorant but arrogant. I don't think it would be the worst thing to
take a step back and say we are going to pivot to do a jobs thing," and
include elements of health care reform in it, he said.

Rep.
David Camp (R-MI), Ranking Member on the House Ways and Means
Committee, declared Democrats’ health care overhaul legislation “dead”
and said that instead of full-scale change Congress should take a
“first step toward comprehensive reform” of the nation’s health care
system.

Issue Overview: Nebraska Medicaid Deal
While
key elements of the health care reform legislation remain in flux, the
Congressional Budget Office (CBO) released its cost estimate of the
expansion of the State of Nebraska’s Medicaid Deal, negotiated by
Senator Ben Nelson (D-NE) who then voted for the Senate’s Patient
Protection and Affordable Care Act, HR 3590.

The
letter responds to a request from Rep. Paul Ryan (R-WI)), Ranking
Member, House Committee on the Budget, asking if the cost estimate of
the Senate health reform bill would change if all states received the
same level of federal assistance for Medicaid as Nebraska receives
under the bill.

The CBO stated on
January 21 that the net spending for the Senate legislation would
increase by $35 billion over ten years if all states received the same
level of assistance as Nebraska.

Under the Senate’s provisions,
non-elderly individuals with incomes below 133 percent of the federal
poverty level would be eligible for Medicaid beginning in 2014. The
federal government would pay the cost of covering newly eligible
enrollees through 2016; and federal spending would be about 90 percent
by 2019. The Senate legislation states that it would pay all Medicaid
expansion costs to Nebraska beginning in 2014.