White House Summit Produces More Political Theater Than Agreement
The Obama administration hosted its bipartisan health summit yesterday, with leading members of Congress in attendance. As expected, the summit yielded more political speeches than substantive policy discussions or negotiations. While there were some points of agreement, particularly on cost containment and some insurance market reforms and pooling coverage for individuals and small business, in general the summit publicly highlighted the philosophical differences between the two parties on the issues. The GOP continuously expressed their desire to start the process over and build a bipartisan bill from the ground up, while the Democrats repeatedly articulated their preference to work with the already-passed measures as a framework. President Obama concluded the day by giving the two sides four to six weeks to come to an agreement, and then strongly suggested that if they couldn’t do so, that the Democrats would go at it alone, allowing the November 2010 elections to determine what the voters think the best course for health care reform in this country should be.
If the president and his party do decide to tackle health reform alone, they face the same challenges that have plagued them for months—keeping their fractured caucus together and finding a procedurally acceptable way to pass a measure that appeals to enough members of Congress from both chambers. The Senate no longer has its 60-vote majority to pass any new legislation through conventional means, and the House Democrats do not have the votes to pass the Senate-passed legislation as it currently stands (they are short at least 20 votes). To move forward, they are demanding that the Senate pass a second health reform bill called a “sidecar” that fixes key concerns with the Senate bill first, using the budget reconciliation process. But as NAHU has previously reported in the Washington Update, there are many, many procedural and legal hurdles that would prevent the Senate from passing such a fix bill first under the budget reconciliation rules. Just this week, Senate Budget Committee Chairman Kent Conrad (D-ND), whose committee would oversee the reconciliation process if it was used in this manner, effectively ruled out this strategy. AsPoliticoreportedearlier this week:
"I don't know of any way where you can have a reconciliation bill pass before the bill that it is meant to reconcile passes," said Conrad, who would be a central figure on the Senate floor if Democrats embark on the complicated process. "I don't know how you would deal with the scoring. I don't know how I could look you in the eye and say this package reduces the deficit. It's kind of got the cart before the horse." When reminded that House Democrats don't want to do health care in that order, Conrad said bluntly: "Fine, then it's dead."
Obama Releases Health Care “Bill”
On Monday, prior to the summit, the Obama administration released the president’s version of a comprehensive health reform plan to the public. The measure combines provisions included in both the House and Senate-passed health care reform bills and makes some changes and additions. The White House estimates that the new plan would cost the federal government $950 billion over 10 years, but the Congressional Budget Office has not officially scored the proposal. Upon its release on Monday, CBO Director Doug Elmendorf released a statement on hisblog indicating that CBO had been given neither sufficient time nor details to create an accurate cost estimate for the proposal.
It’s important to note that while he refers to his plan as a bill or an act, the president did not actually release any bill language. Instead he released an 11-pagesummary of his legislation and awebsite broken down by sections. Some of the information on his plan’s provisions included on the website are not addressed in the summary, and vice versa, but, based on the information provided in both taken cumulatively, NAHU has updated ourside-by-side comparisonof the major reform plans offered by the Democrats to include the Obama administration’s plan. [return to top]
House Passes Legislation Eliminating Antitrust Exemption for Health Insurers
On Wednesday the House of Representatives voted 406-19 on H.R. 4642, a measure to eliminate the federal antitrust exemption provided by the McCarran-Ferguson Act. The legislation is a stripped-down version of what was initially proposed and only impacts the health insurance industry, not medical malpractice insurance or other property and casualty lines of coverage. A solution in search of a problem, the legislation strips the exemption of its ability to protect insurers against egregious violations of bid-rigging, price fixing and market allocation abuses, all of which are already illegal under federal law. It is NAHU’s view that the end result of this bill will be to merely make the cost of providing some consumer protections more expensive for health insurers. However, the bill now goes to the Senate, where it is unlikely to be acted upon. [return to top]
Reid Releases a New Jobs Bill—This Time with Health Provisions
Just hours after passing a limited jobs bill in the Senate that contained no health-related provisions, Majority Leader Harry Reid introduced another jobs-related measure that contains a number of health-related provisions likely of interest to NAHU members and their employer clients. This new bill is not the same as the bipartisan Baucus-Grassley jobs bill that was released earlier in the month and scuttled by Reid, but it does address a number of similar health-related issues and is expected to be taken up in the Senate in the near future.
The new bill extends eligibility for the federal COBRA subsidies to those laid off through December 31, 2010—a 10-month extension of the current deadline of February 28, 2010. Subsidies would last for up to 15 months (this was extended from nine months in the Department of Defense appropriations bill, P.L. 111-118, in December). The bill would potentially create a new class of eligible individuals for the subsidy as well, by clarifying that individuals whose hours were reduced prior to being laid off entirely would become eligible for COBRA subsidies upon loss of employment. It also includes new penalty language establishing the ability of individuals to bring civil action against health plan sponsors and health insurance issuers based on subsidy determinations, and a fine of up to $110 dollars a day for employers or health plan issuers that refuse to comply with federal determinations relative to the subsidy within 10 days of receiving such a determination.
The legislation extends federal unemployment payments and would give the states a six-month extension of their expanded federal Medicaid match payments that was provided as part of the American Recovery and Reinvestment Act of 2009. The bill specifies that these provisions, as well as the COBRA extension, are exempt from the Senate’s pay-go rules to offset new spending with budgetary cuts.
The other health-related provisions in the new Reid bill would be paid for by a draw-down of $8 billion from the Medicare Improvement Fund. These provisions include a seven-month fix to the Medicare Sustainable Growth Rate (SGR) problem by extending the current reimbursement rate fix for Medicare providers through September 30, 2010. However, the bill does not address the Medicare provider payment issue in the long term, meaning, absent further congressional action, Medicare payments to providers would have to be cut by at least 21% on October 1. Currently they are set to be cut on March 1, unless this legislation or something similar is signed into law. In addition, the bill contained a variety of other “Medicare extenders,” such as a full-year extension to the Medicare therapy caps exception process. House Democrats have already expressed disappointment with the bill. [return to top]
Policymakers Seek Information on Individual Market Premium Rates
The House Energy & Commerce Committee's Subcommittee on Oversight and Investigationsheld a hearingon Wednesday to question WellPoint about its recently announced 39% 2010 rate increase for individual health insurance consumers purchasing coverage through Blue Shield of California. While committee members decried the rate increases as unfair and cited internal documents to call them profit-motivated, WellPoint executives responded that their rates were filed with and approved by the state’s insurance commissioner in November 2009 and are actually a reflection of soaring medical care costs, the state’s COBRA conversion law and the adverse selection impacting California’s individual health insurance market, as scores of young, healthy individuals drop their coverage in this poor economy.
Also on Wednesday, Senate Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Chuck Grassley (R-IA)sent lettersto WellPoint, Aetna, Health Net, Blue Shield of California, Kaiser Permanente and UnitedHealth Group requesting information on their planned 2010 premium increases and asking them to detail why such increases may be necessary.
Continuing the theme, Health and Human Services SecretaryKathleen Sebelius invitedthe chiefs of WellPoint, UnitedHealth, Aetna, Health Care Service Corp. and CIGNA HealthCare to a March 3 meeting in Washington to discuss insurance premiums.
Policymakers have in recent weeks repeatedly cited these rate increases as a means of highlighting the need for health reform. While NAHU agrees that responsible reform is needed, the current rate increases in the individual market only foreshadow what will happen if national reforms are enacted that do not seriously attempt to bend the health care cost curve but instead simply limit what insurers can charge while at the same time failing to adequately incent all individuals to buy and maintain healthy coverage to ensure adequate risk-spreading. [return to top]
SENATE PANEL APPROVES FEDERAL HEALTH CARE MANDATE BAN
On a party-line vote, the Senate Health Policy Committee approved language that would constitutionally protect Michigan residents from a federal health care mandate.
The reported version ofSJR Kalso includes language fromSJR R, both giving Michigan residents the right to opt out of any mandated health care program developed by the federal government.
Sen. Bruce Patterson(R-Canton Twp.), sponsor of SJR R, said the provisions were not actually needed because the U.S. Constitution does not give the federal government any authority in the area of health care.
"They are an expression of distrust and disbelief that the Congress is willfully violating the Constitution they swore to uphold," Mr. Patterson said.
He said, in response to questions, that Medicaid and Social Security continue to exist only because they have not been challenged in court.
ButSen. Gilda Jacobs(D-Huntington Woods) questioned the wisdom of amending the state Constitution, particularly in reaction to policy that has not yet been adopted. "Sometimes we have a knee-jerk reaction to things that are going on," she said. "I don't want to tinker with our state's Constitution and then find there are unintended consequences down the road."
