The Political Bridge

The AFL-CIO's Problems with the Senate Health Care Revision Bill: "Bailout of the Insurance Industry"

From Workday Minnesota

The federation is frustrated with the health care revision bill for several reasons:

• Gone are cost-control measures such as enactment of a “public option” to compete with private insurers and  letting people aged 55-64 buy in to Medicare.

• Provides a tax on everyone’s health insurance, above a floor of $8,500 for an individual and $23,000 for a family.  

 

Many (labor) leaders now view the developing Senate health bill as “a bailout of the insurance industry."

The Senate Kills Sanders' Single-Payer Amendment; The Obama Plan Moves Towards Passage

 The Sanders’ single-payer amendment died Wednesday night in the Senate. Senator Sanders of Vermont vowed it will return when the realization dawns that private insurance companies "are no longer needed."

The proposal's demise came as Senate Democratic leaders and the White House sought agreement with Sen. Ben Nelson, D-Neb., to become the 60th supporter of President Barack Obama's health care overhaul - the number needed to overcome a Republican filibuster.

Information from AP

AP Reports: Senate Democrats Have Tentatively Agreed to Drop the "Public-Option Plan"

WASHINGTON – After days of secret talks, Senate Democrats tentatively agreed Tuesday night to drop a full-blown government-run insurance option from sweeping health care legislation, several officials said, a concession to party moderates whose votes are critical to passage of President Barack Obama's top domestic priority.

In its place, officials said Democrats had tentatively settled on a private insurance arrangement to be supervised by the federal agency that oversees the system through which lawmakers purchase coverage, with the possibility of greater government involvement if needed to ensure consumers of sufficient choices in coverage..

New York Times: Liberal Senators Press for Expansion of Medicare

One of the changes being pushed by the liberals would lower the age of eligibility for Medicare to 55, from 65. Another would expand Medicaid to cover people with incomes up to 150 percent of the poverty level (up to $33,075 for a family of four).  

A third liberal proposal would require insurers to spend a specified share of premiums — about 90 percent — on clinical services and activities that improve the quality of care.  

Read More Click Liberal Senators

The Congressional Research Services' Summary of S.1796, The America's Healthy Future Act of 2009(The proposed Senate health care bill)

S.1796
Title: An original bill to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.
Sponsor: Sen Baucus, Max [MT] (introduced 10/19/2009)  Cosponsors (None)
Related Bills: H.R.3200
Latest Major Action: 10/19/2009 Placed on Senate Legislative Calendar under General Orders. Calendar No. 184.
Senate Reports: 111-89

---

SUMMARY AS OF:
10/19/2009--Introduced.

-America's Healthy Future Act of 2009  Amends the Social Security Act (SSA) to add a new title XXII (Health Insurance Coverage) to ensure that all Americans have access to affordable and essential health benefits coverage.

Requires all health benefits plans offered to individuals and employers in the individual and small group market to be qualified health benefits plans (QHBPs).

Prohibits QHBPs from excluding coverage for preexisting conditions, or otherwise limiting or conditioning coverage based on any health status-related factors.

Requires QHBPs to offer coverage in the individual and small group markets on a guaranteed issue and guaranteed renewal basis.

Requires states to: (1) establish rating areas; (2) adopt a specified risk adjustment model; and (3) establish transitional reinsurance programs for individual markets.

Requires QHBP offerors in the individual and small group markets to consider all enrollees in a plan to be members of a single risk pool.

Requires the Secretary of Health and Human Services (HHS) to establish: (1) risk corridors for certain plan years; (2) high risk pools for individuals with preexisting conditions; (3) a temporary reinsurance program for retirees covered by employer-based plans; and (4) a program under which a state establishes one or more QHBPs to provide at least an essential benefits package to eligible individuals in lieu of offering coverage through an exchange.

Entitles a qualified individual to the choice to enroll or not to enroll in a QHBP offered through an exchange covering the individual's state as well as QHBPs in the individual market. Requires such individuals to be U.S. citizens or lawful residents.

Requires each state to establish: (1) an exchange designed to facilitate enrollment in QHBPs in the individual market; and (2) a Small Business Health Options Program (SHOP) exchange designed to assist qualified small employers in facilitating the enrollment of their employees in QHBPs in either the individual or the small group market.

Directs the Secretary to: (1) establish a system allowing state residents to participate in state health subsidy programs; and (2) study methods exchange QHBPs can employ to encourage health care providers to make increased meaningful use of electronic health records.

