The Political Bridge

Sweetners in the Senate's Health Care Vote

Information from the NY Times

A Few of the Giveaways for Votes:

· Increased Medicare payments to States with (at least) 50% frontier counties(less than 6 people per square mile)--presumably Montana, North Dakota, South Dakota, Utah, and Wyoming

· Additional Medicaid money for Nebraska

· $100 million to an unmanned “health care facility”

· “Doctor-owners can continue to refer Medicare patients to the hospital” in eastern Nebraska.

· Increased Medicare payments to certain “low-volume hospitals” treating limited numbers of Medicare patient

 .

An Analysis of Health Insurance Premiums under the U.S. Senate's Patient Protection and Affordable Care Act

 Information below has come for a Congressional Budget Office(CBO) and Joint Committee on Taxation Report, which has been released on November 30, 2009. To read the entire report Download 11-30-Premiums

 

 

The CBO’s and JCT’S Definitions of insurance groups:

Nongroup Policies: New policies purchased from insurers individually

Small Group Market: Employer-based policies for organizations/business with 50 or fewer workers.

Large Group Market: Employer-based policies for organizations/business with more than 50 workers.

 Nongroup Policies CBO and JCT estimate that the average premium per person covered (including dependents) for new nongroup (policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law. About half of those enrollees would receive government subsidies that would reduce their costs well below the premiums that would be charged for such policies under current law.

Small Group and Large Group Markets

The legislation would have much smaller effects on premiums for employment-based coverage, which would account for about five-sixths of the total health insurance market. In the small group market, the CBO and JCT estimate that the change in the average premium per person resulting from the legislation could range from an increase of 1 percent to a reduction of 2 percent in 2016 (relative to current law).6 In the large group market the legislation would yield an average premium per person that is zero to 3 percent lower in 2016.

 

Congressional Budget Office Estimate of Subsidies and Payments at Different Income Levels Under the Patient Protection and Affordable Care Act(The Senator Reid Bill)

 Download Reid_Subsidy_Examples_11-20 for the complete CBO analysis. 

 

The enclosed table focuses on enrollees who purchase a “reference” plan—the second lowest cost “silver” plan, as defined in the bill—because federal subsidies would be tied to the premium for it. Such a plan would have an actuarial value of 70 percent, which represents the average share of costs for covered benefits that would be paid by the plan. Although premiums under the bill would vary by geographic area to reflect differences in average spending for health care and would also vary by age, the table shows the approximate national average for that lower-cost reference plan: about $5,200 for single policies and about $14,100 for family policies in 2016. Enrollees could purchase a more expensive plan or more extensive coverage for an additional, unsubsidized premium—and CBO anticipates that many enrollees would do that, so the average premiums actually paid in the exchanges would be higher (although average cost-sharing amounts could be lower than those shown in the table). The figures are presented for 2016 in order to illustrate the likely situation after the proposed changes in insurance markets were fully implemented.  A downside of that approach is that the figures are harder to compare with those observed in 2009.

 

Under the bill, the maximum share of income that enrollees would have to pay for the reference plan would vary depending on their income relative to the federal poverty level (FPL). For enrollees with income between 133 percent and 300 percent of the FPL, that maximum share of income would vary linearly from about 4 percent of income to 9.8 percent of income in 2014. For enrollees with income between 300 percent and 400 percent of the FPL, that maximum share of income would equal 9.8 percent. After 2014, those income-based caps would all be indexed so that the share of the premiums that enrollees (in each income band) paid would be maintained over time. As a result, the income-based caps would gradually become higher over time; for example, they are estimated to range from about 2.1 percent to about 10.2 percent in 2016. Enrollees with income below 200 percent of the FPL would also be given cost-sharing subsidies to raise the actuarial value of their coverage to specified levels: 90 percent for those with income below 150 percent of the FPL and 80 percent for those with income between 150 percent and 200 percent of the FPL

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

AP: The House Health Care Plan is Dead on Arrival in the Senate

WASHINGTON – The glow from a health care triumph faded quickly for President Barack Obama on Sunday as Democrats realized the bill they fought so hard to pass in the House has nowhere to go in the Senate.

The government health insurance plan included in the House bill is unacceptable to a few Democratic moderates who hold the balance of power in the Senate.

Las Vegas Sun: Senate Leader Harry Reid is the New Hero to the Left for Including a Public Option in the Health Care Bill

Washington — In the 10 minutes it took for Senate Majority Leader Harry Reid to outline his proposal for including a public option in the health care bill, the Nevadan went from being the political left’s punching bag for failing to lead on perhaps the biggest issue of his career to its celebrated champion of health care reform.

The accolades rang all afternoon, and by Tuesday morning the Progressive Leadership Alliance of Nevada was collecting signatures in an online petition thanking Reid “for standing with all of us.”

 To read more of this interesting article click Senator Harry Reid