February 19, 2010
Getting Ready for the Bipartisan Health Summit
The health policy community in Washington, DC, is busy preparing for next Wednesday’s bipartisan health summit at the White House. The six-hour summit, to be moderated by President Obama, will be nationally televised on C-SPAN. According to news reports from yesterday, the Obama administration will release its own version of a comprehensive health reform bill to be discussed at the summit and post it online on Monday. It was previously reported that the congressional Democrats might arrive at the summit with a merged version of the House and Senate bills that they could agree on for passage, but it has become clear in recent days that no agreement between the two chambers has been reached. In addition, the Obama administration has let it be known that the bill they will be presenting has not been agreed to by either House or Senate leaders, but that they have instead independently picked what they considered to be the best provisions from each of the two bills currently on the table. It does not appear that the Obama bill will have been scored by the Congressional Budget Office. The Republican leadership has been asked to also present its own comprehensive alternative bill on the 25th, and also post it online by this coming Monday. It’s still unclear whether or not they will do so, as there are several different versions of GOP comprehensive health bills that have been proposed in the House and the Senate. These include the Empowering Patients First Act and the Patients' Choice Act, among others. Attendees at the summit will include the president and vice president, HHS Secretary Kathleen Sebelius, head of the White House office on Health Reform Nancy Anne DeParle, as well as representatives from the Congressional Budget Office, the Office of Management and Budget and the Joint Committee on Taxation. From Congress, the most senior House/Senate respective party leadership, as well as the chairmen and ranking members of the committees that oversee health insurance reform legislation in both chambers have been invited. In addition, each party’s congressional leadership will be allowed to ask four additional members of Congress to attend. Who these additional attendees will be is being kept very close to the vest by both parties, as a surprise element. From the GOP side, possibilities include: Senator Orrin Hatch (UT), who serves on both the HELP and Finance Committees; Senator Olympia Snowe (ME) of the Finance Committee; Senator Tom Coburn (OK), who serves on the HELP Committee and is an M.D.; Representative Tom Price (GA), who is an M.D, and, due to his role as chair of the GOP Study Committee, was the principal author of the GOP alternative health reform bill offered in the House; Representative Paul Ryan (WI) of the Ways & Means Committee; and Representative Michael Burgess (TX), who serves on Energy & Commerce and is also an M.D., among others. Democrats angling for an invitation include: Senators Jeff Bingaman (NM) of the HELP and Finance Committees; Kent Conrad (ND), who chairs the Budget Committee and serves on Finance; Jay Rockefeller (WV), who chairs the Finance subcommittee on Health; Barbara Mikulski (MD) of the HELP Committee; Chris Dodd (CT); and Charles Schumer (NY), who serves in both the Senate leadership and the Finance Committee, among others. On the House side, contenders for inclusion may be Representatives Pete Stark (CA), Rob Andrews and Frank Pallone, both of New Jersey, who serve as the ranking members of the various health subcommittees in the House, as well as former Energy & Commerce Chair John Dingell (MI), and Blue Dogs with a vested interest in health reform like Bart Stupak (MI) and Mike Ross (AR). As the summit date approaches, there has been much speculation as to who it will actually benefit, whether or not any bipartisan progress can be made, or if the whole event is simply a political stunt. NAHU has consistently called for a true bipartisan effort to pass substantive health reform, and as Congress and the Obama administration prepare for the summit, we continue to advance NAHU’s ideas for affordable, responsible health reform with lawmakers on both sides of the aisle. If you have any questions about our activities, please do not hesitate to contact any member of NAHU’s government relations staff.
HHS Secretary Kathleen Sebelius held a press conference yesterday regarding the department’s report criticizing recent individual market rate increases announced by WellPoint in California, Blue Cross Blue Shield of Michigan, Anthem Blue Cross and Blue Shield in Connecticut, various insurers in Rhode Island and Regence Blue Cross Blue Shield in Oregon. The Obama administration has used the rate increases, which were approved by each state’s insurance regulators, as examples of why national health reform is needed and have also used the rate increases as a means of criticizing the profit margins of our nation’s largest health insurance companies. However, the health insurance industry and others have fought back, explaining that the rate increases are actually a reflection of soaring medical care costs, adverse selection in the individual market risk pools in these states, and changes to state laws regulations. Instead of highlighting the need for health reform that includes guaranteed issue of individual coverage, it shows what will happen if national reforms that limit what insurers can charge, preclude health status rating and do not adequately incent all individuals to buy and maintain healthy coverage to ensure adequate risk-spreading, are enacted. In addition, insurers have used this incident as an opportunity to point out that, according to national Health Expenditure Accounts, health plan administrative costs have fallen over the past two years from 12.8% in 2006 to 12.5% in 2007 to 11.7% in 2008 (See Table 12) and that Fortune 500 puts the health plan industry profits at 2.2%, 35th on its list of profits by industry sector—well below other sectors of the health care industry. The California increase in particular is almost completely attributable to the state’s COBRA conversion laws, which prohibit individual insurers from dropping those whose federal COBRA eligibility has expired, does not allow these individuals entry in the state’s high-risk pool and caps the rates that can be charged for conversion policies. The recent economic downturn has led to an expansion of the conversion market, as well as many younger, healthier purchasers of individual coverage dropping their policies. The result was $58 million in losses for WellPoint during the past year on this block of business. That is why California Insurance Commissioner Steve Poizner approved the rate increase in November 2009, and why past president of the National Association of Insurance Commissioners (NAIC) and current chair of the NAIC’s Health Insurance and Managed Care Committee, Kansas Insurance Commissioner Sandy Praeger, said she agrees with others that Anthem Blue Cross is operating within the law. "I thought the explanation made perfect sense," says Praeger. "In this job climate, if people are young and healthy, they're just not going to buy insurance. And the people who do keep it are the ones who need it."
Senators Attempt to Revive Public Option
As Washington prepares for the upcoming health care summit on Thursday, a group of progressive senators have renewed their call for the inclusion of a government-run public plan option in health reform legislation. So far, 18 Senate Democrats have signed onto a letter to Senate Majority Leader Harry Reid (D-NV), calling on him to use the budget reconciliation process to pass a comprehensive health reform bill that includes a government-run public plan. The letter was initially authored by Senators Michael Bennet (D-CO), Kirsten Gillibrand (D-NY), Jeff Merkley (D-OR) and Sherrod Brown (D-OH). In addition, HHS Secretary Kathleen Sebelius, who earlier last year indicated that a public option was “not an essential” part of health reform, told MSNBC yesterday that if the Senate leadership included a government-run public plan option in a bill, the Obama administration would support it. While inclusion of a public option plan in a bill offered in the Senate still remains highly unlikely, as there have never been the votes to support a public-option’s passage in that chamber, all of the discussion and its timing is an interesting part of the current health policy debate. It reflects the continued disunity within the Senate Democratic caucus leading up to the summit, the strong desire of some to pursue a different course without compromise and attempt to use the budget reconciliation method to pass an extremely progressive version of health reform—a move that polls continue to show is opposed by the majority of Americans.
New Study Shows the Cadillac Plan Excise Tax Would Overwhelmingly Impact Non-Union Workers
Two health economists, Ken Jacobs and William Dow, from the University of California at Berkeley Labor Center released an interesting study this week on the impact of the excise tax on so-called “Cadillac” plans that is proposed as a primary financing mechanism of health reform in the Senate-passed comprehensive legislation. The study, which examines both the Senate-passed bill and the compromise deal struck by Senate leaders, the White House and key unions in January (but is not actually reflected in any current legislation), found that 80% of the individuals impacted by the tax by 2019 will be non-union employees and that number will rise to 83% by 2024. The study also finds that, by 2024, even with the proposed union carve-out, a quarter of Americans in employer-sponsored plans would be impacted by the 40% excise tax on their coverage. The study seems to confirm many of NAHU’s long-standing concerns with the proposed excise tax—that it is not just a union issue, that many plans that would be deemed “Cadillac” coverage do not actually contain excessive benefits but are simply the result of high medical care costs in an area and an older workforce, that the tax would not curb rising medical care costs, and that with each passing year more and more Americans in standard employer-provided plans will be impacted by the tax as it is not properly indexed for medical inflation. Also this week, the Employee Benefits Research Institute released a very good resource on current and future prospects of the employer system, Issue Brief No. 339: Employers, Workers and the Future of Employment-Based Health Benefits. This is a recap of a health care policy forum with finance, benefit, business and labor practitioners sponsored by EBRI on December 10, 2009. The forum took place as debate over health care reform legislation was occurring in Congress, including proposals to tax high-cost health plans.
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New Insurance and Financial Regulatory Reform Bill on Its Way
Senate Banking Chairman Chris Dodd (D-CT) said this week he hopes to unveil a revised insurance and financial regulatory overhaul plan next week as he moves toward a committee markup the week of March 1.
Three months after his sweeping initial proposal was widely criticized by Republicans, Dodd has been negotiating with committee Democrats and Tennessee Republican Bob Corker in an effort to craft a bipartisan deal that can win 60 votes on the Senate floor.
The details of Dodd’s plan remain unclear, including how he will structure an entity to police consumer financial transactions. The House of Representatives passed its version of financial regulatory reform (H.R. 4173) in December.
The Congressional Research Service has published this very good report on this pending legislation and issues in the 111th Congress.
2/9/10 MAHU is having an impact on the health care debate
Under the leadership of Mike Embry, MAHU legislation Chairman, the Michigan Association of Health Underwriters is making an impact on the course of debate in the Michigan Legislature.
Mike Embry testified in front of the Senate Health Policy Committee in support of a pair of resolutions that would allow the State of Michigan to opt out of any federal health care system. The measures are sponsored by Sen. Wayne Kuipers (R-Holland) and Sen. Bruce Patterson (R-Canton).
According to Mr. Embry, the health care bills in Washington fail to address the nation’s most basic health care issue.“The issue is the number of people in the system,” Embry said. “Many people choose not to purchase health insurance, particularly the young… the ’invincibles.’ The concept of insurance is to have a large pool of people to lower the cost of coverage. We don’t have that now.” “Unfortunately, the federal legislation that’s being debated today doesn’t create that situation.” Embry said. The position of MAHU is that it is in the best interest of Michigan citizens to have the right to opt out of a federal health care system.