Prescribes the contents of an essential benefits package, including little or no cost-sharing, no annual or lifetime limits on coverage, and preventive services.

Declares that nothing in this Act requires health care benefits plans to provide coverage for abortions. Requires the plan offeror to determine whether or not the plan provides coverage of abortion services for which federal funding: (1) is prohibited; or (2) is allowed. Requires the Secretary to assure that: (1) at least one QHBP covers abortion services for which federal funding is prohibited or allowed; and (2) at least one QHBP that does not cover abortion services for which federal funding is allowed. Prohibits the use of premium credits and cost-sharing subsidies for QHBPs covering abortion services for which federal funding is prohibited.

Prohibits QHBPs from discriminating against any individual health care provider or health care facility because of its willingness or unwillingness to provide, pay for, provide coverage of, or refer for abortions.

Continues application of state and federal laws regarding abortion.

Amends the Internal Revenue Code to: (1) allow tax credits related to the purchase of health insurance through the state exchanges; and (2) impose an excise tax on individuals without essential health benefits coverage and on employers who fail to meet health insurance coverage requirements with respect to their full-time employees.

Requires the President to: (1) certify annually in the President's Budget whether or not the provisions in this Act will increase the budget deficit in the coming fiscal year; and (2) instruct the HHS Secretary and the Secretary of the Treasury to make required reductions in exchange credits and subsidies.

Establishes a new mandatory eligibility category under SSA title XIX (Medicaid) for all non-elderly, nonpregnant individuals who are otherwise ineligible for Medicaid.

Revises Medicaid benefits.

Rescinds funds available in the Medicaid Improvement Fund for FY2014-2018.

Makes appropriations for Aging and Disability Resource Center initiatives.

Increases the federal medical assistance percentage (FMAP) for states to offer home and community-based services as a long-term care (LTC) alternative to nursing homes.

Creates a Community First Choice Option.

Adds a new optional categorically needy eligibility group to Medicaid for individuals: (1) with income that exceeds 133% of the poverty line; and (2) certain other individuals, but only for benefits limited to family planning services and supplies.

Directs the Secretary to establish a grants program to support school-based health centers.

Removes smoking cessation drugs, barbiturates, and benzodiazepines from Medicaid's excluded drug list.

Revises requirements for Medicaid disproportionate share hospital (DSH) payments.

Directs the Secretary to establish a Federal Coordinated Health Care Office within the Centers for Medicare & Medicaid Services (CMMS).

Directs the Secretary to establish a Medicaid Quality Measurement Program.

Revises requirements for the Medicaid and CHIP Payment and Access Commission (MACPAC). (CHIP refers to SSA title XXI [Children's Health Insurance Program].)

Sets forth special rules relating to American Indians and Alaska Indians.

Requires the Secretary to establish procedures for sharing data collected under a federal health care program on race, ethnicity, sex, primary language, type of disability, and related measures and data analyses.

Amends SSA title V with respect to the Maternal and Child Health (MCH) block grant program.

Provides funding for abstinence education.

Amends the Internal Revenue Code to codify and revise the Health Insurance Portability and Accountability Act of 1996 (HIPAA) wellness program regulations.

Elder Justice Act of 2009 - Amends SSA title XX (Block Grants to States for Social Services) with respect to elder abuse, neglect, and exploitation and their prevention.

Establishes within the Office of the Secretary an Elder Justice Coordinating Council.

Directs the Secretary to establish a hospital value-based purchasing program under Medicare.

Extends Physician Quality Reporting Initiative program (PQRI) incentive payments beyond 2010.

Modifies the Physician Feedback Program.

Requires the Secretary to develop a plan to implement a Medicare value-based purchasing program for home health agencies and skilled nursing facilities (SNFs).

Amends SSA title XVIII (Medicare) to direct the Secretary to establish a national strategy to improve the delivery of health care services, patient health outcomes, and population health.

Directs the President to convene an Interagency Working Group on Health Care Quality.

Amends SSA title XI (General Provisions) to provide for the establishment of a Center for Medicare and Medicaid Innovation within CMMS.

Amends SSA title XVIII to direct the Secretary to establish a shared savings program that promotes accountability for a patient population and coordinates items and services under Medicare parts A (Hospital Insurance) and B (Supplementary Medical Insurance).

