MICHIGAN ASSOCIATION OF HEALTH UNDERWRITERS

March 5, 2010
 
Moving Forward, Like It or Not
 
Less than a week after the bipartisan health summit at Blair House during which President Obama asked both Republicans and Democrats to spend the next four to six weeks working cooperatively on health reform legislation, President Obama switched strategies in a nationally televised address,calling on the House and Senate to have an up or down vote on the comprehensive health reform bills already on the table within the next few weeks, stating, “I do not know how this plays politically, but I know it's right.”
While President Obama never used the words “budget reconciliation” in his remarks, he and the members of his administration, as well as Democratic congressional leaders, appear to have endorsed the controversial budget reconciliation strategy to pass the legislation. However, in an interesting twist, they have abandoned they idea of passing a reconciliation bill first that includes all of the negotiated changes and deals to things like the Cadillac tax, as well as the bipartisan ideas the president keeps touting in his summary plan for reform. Instead, Democratic leaders appear to have agreed to attempt to have the House pass the original Senate bill verbatim first, then move forward with fixing what they can through reconciliation. 
In some ways, this makes the reconciliation process a little bit easier for them, as there was much concern that going forward under the other method was both procedurally impossible and illegal, since you can’t amend a law before its actually signed into law. However, politically, the process is still fraught with peril (see reconciliation article below). President Obama has also called for an extremely aggressive timeline for this course of action, hoping to have the whole matter wrapped up before Congress leaves for Easter break in three weeks, with the House voting on the original Senate-passed legislation by March 18 before the president leaves for a trip to Asia. He’s also begun aggressively courting House Democrats for their votes. Speaker Pelosi and House Majority Leader Steny Hoyer both stated yesterday that the Obama time frame may be unrealistic, and that they will not necessarily rush a vote before Easter.
NAHU opposes both the original Senate-passed bill as well as the use of the budget reconciliation process to pass comprehensive health care reform legislation. While we strongly believe that our country could benefit from some affordable and responsible reforms to our private-market delivery system, legislation of this magnitude should not be developed and passed by a single political party. 
Our members attending NAHU’s annual Capitol Conference in Washington will be meeting with their congressional representatives in person to spread this message, and we have been working in conjunction with coalition partners like business groups, other agent trade associations and the health insurance industry to promote sensible and bipartisan reform. We’re particularly targeting members of the House of Representatives who either voted “NO” on the original House legislation or those who voted “YES” but have indicated that they may not be able to support the Senate-passed legislation as it currently stands. Here’s a letter on this issue you can send today to your member of the House of Representatives and here is another one that you can encourage your clients, family and friends to send.
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.

2/16/10 NAHU News

Snow Slows Health Care Action, But Doesn't Halt It Completely
 
Washington, DC, is famous for many things, including its complete inability to handle any weather-related emergency gracefully. This week’s two record-breaking blizzards were no exception, resulting in the federal government closing its doors for business four out of the past five days. As a result, little substantive legislative activity took place this week, but that doesn’t mean that there wasn’t any action at all on health care reform.
During a nationally televised interview with Katie Couric prior to the Super Bowl on Sunday, President Obama called for a bipartisan televised health care summit to be held at Blair House on February 25. "I want to consult closely with our Republican colleagues," Obama told Couric. "What I want to do is to ask them to put their ideas on the table... I want to come back [after the President’s Day recess] and have a large meeting, Republicans and Democrats, to go through, systematically, all the best ideas that are out there and move it forward." Obama followed up on this call for bipartisan cooperation with a meeting of Republican and Democratic congressional leaders at the White House on Tuesday. After the meeting, he told reporters about the GOP, “I’m willing to move off of some of the preferences of my party in order to meet them halfway, but there’s got to be some give from their side as well.” 
But there was decidedly non-bipartisan action going on as the snow piled up outside the Capitol too. Democratic Senate staffers continued to ponder scenarios to move health care reform legislation acceptable to Democrats in both chambers forward using the budget reconcilliation process. However, procedural hurdles (as reported in last week’s Washington Update) still daunt them.
In addition, in an interview with Roll Call on Tuesday, House Speaker Nancy Pelosi (D-CA) continued to urge the use of reconcilliation to pass health reform in the Senate. “It’s up to us to make sure the public knows that this is not extraordinary,” she said. “ And the public knows that a constitutional majority is 51. It would be a reflection on us if we could not convince people that this is not an unusual place to go.”
At an Academy for Health meeting that same day, her top health care aide, Wendell Primus, outlined a way in which he believes the Senate could do so. “The trick in all of this is that the president would have to sign the Senate bill first and then the reconciliation bill would be signed second and the parts of the reconciliation bill that trump the relevant portions of the first signed bill. You would really have to use the fact that a later enacted bill takes precedent over a previously enacted bill to achieve the right outcome.”
It’s very unclear whether or not Primus’ strategy would be deemed legal, as rules seem to not allow Congress to pass changes to a bill that is not yet law. And the Senate parliamentarian (who would make this determination) has yet to weigh in on Primus’ theory. 

