CODE BLUE: New Health Reform Resources from NAHU 7/8/10

Dear NAHU Member,

As part of our ongoing efforts to keep you informed and up to date on the latest in health care reform, we have added two new resources to our Health Reform Resources page:

• New Form W-2 Reporting Requirements for Employers (NAHU issue brief)
• Self-Insured Health Insurance Coverage (Congressional Research Service report)

CODE BLUE: Additional Resources on
Grandfathered Health Plan Rules

Dear NAHU Members,

As you know, this week the U.S. Departments of HHS, Labor and Treasury issued interim final regulations with request for public comment on the proposed rules governing “grandfather” status of certain health plans under the new health reform law. The interim rules will be published in the June 17 issue of the Federal Register.

NAHU has developed for the benefit of members an issue brief analysis on the grandfathering rules, so you can best advise and service your clients.

Also for the benefit of members, we commend your attention to this legal analysis of the proposed rules (courtesy of the Groom Law Group) and this PowerPoint presentation (courtesy of the American Benefits Council).

These materials are also available on the NAHU website's Health Reform Resources page.

Please note and remember no new policies sold after March 23, 2010 will be considered grandfathered.

Additionally, these regulations have immediate impact and implications for plan renewals on or after July 1! Any change in health insurance carriers beginning July 1, 2010 will result in the loss of grandfather status. Plans renewed after June 17, 2010 will have to comply with the terms of the regulations in their entirety without any grace period or good-faith compliance standard, or else will lose their grandfathered status.

CODE BLUE ALERT

June 14, 2010
 
"Grandfathered" Health Plan Proposed Rules Released
 
Today the U.S. Departments of HHS, Labor and Treasury issued interim final and proposed regulations for group health plans and health insurance coverage relating to status as a grandfathered health plan under the Patient Protection and Affordable Care Act (P.L. 111-148). The regulations, which also call for comment, will be published in the June 17 Federal Register.

The PPACA exempts “grandfathered” plans that were in existence on March 23, when the law was enacted, from many of the new requirements of the law, which will cost more for plans to incorporate.

NAHU staff will be providing soon more detailed analysis and summaries of the proposed rules, but you may be interested in this fact sheet released today by HHS.

On Wednesday, June 9, 2010, the West Michigan Association of Health Underwriters held "Healthcare Reform & What It Means for You" featuring Janet Trautwein, CEO, National Association of Health Underwriters, Washington, D.C.

We are pleased to provide her presentation for anyone that was not able to attend.

NAHU NEWSWIRE 5/3/10

DC And 21 States Agree To Participate In Federal High-Risk Pool.

The Los Angeles Times (5/1, Levey) reported, "As many as 20 states likely will not operate new insurance programs for Americans who have been denied health coverage, forcing the federal government to step in and placing a new burden on the Obama administration to implement its health overhaul, according to administration officials." Notably, "Democrats earmarked $5 billion in the recently passed healthcare legislation to create state-based high risk pools as a way to help sick, uninsured Americans between now and 2014." But, "led by the Georgia insurance commissioner...a succession of mostly Republican state officials have been rejecting the idea of creating state pools, voicing concerns that state governments would end up having to pay some of the costs of operating the pools over the next 3 1/2 years."

        According to the AP (5/1), HHS announced on Friday that several "states and the District of Columbia have notified the administration they want to run special high-risk insurance pools. The programs will be in place until 2014 -- when health insurance companies will no longer be allowed to deny coverage to people in poor health." Meanwhile, "15 states said they would not set up their own pools, including several in which Republican governors opposed the overhaul legislation. In those states, the federal government will step in and run the program."

        The Hill (5/2, Pecquet) reported, "The decision whether to operate their own high-risk pool for sick people who can't get insurance has become a highly politicized issue in some states, with a number of Republican governors blasting the $5 billion set aside for the provision as insufficient." The Hill added, "As of mid-day Friday, 21 states and the District of Columbia had decided to run their own pool, while 11 states had opted to let the federal government take over. Of the latter, all have Republican administrations save for Tennessee and Wyoming." In contrast, "all but five of the 21 states that opted to run their own pools are led by Democrats. The exceptions: Connecticut, Rhode Island, South Dakota, Vermont, and California, where Arnold Schwarzenegger on Thursday became the first Republican governor to endorse the health reform law."

        CQ HealthBeat (5/1, Norman, subscription required) noted that as of early Friday afternoon, the following states had indicated that they would operate high-risk pools: "Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Illinois, Kansas, Kentucky, Maine, Maryland, Michigan, Missouri, Montana, New Jersey, North Carolina, Ohio, Oklahoma, Rhode Island, South Dakota, Vermont, and Washington."

        The Wall Street Journal (5/1, Adamy, subscription required) reported that the refusal by several states to participate in the federal high-risk insurance pool shows the "pitfalls" of placing much of the responsibility of implementing healthcare reform on the states. The Journal also noted that the states were chiefly concerned that they would become fiscally responsible for the program once federal funds ran out, and they sought to obtain additional information from the Obama Administration about this concern, to no avail. Indeed, HHS spokeswoman Jenny Backus would only say, "I think we need to get the programs up and running before we start speculating."