Creates a Hospital Readmissions Reduction Program.

Directs the Secretary to establish a Community-Based Care Transitions Program

Revises requirements with respect to residents in teaching hospitals.

Increases the Medicare physician payment update.

Directs the Secretary to establish a Working Group on Access to Emergency Medical Care.

Extends the Medicare-Dependent Hospital Program.

Amends the Tax Relief and Health Care Act of 2006 with respect to the hospital wage index.

Establishes a Medicare prescription drug discount program for brand-name drugs for beneficiaries who enroll in Medicare part D (Voluntary Prescription Drug Benefit Program) and have drug spending that falls into the coverage gap.

Establishes an independent Medicare Commission to reduce the per capita rate of growth in Medicare spending.

Amends SSA title XI to add a new part D (Comparative Effectiveness Research) under which is established a Patient-Centered Outcomes Research Institute.

Establishes in the Treasury the Patient-Centered Outcomes Research Trust Fund.

Establishes a nationwide program for national and state background checks on direct patient access employees of LTC facilities and providers.

Directs the Secretary to establish new procedures for screening providers of medical or other items or services and suppliers under the Medicare, Medicaid, and CHIP programs.

Directs the Secretary to establish a self-referral disclosure protocol to enable health care service providers and suppliers to disclose violations.

Requires the Secretary to expand the number of areas included in Round Two of the durable medical equipment (DME) competitive bidding program.

Extends the period for collection of overpayments due to fraud.

Amends the Internal Revenue Code with respect to: (1) an excise tax on the excess benefit of high cost employer-sponsored health coverage; (2) distributions from health savings accounts for drugs and insulin that are prescribed drugs and insulin only; (3) a limitation on salary reduction contributions by employers to a health flexible spending arrangement; (4) expanded information reporting requirements; (5) additional qualifying requirements for charitable hospital organizations; and (6) a qualifying therapeutic discovery project tax credit.

Imposes annual fees on: (1) manufacturers and importers of branded prescription pharmaceuticals or of medical devices; and (2) health insurance providers.

Increases the threshold for the itemized income tax deduction for medical expenses.

Prescribes a special rule to limit excessive remuneration by certain health insurance providers.

Excludes from an individual's gross income the value of any qualified Indian health care benefit.

Prescribes treatment of small business employers maintaining a simple cafeteria plan.

Reuters News Service: The Proposed Senate Plan for Financing Health Care Reform

…The House bill would impose a 5.4 percent surtax on individuals earning more than $500,000 a year and couples making more than $1 million. It also raises money by imposing a 2.5 percent excise tax on medical devices, by ending some tax breaks for multinational companies…and iincludes a 40% excise tax on high cost health insurance plans. Medicare payroll taxes would go up from 1.45 to 1.95 percent for individuals earning $200,000+ and for couples earning $250,000+.

Read More: Click Financing

Breaking News from the Washington Post: Senate Majority Leader Harry Reid to Unveil $849 Billion Compromise Health-Care Bill

Senate Majority Leader Harry Reid has assembled a compromise health package that would expand coverage to more than 31 million Americans at a cost of $849 billion over the next decade, a senior leadership aide said late Wednesday.

The cost of the package would be more than made up for by cuts in future Medicare spending and an array of new taxes, the aide said, reducing projected budget deficits by $127 billion no later than 2019...

To Read More:  Click Senate Health-Care Bill

Fact Checking H.R. 3962: The Amount of the Fine for People Who Don't Get Health Coverage

From FactCheck.org

Information for this comes from a letter written by Thomas Barthold (chief of staff of the House Joint Committee on Taxation) about enforcing the individual health insurance mandate of H.R. 3962, the House-passed bill.  Those who don’t get coverage will be subject to a tax of 2.5 percent of their adjusted income beyond that threshold, up to the cost of the average national premium.

To read this letter Download JCTletter110509

"The Affordable Health Care for America Act:” After the Tumult and Shouting Subside, Will the House Divide and Fall? By DrTed

When Speaker Pelosi announced passage of the Affordable Health Care for America Act (H.R. 3962), Democrats in the House of Representatives erupted in cheers and high fives.

 

Across the aisle, the Republicans watched glumly.

 

Afterwards, the Democratic and Republican House Leaders made predictable claims about H.R. 3962.

 

John Dingell (D- Michigan), the Act’s sponsor, trumpeted its passage by declaring that the “House Makes History on Health Reform:  For the first time in U.S. history, the House votes to provide quality, affordable health insurance for all Americans.”