The New York Times (1/30, A14, Pear) reported the Obama Administration "issued new rules...that promise to improve insurance coverage of mental healthcare for more than 140 million people insured through their jobs." Under the rules that go into effect July 1, "employers and group health plans cannot provide less coverage for mental healthcare than for the treatment of physical conditions like cancer and heart disease."         The AP (1/30) reported that the new rules prohibit "separate annual deductibles for mental health treatment" and higher "copayments for visiting a psychiatrist or social worker." The measure "also prohibits health plans from setting limits on number of visits or hospital days for mental health problems that are different from any such limitations on treatment for medical problems."         CQ HealthBeat (1/30, Norman, subscription required) reported that HHS Secretary Sebelius said, "The rules we are issuing today will, for the first time, help assure that those diagnosed with these debilitating and sometimes life-threatening disorders will not suffer needless or arbitrary limits on their care. ... I applaud the long-standing and bipartisan effort that made these important new protections possible."         Modern Healthcare (1/29, Zigmond) reported, "The rule applies to group plans of 50 or more people and divides benefits into the following six categories: inpatient, in-network; inpatient, out-of-network; outpatient, in-network; outpatient, out-of-network; emergency care; and prescription drugs."
FROM NAHU
1/29/09

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.

1/29/10 NAHU Newswire

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."
1/15/10 NAHU

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).

1/15/10 NAHU Newswire

The New York Times (12/30, A19, Cave) reports that Florida Attorney General William McCollum, "a Republican who is running for governor in 2010," on Tuesday "questioned the constitutionality of the federal healthcare bill." McCollum called "on states to study whether to file suit to kill a provision requiring that individuals buy health insurance or pay a fine." He called the insurance mandate "an affront to our country's principles." The view "places him in line with the attorneys general of South Carolina and nearly a dozen other states who have also threatened to sue over the mandate."         According to the Miami Herald (12/30, Logan), McCollum said the mandate "would penalize people who choose to do nothing, compared with the car-insurance requirement, which is connected with the decision to own a car and drive." He "directed his staff Tuesday to investigate the legality of" the requirement and "sent a letter to his counterparts in other states, asking them to join his investigation."         The St. Petersburg Times (12/30, Logan) notes that McCollum "also said he will join other attorneys general looking into the constitutionality of a Senate bill provision that would pay for Nebraska's share of the proposed Medicaid expansion, a deal secured by Sen. Ben Nelson (D-NE)."         The Christian Science Monitor (12/30, Richey) reports that the individual health insurance mandate "is a centerpiece of the healthcare bills currently pending in Congress." While "conservative analysts have been debating the legality of the measure for months," their liberal counterparts "have dismissed these concerns as overblown and political posturing."         In a telephone conference with reporters, McCollum "rejected several questions about his motivation being political," the AP (12/30, Kallestad) reports. He said, "I'm not opposed to healthcare reform as such although I'm not happy about this particular bill." Florida's Palm Beach Post (12/30, Bender) also covers the story.         Utah AG to join constitutional challenge. KSL-TV Salt Lake City (12/30) reports that Mark Shurtleff, Utah's attorney general, "is preparing to join a lawsuit that challenges the Senate's massive healthcare reform bill. Utah is one of 10 conservative states prepared to challenge the healthcare bill." The attorneys general "say the so-called Nebraska compromise part of the deal smells of corruption."
12/29/09 NAHU Newswire
Nebraska Medicaid deal may be "unconstitutional," South Carolina AG says.

Audits reveal $92 million in improper Medicaid payments in New York.

Healthcare bill passes 60-vote threshold in Senate bid to close debate.