The resolution promoted by Sen. Kuipers guarantees Michigan citizens the right to independent health care, and the right to make their own health care choices.
The Michigan legislature has been debating health care policy for most of the past year. MAHU has been a trusted and valuable resource to the Senate Health Policy Committee. MAHU members have been asked to testify before the committee as well as submit opinions on resolutions that have come before the committee.
Why We Need You in Washington, DC, This March
NAHU’s Capitol Conference is five weeks away and we need you there! The battle over health care reform is far from over; we will soon be seeing new efforts to pass incremental reforms, many of which would hurt our clients and our industry. Please watch this short legislative update from NAHU CEO Janet Trautwein. We hope to see you at Capitol Conference in March!
1/29/10 NAHU Health Reform: Dead or Alive? On a Back Burner or on Life Support?
While many in Washington, DC, and across the nation assumed that congressional Democrats and the Obama administration would have made a clear decision on the best way to advance health reform forward by now, they have instead been all over the map with no agreement on strategy.
During his State of the Union address on Wednesday, the president did call on Congress to not give up on health care reform and asked them to reconsider the two bills currently on the table. But he also asked for anyone, on a bipartisan basis, who could come up with a better plan to bring their ideas to him, and stated that his current top legislative priority is a jobs bill.
Over the course of the week, congressional leaders have made all kinds of conflicting statements about health reform, ranging from pursuing a quick resolution through the use of the budget reconciliation process in the Senate to focusing on jobs immediately and taking the rest of the year to address the issue. Perhaps a clearer indication of at least the president’s goals for moving forward will come next week when the administration is due to release its draft FY 2011 budget to Congress and public, as it will contain his health care spending blueprint for the upcoming year.
While their ultimate path remains unclear, if you listen closely to what the Democrats are saying, a few key themes are evident. First, it’s clear that they haven’t abandoned the idea of health reform entirely—it’s not dead, it just may take them a while. Second, their focus is going to be on health insurance market reforms and not cost containment, helping the uninsured or other delivery system improvements. In the Senate, Democratic aides are still investigating various procedural means of advancing H.R. 3590, including any way they could use the reconciliation process to pass fixes to the Senate bill with just a simple majority vote. But reconciliation is a complicated procedural maneuver and its use is not supported by several key Democratic senators. Also, because the rules governing its use limit it to matters with a direct federal budgetary impact, the process may not even be capable of satisfying the political problems many House members see with the Senate bill. Over the past few days, Senate leaders have indicated that it may take weeks or even months to decide what process will make the most sense for their chamber and that their current focus will be on jobs. Senator Reid even went so far as to say that the 111th Congress still has another year to act. The clearest anyone has been on how they plan to forge ahead so far is House Speaker Nancy Pelosi (D-CA). Yesterday, she indicated that the House would move a series of market reform-oriented bills aimed at addressing the issues House members feel are most important. At the top of her list was eliminating the federal antitrust exemption for health insurers (see more detailed story below), and she identified other market-reform possibilities including medical loss ratios, pre-existing condition clauses, rescission protections and rating reforms as potential future bill topics. Pelosi said she was not giving up on passing a comprehensive bill, but she made it very clear that there are serious differences between the House- and Senate-passed legislation that will have to be addressed first and that there is really only about 70% agreement between the two bills. With the focus now seemingly on insurance market reform, NAHU plans to be more vigilant than ever in advancing affordable, responsible reforms that will help contain costs and bring needed access to the private market. Many of the market-reform ideas promoted in both of the comprehensive measures, particularly in the House-passed bill, would be incredibly damaging to the private market, so we have our work cut out for us! As our press release following the State of the Union indicates, we have long advocated, and continue to advocate, members of Congress working together in a bipartisan fashion on sensible solutions that rein in health care costs, provide better access to care, improve quality, create better efficiency, and put our health care system on an affordable and sustainable path.
The halls of Congress are still shaking after Tuesday’s special election upset victory of Massachusetts Republican Scott Brown over Democrat Martha Coakley in the race to fill the late Senator Ted Kennedy’s seat. In addition to causing fear in vulnerable Democrats everywhere, the biggest impact the election has had is on the fate of the two comprehensive health reform bills passed by both the House and Senate late last year. With their super-majority in the Senate eliminated, congressional Democrats and the Obama administration have spent the week scrambling to figure out a way to move health reform forward. Initially there was talk about an attempt to rush an agreement through on a bill before Senator-elect Brown could be sworn in and seated in the Senate. However, that option has been effectively eliminated for a number of reasons: 1. The congressional Democrats are still far from coming to terms on the contentious parts of the two bills. 2. Even if an agreement were somehow quickly reached, the Congressional Budget Office (CBO) would still need a week to 10 days to determine the cost of the bill to the federal government, along with a 72 hours before a final vote. 3. Despite initial threats to delay certification of Senator-elect Brown until all absentee ballots from overseas were counted, which could take several weeks, the margin of victory was so large (more than five percent) and the public pressure has been so great, Massachusetts officials have agreed to process the certification quickly. 4. Bowing to pressure from both the public and several of his moderate colleagues, Senate Majority Leader Reid publicly promised earlier this week to delay any further action on health reform until Senator-elect Brown is seated. This leaves the Democrats with several different political options, all which have their problems. They include: Attempting to quickly pass the Senate-passed legislation through the House, thereby avoiding another Senate vote. While this was initially the option favored by congressional leadership and the Obama administration, it has become clear in the last few days that it isn’t a politically viable one. House Speaker Nancy Pelosi (D-CA) announced yesterday that she does not have the 218 votes to do this, due to the political concerns of many in her caucus. Getting the House to approve the Senate-passed bill, along with a separate pre-negotiated bill to “fix” all of the problems House members see in the current legislation. This idea is being touted by Families USA President Ron Pollack and others, but it could be very difficult to achieve. First of all, House and Senate Democrats would have to come to terms on the substantial differences between their two bills, which they have been unable to do thus far. Both bills would need to be scored, and then the “fix” bill would need to be virtually guaranteed to pass the Senate. That means Senate Majority Leader Reid would either need a 60th vote that he doesn’t have or the budget reconciliation process would have to be used to pass the “fix” bill, which is problematic for reasons described below. Attempting to pass legislation through the Senate using the budget reconciliation process, which would only require 51 votes. While lots of Democrats and pundits continue to throw around this option, it is one fraught with political perils. It would require that the bill go back to the Senate committees of jurisdiction to be reworked because only provisions directly related to the federal budget can be considered under these rules. This would effectively eliminate most of the insurance reforms, abortion language, language on undocumented immigrants and other key elements Democrats feel are essential for passage and it would limit the authorization of most provisions to just five years. Also, even though debate would be limited and just 51 votes would be needed for passage, any senator could challenge any provision at any time and send it to the parliamentarian for a ruling. Sixty votes are needed to override the ruling of the parliamentarian on any issue, which could lead to lengthy and embarrassing votes on the Senate floor that the Democrats could lose. Another obstacle is that a number of Democrats, including Senators Byrd, Baucus and Conrad, have been steadfastly and publicly opposed to the use of this option for months and Reid, who is the fight for his political life in 2010 at home in Nevada, publicly stated in December this option was off the table. For more detailed information on how the budget reconciliation rules work, check out this article by the Kaiser Health News. Trying to “pick-off” a Senate Republican to serve as the 60th vote. This would probably be an impossible task for the Democratic leadership at this point. Potential targets like Senators Olympia Snowe and Susan Collins of Maine have stated in recent days they will not go at it alone, and Senator Reid insulted Senator Snowe in December by publicly stating that past negotiations with her had been a waste of time. In addition, the Massachusetts election has strengthened the GOP's hold on its members and their resolve for true bipartisan negotiations. Negotiating a limited health insurance reform bill and/or pivoting to a jobs bill and trying to include some of the more popular health insurance reforms. This seems to be the option that many Democrats and the Obama administration are leaning toward at the moment. However, it does involve some admission of political defeat and loss of political capital. Plus, the Democratic leadership still will need to obtain 60 votes for Senate passage, as well as deal with the 2010 election and related concerns of politically vulnerable Democrats in both chambers. Also, there is some question as to whether or not members of the GOP would hand Obama and Democrats even a limited victory before the 2010 election. At least in the House, taking up several smaller “rifle shot” health care bills that break the package into smaller, easier-to-digest and easier-to-sell chunks, which may be pursued along partisan or bipartisan lines. Republicans would be wary of engaging in this process unless they have an iron-clad agreement in public with House leadership that it would be truly bipartisan and both sides would have policy input on what gets considered. Otherwise, they are likely to see this as a partisan exercise that does not take into consideration a holistic approach to the problems in the health care system. In addition, these bills would still need to achieve the 60 vote standard to win passage in the Senate. A final option would be scrapping the current bills and starting from scratch on health reform. In addition to the political blow to the administration, which has in recent days repeatedly reiterated that they don’t want to lose complete momentum on health reform and has been reluctant to move back to the political center in the past, this course of action would certainly damper core Democratic voter enthusiasm going into the 2010 election. If they really did go back to the drawing board and work openly with the GOP, the Democrats might win political points for bipartisanship. They also could turn more attention to jobs and the economy. But it would be unlikely that a new bill would be finished before the mid-term elections—neither side would want to give the other anything to tout—and bipartisan cooperation could certainly blow up, as it has many times in the past in Washington. As the course for health reform shakes out over the next few days, NAHU will continue to work with our allies in the agent and broker, carrier and business communities. Our staff and members also continue to meet with lawmakers and congressional staff on our key issues relative to the two bills that are still technically on the table. Our plan is to keep advancing NAHU’s American Solution policy agenda and the role and value of health insurance agents, brokers and consultants no matter what course of action Congress and the administration ultimately take on reform. NAHU has issued a press statement calling for bipartisan, responsible and affordable action on health reform that brings down the cost of medical care and makes needed improvements to our system. This week we are encouraging all of our members to call for responsible bipartisan reforms as well, by sending a message to their lawmakers through Operation Shout. Now is not the time to stop our grassroots activity—it’s the time to ramp it up!