Michigan to create high-risk insurance pool

By Jay Greene –

Crains

Michigan intends to create a high-risk medical insurance pool as part of the recently approved federal health care reform bill, said Insurance Commissioner Ken Ross.

In a letter e-mailed today to Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, Ross said the Michigan Office of Financial and Insurance Regulation will likely subcontract with a health insurer to provide the subsidized coverage to eligible people.

Under the Patient Protection and Affordable Care Act, states were required to inform HHS by April 30 whether they would create an insurance pool or defer to the federal government.

The legislation requires states to create insurance pools for people who have been without health coverage for at least six months because of a pre-existing health condition.

HHS said Michigan could likely receive up to $141 million in federal funds to subsidize its high-risk pool for the next three years. The federal government will provide up to $5 billion nationally for the program.

Some 34 other states already operate a high-risk pool. The pool is supposed to be operating by July 1.

The pool is considered a temporary fix until 2014, when uninsured people will be required to have health insurance through a government program or be required to buy it on the private market through state-based insurance exchanges.

Ross said OFIR must wait until HHS creates regulations to govern the high-risk pool. For example, HHS plans to establish “essential benefits” for those covered in the plan.

For more information on the high-risk pools, visit HHS online.

NAHU NEWS 3/26/10
March 26, 2010
 
Health Reform Finalized After 18 Months of Ups and Downs
 
The past week has seen the greatest changes in more than half a century to our country’s private health care system brought to fruition. On Sunday, the U.S. House of Representatives passed H.R. 3590, the comprehensive health reform legislation passed by the U.S. Senate on December 24, 2009, and President Obama signed it into law on Tuesday. The legislation passed narrowly in the House on partisan lines by a vote of 219-212. All Republicans and 34 Democrats voted in opposition.  
NAHU opposed this measure in favor of a bipartisan effort that would better contain medical care costs and implement private market reforms in an affordable and responsible way, and we hope that you will take the time to thank your members of Congress if they cast one of the 212 courageous "no" votes.
Once the comprehensive reform bill, the Patient Protection and Affordable Care Act became law, the U.S. Senate began consideration of H.R. 4872, The Health Care and Education Reconciliation Act of 2010, which had previously been passed by the House of Representatives on March 21. This legislation, which was considered under the controversial budget reconciliation process that limited debate on the measure and only required a 51-vote simple majority for passage in the Senate, contained a number of amendments to H.R. 3590. These amendments, which were considered necessary to ensure House-passage of the original legislation, were passed by the Senate yesterday by a vote of 56-53. All Republicans, with the exception of ill Senator Johnny Isakson (GA), joined with Democrats Ben Nelson (NE), Blanche Lincoln (AR) and David Pryor (AR) in opposing the reconciliation package. The bill was then sent back to the House to approve modest changes relative to the education provisions, and the House approved it 220-207 yesterday afternoon. President Obama is expected to sign the reconciliation legislation into law in the next few days.
Now that the legislative work on this reform measure is complete, the numerous groups who opposed the legislation are working on the next steps. In Congress, the GOP is focusing on a structure of repealing and replacing many of the current aspects of the legislation. Democrats are looking at additional measures to close loopholes in the new legislation, including one that limits the ability to provide coverage to children without regard to preexisting conditions in 2010.
In the states, so far 13 Attorneys General have joined forces in initiating a suit regarding the constitutionality of the individual mandate provisions of the legislation, with the Attorney General of Virginia filing an additional separate suit. In addition, on March 17, Idaho became the first state to adopt legislation requiring the state to challenge the implementation of health reform, and similar measures are pending in 37 states. Employer groups, health plans, providers and others are now scrambling to begin the process of implementing the aspects of the reform proposal that will take effect this year, and to deal with the associated costs, which are expected to have a significant economic impact and dramatically affect private health insurance prices. 

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Health Reform Webinar
 
NAHU CEO Janet Trautwein and senior government affairs staff will be hosting a free webinar, Health Reform: the Changes You Need to Know, on Monday, March 29, at 1:00 p.m. EDT. This webinar is currently at capacity, so we will be holding a second webinar on Thursday, April 1 at 1:00 p.m. EDT. The webinar will outline what you need to know about the newly passed legislation and the changes being implemented over the next few years. To register for the webinar on April 1, click here. Registration is limited to the first 1,000 registrants, but the call will be recorded for those unable to attend.

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As NAHU Members, Where Do We Go From Here?
 
While NAHU opposed the legislation at hand, the reforms passed by Congress either are, or are about to become, the laws of the land. Our private health insurance marketplace may change dramatically, but with great change also comes great opportunity. NAHU is committed both to helping implement these measures in a way that ensures the greatest possible preservation of the private market and working to fix or repeal the provisions we find most problematic through the legislative and regulatory processes at the state and federal level. It is also important to keep in mind that this legislation, like most things, isn’t all bad news. For example:
• The legislation specifically includes health insurance agents and brokers as the marketing force and source of subsidy assistance for the purchase of private health insurance coverage both inside and outside the new exchanges. Government regulators will not set agent commissions and fees, as was initially proposed. You will continue to be allowed to be compensated at fair market rates by private health insurance carriers.  
 