December 18, 2009
	Scrooge, Grinch or Just Plain Crazy? Despite Obstacles, Majority Leader Reid Continues to Eye Christmas Eve Health Reform Vote
The Senate Democrats continue to stampede toward passing some form of health reform before year's end, even though only 31 percent of the American people support what Senate Majority Leader Harry Reid (D-NV) is doing, bill language is still not finalized and the Congressional Budget Office still hasn’t released an estimate of how much it will cost the American taxpayer. Several Democratic senators still haven’t committed to vote on the bill, while House Democrats are threatening to oppose the legislation in conference committee and key unions and Democratic party leaders are blasting the legislation. Procedurally, in order to vote before Christmas, Reid has to lock down the 60 votes he needs by tomorrow night. Under that scenario, the Senate would release a revised version of the bill this weekend or on Monday, take a series of votes on the bill next week and end with a vote to close debate at about 7:00 p.m. on Christmas Eve. This is all contingent on Reid’s securing 60 votes together in the coming days and keeping the Senate working practically round-the-clock.   As House Minority Whip Eric Cantor (R-VA) predicted this past summer, "If the bill fails it will be because of disagreement among the Democrats." Currently, Senator Ben Nelson (D-NE) remains uncommitted on the bill and on Thursday he rejected compromise language offered by his colleague Bob Casey (D-PA) relative to public financing of abortion-related services in health insurance policies sold through the exchanges. Nelson has publicly threatened to oppose the legislation if it does not include protections against public funding of abortion-related services similar to what were included in the Stupak amendment to the House-passed legislation, but those provisions are vehemently opposed by many liberal senators. Nelson has also expressed concerns about the bill’s cost, the CLASS Act, any public option language and the lack of available bill language to review. On the other end of the political spectrum, Independent Socialist Senator Bernard Sanders (VT), who caucuses with the Democrats, has also refused to commit to vote on the bill. Sanders was forced to withdraw his single-payer amendment to the original bill, H.R. 3590, this week after Senator Tom Coburn (R-OK) insisted the Senate clerk read the 767-page amendment for three hours on the floor, so that senators and the American people could understand what a single-payer system would entail. Since most variations of any type of government-run public plan option have been taken off the negotiating table, Sanders has refused to say if he will support a compromise Senate bill until he can review it and determine if it is strong enough for him.Beyond Sanders and Nelson, other moderate Democratic senators like Bayh (IN), Lincoln (AR), Webb (VA), Landrieu (LA), Specter (PA), as well Independent Joe Lieberman (CT), are not certainties either. Currently these senators seems to be on board, but since no senator has seen a completed new bill yet, and since a final cost analysis has yet to be made public, it is uncertain whether or not these moderates will have additional concerns once an actual draft and/or cost analysis is released. We've certainly seen that before in this process!Reid is also experiencing difficulty from key party leaders outside of the Senate. Former Vermont Governor and Democratic National Committee Chair Howard Dean came out in opposition to the Senate bill in a column in the Washington Post on Wednesday because it does not contain enough government intervention. The Service Employees International Union and the AFL-CIO are also publicly attacking the bill, particularly relative to its financing provisions which would levy a 40% excise tax on the highest cost health plans, like those that unions offer to their members. In addition, a number of more liberal House Democrats are voicing their displeasure about the potential compromises being considered by the Senate that they feel water down the bill, and have threatened to derail the legislation should it get to a conference committee.NAHU continues to oppose the Senate legislation in its current form, and we will continue to inform our membership of any breaking developments on the bill as they occur. Expect updated analysis from NAHU as soon as the revisions to the measure are released. In the meantime, we encourage you to contact your senators to oppose this legislation, particularly those of you represented by moderate Democrats who have expressed serious concerns about the cost of this measure and its potential to increase premium costs on the American people. We also encourage you to contact your senators about these specific provisions in the bill. [back to the top]

HHS awards $72M to nine states for gains in children's health insurance.

Liberals express outrage over White House tactics in healthcare debate.

Obama "cautiously optimistic" about prospects for health reform.

Senate Democrats appear close to dropping Medicare expansion.

Reid seeks to line up 60 votes for Senate health bill.