Media reports and analyses are describing Scott Brown's upset win in the Massachusetts Senate race as a very serious blow to the President's healthcare reform agenda. The healthcare push, the AP (1/20, Alonso-Zaldivar) reports, is "not dead," but was sent "to the emergency room in fragile condition." While Democratic leaders are exploring avenues to push a bill through, media reports cast those efforts very much as an uphill battle. So much so that the New York Times (1/20, A13, Hulse) reports that "House Democrats appeared to rule out the idea of quickly approving a Senate-passed healthcare measure and sending it to President Obama." In fact, DCCC chairman Chris Van Hollen (D-MD) took a clear shot at the Senate measure last night, saying, "Healthcare was also part of the debate, and the people of Massachusetts were right to be upset about provisions in the Senate bill like the Nebraska purchase and other special deals." The Washington Post (1/20, Murray, Montgomery) likewise, reports that "the White House and Democratic leaders in Congress spent Tuesday searching for ways to keep their hard-fought healthcare overhaul alive," but "no workable Plan B emerged." The Democratic stance moving forward may have been affected by statements from a number of Democrats who are expressing misgivings about the options put forth so far. USA Today (1/20, Kiely, Fritze) notes that "Massachusetts Rep. Barney Frank (D), a strong supporter of the healthcare legislation, said Brown's victory means Congress will have to 'start over on healthcare.' He said he will vote against any bill rushed to the floor before Brown can be sworn in." Roll Call (1/20, Pierce, subscription required) reports that "many House Democrats dismissed the suggestion" of adopting the Senate bill "after a Caucus meeting Tuesday evening." Rep. Stephen Lynch (D-MA) told reporters, "If it comes down to that Senate bill or nothing, I think we're going to end up with nothing. I don't hear a lot support on our side for that bill." In another possible area of contention, were the House to vote on the Senate bill, the Washington Times (1/20, Haberkorn) reports that "Rep. Ahn 'Joseph' Cao of Louisiana, the only Republican to vote for the bill in November, won't support it again if the House's strict abortion restrictions are not preserved, his spokeswoman said Tuesday." Cao's "defection would...slice Democrats' vote margin even further. The health bill passed 220-215, just two more than the 218 required for passage." The Washington Post (1/20, Murray, Montgomery) quotes Sen. Russ Feingold (D-WI) after the election saying, "It's a serious problem, and it's probably back to the drawing board on healthcare, which is unfortunate, because everybody agrees we have to do something about healthcare." The Wall Street Journal (1/20, Adamy, Bendavid, subscription required) quotes GOP Sen. Susan Collins (R-ME), sometimes mentioned as a swing Republican vote, saying of the Senate bill, "People in my state, Massachusetts, and elsewhere were appalled at the process by which the bill was negotiated behind closed doors, it had special deals inserted to win votes and was rammed through the Senate with only limited debate. ... If this bill is pushed through despite the message sent from Massachusetts, I believe it will spur a tremendous backlash." Snowe called a possible 60th Senate health reform vote. CQ HealthBeat (1/20, Reichard, subscription required) reports on the possibility of Sen. Olympia Snowe (R-ME) voting for a final healthcare reform bill. Sen. Snowe "has worked long and hard on healthcare overhaul issues, and she cast a 'yes' vote on overhaul legislation in the Senate Finance Committee on grounds that the status quo is no longer tenable." On Tuesday, White House Press Secretary Robert Gibbs said "that President Obama is pursuing Snowe's vote to get the measure across the finish line. 'The president continues to work hard' toward that end, Gibbs said." According to CQ, Democrats "seem likely to keep pursuing Snowe, however futile the effort might be."
Media reports and analyses are casting today's Senate election in Massachusetts as a dire threat to President Obama's plans to overhaul the country's healthcare system. In preparation for the possibility of Republicans getting a 41st Senate vote, Democrats are said to be looking for a way to salvage their reform effort. Reports, however, downplay the likelihood that what is portrayed as the preferred Democratic back-up plan -- having the House vote on the Senate bill -- will succeed. The AP (1/18, Babington) described the White House and its "Democratic allies" as "panicky," as they "scrambled Sunday for a plan to salvage their hard-fought healthcare package in case a Republican wins Tuesday's Senate race." AFP (1/18) noted that "Obama advisor David Axelrod denies that there is any panic," and says that Obama campaigned for Coakley "because 'he was asked.'" The Washington Times (1/18, Dinan) noted that in his remarks, "Obama steered clear of healthcare -- the issue that Republicans say has fueled Mr. Brown's rise -- and instead reprised the anti-Wall Street, anti-Bush Administration language that carried him to victory in 2008." The Wall Street Journal (1/18, Hitt, subscription required) reported that also appearing at the rally, Sen. John Kerry said of the President's agenda, "A lot of these measures are going to rest on one vote in the United States Senate. ... So understand what's at stake here, Massachusetts. It's whether we're going forward or we're going backwards." The Hill (1/18, O'Brien, subscription required) reports that Obama similarly said, "On many of the major questions of our day, a lot of these measures are going to rest on one vote in the United States Senate." The Washington Post (1/19, Balz, Cillizza) reports that "some Democrats said Monday that the methods proposed for pushing through a health bill if they lost...in Massachusetts were unlikely to work, with House Speaker Nancy Pelosi's (D-CA) office signaling the House wouldn't adopt the version already passed in the Senate." Other "top Democratic aides on Monday" also "described" that plan "as an unlikely scenario." The Post adds, "Democratic officials, while publicly saying the bill remained on track, were facing the sobering reality that the effort, after seeming nearly assured of success just days ago, could collapse." On its front page, the New York Times (1/19, A1, Herszenhorn, Pear) describes "the White House and Democratic Congressional leaders" as "scrambling for a backup plan," and adds that "have begun laying the groundwork to ask House Democrats to approve the Senate version." But, "some lawmakers, aides, and lobbyists described numerous obstacles to House approval of the Senate-passed bill." For example, "in an interview on Monday, Representative Bart Stupak, Democrat of Michigan...said: 'House members will not vote for the Senate bill. There's no interest in that.'" Politico (1/19, O'Connor) also reports that "House Democrats privately worry that the rank-and-file would reject" the "doomsday strategy that requires them to approve the Senate healthcare bill," with one "aide" predicting, "Progressives and conservatives in the caucus won't go for it." The Wall Street Journal (1/19, Adamy, Bendavid, subscription required) runs a similar analysis under the headline "Massachusetts Race Now Key To Health Bill," and McClatchy (1/19, Lightman) reports that the election "could deal a fatal blow" to reform efforts. AFP (1/19, Smith), meanwhile, says that the election could "possibly" decide "the fate of...Obama's ambitious reform agenda." Democrats "are scared," and "racing to draw up contingency plans." The AP (1/19, Fouhy) reports that "Brown has thrown Democrats for a loop, riding a wave of voter anger with Obama's healthcare plan and what critics call big government spending." Meanwhile, The Hill (1/19, O'Brien, subscription required) reports, "Democrats are eyeing a parliamentary maneuver to sidestep the Senate's filibuster rules to pass healthcare if they lose their supermajority, one House lawmaker hinted Monday." Rep. Allyson Schwartz (D-PA), who heads "the New Democrat Coalition taskforce on healthcare, suggested that Senate Democrats may use budget reconciliation to pass a health bill."
Dear NAHU Members,
As all of you know, the very close Massachusetts Senate seat special election this coming Tuesday, Jan. 19, could determine the fate of the current health care reform bills that the Democratic Congress and Obama administration are stampeding to pass into law.
Republican state Senator Scott Brown's campaign has surged since the holidays and has unexpectedly turned the special election into a nail-biter against Democratic Attorney General Martha Coakley, pulling the race to an essential “toss up.”
Should Scott Brown prevail, it would reduce the Democrats’ Senate majority to 59, one less than the 60 votes necessary to pass controversial legislation in the Senate.
Many of you have expressed interest and supported NAHU’s involvement in this race through our political arm, HUPAC. You will be pleased to know that in the last few weeks HUPAC has maxed out our contribitions to Scott Brown’s campaign with $5,000 in financial support, the maximum amount allowable under election rules. In fact, the president of our Massachusetts AHU chapter presented the contribution to Mr. Brown personally!
Highlighting the sense that the political climate is shifting rapidly, the White House announced Friday that President Obama would travel to Massachusetts on Sunday to campaign for Ms. Coakley, hoping to generate Democratic enthusiasm in a contest that will hinge on turnout. The decision to put the president’s political prestige on the line after the White House initially said he would not make a trip is a gauge of how seriously the administration is taking this threat.
A victory by Scott Brown could cause the fragile Democratic coalition behind the health care legislation to unravel and put approval of the measure itself in jeopardy. Should he win and take his seat before final consideration of the health legislation, Democrats would be one vote short of the 60 needed to get the bill through the Senate!