• The measures do not include a government-run public plan option.
 
• While there are significant employer-responsibility requirements and fines in the new measures, they do not include the oppressive employer mandates to provide coverage contained in the House’s original legislation or the initial draft of the Senate Bill.
 
• The exchanges that will be created will be state-based, not national. There are opportunities for multiple exchanges in a state, states may obtain waivers regarding exchange design, and health insurance agents and brokers have a specific role in the exchanges. In addition, the private group and individual markets are preserved independent of the exchanges. No individual or company will be forced to buy exchange-based coverage.
 
• The legislation makes it mandatory for states to establish private health insurance premium assistance programs to subsidize qualified employer-sponsored coverage for Medicaid recipients, an idea for which NAHU has long advocated. This provision will also make it easier to expand state-based premium assistance programs for CHIP, which has also been a long-term goal of NAHU’s.
 
• The bill includes numerous improvements to bona fide wellness programs and small employer wellness program grants, which have been long-standing NAHU legislative goals.
 
• The measures create high-risk pool coverage in states without current options for medically uninsurable people, another goal that NAHU has pursued for more than a decade.
 
• The small business tax credits for the purchase of private coverage, while limited in scope, will still provide many of your clients with needed assistance to buy private coverage.
 
• While the cost containment provisions in the measures are far less extensive that we would like, they are a beginning and will provide for greater transparency requirements, provider payment reforms based on performance and value and more.
If you have any questions about our government affairs efforts going forward, both nationally and in the states, please do not hesitate to contact a member of our government affairs staff. 

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NAHU Compliance Resources
 
We know many of you have questions about what the newly passed health care reform legislation, H.R. 3590, contains and how it will impact you and your clients. NAHU is working hard to provide you with the information and tools you need to better understand the changes and what your clients need to know moving forward.
The amount of information about the reform bills being released right now is staggering, and NAHU feels that it is very important to make sure we analyze these measures thoroughly to help you provide the best information to your clients. We ask that you keep in mind that we are at the beginning stages with the passage of this legislation and the implementation and regulatory processes surrounding these measures will take years. Right now is a great opportunity for you to showcase your value to your clients.
We have assembled two new charts this week to help you better understand and explain the provisions and timeline for implementation of the new law. The first is a very detailed chart for your reference that explains how all of the new health insurance reforms in both the Senate bill and the reconciliation bill will impact private health insurance organized by effective date. The second chart is a simplified timeline that explains how both pieces of health care reform legislation will impact your individual and employer clients. Please feel free to use these documents as part of your business and distribute them to clients if you wish.
Over the next few weeks we will continue to prepare additional resource materials for you to help you educate your employer clients, including PowerPoint presentations with detailed speakers notes and one-page summaries of how specific elements of the legislation will work. If you have implementation questions or suggestions about what kind of resources would be helpful to you and your clients please send them to reformimplementation@nahu.org.
We will also be working closely with state and federal regulators on new guidance and regulations and programs as they are rolled out, and will keep our membership informed about all developments as they occur. Some of the specific programs and issues we are working on immediately include:
• The small employer health insurance premium tax credit program, which is retroactive and will apply to premiums paid in taxable years beginning after December 31, 2009. This credit will give certain qualified small employers who have no more than 25 full-time equivalent employees, pay average annual wages of less than $50,000 and provide qualifying coverage, among other criteria, a maximum tax credit, based on number of employees, of up to 50% of premiums for up to two years if the employer contributes at least 50% of the total premium cost.
 
• The development of the national high-risk pool program for individual market consumers with preexisting conditions, which will become effective in 90 days. Existing state high-risk pools will be impacted, and there will also be significant individual market changes for those states that currently do not have a high-risk pool.
 
• The development of the temporary reinsurance program for employers that provide retiree health coverage for employees over age 55, which is also scheduled to begin within 90 days.
 
• The development of the relevant definitions that will govern the medical loss ratio requirements for health insurance carriers by the National Association of Insurance Commissioners. This process must be completed by December 31, 2010.
 
• The development of the new grant program for small employers who offer wellness programs, slated to begin in October 2010.
 
• The roll-out of the new market reforms and coverage provisions that will apply to all plans within six months, including grandfathered plans. These provisions include the increase in the dependent age to 26, the new preventive care provisions and other mandates, the policy rescission provisions and the restrictions on annual and lifetime benefit limits.
As information, rules and guidance on all of these programs and more are released, you can look to NAHU as your source for reliable information!

FROM NAHU 3/25/10 5:00 pm

We know many of you have questions about what the newly passed health care reform legislation, H.R. 3590, contains and how it will impact you and your clients. NAHU is working hard to provide you with the information and tools you need to better understand the changes and what your clients need to know moving forward.

The amount of information about the reform bills being released right now is staggering, and NAHU feels that it is very important to make sure we analyze these measures thoroughly to help you provide the best information to your clients. We ask that you keep in mind that the passage of this legislation is just the beginning point, and the implementation and regulatory processes surrounding these measures will take years. Right now is a great opportunity for you to showcase your value to your clients.