	Health Care Reform in the Senate — What in the World Is Going On?
It’s been a whirlwind week in the U.S. Senate regarding health reform developments. On Tuesday, Senate Majority Leader Harry Reid (D-NV) announced that he, along with five more liberal senators (Schumer-NY, Feingold-WI, Rockefeller-WV, Harkin-IA) and five moderate Democrats (Ben Nelson-NE, Carper-DE, Pryor-AR, Landrieu-LA and Lincoln-AR) had come to terms on a plan that would replace the public option in the current Senate bill with a new national insurance plan offered by private insurers, and provide a chance for older Americans to buy in to Medicare. Much like last month when Reid announced he and key moderates and progressives had come to terms on the inclusion of a public option with a state opt-out provision (an idea that is now apparently off the table), no real details or legislative language on the “deal” have been released–even to other senators. However, the group did agree to send information over to the Congressional Budget Office for scoring–a process that is expected to take the weekend and perhaps be completed by next Monday or Tuesday. Reid has told reporters and his caucus that the final details of the proposal, which could be offered as a “Manager’s Amendment” to H.R. 3590 as early as the middle of next week (depending on its cost) will not be released until the CBO has completed its work. Some of the consensus details that are known include: The creation of a national insurance plan to be administered by the federal Office of Personnel Management, which is the same agency that oversees the Federal Employees Health Benefits Program (FEHBP). Like FEHBP (which is really just the nation’s largest employer-sponsored health plan offering), the insurance options within the new plan would be offered by private carriers. And while the new plan would have many similarities to FEHBP, it would not be an opening of the FEHBP pool to the general public. A trigger option for a government-run plan if private carriers fail to participate in the new program. Expanded access to Medicare allowing people age 55 to 64 to purchase coverage in the program. Details of who would be eligible within that age group are unclear, as is if the rating and pricing for this population would be separate from the rest of the Medicare population. Some of the Senate negotiators have indicated that the buy-in period could start in 2011 (three years earlier than most other market reforms and the exchanges would take effect), but that no subsidies would be available for such coverage until 2014.  A medical loss ratio requirement for insurers to spend at least 90% of premium money on medical care, rather than on administrative costs or profits. It is unclear at this time if this requirement would apply to just the new national insurance program or to other markets/the exchanges as well. A reauthorization of the Children’s Health Insurance Program, which was set to expire on October 1, 2013. It is unclear at this time how the program would be impacted, whether or not this population would eventually move to the exchange, as is proposed in H.R. 3590 and if the mandatory premium assistance provisions in H.R. 3590 (which NAHU strongly supports) will be impacted. While we are waiting for actual legislative details to emerge, NAHU is opposed to all of the components of the compromise deal in concept. A new national insurance option is both unnecessary and a new government expense, and we believe the other significant market reforms under consideration should be given a chance to work before any type of new government-run plan is considered. A buy-in to Medicare would create an enormous adverse selection problem for an already financially troubled program and it would further exacerbate the existing Medicare/private insurance cost-shift, which already costs privately insured American families almost $1800 a year. We believe that it could represent a gateway to the full government takeover of American health care. Furthermore, it is unnecessary, as the new market reforms and high-risk pool provisions in the current bill will provide immediate access to coverage to anyone in this population who does not have it currently.  Finally, the 90% MLR idea is completely unworkable and unprecedented—no state insurance market has anything remotely similar, and we have seen the negative impact in state markets that have tried to set MLR levels at lower levels than those proposed. It will result in higher premiums and the loss of necessary consumer services that are not considered direct medical care costs, like claims processing, fraud protections, disease management, and more, not to mention its potential impact on the role of health insurance agents and brokers and the education and service they provide to consumers.

Hospital, physician groups opposed to Senate Medicare provision.

Senate public option compromise buoys Democratic health reform supporters.

Senate Democrats discuss compromise alternative to public option.

State approves UnitedHealth acquisition of Health Net Connecticut's membership renewals.

Senate defeats GOP amendment to reverse Medicare cuts in healthcare bill.

AARP voices support for proposed Medicare cuts in Senate healthcare bill.

Sen. Coburn targets health reform bill's Medicare cuts.

Senate Democrats' coalition on health reform said to be fracturing.

HHS report enumerates benefits of healthcare reform.

The Los Angeles Times (11/17, Levey, Hamburger) reports that "Congressional Democrats' intensifying efforts to pay for their healthcare overhaul and provide more relief for consumers are threatening to unravel a White House deal with the pharmaceutical industry and turn one of Washington's most powerful lobbies against the legislation." Under a "White House deal struck in the summer, companies pledged to support an overhaul and provide limited discounts to Medicare patients in exchange for a promise that no other controls would be imposed on pharmaceutical prices." But now a "bipartisan group of senators" is considering opening "the door to lower-priced prescription drugs from other countries." Meanwhile, "other lawmakers want to speed the development of cheaper generic versions of biologic drugs."

        AARP report shows higher prices for brand-name drugs. CQ HealthBeat (11/17, subscription required) reports, "A study released Monday by the senior advocacy group AARP found that brand-name drug prices have climbed by 9.3 percent since October 2008, despite the economic downturn." According to the AARP Rx Watchdog Report (pdf), "average manufacturer price increases for brand name and specialty prescription drugs often used by Medicare beneficiaries shot ahead of price increases for other consumer goods in the past year." Meanwhile, "average prices for generic drugs decreased."