With the stakes at an all-time high for the future of our industry, we want to take this opportunity to urge all of our members to become regular contributors to HUPAC. Our PAC is an important tactical asset in helping to elect candidates dedicated to ensuring that the health care industry – and private health insurance – continues to be a strong and affordable choice for all Americans.
For those of you who are already regular contributors, we thank you immensely, and ask that you consider increasing your yearly contributions.
If you have not previously contributed, it’s very quick and easy. Just go to the HUPAC home page and you will see a link for registering. Fill in the required information, and select the amount you would like to contribute. We offer several different levels of giving, sure to fit a variety of budgets: General Supporter ($10 per month); 365 Club ($30 per month); and our highest distinction of Capitol Club (at least $85 per month, or $1,000 per year). The maximum allowable contribution to HUPAC each year is $5,000 (our Triple Diamond Level).
Now, more than ever, we need your assistance to provide funds to support those elected officials who believe that agents and brokers are part of the solution in shaping the new health care agenda.
The outcome of the Massachusetts special Senate election is critical, and your contributions can make a difference. We need the support of committed members like yourself.
Thank you so much for your continued involvement and support for our industry. In politics, like most endeavors, there is strength in numbers. Please consider becoming a new contributor to HUPAC, or increasing your contributions. .
Sincerely,
1/15/10 NAHU NEWS
January 15, 2010
Closed-Door Sausage-Making Greases House-Senate Health Reform Negotiations
Hidden from C-SPAN cameras or any other kind of public scrutiny, Democratic congressional leaders and the Obama administration were hard at work this week seeking to reach a deal on the broad outlines of a final health care bill by Friday or Saturday, and President Obama is promising to sell it to the public. The President went to Capitol Hill late Thursday to reassure House Democrats who had assembled for their annual issues conference and to promise that once a bill is passed and signed into law, he will launch an all-out campaign to sell its provisions to the American people. Democratic leaders and Democratic committee chairmen held a marathon negotiation session Thursday at the White House on sticking points between the House and Senate bills (H.R. 3962, H.R. 3590). They hoped to build on a breakthrough reached earlier on financing of the huge package, so that the proposal can be sent to the Congressional Budget Office (CBO) for analysis of its costs and benefits. It will likely take CBO several days, possibly a week or longer, to produce a cost estimate necessary before a vote. Labor leaders who spent much of Wednesday at the White House battling to ease the burden of the Senate’s proposed excise tax on high cost employer-provided health insurance plans, announced a supposed deal that they discussed Thursday with House Democrats. The deal, however, appears unlikely to soothe the concerns of House opponents of the excise tax. Under the Senate-passed legislation, the 40% excise tax would be assessed on health plans that cost more than $8,500 for individuals or $23,000 for families. A higher limit of $9,850 for individuals and $26,000 for families would be allowed for retirees over 55 but not yet eligible for Medicare, and for workers in high-risk professions, such as law enforcement, firefighting, and construction. Union leaders and President Obama agreed on a plan that would bump up the threshold before the 40% tax is imposed to $24,000 for a family—a $1,000 increase from the Senate-passed bill (H.R. 3590)—while excluding vision and dental insurance from being counted toward the threshold beginning in 2015. Individuals would see their thresholds rise $400 (to $8,900) under the compromise. The threshold levels would also be adjusted to account for age, gender, and geographic areas to keep people in high-cost groups from being disproportionately impacted by the tax. Most controversially, the pact with labor unions would gradually phase in the excise tax for workers subject to collective bargaining agreements. The excise tax would be subject to a transition period for collectively bargained health care plans, as well as health care plans for all state and local government workers. While the excise tax would go into effect in 2013 for most plans, collectively bargained and state and local plans would not be taxed until 2018. These same plans would be allowed to enter into the proposed health care exchanges in 2017, AFL-CIO President Richard Trumka told reporters. White House aides and Trumka defended the phase-in period for workers under collective bargaining agreements, saying that transition periods are common in legislation and are already used throughout other parts of the health care reform bill. Trumka said the change is akin to the five-year transition period the insurance companies have to phase in all the costs. As the costs are being phased in, he said, the plans need a couple of years to be able to make the adjustments. The announced compromise would of course lower the revenues generated by the high-cost excise tax provision: the Senate bill would generate about $150 billion over 10 years and the compromise would reduce that figure to around $60 billion. Because of this, negotiators are looking for ways to fill the hole with further savings from various health care sectors. Industry lobbyists said pharmaceutical companies could be asked to contribute further savings between $10 billion and $20 billion over 10 years, in addition to the $80 billion they have already committed to providing. The Senate bill would index the threshold to the rate of growth using the consumer price index for all urban consumers plus one percentage point, but opponents have argued that the index would still result in a growing number of middle class households with health insurance that falls into the category of so-called “Cadillac” plans over the next decade. The White House did agree to allow the thresholds to be adjusted upward, however, if health care inflation is above the assumptions for inflation between 2010 and 2013. That change would keep more households from being affected by the excise tax immediately after the new provisions go into effect. White House aides speaking on condition of anonymity said President Obama made the deal because he strongly believes the excise tax is needed to help drive down long-term health care costs, but he does not want the legislation to be paid for “on the backs of the middle class.” This is despite the fact that President Obama during the 2008 campaign strongly opposed and attacked Sen. John McCain’s proposals to convert the employer tax exclusion and for the first time begin to tax health benefits. Meanwhile, five Democratic senators this week urged the Senate Majority Leader Harry Reid of Nevada to include a “fail-safe mechanism” in the final version of major health care legislation in order to guarantee the hundreds of billions of dollars in projected government savings that are intended to help pay for the bill. In a letter to Mr. Reid, the five senators urge that the legislation include some sort of fast-track and fail-safe mechanism that they said would give Congress “the tools to keep cost under control should the current savings estimates fail to materialize.” The letter was signed by Senators Evan Bayh (IN), Michael Bennet (CO), Kay Hagan (NC), Claire McCaskill (MO) and Mark Warner (VA).
Here is this weeks Washington Update. We expect much more behind closed door negotiations going on this week. Keep up the pressure on our legislators to open this up to the public! While it may seem that our calls and email fall on deaf ears, that is not the case. The legislators offices are requires to keep count of the emails and calls that come in on specific subjects.
I’ve also attached a couple of documents that will better explain the differences in the bills.
Thanks for your continuing interest and efforts!
Take care,
Mike
Michael A. Embry Sr., RHU
Comerica Insurance Services Phone: (313) 222-0221
Fax: (313) 222-3130
1/8/2010
January 8, 2010
Message from NAHU CEO Janet Trautwein
As Congress moves forward with the process of combining their respective health reform bills into one piece of final legislation, I know many of you are understandably very nervous about the future of our industry. There are many disturbing components to both the House and Senate-passed bills, and NAHU has come out in strong opposition to both measures. However, as your professional trade association, it is also our obligation to ensure that if legislation is passed our membership still has a role in the system, and that as much of the private market is preserved as possible. While we do not like much of what is contained in these bills, I can confidently say that they both would have been much worse without the active involvement of NAHU and our membership, and there are still opportunities to make improvements to a final measure, if one should pass. I encourage you to read today's update carefully and respond to our call to reach out to your lawmakers in support of the private market.
As this process moves forward, NAHU will continue to advocate tirelessly for agents, brokers and consultants, as well as for the private financing of health care. We are committed to ensuring that you have the the most up-to-date information about the legislation, which includes providing you with resources to help guide your clients as changes occur. Thank you for your continued support and I hope that you and your families are having a very happy and healthy new year!
December 30, 2009
Informal Health Reform Legislation Conference Discussions Begin
This week, some House and Senate health aides began informal discussions and negotiations to merge H.R. 3590, the health reform legislation passed by the U.S. Senate on December 24, with H.R. 3962, the comprehensive health measure passed by the House of Representatives in November. For NAHU’s side-by-side comparison of the two bills, click here.
It will take a substantial amount of negotiations to merge these two bills while maintaining a coalition of Democrats large enough for final passage. This week, many congressional staffers were out of the office or reviewing the thousands of pages of legislative language that comprise the two bills. While it is clear that some informal discussions among leading staff have already begun, every discussion so far has been behind the scenes. As for our elected officials, House and Senate members are not formally scheduled to return from their holiday recess until mid-January, but the health care discussions between key members are expected to get under way far in advance of that. Senate Finance Committee Chairman Max Baucus (D-MT) indicated last week that key senators may conduct limited discussions this week via telephone.
It remains unclear whether a formal conference committee, which is typically televised on C-SPAN, will be held to resolve those differences, or if the negotiations to resolve differences between the two bills will be conducted on an informal basis between congressional leaders. Democratic leaders will make the decision on the conference committee procedure in early January and make formal appointments to the committee at that time, if necessary.
The key differences that need to be resolved in conference include the potential creation of a government-run public plan or some variation, the provisions addressing the use of federal funds to cover abortion procedures, and the financing of the measure. The House bill pays for it primarily through an income tax surcharge on the wealthiest Americans, whereas the Senate imposes an excise tax on high-cost health plans, raises the Medicare payroll tax by 0.9% for higher-wage earners, and imposes new taxes on health insurers and other industries.
Another wrinkle is that both versions of the legislation use substantial cuts to Medicare to finance large portions of the bill. However, the Congressional Budget Office recently reported that this funding was also to be used to shore up the solvency of the Medicare trust fund, and cannot be spent twice.