We have assembled two new charts to help you explain the timeline for implementation of the law. The first is a very detailed chart for your reference that explains how all of the new health insurance reforms in both the Senate bill and the reconciliation bill will impact private health insurance organized by effective date. The second chart is a simplified timeline that explains how both pieces of health care reform legislation will impact your individual and employer clients. Please feel free to use these documents as part of your business and distribute them to clients if you wish.

In addition, NAHU CEO Janet Trautwein and senior government affairs staff will be hosting a free webinar, Health Reform: The Changes You Need to Know, on Monday, March 29, at 1:00 p.m. EDT. The webinar will outline what you need to know about the newly passed legislation and the changes being implemented over the next few years. To register, click here. Registration is limited to the first 1,000 participants, but the call will be recorded and repeated if necessary.

CLICK HERE TO SEE THE TV 6 INTERVIEW

3/23/10 GONGWER NEWS

Health Bill Will Mean Costs, Savings For State

Michigan will see some of its Medicaid costs rise under the federal health care bill that is expected to see enactment in the coming days, but it is unclear yet how much of that will be offset by savings the bill also would bring to Medicaid and other areas of the budget.

The package is touted to make private insurance more available and more affordable for individuals and business, but it also, eventually, makes more people eligible for Medicaid.

Overall, though, it will be a benefit for the state by providing more health care coverage for residents, said Community Health Director Janet Olszewski.

"It's a positive development for Michigan families," Ms. Olszewski said.

"The bill Congress passed is probably the most important piece of middle-class legislation since Medicare was passed," said U.S. Secretary of Health and Human Services Kathleen Sebelius in a media call Monday.

But the proposal still raised some concerns among human services groups that it would increase costs for the state.

"It's going to be challenging for Michigan because we having a hard time paying for Medicaid right now," said Judy Putnam with the Michigan League for Human Services. "There's going to be a whole group of folks who are eligible for Medicaid who aren't eligible now."

John Freeman, state director for Healthcare for America Now, said the bill would mean $12.5 billion annually for Medicaid and $15.8 billion for direct subsidies to those purchasing private insurance according to the group's analyses of the bill.

But he noted there was some additional match money the state would have to provide.

One benefit for the state budget is the Medicaid changes do not take effect until January 1, 2014, so there will be no hit to state coffers in the coming year.

But in that year, another 375,000 people could be eligible for Medicaid, Ms. Olszewski said. The bill would increase Medicaid eligibility to 133 percent of poverty for all residents and eliminate the categoricals that control adult eligibility for assistance, she said.

"That will be just a godsend for Michigan, but we still have to come up with that 10 percent," Ms. Putnam said.

The state would not have to start covering the cost of any of those new enrollees until 2016, and by 2019 would be covering 10 percent of those costs.

The state currently covers slightly less than 41 percent of Medicaid costs, Mr. Olszewski said.

Hospitals also could see some cost hits under the measure, said Michigan Health and Hospital Association President Spencer Johnson. Among other issues, hospitals could face penalties for some things out of their control.

Mr. Johnson also said the bill waits too long to provide assistance.

"Achieving universal health care coverage has been a goal of the MHA and the American Hospital Association for more than a decade, and this progress is a step in the right direction toward increased coverage and access for all," he said. "However, many coverage expansion provisions will not truly begin until 2014, translating into several more years of hospitals and other health care providers struggling to keep the health care system patched together to protect patients."

One place where the state could see some immediate costs is in a health care pool that would help insurance companies and businesses offset the cost of covering those with some of the most expensive illnesses. Currently in the bill, the state would have to contribute about 3 percent to that pool, but another bill working its way through Congress would reduce that to about 2 percent.

Mr. Olszewski said the state would also benefit from that pool. It would reimburse up to 80 percent of catastrophic costs for state retirees not yet eligible for Medicare, she said.

The state could also see some people move back to private insurance from Medicaid, or at least not add some new recipients, Ms. Olszewski said.

"Clearly there will be opportunities for people who are uninsured now to roll back into private insurance," she said.

The bill eliminates lifetime caps on coverage, meaning those with severe illnesses cannot be canceled for excessive costs. Many policies now limit coverage to $1 million per person.

Ms. Olszewski said the state has a number of Medicaid recipients who have reached that cap on their private insurance and are eligible for Medicaid because of the percentage of their household budget dedicated to medical expenses. She said she did not know how many recipients fit that category or whether that provision of the bill was retroactive and would allow any of those people currently at the cap to return to private coverage.

More businesses and individuals are also expected to be able to afford private insurance under the bill between tax incentives and health care cost reductions.

"It's wonderful news for people who have insurance now but because of the changing marketplace are losing it shortly," Ms. Putnam said.

Provisions in the bill will also cut overall medical spending nationally, Ms. Sebelius said.

"The bill has been confirmed that it will rein in soaring premiums," she said.