        AFP (11/17) also notes that price increase "was considerably greater than the average increase over the past seven years -- 5.8 to 8.3 percent a year -- even though the US economy has been in a dive during much of the past year." The data also showed that "drug prices as a whole, including low cost generics, rose 5.4 percent in the past 12 months."

        Rising drug prices seen as betrayal of cost savings promises. In an editorial, the San Jose Mercury News (11/17) calls the pharmaceutical industry "cunning," as "only weeks ago, President Barack Obama was hailing a White House deal with drugmakers to 'save' the nation $8 billion a year in prescription drug costs. Now it turns out that Big Pharma has been quietly hiking wholesale prices of prescription drugs." The President "should renew his push to give the federal government the ability to negotiate bulk purchases of prescription drugs," according to the News. "Drugmakers deserve a fair profit for their lifesaving products. But they shouldn't get away with hoodwinking the president and the American public."

The AP (11/16, Yen) reports, "The government paid more than $47 billion in questionable Medicare claims including medical treatment showing little relation to a patient's condition, wasting taxpayer dollars at a rate nearly three times the previous year," according to a "fiscal 2009 financial report." According to the AP, President Obama "is expected to announce new initiatives this coming week to help crack down on Medicare fraud, including a government-wide website aimed at providing a fuller account of healthcare spending and improper payments made by various agencies." Likewise, CMS "will launch a Web interactive next month that will allow users to track Medicare payment information by categories such as state, diagnosis and hospital."

        Letters show CMS ignored Medicare fraud warnings. The AP (11/14, Kennedy) reported that, according to letters provided to the AP by Sen. Charles Grassley's (R-IA) office, CMS "received roughly 30 warnings from inspectors over three years...but didn't respond to half of them, even after repeated letters." The agency "repeatedly ignored internal watchdog warnings about swindlers stealing millions of dollars by scamming several programs." HHS Secretary Kathleen Sebelius said the CMS "typically responds to fraud warnings promptly, and has investigated more than 300 since 2006. She was not satisfied that all fraud alerts were receiving sufficient responses and her office is implementing a new process for tracking the red flags." Sen. Grassley said CMS should "respond to future fraud warnings within two months and Sebelius agreed. After Grassley's letter, all of the warnings were investigated, according to Sebelius spokesman Nicholas Papas."

The New York Times (11/13, A19, Pear) reports Senate Majority Leader, Harry Reid "is considering a proposal to increase the Medicare payroll tax on high-income workers" to help offset healthcare reform costs, Senate aides said. Reid "is apparently considering an increase in the Medicare payroll tax rate for workers with incomes of more than $250,000 a year." The proposal "is part of a legislative package that Mr. Reid has put together in secrecy" and sent to the Congressional Budget Office for analysis. The Wall Street Journal (11/13, A4, Bendavid) says the Medicare tax proposal is gaining popularity in the Senate.

        Reid seen as negotiating reform's cost while raising numbers of insured. The Wall Street Journal (11/13, A4, Adamy) reports that the health reform bills approved by the Senate committees each would expand coverage to a different percentage of Americans. In combining the bills, Senate Majority Leader Harry Reid (D-NV) must expand coverage to the most people possible, while keeping the total cost of the bill around $900 billion. Currently, 83% of legal US residents have health insurance, a number which the Senate Finance Committee bill would raise to 94%. Notably, the House healthcare reform bill passed recently would raise insured levels to 96%.

        Health reform bills would cut HMO funds. The Miami Herald (11/13, Dorschner) reports, "At the moment, both House and Senate healthcare reform proposals are seeking to slash funds to the HMOs that have attracted...283,000...South Florida seniors because of rich benefit packages that can include free dental and many other perks." However, "the House bill, which has already passed, and the main Senate proposal, still in committee, offer widely different specifics for reducing benefits for South Florida's elderly." The House bill would cut "HMOs down to the same level as fee-for-service plans. Some areas could be extremely hard-hit by that provision -- since they are high far higher than the average of 14 percent. South Florida would hardly be touched, except for one small provision." The Senate Finance Committee's bill, meanwhile, "would force insurers into competitive bidding to get the Medicare HMO contract for an area."