 

John Boehner(R-Ohio), the House Minority Leader, warned that “Speaker Pelosi’s Government Takeover of Health Care Will “Dim the Light of Freedom.”

 

In all this tumult and shouting, little has been said about the impact of the proposed health care reforms upon the 50 states. This might be one of the most contentious and divisive issues in reforming America’s health care system.

 

Implementing any enacted health care reform (H.R. 3962, S. 1796 or a conciliatory measure) will be costly to the states. Nearly everybody agrees.

 

The Congressional Budget Office(CBO) has a $39 billion increase in state spending over the next ten years as a consequence of implementing H.R. 3692. This projection is based upon mandated changes in state laws governing Medicaid and Children’s Health Insurance Program (CHIP) enrollment requirements. An unforeseen  number of working poor might also be added to these rolls, because they will be unable to either purchase the required health insurance or pay the fine for not having insurance(Reuters). 

 

The Reuters’ analysis of H.R. 3692 indicates still further costs to the states. Several states anticipate allocating millions of dollars for the technology needed to administer the proposed health-care exchange system.

 

With Medicaid expenditures and state budgets currently headed toward a fiscal precipice ( Download 8001), what are the states to do about the forecasted H.R. 3962-related costs?

 

Raise taxes?  Not a good option for state officials who want to remain in office.

 

Cut core services?  Many states have already done that, and cutting more services would only compound their troubles.

 

Devising tougher Medicaid and CHIP eligibility requirements?  This, I believe, is not permissible under H.R. 3962, which prescribes a more standardized and less stringent eligibility requirements that the current Medicaid and CHIP regulations demand.   

 

Opting out of the federally mandated Medicaid and CHIP Programs? Going down this road could lead to a constitutional crisis on the question of states’ rights versus the federal government.

 

Several notable Republicans have talked about invoking state sovereignty (the Tenth Amendment  to the U.S. Constitution). Governor Tim Pawlenty (R-Minnesota), for instance, has suggested that Minnesota might cite this Amendment as a reason for not implementing portions of the (eventually) enacted federal health care program.

 

While Governor Pawlenty has been backtracking from this threat, there is a burgeoning state sovereignty (self-determination) movement in America. Nine states from conservative Georgia to liberal Washington have introduced bills or resolutions declaring self-determination under the Tenth Amendment.  A dozen (mostly red) states have been contemplating similar legislation.  

 

This recent self-determination movement has been most clearly manifested in health-related matters.  As of July, 2009, 17 (mostly blue) states have either enacted and or have been moving towards comprehensive health care reform. The medical use of marijuana has become legal in 13 states.

 

An enactment of H.R. 3692 of S.1796, or a compromise measure will then most likely give a huge boost to the state-sovereignty movement.  

 

I fear this development because Americans fought a bloody civil war to become the United States of America rather than these United States.

 

I believe that President Lincoln was right in waging that war—a house divided cannot stand.

Healthcare-NOW!'s View on The Passage of the Health Care for America Act

On Saturday, November 7, 2009, the House passed H.R. 3962, the Affordable Health Care for America Act, to much celebration by the Democratic party. Healthcare-NOW!'s view, however, is that the House bill is a gift to the insurance industry at the further expense of the people of this nation.

The bill's advocates claim it will cover an additional 36 million people, subsidize the cost of insurance for families up to 400% above the poverty level, increase Medicaid coverage to 150% above the poverty level, close the Medicare donut hole by 2019, place a surcharge on individuals making more than $500,000 and couples making more than $1,000,000, will end rescissions and pre-existing conditions.

What the Democrats fail to mention is the bill leaves millions of people uninsured, allows medical bankruptcies to persist, criminalizes and fines the uninsured, increases the number of underinsured, does nothing to contain the sky rocketing costs, blocks women from their reproductive rights, transfers massive public funds to private insurance companies strengthening their control over care, protects pharmaceutical companies' superprofits at patient expense, fails to reclaim the 31% of waste in our system, expands Medicaid without regard to the state budget crises, discriminates based on immigration status and age, and sets up several levels of care covering less for those without the ability to pay. Those who have coverage will increasingly find care unaffordable and will go without. The whole system will inevitably fail from being fiscally unsustainable.

To read more about HealthCare-NOW!'s efforts click Mobilize for Healthcare