Over time there also will be new, lower-cost options for health care coverage, Ms. Sebelius said. "What the insurance changes are aimed at is over a few years creating a new market, a new pool of choices," she said. "The new market won't be fully up and running until 2014."

And there will be fewer reasons for insurers to cancel coverage, she said. "We're ending the worst practices we see around the country of insurance companies," Ms. Sebelius said.

G.O.P. Launches Challenges To Health Care Law

With the Legislature unlikely to muster the needed two-thirds vote in the House and Senate to place a constitutional amendment on the ballot designed to let Michigan opt out of the new federal law requiring all Americans to have health insurance, opponents launched a petition drive Monday to put the question on the November ballot.

Meanwhile, Attorney General Mike Cox joined with other states to file a legal challenge to the law's constitutionality, contending that health care law violates the 10^th Amendment of the U.S. Constitution that reserves those powers to the states not expressly granted to the federal government in the Constitution. The challenge contends that the law does not fall under the so-called commerce clause of the Constitution that empowers Congress to regulate interstate commerce.

The ballot drive - if supporters succeed in gathering the 380,126 signatures of registered voters and convincing voters to pass it - would face a major constitutional problem of its own. Article VI of the U.S. Constitution, known as the supremacy clause, would appear to cause any state effort to opt out to fall against the weight of federal law.

"This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding," the Constitution says.

Still, the potential hurdles will not dissuade those upset about the new law from trying to stop it, said Rep. Tom McMillin (R-Rochester Hills), a supporter of the ballot drive.

"We're going to go down fighting," he said. "We're not going to give up our freedoms without a good fight. We're Americans."

And Mr. McMillin pointed to the arguments of the Arizona-based Goldwater Institute, which has assisted efforts in several states toward passing such laws. The institute asserts that the federal government will have to show that the legislation comports with the commerce clause, the 10^th Amendment and the 11^th Amendment that protects the states from being used as instrumentalities of the federal government.

At this point, it appears Democrats, who have the necessary votes in the Legislature to block the proposal (SJR K ) from the ballot, will prevent the measure from reaching the ballot, making a petition drive necessary, he said.

Mr. McMillin said tea party activists would take up the effort to collect the signatures before July 5. "We got the marriage petition amendment on the ballot without paying for signatures," he said. "We can do this."

Opposition to the effort already is underway. Progress Michigan, a coalition of liberal groups, asked its members to send contributions to help fight the constitutional amendment.

"We must take this threat to block health care reform seriously," the letter to supporters said. "To win, we're going to need to more resources to mount a strong campaign to make sure Michigan's hard-working families get the change, and the health care reform, they voted for. The stakes are high. Our opponents' plan is to deny 1.3 million Michiganders access to affordable care, and saddle hospitals and health care providers with over $2 billion in uncompensated care costs."

Michigan's congressional delegation voted 8-7 along party lines, Democrats in support and Republicans in opposition, on the proposal. Both parties moved quickly to define the soon to be law.

"This bill will ban the health insurance companies from denying coverage for pre-existing conditions or the loss of a job, close the Medicare prescription drug donut hole for seniors, cut the deficit by $1.3 trillion and allow families to sign up for the same kind of quality, private health insurance plans that are available to members of Congress," said U.S. Rep. Mark Schauer (D-Battle Creek), who probably will be the test case for the issue's impact in Michigan politics.

"For me, this wasn't about politics - it was about doing what's right for the people I represent. Doing what's right isn't always easy, but I didn't run for Congress to walk away from a tough fight."

Republicans blasted the legislation and Michigan Democrats for supporting it.

"Michigan's own Democrat Congressional delegation - including Gary Peters, Mark Schauer and even Bart Stupak - gave in to the pressures of back-room deals and turned their backs on the Michigan families they represent," Michigan Republican Party Chair Ron Weiser said in a statement. "Because of their vote, Michigan families will no longer be free to make personal decisions about their own healthcare. They will be forced to pick from Washington, D.C. approved packages - packages Congress won't accept for themselves."

But Democrats hailed the legislation as a historic move to address the millions of people without health insurance.

"After decades of failed attempts, this legislation will give Michigan families and businesses more control over their own health care, will give them the security and stability that come with health care coverage and will reduce overall health care costs," Governor Jennifer Granholm said. "No state has needed reform more than Michigan, and I applaud and thank the members of our congressional delegation who voted for this legislation."

MIRS NEWS 3/22/10

Health Care Passes, Stupak Vilified
U.S. Rep. Bart STUPAK (D-Menominee) dominated the health care debate this weekend, culminating with him being called a "baby killer" by a fellow congressman on the floor.

Late Sunday night, the U.S. House took up two votes on health care reform. The bill passed, 219-212. The vote for amendments passed, 220-211. Republicans attempted to kill passage and send the bill back to committee with Stupak's original anti-abortion language, but that failed, 199-232. President Barack OBAMA will sign the bill on Tuesday.

The Michigan delegation voted 8-7 along party lines in favor of the legislation. The House Energy and Commerce Committee said that 536,000 uninsured Michigan residents will now have access to health insurance, as will 32 million Americans. Almost 2.5 million middle-class Michigan families will receive a tax cut to help pay for health coverage. 