The Washington Post (11/12, Thompson) reports, "The nation's Hispanic lawmakers and largest advocacy groups are scrambling to develop a strategy to counter what they see as efforts to shortchange immigrants in health bills on Capitol Hill. ... With the current bills excluding more than a million Hispanics -- mostly legal immigrants -- the debate runs into the issue of immigrants' rights." According to the Post, "Under the health bill passed in the House on Saturday, illegal immigrants would be allowed to buy insurance on a newly created exchange with their own money and without government subsidies," but "the bill expected in the Senate would bar illegal immigrants from the exchange altogether. In both the Senate and House, all legal immigrants are eligible for government subsidies to buy insurance on the exchange, but immigrants who have been in the country for less than five years would remain barred by existing law from enrolling in Medicaid and Medicare."

        USA Today debates including undocumented immigrants in health overhaul. USA Today (11/12) editorializes that uninsured, undocumented immigrants "will continue to get sick" and continue to receive hospital and clinic care -- "both of which are supported directly or indirectly by taxpayers, the insured population, or both." Hence, it is illogical to exclude them when doing so could help "defray the costs" of insurance premiums and taxes. Moreover, data from the Migration Policy Institute show that "of the estimated 12 million unauthorized people in this country, about 3.7 million have insurance through an employer"; approximately 7 million are uninsured; and about 362,000 buy individual insurance. "Only the last group, plus the small segment of uninsured who have the means to buy insurance, would be" affected by health reform.

        In an "Opposing View" column in USA Today (11/12), Dan Stein, president of the Federation for American Immigration Reform, argues that extending insurance to unauthorized immigrants would make healthcare "even more expensive." According to Stein, "uncompensated care for illegal aliens already costs taxpayers $11 billion" annually. He cites a CBO analysis, which concluded that "expanded utilization" often leads to higher medical spending; and adds that greater utilization by undocumented immigrants would also "impact healthcare quality," by increasing physician wait times and reducing "access to services." Stein also contends that allowing unauthorized immigrants to purchase insurance under exchanges would create a "powerful magnet" for increased "illegal immigration."

The AP (11/11, Espo) reports that former President Bill Clinton "urged Senate Democrats on Tuesday to pass healthcare legislation by year's end, pointedly telling skittish lawmakers that an imperfect bill is preferable to another failure like the one he and the party endured in 1994." After the caucus meeting, Clinton said, "It's not important to be perfect here. It's important to act, to move, to start the ball rolling." The AP adds that Clinton "made an unusual visit to the party's weekly closed-door caucus meeting at the invitation of Majority Leader Harry Reid (D-NV) who has said he hopes the Senate can vote on a bill before the year is out."

        ABC World News (11/10, story 5, 0:15, Gibson) reported Clinton "called the bill an economic imperative. He warned Senators there will always be unintended consequences for whatever they do, but the worst thing to do, he said, is nothing." The New York Times (11/11, A22, Herszenhorn) notes that Clinton's "visit that seemed intended especially to encourage centrist Democrats who have yet to commit their support, including Senator Blanche Lincoln of Arkansas, Mr. Clinton's native state."

        McClatchy (11/11, Lightman) reports that Clinton urged the Senate Democrats, "Don't get too stubborn or demanding as you consider different pieces of the vast bill...just pass something." Clinton's "pitch came as" Majority Leader Reid "said he hoped that the full Senate could begin considering a healthcare plan next week. Reid faces enormous hurdles," and Clinton's "appearance Tuesday didn't appear to sway anyone."

        The Hill (11/11, Rushing) reports that Democrats "say Clinton explained his missteps during the 1993 debate, avoided specifics such as urging a public option plan and zeroed in on the need for quick action." Clinton also "was frank about his failure to pass healthcare during his presidency, added a third senator. Specifically, Clinton said he did not adequately explain to the public the impact of Senate filibusters and the need for reform." The Wall Street Journal (11/11, A4, Bendavid, Adamy, subscription required) also covers the story.

        Kennedy's long term insurance proposal could be sticking point. The Washington Times (11/11, Haberkorn) reports an insurance plan "championed by Sen. Edward M. Kennedy that would help elderly or disabled people avoid nursing homes ironically adds yet another sticking point to the comprehensive healthcare reform plans for which the Massachusetts Democrat fought through much of his career." The Community Living Services and Support (CLASS) Act "is designed to help those who need assistance with basic daily tasks pay for in-home assistance. But moderate Democrats and Republicans worry about the plan's impact on the deficit and the potential for saddling the federal government with the responsibility of another insurance program."