In addition to the more high-profile issues, additional items that are of high priority to NAHU and need to be resolved are the role of the states in the exchange and health reform generally, the medical loss ratio requirements and the structure of the exchange and other health insurance market reforms—including the individual mandate and its potential enforcement. We are working, in conjunction with industry and coalition partners, on a conference committee strategy concerning these key issues and will continue to keep you informed of any breaking developments. If you have any questions, please feel free to contact a member of our Government Relations Department.
After weeks of debate, backroom meetings and deals cut in the wee hours of the mornings, the Senate has just concluded the vote on HR 3590 – The Patient Protection and Affordability Act has passed by a straight party line vote of 60 to 39.
While this is a disappointing move that many of us have opposed, it comes as no surprise as we have seen partisan politics replace the will of the majority of the American people. This 2800 page monstrosity that will increase the cost of healthcare and health insurance was destined to be jammed through in the early morning hours of Christmas Eve to further the agenda of the Democratic Party.
I would like to take this time to personally thank everyone for taking the time to read the updates that I’ve been sending and for taking the time to contact your Senators during this debate. It was only by the power of the people that some of the most egregious parts of this bill were struck such as the public option.
The work will begin again in earnest in January after the House and the Senate reconvene. The next step will be to attempt to combine the House and Senate versions of the bill during conference committee. We have an excellent opportunity to reach out to our Representatives and Senators during the Holiday break to let them know how disgusted we are with the legislation that was passed by both the House and Senate.
Much can be accomplished during this time. Please continue to let your voice be heard!
I wish everyone a Very Merry Christmas and a Happy New Year.
Sincerely,
Mike
12/23/09
Health Reform Legislation Will Advance through the Senate at Approximately 7:00 A.M. Christmas Eve
The Senate leaders of both parties, Harry Reid (D-NV) and Mitch McConnell (R-KY), reached an agreement yesterday on a schedule for the next two days that will enable the Senate to vote on the Patient Protection and Affordable Care Act of 2009, H.R. 3590, as well as on the debt limit by early morning on Christmas Eve.
Over the course of the weekend, through a series of deals with various senators, the Democratic leadership secured the 60 votes they needed to move forward with health reform legislation on the Senate floor this week. Originally, while acknowledging that they could not stop the Senate Democrats from acting this week on the health care reform bill, Senate GOP members planned to use the maximum time allowed to debate the legislation. This would have forced a vote late at night on Christmas Eve. However, after a caucus meeting yesterday, the Republicans agreed to use their leverage relative to delaying the vote to help with political issues when they return in January. As part of the deal, the GOP will be able to offer a series of amendments to the debt limit legislation in January.
Under the new schedule, a cloture vote to move forward on H.R. 3590 will occur today around 2:15 pm. The vote may be delayed slightly by a constitutional point of order raised yesterday by Senators John Ensign (R-NV) and Jim DeMint (R-SC) (see section below). Then, once that vote occurs, all post-cloture time will be deemed to have expired at 7:00 a.m. tomorrow, rather than requiring the maximum 30 hours of time to expire. At 7:00 a.m. on Christmas Eve, the Senate will proceed to a vote on passage of H.R. 3590, then immediately proceed to a vote on passage of H.R. 4314, the House-passed $290 billion increase in the debt limit. Per the agreement, 60 votes will be required for passage of that measure.
NAHU has a number of concerns about the health reform legislation the Senate is poised to pass, and has articulated them to the Senate leadership in a formal letter of opposition. In it we detail our specific concerns with H.R. 3590 as currently structured and encourage senators to instead work together on a bipartisan basis to develop an affordable and responsible means of achieving the needed reforms to our nation’s health care delivery system. Even though the Senate vote is a foregone conclusion, we encourage you to contact your senators today and urge the same things. It’s important for our elected officials to understand that many Americans have serious concerns about specific provisions in this bill, and it will be helpful to have those objections on record as the Senate and House move toward a conference committee.
To help you learn more about the Senate bill, NAHU’s strategy moving forward and what you can do to help, NAHU CEO Janet Trautwein has prepared this video message. In addition, NAHU’s analysis of the major provisions contained in Senator Reid’s manager’s amendment to H.R. 3590, which he released on December 19 and was approved by the Senate this week, can be found here. We have also updated our side-by-side analysis comparing the House-passed legislation with H.R. 3590 as amended, both by the Reid amendment and by the other amendments passed over the course of the Senate’s three-week floor debate.
Even though NAHU opposes the overall legislation, it is important to note that the bill does contain a number of improvements over the original draft. Some positive changes we were able to secure in the manager’s amendment include:
• The elimination of the provision that would have required the secretary of Health and Human Services to set agent/broker commissions in the exchange.
• The addition of the provisions that gives the National Association of Insurance Commissioners some control over the establishment of minimum loss ratio requirements.
• The indexing of the $2,500 FSA contribution cap for inflation.
• The elimination of the government-run public plan option and the elimination of an expansion of the federal Medicare program to early retirees.
In addition, NAHU is working, in conjunction with industry and coalition partners on a conference committee strategy. House and Senate leaders will begin to meet informally about resolving differences between their two bills, and we are hopeful that we will be able to secure some additional changes to the legislation. Some of the key issues to be resolved during the conference discussions include the role of the states in the exchange and health reform generally, the structure of the exchange, and the financing of the measure, in addition to the more high-profile issues of a government-run public plan and federal funding of abortion services. NAHU will continue to keep you informed of any breaking developments as they occur. If you have any questions, please feel free to contact our Government Relations Department staff.
12/22/09
As the Senate moves forward with health reform legislation, there are still many things NAHU members can do to help the process along. In the video below, Janet Trautwein addresses members about areas of concern, how the legislation still explicitly preserves the role of health insurance agents and brokers, and some specific actions to take to ensure Congress gets health care right.
Very late Sunday night, just prior to the cloture vote that occurred early this morning, NAHU sent a formal letter expressing our opposition to H.R. 3590 to the Senate leadership. In it we detail our specific concerns with H.R. 3590 as currently structured and encourage senators to instead work together on a bipartisan basis to develop an affordable and responsible means of achieving the needed reforms to our nation’s health care delivery system. We encourage you to contact your senators today and urge the same things.
Click below to play this video message and find out what you can do to help. If the video below does not work, please click here to see the message in a new window.
Media reports are portraying the Senate's 60-40 cloture vote on the healthcare bill as a critical victory en route to a planned final vote on Christmas Eve. USA Today (12/21, Fritze) reports that despite "fierce Republican opposition and the lingering effects of a major Northeast snowstorm, Senate Democrats cleared a critical vote on a 10-year, $871 billion healthcare bill early this morning, steering the proposal toward approval on Christmas Eve." On a "party-line vote, the Senate agreed 60-40 to close debate and advance a retooled version of the healthcare legislation unveiled over the weekend by Senate Majority Leader Harry Reid (D-NV)." The New York Times (12/21, Herszenhorn, Pear) reports that the 60 to 40 tally "is expected to be repeated four times as further procedural hurdles are cleared in the days ahead, and then once more in a dramatic, if predictable, finale tentatively scheduled for 7 p.m. on Christmas Eve." The Los Angeles Times (12/21, Hook, Levey) reports that with "final Senate approval of the bill expected this week, Democrats and the White House were moving to shift the focus from their dozens of concessions -- such as jettisoning a government alternative to private health insurance -- toward the momentous changes they said it would bring: providing insurance access to 31 million more Americans, cracking down on insurance practices, and beginning to curb healthcare cost inflation." Opinion polls "indicate that the public's support for the healthcare overhaul is waning. Hoping to reverse that slide, Democrats and the White House are intensifying efforts to reshape public perception of the bill as a glass half full, not half empty." The Washington Times (12/21, Haberkorn) reports while Senate Democrats "spent much of December leaving the most contentious pieces of their historic healthcare reform bill on the cutting-room floor, both they and President Obama argue that what remains will still transform a broken healthcare system and improve the lives of every American." Notably, however, in the "search for compromise to reach 60 votes, the bill doesn't have the public insurance plan or the Medicare expansion for which some Democrats had been hoping." The Washington Post (12/21, Murray, Montgomery) reports that although "admittedly outflanked, Republicans declined to relent. In the hours before the cloture vote, GOP lawmakers took turns condemning the bill in impassioned speeches on the Senate floor. Sen. Lamar Alexander (R-TN) called it a 'historic mistake.' Senate Minority Leader Mitch McConnell (R-KY) accused Democrats of producing 'a mess' that represented 'a blind call to make history.'" The AP (12/21, Espo) reports the "atmosphere was intensely partisan, but the outcome preordained as senators cast their votes from their desks, a practice reserved for issues of particular importance." Sen. Ben Nelson's (D-NE) "announcement Saturday that he had decided to support the bill -- in exchange for a variety of concessions -- cemented the Democrats' 60-vote majority behind a bill assembled at the direction of" Majority Leader Reid. Nelson "came in for strong criticism from Republicans in Washington, who complained that he had won favorable treatment for his home state's Medicaid program." Politico (12/21, Brown, Shiner) reports that until Reid "secured Sen. Ben Nelson's support late Friday night, the bill was in doubt. But after nearly a year of discussion and debate on President Barack Obama's top legislative priority, there was little suspense about the final outcome of the early-morning vote. One by one, wavering Democrats announced their intentions to vote yes -- just as every single Republican announced plans to vote no."
The Congressional Budget Office and Joint Committee of Taxation also released their revised cost estimate for the legislation, stating that the cost to the federal government over the next 10 years would be $871 billion.
NAHU’s analysis of the major provisions contained in the manager’s amendment can be found here.