The 6.3 million Michigan residents who currently have insurance can keep their current plan. Legislation prohibits annual and lifetime benefit limits, outlaws dropping individuals who become ill while insured and reduces the cost of preventive care, according to the committee.

The nonpartisan Congressional Budget Office found that legislation would reduce the deficit by $142 billion over the next 10 years, and by about $1.2 trillion over the second decade. 

Stupak, who became the leader of anti-abortion Democrats opposed to health care legislation, brokered a deal with the White House this weekend and won an executive order that no federal money will be used for abortion. He and several other anti-abortion Democrats agreed to vote for the bill as a result. U.S. Rep. Dale KILDEE (D-Flint), who is anti-abortion, had agreed to vote for the bill earlier in the week (See "MI Delegation 8-7 Against Health Care Reform," 3/19/10). 

"Although this legislation is not perfect and does not do everything I believe is necessary to reform our health insurance industry, it is a tremendous step forward for northern Michigan residents and for our nation," Stupak said. "Skyrocketing health care costs are unsustainable for our families, our seniors, our businesses or our government. This legislation will protect consumers from unconscionable industry practices while helping to lower costs and make the health insurance industry more competitive."

But he quickly went from being the darling of Right to Life and some Catholic groups to being demonized. U.S. Rep. Dave CAMP (R-Midland) tried to stop passage with a procedural move, arguing that the bill would expand abortion. As Stupak was speaking, U.S. Rep. Randy NEUGEBAUER (R-Texas) shouted, "Baby killer!" He apologized today, saying he said it during the "heat and emotion" of the debate he was referring to the agreement, not Stupak. 

"I did receive an apology call from Congressman Neugebauer this afternoon. I accepted his apology," Stupak said. "I also let him know that, while we all have had a very long week and tensions were high leading up to the vote Sunday night, I feel it is important for Members to maintain decorum of the House. Over the past year there have been a couple of incidents on the House floor where outbursts have tarnished Congress's reputation and I hope there are no further incidents." 

U.S. Rep. John DINGELL (D-Dearborn) noted he is anti-abortion on WDET-FM today and called the outburst "very shameful behavior." Dingell met with Stupak on Saturday and made a pitch for the bill. Dingell told MIRS he and Stupak hunted together and they were able to take "fairly major steps to resolve [Stupak's] concerns." 

"The nation is better off and Bart Stupak deserves the respect and affection of the American people," Dingell said on WDET. 

Dingell presided over the final vote. His father, John DINGELL Sr., began introducing single-payer health care in Congress in 1943 and his son has carried on the tradition for 54 years. MIRSasked if he expected reform to take so long.

"Often times great changes require a lot of time," Dingell said, adding that the insurance lobby has spent "huge sums" of money fighting legislation. 

He also stressed that the bill that passed Sunday was not universal health care, although he said it would be a "significant improvement" for millions of Americans.

"There are all sorts of falsehoods being spread," Dingell said. "Remember death panels? A barefaced lie. Remember we were going to pull the plug on grandma? A barefaced lie. There is no government takeover of health care. This is a government program to improve health care and prevent unfair treatment of insurance companies.

MIRS asked if Democrats would lose seats in November because of health care reform, as many pundits and Republicans have suggested.

"No," Dingell said. "When people understand what's in the bill and what it does, they'll see that it's going to be very helpful."

But his GOP opponent for the 15th Congressional District, Dr. Rob STEELE of Superior Township, sees things differently. 

"The new health care plan that passed the U.S. House is not going to solve what ails us," said Steele. "This bill is an example of legislative malpractice, including both a misdiagnosis and the wrong, high-priced prescription." 

U.S. Rep. Pete HOEKSTRA (R-Holland), who is running for governor, also repeated the GOP claim that the bill permits taxpayer-funded abortion. He also said that the next step is to find other ways to stop the legislation. 

"First, we need to work to challenge its constitutionality, second we need to allow states to opt-out and third we need to repeal the bill to protect the insurance of the 85 to 90 percent of Americans who have it and fix it incrementally for others," he said. "The House has passed the bill, and the president intends to sign it into law, but we can and will continue to work to stop it."

Gov. Jennifer GRANHOLM cheered Congress' action moments after passage.

"The passage of health care reform is historic for Michigan," she said. "After decades of failed attempts, this legislation will give Michigan families and businesses more control over their own health care, will give them the security and stability that come with health care coverage, and will reduce overall health care costs. No state has needed reform more than Michigan, and I applaud and thank the members of our congressional delegation who voted for this legislation."

Meanwhile, Attorney General Mike COX today announced that Michigan has joined the State of Florida in a lawsuit challenging the constitutionality of health care legislation passed by the U.S. House. Cox is running for governor.

"Congress' attempt to force Michigan families to buy health insurance or else raises serious constitutional concerns," said Cox. "We will fight to defend the individual rights and freedoms of Michigan citizens against this radical overreach by the federal government."

Other impacts of the health care reform bill on Michigan are:

- Over 200,000 small businesses will receive a tax break to help provide health coverage for owners' families and employees, and will be able to purchase insurance at more competitive prices on insurance exchanges.