        Reid expects to finish healthcare reform before Christmas. The New York Times (11/11, A22, Herszenhorn) reports Senate Majority Leader Harry Reid (D-NV) "said Tuesday that he expected to bring major healthcare legislation to the floor next week and to complete work on the bill before Christmas," but "other Democratic leaders said it was unlikely that a bill could reach President Obama's desk by year's end." In a "first procedural step toward Senate debate, Mr. Reid on Tuesday night moved to put the House bill on the Senator calendar, from which he could call it up any time after Tuesday." Aides "said there was still much uncertainty, and Senate Democrats have repeatedly missed self-imposed deadlines on the health bill."

        Senate bill said to be preferable to House measure. In his New York Times (11/11, B1) column, David Leonhardt writes, "Making the medical system more efficient is, in short, about saving lives and giving Americans a long overdue raise. It is arguably the single most important step that the federal government could take to improve people's lives. And the bill that the House of Representatives passed last weekend simply does not get it done." The House bill "falls far short when compared with a bill that passed the Senate Finance Committee last month. It also fails to live up to Mr. Obama's campaign proposals and recent speeches."

The House passed H.R. 3962, the Affordable Health Care for America Act, by a 220-215 vote at 11:16 p.m. Saturday evening. Rep. Joseph Cao (LA) was the lone Republican to join 219 Democrats in supporting the bill, while 39 Democrats joined 176 Republicans in opposing it. About an hour earlier, the Republican alternative plan sponsored by Minority Leader John Boehner (R-OH) was rejected on a vote of 258-176, completely along party lines with the exception of GOP Rep. Timothy Johnson's (IL) vote against his party's measure. An amendment offered by Rep. Bart Stupak (D-MI) limiting abortion coverage in insurance policies, seen as crucial to getting anti-abortion Democrats to vote for the final measure, passed 240-194, with Republican Rep. John Shadegg (AZ) voting present. On that vote, 176 Republicans and 64 Democrats voted yea, while 194 Democrats voted nay.

        The AP (11/8, Espo) reported that the "Democratic-controlled House narrowly passed landmark healthcare legislation," against "nearly unanimous" Republican opposition. The vote "cleared the way for the Senate to begin a long-delayed debate on the issue that has come to overshadow all others in Congress." According to the AP, a "triumphant Speaker Nancy Pelosi (D-CA) likened the legislation to the passage of Social Security in 1935 and Medicare 30 years later -- and Obama issued a statement saying, 'I look forward to signing it into law by the end of the year.'"

        In a front-page story, the Washington Post (11/8, A1, Montgomery, Murray) added that "Democrats closed ranks" on the vote "after months of acrimonious partisanship." The Post also noted Rep. Cao's "surprise" vote, saying Cao, who represents "the Democratic-leaning district of New Orleans," had been "the target of a last-minute White House lobbying campaign."

        The Los Angeles Times (11/8) reported, "After a day of testy, sometimes repetitive debate," the House passed "a landmark healthcare bill that would create a new role for the federal government in supplying insurance for almost all Americans." The New York Times (11/8, A1, Hulse, Pear) reported in a front-page story that Republicans "were united in their withering criticism of the proposal" throughout the daylong debate, portraying it "as a government takeover of medical care that would damage a struggling economy, lead to job loss and result in the rationing of healthcare." Bloomberg News (11/7, Jensen, Rowley), McClatchy (11/8, Lightman), the San Francisco Chronicle (11/8, Lochhead), the Washington Times (11/8, Haberkorn, Miller), The Hill (11/8, Soraghan, Allen), and AFP (11/8) also reported on the vote.

        Major hurdles said to remain on path of healthcare reform drive. Media reports last night and this morning cast Saturday night's House vote on healthcare reform as a key step toward enactment of healthcare reform legislation. Analysts, however, say significant challenges remain as the reform push moves to the Senate. The AP (11/9, Alonso-Zaldivar), for example, reports that "the glow from a healthcare triumph faded quickly for President Barack Obama on Sunday as Democrats realized the bill they fought so hard to pass in the House has nowhere to go in the Senate." The Senate "won't run with" the House bill, because "the government health insurance plan included in the House bill is unacceptable to a few Democratic moderates who hold the balance of power in the Senate." AFP (11/9, Knox) notes that GOP Sen. Lindsey Graham (SC) said Sunday, "The House bill is dead on arrival in the Senate."

        NBC Nightly News (11/8, lead story, 3:30, Holt) referred to the House vote as "a critical milestone," but cautioned that "the battle is far from over." Obama was shown saying, "Given the heated rhetoric surrounding this legislation, I know this was a courageous vote." NBC went on to point out that "though the President cleared a big hurdle last night, an even bigger one looms in the Senate where there's disagreement on public option and how to pay for all it."