Over the course of the weekend, through a series of deals with various senators, the Democratic leadership secured the 60 votes they needed to move forward with the legislation on the Senate floor. At about 1:15 a.m. this morning, the Senate voted 60-40 on a cloture vote on the manager’s amendment to H.R. 3590. This vote sets the Senate procedural clock hurling toward an eventual vote on the entire reform bill later this week. Unless a Democratic senator agrees to switch his or her vote and oppose the overall bill, H.R. 3590 will pass this week and a conference committee with the House will begin in the New Year.
Very late yesterday night, just prior to the cloture vote that occurred early this morning, NAHU sent a formal letter expressing our opposition to H.R. 3590 to the Senate leadership. In it we detail our specific concerns with H.R. 3590 as currently structured and encouraged senators to instead work together on a bipartisan basis to develop an affordable and responsible means of achieving the needed reforms to our nation’s health care delivery system. We encourage you to contact your senators today and urge the same things.
Some positive changes in the manager’s amendment include: • The elimination of the provision that would have required the secretary of Health and Human Services to set agent/broker commissions in the exchange.
• The indexing of the $2,500 FSA contribution cap for inflation.
• The elimination of the government-run public plan option.
Some of our most serious concerns with H.R. 3590, as amended, include: • A minimum loss ratio requirement that applies to all fully insured plans, including grandfathered plans, as of January 1, 2011. This will negatively impact coverage choice and affordability, especially during the transition time prior to 2014 when insurers will have all of the same expenses they have today plus transition expenses. The MLR in this bill is now set 85% for large group plans and 80% for individual and small-group plans (100 and below). This rate must be lowered to 75% at least in the individual market to allow an adequate transition period.
• A completely ineffective individual mandate requirement that will make it more financially advantageous for many healthy Americans to forgo coverage until they are sick and then utilize the guaranteed-issue protections to temporarily obtain coverage and then drop it again.
• Strict modified community premium rating requirements (including age bands of 3:1) that now apply to all fully insured plans. This means all fully insured groups are required to abide by the modified community rating provisions, regardless of their size.
• State-based exchanges that create costly and confusing layers of dual regulation. The exchange structure proposed in the bill gives too much authority to the secretary of Health and Human Services, and makes the exchanges unnecessarily complex for consumers and costly to for states administer.
• New employee voucher provisions to allow choice between employer coverage and the exchange, which could actually hurt participation in employer-based health insurance plans. These provisions will require employers to give a vouchers to use in the individual market or exchange to certain lower-income employees who would normally be ineligible to purchase subsidized coverage through the exchange instead of participating in the employer-provided plan.
• An expansion of the federal Medicaid program to individuals up to 133% of the Federal Poverty Level (FPL). This will be financially crippling in the long run to our already struggling state governments, displacing millions of Americans from private coverage and further exacerbating the public program cost-shift to privately insured Americans.
• The creation of a huge new federal long-term care program that threatens the private long-term care insurance market and is inadequately financed. There is widespread and bipartisan agreement that the CLASS Act will be a financial albatross for our nation once it is fully implemented.
• Financing mechanisms that would significantly, and negatively, impact the health care industry, consumers, employers and our overall economy.
• New annual health insurance premium taxes of over $6 billion per year to be enforced on 2010 contracts that have already been priced and sold prior to the enactment of the bill and taxes. This means that the taxes were not included when pricing plans. In 2011, there will be a new tax liability. So when pricing health insurance for 2011, consumers will be hit with taxes for two years at one time.
• The 40% federal excise tax on high-cost health plans ($8,500 for individuals and $23,000 for families) is not properly indexed for inflation, and this bill does so little to control the medical care costs that are the true drivers of health insurance premiums, eventually all plans may fall under this excise tax umbrella.
• Massive proposed cuts in funding to Medicare, particularly the Medicare Advantage program. The Process Moving Forward The Senate recessed early this morning and will reconvene at noon today to continue discussing H.R. 3590. Since the Democratic leadership has filled the “amendment tree,” no substantive changes to the bill are likely to be considered. That means the bill as it stands with the manager’s amendment changes is what the Senate is likely to pass as a final bill. There will be a series of procedural votes this week before a scheduled vote on final passage, which will in all likelihood occur on Thursday, December 24. Before leaving for Christmas, in addition to the health care reform bill, the Senate also needs to consider the legislation to raise the debt ceiling. However, the debt ceiling measure will not be addressed until there is a final vote on the health care reform bill.
NAHU is working, in conjunction with industry and coalition partners, on a conference committee strategy and will continue to keep you informed of any breaking developments as they occur. If you have any questions, please feel free to contact our Government Relations Department staff.
Well, as you probably have heard already, Senate Majority Leader Reid has secured the 60th vote from Senator Ben Nelson of Nebraska. This was accomplished by promising him that Nebraska would NEVER have to pick up the state’s share of the Medicaid expansion in this legislation.
Looks like that is how they are going to get the votes needed to pass this revised version of the Senate bill by Christmas. Pretty sad that it has come to this however it’s not surprising as they had to do this to Senator Landreau to get her earlier vote.
Don’t be discouraged however, since this is just another step in the process as the House has already recessed for the holidays and won’t be back until after the first of the year.
They still need to conference the House with the Senate to create a compromise bill and with so many differences between the bills, this isn’t going to be easy. Remember that the House version has the Public option and Reid had to give that up to get this bill through.
He had to give up so much that this bill has lost a lot of it’s teeth.
I’ll still be watching C-Span and provide you with any updates that are important. When our Senators Stabenow and Levin come back to Michigan during the Holidays, we need to give them an earful.
I hope everyone has a Very Merry Christmas and a Happy New Year.
I’m very thankful for all of your support in fighting the good fight!
Mike
Michael A. Embry Sr., RHU Comerica Insurance Services
As you know, health care reform is currently making its way through Congress. We will continue to keep all of our members informed during the process through our weekly Washington Updates, Operation Shouts and legislative updates. We also encourage our chapter leadership to utilize some tools we've created to help their chapters stay informed. NAHU staff has compiled an updated side-by-side comparison chart of the Senate bill and the House bill that is a great reference for the specific offerings of each bill and how they differ. We have also recently updated a federal legislative PowerPoint presentation complete with information on the new Senate bill as well as talking points that we encourage you to review and use at your next chapter meeting. We urge all of you to use these resources in the coming weeks as the Senate begins their debate. If you have any questions or need further information, do not hesitate to contact a member of the Government Relations department. [back to the top]
McClatchy (11/25, Lightman) reports, "Americans could pay billions of dollars more in new taxes for a few years before they're likely to see significant change in the nation's healthcare system under legislation that Congress is considering." McClatchy adds that "some analysts said that's not necessarily bad," because the extra years' revenue "would give the government sufficient money and time to get things right," but "critics counter that there's no guarantee that the money will be enough, and in the meantime, higher taxes could stifle an ailing economy." Congressional Democrats "point to another benefit: The revenue would help fund a series of steps that could take effect in 2010. The Senate bill, for instance, includes $5 billion for a new program to help uninsured people with pre-existing conditions afford policies." Republicans criticize imposing tax hikes prior to providing credits to aid insurance purchases. The CBS Evening News (11/24, story 5, 4:55, Rodriguez) reported that healthcare reform will not add to the deficit, "according to the non-partisan Congressional Budget Office," which "found the Senate bill would not only pay for itself through a raft of cuts and taxes, but would actually reduce the deficit by $130 billion over ten years. Likewise, the House bill would put $138 billion back into the budget. ... But, there's a catch say Republicans. They argue Democrats artificially lowered the cost of reform by imposing new taxes years before the tax credits would kick in to help Americans buy insurance." CBS added, "That's true, but Democrats contend the bill's major taxes are aimed at the wealthiest Americans. The Senate bill, for example, boosts the Medicare payroll tax but only for individuals making more than $200,000 a year, while the House bill hits those making more than $500,000, with a 5.4% surtax on income. Republicans argue that many of the other proposed taxes on medical devices and drugmakers or on high cost insurance plans will quickly get passed along to consumers." Centrist Senators urged to push for more cost containment in reform bill. In his "Economic Scene" column on the front of the New York Times (11/25, B1) Business Day section, David Leonhardt writes that the Senate healthcare reform "bill includes nearly every big idea that health economists and medical researchers have for slowing cost growth -- as well as for improving the patchwork quality of American healthcare." However, "many of the ideas...have been at least partly neutered." Leonhardt argues that this gives centrist Senators an opportunity to push the cost containment proposals they have been claiming to support. "To achieve their stated goal, they don't suddenly need to turn themselves into healthcare wonks and rewrite the bill. They just need to improve what's already there."
Good Evening,Thankfully we have a few days rest before the Senate starts the debate next week. Here is the latest from Heritage as well as some info that I have received from NAHU.Get ready for the fight to begin next week!Thanks to everyone that is interested in keeping the government out of the healthcare business.For this year we have many things to be thankful for!Wishing everyone a Safe and Happy Thanksgiving,Mike
As you may know, Senate Majority Leader Harry Reid (D-NV) released a merged version of the Senate comprehensive reform legislation last night, thePatient Protection and Affordable Care Act, or H.R. 3590. NAHU is in the process of reading through the 2,074-page bill and will include a detailed analysis in tomorrow's edition of Washington Update. In addition, we will provide talking points and materials you can provide to your clients.