- Almost 1.6 million Medicare beneficiaries will see expanded benefits, such as new access to no-cost preventative care. 

- 135,000 Michigan seniors affected by the Medicare Part D "donut hole" will have the hole eliminated over 10 years. Those entering the donut hole will receive a $250 rebate for prescription drugs this year, and the average beneficiary will save $700 in 2011 and $3000 by 2020 when the donut hole is eliminated. 

- 141,000 Michigan residents with preexisting conditions like cancer, heart disease and diabetes could no longer be denied health coverage.

- 781,000 young adults in Michigan could now remain on their parents' health care coverage until they are 26.

March 12, 2010

    The Action's in the House as Democrats Work to Finalize Health Care Reform Legislation

The House Democratic leadership still continues to move full steam ahead in their efforts to bring comprehensive health reform legislation to the House floor. The White House and House leadership have softened on their original deadline for a vote by March 18, before President Obama would have left for a planned trip to Asia, but they continue to insist that they will vote very soon, perhaps by the end of next week. The House leaders met with members of the entire Democratic caucus both Wednesday and Thursday regarding the health bill, promising to soon release the text of a reconciliation package to “fix” some of the problems House members have with H.R. 3590, the bill passed by the Senate on December 24, 2009. In addition, they promised to soon make available a “score” from the Congressional Budget Office, indicating the cost of the proposed reconciliation “fix” measure to the federal government. House members were assured they will have at least a week to review the text of the bill before voting. Public option language will not be included in the reconciliation package, according to Speaker Pelosi, but the House may include student loan provisions, which have already passed the House with large margins, in the reconclliation bill package so that the Senate can consider them as well. President Obama also announced today that he will delay his trip to Asia until March 21, just so that he can focus on getting the health care reform legislation passed in the House.

While NAHU agrees that responsible changes need to be made to our private-market health care delivery system, we continue to oppose the Senate-passed health care reform legislation, with or without some type of attached “fix” bill. We also remain completely against the use of the budget reconciliation process to pass a comprehensive health reform measure. No legislation of this magnitude should rely on only the support of one party. We have sent another letter to House and Senate leadership signaling our opposition and urging them to 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 ask them to consider addressing true cost-containment principles, reasonable market reforms and fair and fiscally responsible financing as outlined in NAHU’s American Solution plan, which was recently updated by the NAHU Legislative Council and approved by the NAHU Board of Trustees at its March 7 meeting.

We also encourage all of our members to send messages to their lawmakers urging them to vote against the reform proposals currently on the table, and instead encourage them to work together on quality health reform legislation in a true bipartisan manner. We also encourage you to pass the letter along to your friends, clients and other interested parties, asking them to oppose the legislation and its proposed means of passage. We are particularly asking our members to focus on this list of House Democrats, all of whose votes are considered to be in play.

    Procedural Blows to Democrats Will Make It More Difficult for Health Care Reform to Make It Through the House

House Democrats suffered some blows yesterday that may make it significantly more difficult for their leadership to garner the necessary 216 votes to pass H.R. 3590, the Senate-passed comprehensive health reform bill, in the House. First and foremost, the Senate Parliamentarian, at the request of Senate Republicans yesterday, verbally ruled that H.R. 3590 must be passed by both chambers and signed into law by President Obama before the Senate can take up any reconciliation measure to amend the bill. This ruling seemingly undermines several of the complicated plans under consideration by the Democratic congressional leadership to garner the votes needed to pass a comprehensive bill acceptable to members of Congress from both chambers. 

First, it seriously limits the possibility that the Senate pass a “fix bill” via reconciliation first, allowing the House to pass the objectionable Senate bill second, after they have a guarantee that all of the items they find concerning (like the special deals for particular states and the excise tax provisions as originally structured), would never actually go into effect. The Senate Parliamentarian stated today that the only way Democrats could exercise this option is if all of the proposed changes in the reconcilliation bill only dealt with existing law (i.e., an expansion of Medicaid). Anything new, like the proposed excise tax, could not be included, which essentially renders the option pointless for House Democrats. 

Second, the ruling seemingly prevents the House leadership from procedurally tying the passage of the reconciliation bill and the Senate bill together. House leaders were attempting to convince members of their party that were on the fence earlier this week that if they would vote for the Senate bill as originally passed, then they would not send that bill to President Obama to sign until the Senate had passed the reconciliation bill with the necessary changes, thereby giving the on-the-fence House members a guarantee that their concerns with the Senate bill would be addressed. 

The House can still pass the Senate bill, but the members of that chamber now have no guarantee that the reconciliation “fix” bill will not ultimately be abandoned in the Senate and the original Senate bill will become the law of the land without any changes. And even if the reconciliation bill is passed in the Senate, there are also no guarantees that all of the Senate bill's problems can be fixed through reconciliation because of the strict rules that govern what types of provisions can and can’t be considered under that process.

For example, the House Democratic leadership admitted publicly yesterday that they would not be able to include the so-called “Stupak amendment” provisions relative to the public financing of abortion in any “fix” bill that would be considered under budget reconciliation rules. They have determined that many of the amendment’s provisions that were necessary to secure the yes votes of 6-12 representatives on the original House-passed legislation, would not be considered germane under the very specific procedural rules that govern the use of reconciliation in the Senate. Democratic Rep. Henry Waxman of California, chairman of the Energy and Commerce Committee, said yesterday that the leadership will press ahead anyway. But they will need to make up some of the “yes votes” that they will likely lose over the lack of an acceptable abortion compromise by flipping some of the other 39 Democrats who voted no on the House version of comprehensive health reform last November. There are also discussions that the so-called “Stupak Twelve” are being promised that the House leadership will attempt to “fix” the objectionable abortion provisions of H.R. 3590 by attaching rider language to another likely-to-pass measure later this year. 

Good Evening, 

We have concluded our 2010 NAHU Capitol Conference and I can say that this has been the wildest Conference that I’ve attended in the past 10 years I’ve been coming to DC to lobby on behalf of my clients and my industry! Over the past 3 days I’ve heard  many speakers on both sides of the Healthcare Reform issue and had meetings myself in the offices of Reps, John Conyers, Candice Miller, Dale Kildee, Fred Upton, Carolyn Kilpatrick, Mike Rogers and Senator Debbie Stabenow. The other members of our Michigan NAHU delegation held meetings with all of our other Michigan legislators.

What was so amazing in all of the meetings that I held was that every legislator had a different prediction on whether the Senate bill would be passed in the House. Even John Conyers’ office which is one of the most liberal Democrats believes that it will be a very close vote and may pass or fail by only one vote.

There are a number of dynamics at work here in DC and some of them are very interesting to watch. These are just the ones that I could find out from our meetings and discussions with our NAHU staff and lobbyists. There are probably other dynamics going on behind the scenes!

• All of the 39 Democrats that voted No on the original House bill have been called to the White House for a conference to discuss their position.

• The House Parliamentarian was called to a meeting in Speaker Pelosi’s office along with Rahm Emanuel to discuss the rules of the House.

• Blue Dog Democrat Bart Stupak is holding fast on his statement that he will not vote for the Senate bill unless they can “fix” the public funding of Abortion issue. He has 6 other Blue Dogs that are holding the line with him and that would be enough to defeat the Senate bill and the debate would be over.

• The Senate Republicans are planning on challenging every provision of the reconciliation bill as to it’s relevance to the budget.

• Some Democrats don’t like the Individual Mandate which is a part of both the Senate and House passed bills.

• The numbers still don’t add up to create the deficit reduction that the President states it will.

• If the House passes the bill, all of the “Sweetheart” deals would still be in the legislation!

The message that I took to the legislators is that my clients, colleagues and most of the citizens that I’ve spoken to don’t want the Senate bill passed in the House! Especially based on the promise that the Senate will “fix” the issues during the Reconciliation process.

If the Senate bill gets passed in the House then a number of things could happen as a result:

1.  The Senate could then declare victory and send the bill to President Obama for his signature and it would become law.

2.  The Senate could start the reconciliation process and then claim they can’t get reconciliation done and throw up their hands claiming they tried. Same result as # 1 above. They could then blame the GOP for stopping reconciliation from happening.

3.  The Senate could actually pass and approve the “fixes” they promise to address in reconciliation. Then that new bill would be passed in both chambers and would become law.

4.  The Abortion issue could be handled in a separate “side-car” bill that would be pulled form the Senate bill and addressed separately.

The President has told the House that he wants the bill passed by March 18^th before he leaves for Indonesia. Time is running out very quickly since it won’t be long before the Fiscal year is over and the 2010 budget year begins and this legislation must be handled in the current budget.

For those interested, the magic number to pass the bill in the House is 216 yea votes. As of the time I write this, the “nose counting” continues but so far it appears that Speaker Pelosi doesn’t have the votes.

I would ask that if you live or work in a Democrat’s district, please contact your Congressperson and tell them to stop this bill. It simple doesn’t deliver the needed reforms to reduce the costs of Health Care. It continues to be a partisan power grab!

If you’re not sure who your Legislator is, please visit www.house.gov and you can easily link to your congressperson’s website and sent them an email or call them and let them hear your voice!

Thank you for taking action in this very important debate. We are in the home stretch and can defeat this but it will take all the voices we can muster.

Looking forward to getting back to Michigan tomorrow.

Good Night,

Mike

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 of SJR K  also includes language from SJR 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.

But Sen. 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 Criticizes Individual Market Premium Increases
 
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.

[back to the top]

 
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

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.

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).

1/11/10 (see above for documents)

Good Evening,

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.

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.  

12/20/09
MANAGERS AMENDMENT

Good Afternoon Everyone,

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

12/18/09 Heritage Foundation bill analysis

12/16/09 NAHU PRESENATION ON NATIONAL HEALTHCARE REFORM

12/9/09 FROM NAHU

Tax hikes would precede health reform implementation by several years.

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 kloussedes@nahu.org.

Good Afternoon,

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.

Thanks as always for getting involved.
Mike Embry