Some of the key provisions in H.R. 3590 are:
A government-run public plan option to be sold through the exchanges with the opportunity for states to opt out. Payment rates to providers would be determined by HHS and capped at the average rate of private plans. In addition, start-up funds are provided for the creation of co-ops and states are allowed to offer their own public programs for those between 133% and 200% of the Federal Poverty Level (FPL).
State-based exchanges beginning in 2013 and limited to individuals and small groups until 2017, when large-group participation will be allowed.
The inclusion of agents and brokers to sell policies through the exchanges.
An employer mandate for groups of 50 or more to provide qualified coverage with a $750 fine, indexed for premium growth, for non-covered employees.
An individual mandate to obtain qualified coverage with a fine that begins at $95 in 2014, rises to $750 by 2016, and is indexed for inflation. Exemptions include hardship waivers and those for whom the cost of coverage will exceed eight percent of their income.
Subsidies through the exchanges up to 400% of the FPL, with a 2.8-7% cap on beneficiary costs as a percentage of income.
An expansion of Medicaid up to 133% of the FPL.
Market reforms that include guaranteed issue and renewability of all policies, no preexisting condition limitations or lifetime or annual limits, prohibitions on rating based on health status and gender, and only allowing rating factors of age (3:1), tobacco use (1.5.1), family status and geography.
The minimum allowable actuarial value has been reduced to 60% as determined by HHS, which should accommodate most consumer-directed account-based plans.
Improvements to employer-sponsored wellness programs to allow for discounts of up to 50%.
A limited small-business tax credit to help the smallest of businesses with low-income employees with the cost of coverage.
The creation of a new opt-out federal long-term care program (CLASS Act provisions) with a limited daily benefit.
A variety of financing mechanisms including the fees imposed on the individuals without insurance and employers not providing insurance, a 40% excise tax on high-cost insurance ($8,500 individual/$23,000 family), taxes on medical devices, pharmaceuticals and the health insurance industry, and a Medicare tax increase to 1.96% for individuals earning over $200,000 per year and families earning over $250,000. In addition, the bill contains $464 billion in cuts to Medicare that include: permanent reductions in the annual updates to Medicare’s payment rates for most services in the fee-for-service sector of $192 billion; $118 billion in cuts to Medicare Advantage; $43 billion in DSH cuts; and $23 billion in unspecified cuts by the Medicare Advisory Board.
Cost of the Legislation
TheCongressional Budget Officehas determined the initial cost of the measure to the federal government to be $849 billion. However, CBO notes that the bill includes two significant provisions that will likely alter the true cost of the bill. Medicare participating providers are assumed to get a 23% payment cut in 2011, which would carry into subsequent years. Fixing the rate cut, which is historically and politically likely to happen, would cost $247 billion. Additionally, the CLASS Act provisions, which address the creation of a new federal long-term care program, generate $72 billion over the budget window because fees are collected initially for five years before any claims would be paid. Once the program is fully implemented, it is estimated to run at a significant deficit. According to the Senate Republican Budget Committee, when these factors are accounted for, the legislation is $189 billion in the red. It would also put the real cost of the bill at over a trillion dollars.
In addition, the CBO report says, “Under the legislation, federal outlays for health care would increase during the 2010–2019 period, as would the federal budgetary commitment to health care.” The coverage expansion would drive a net increase in government spending on health by $160 billion over 10 years. CBO scored the bill as reducing the deficit by $130 billion over FYs 2010-2019.
Process Moving Forward
The Senate will consider existing scheduled business all day today, and we expect that Senator Reid will also file his cloture motion later today to proceed on H.R. 3950 and start the Senate floor debate. The cloture vote process takes three days -- file on day one; day two is an intervening day; and the vote occurs on day three. That means the soonest a vote can be taken on the motion to proceed on H.R. 3950 would be Saturday, November 21, and all 60 Democratic Caucus votes will be needed for the measure to pass. Otherwise, the measure cannot be considered on the Senate floor.
It's not clear that Senator Reid has the 60 votes needed to move forward at the moment, because three moderate Senators, Blanche Lincoln (D-AR), Mary Landrieu (D-LA) and Ben Nelson (D-NE) have not given their commitments. Nelson and Landrieu are said to be leaning towards allowing debate to start (while stating publicly that supporting a procedural vote to move forward is not the same as supporting the measure overall) but Lincoln has remained tight-lipped about her plans. Also, Senator Max Baucus (D-MT) has been called away from Washington, DC, to attend to a family emergency. We expect that the motion to proceed efforts may happen on Saturday, but could also extend into next week. Then, during the week of November 30, the Senate will begin to consider health care reform on the floor and the lengthy amendment process will begin.
NAHU will continue to keep you informed of any breaking developments as they occur. If you have any questions, please feel free to contact our government relations department staff.
11/15/09
After sorting through many of the documents that have been produced since the House passed it's version of Healthcare Reform last Saturday, I am listing some items that I feel address many of the major issues of the legislation.
Now is the time for you to write and say thank you to your representatives if they voted against this, and a "shame on you" letter to those who voted for it!
Take a moment, write our Senators, Levin and Stabenow - let them know you oppose this type of legislation. Your voice counts, use it!
We know many of you have been extremely active with legislative issues and we want to thank you for your hard work and assure you it is making a difference. We are seeing some inroads on the legislative front and continue to work diligently with Congress to keep things on the right track.
The next few months will be the most intensive of times for our association's government affairs efforts. We have every reason to believe that health system reform legislation will move forward, and we need to preserve the role of agents and brokers and ensure continuance of the private market. It is for these reasons that we have decided to reinstate our Grass Roots Initiative Program. GRIP is a voluntary donation program created some years ago for our legislative expenses at the national level.
We are now soliciting both individual and chapter contributions to GRIP, and would greatly appreciate any additional help as there is still much to be done on the legislative and regulatory front. Please click here to make a donation to GRIP today.
Janet Trautwein, CEO of the National Association of Health Underwriters, writes in a Wall Street Journal (11/11) op-ed that the Senate needs to adopt a strong individual insurance mandate into its healthcare reform legislation, otherwise healthcare costs will continue to spiral upwards. Trautwein notes that the combination of requiring insurers to sell insurance plans to everyone who wants it and not allowing insurers to charge more to less-healthy individuals will increase the cost of insurance greatly unless a strong individual mandate brings low-risk individuals into the health insurance market.
FOR IMMEDIATE RELEASE Contact: Kelly Loussedes, Vice President of Public Relations
November 5, 2009 (703) 276-3835 or kloussedes@nahu.org
House Health Care Legislation Breaks Campaign Promises
(Arlington, VA) – Janet Trautwein, CEO of the National Association of Health Underwriters (NAHU), made the following statement today in response to the Affordable Health Care for America Act (HR 3962):
"The campaign promise for health care reform has been that if you like your current health insurance, you can keep it. Unfortunately, HR 3962 will break this promise by driving up the cost of coverage for millions of American families and dismantle the employer market. Because the majority of the population is covered by private insurance plans they like, the impact of these new health reform provisions could be devastating in this tightened economy.
"Unlike other types of legislation, once any measure of significant health care reform legislation gets passed and eventually implemented, it will be near impossible to repair the damage that is done. That is why as a country we must ‘get it right’ the first time around.
"The promise that the government- run public plan is simply another ‘option’ is completely untrue. The truth is that a public option would simply shift health care costs onto private payers -- and undermine the private insurance system in the process. And, burdening already-suffering businesses with an expensive new employer mandate will have disastrous consequences for the economy. The National Federation of Independent Business estimates that an employer mandate would cause the economy to shed 1.6 million jobs within the first five years. The Congressional Budget Office warns that low-wage jobs would be among the first eliminated -- a cruel blow to many in these trying economic times.
"The House bill also contains an unworkable individual mandate. If the individual mandate is not effective or enforceable, people could wait to buy coverage until they get sick, causing premiums to skyrocket significantly for everyone. Tens of billions of dollars in new insurer fees and taxes, tight limits on age rating and high minimum benefit levels will make private health insurance unaffordable for many Americans.
"NAHU is committed to bipartisan solutions that will bring down costs, improve quality and extend coverage to all Americans. We look forward to working with members of Congress and the Administration on sensible health care reforms that strengthen the health and financial security of the nation."
Click here
to read the letter sent today to House leadership voicing our concerns with HR 3962.
The National Association of Health Underwriters represents more than 100,000 professional health insurance agents and brokers who provide insurance for millions of Americans. For more information, please contact Kelly Loussedes, vice president of public relations at 703-276-3835 or
Today has been a day of letter writing and going over the various pieces of info to try and provide you with items that provide the most comprehensive look at the work that is ahead in both the House and the Senate as they work to marry their various proposals together to bring legislation to the floor of both chambers.
There will be much wrangling going on over the next week or two so now is the time to call and write your legislators and express your opinion about healthcare reform.
Top Ten Issues to be Debated
A public option Employer or Individual mandates Tax and fee increase to pay for this legislation. $6.7 billion in fees to the insurance providers! Many of the taxes and fees begin in 2010 although the legislation doesn’t go into effect until 2013. This is how it can be shown not to increase the budget. There is a tremendous windfall until it goes into effect. Crowd out of the private market due to a public option At best the legislation would only cover about 50% of the uninsured population Federal funding of Co-ops instead of a public option Over $400 billion in cuts to Medicare
Reduction of FSA allowance and removal of OTC provisions. Price Waterhouse study that indicates that insurance premiums will increase for an individual by $400 per year in 2013 to $1500 per year by 2019 and family coverage will increase by $1700 in 2013 and by $4000 by 2019
I hope this material is helpful in regards to seeing some of the challenges we face.