        In a front-page story, the New York Times (11/9, A1, Stolberg) describes the White House as increasingly "concerned that the Congressional timetable for passing a healthcare overhaul could slip into next year," and as result "stepping up pressure on the Senate for quick action." The Times adds that "the slim margin in the House...suggests even greater challenges in the Senate, where the majority leader, Harry Reid of Nevada, is struggling to hold on to all 58 Democrats and two independents in his caucus." The Los Angeles Times (11/9, Hook), McClatchy (11/9, Lightman), the Wall Street Journal (11/9, Adamy, Bendavid, subscription required), The Hill (11/9, Yager), USA Today (11/9, Fritze), the Washington Times (11/9, Lengell), and the Washington Post (11/9, Shear) also cover the story.

In what media reports termed a surprise appearance, President Obama visited the White House briefing room to tout the endorsements of AARP and the American Medical Association of the House Democrats' healthcare bill. The visit was noted on each of the networks last night, albeit in stories that were largely devoted to the raucous conservative protests at the Capitol. ABC World News (11/5, story 6, 2:45, Karl) reported, "President Obama touted two big endorsements of the healthcare bill, from the AARP and the American Medical Association." President Obama said, "I urge Congress to listen to AARP, listen to the AMA, and pass this reform for hundreds of millions of Americans."

        The CBS Evening News (11/5, story 4, 2:15, Reid) reported, "The White House is worried enough about the vote that the President made an unannounced appearance today to tout endorsements of the bill by the senior's lobby, AARP, and by the AMA, the nation's largest organization of doctors." NBC Nightly News (11/5, story 8, 2:25, O'Donnell) reported, "AARP, the lobby group for Americans over 50, signed on and showed off boxes of supportive petitions."

        The Washington Times (11/6, Ward) reports that Obama "urged Congress to heed new endorsements of the House healthcare bill by the AARP and the American Medical Association and pass the bill on Saturday, in a rare appearance at the White House briefing." The New York Times (11/6, A18, Hulse, Herszenhorn) reports Obama "noted that the endorsements covered viewpoints from two distinct sides of the debate: elderly Americans fearful that a healthcare overhaul could cut into Medicare, and the nation's doctors and medical professionals." Obama said, "We are closer to passing this reform than ever before. And now that the doctors and medical professionals of America are standing with us, now that the organizations charged with looking out for the interests of seniors are standing with us, we are even closer."

        The Chicago Tribune (11/6, Levey) reports that AARP Executive Vice President Nancy LeaMond "said the group saw the House Democratic bill as the most promising proposal." The AARP's backing "counters mounting opposition among employer groups who are stepping up their advertising campaign against the House Democratic bill." The Wall Street Journal (11/6, A8, Bendavid, Adamy, subscription required) also covers the story, noting that the AMA endorsement was not without qualifications.

        The Los Angeles Times (11/6, Muskal) points out that "Obama especially lauded AARP, saying the organization's nonpartisan support was important to reassure seniors worried about losing Medicare benefits if the health plan is signed. Critics contend that as part of the healthcare overhaul package, Medicare would be cut, but proponents say the decrease is just a cost savings and would not affect benefits."

        The Christian Science Monitor (11/6), The Hill (11/6, Young), Roll Call (11/6, Koffler, subscription required), the AP (11/6), USA Today (11/6, Kiely), Politico (11/6, Brown), CNN (11/6), Bloomberg News (11/6, Rowley, Dodge) CongressDaily (11/6, Edney, subscription required), and the Financial Times (11/6, Fifield, subscription required) also cover the story.

        Bloomberg News (11/4, Rowley) reports, "Undeterred by Republican election triumphs in Virginia and New Jersey," House Democratic leaders set a "vote as early as Saturday on the most sweeping overhaul of healthcare policy in four decades." Party leaders "signaled they're ready for the House to begin debating the legislation and vote on its final passage by filing a 42-page amendment that made last-minute changes to the bill." The Washington Post (11/5, A4, Montgomery) reports that Democratic leaders "were still locking down support Wednesday among a handful of holdouts, with the biggest bloc dissatisfied with the measure's handling of abortion." Many Democrats "said passing the measure has become even more crucial politically after Republicans won governor's races in Virginia and New Jersey this week."

        The New York Times (11/5, A22, Pear, Herszenhorn) reports that House Democratic leaders "struggled Wednesday to strike a deal that would restrict the use of federal money to pay for abortions under sweeping healthcare legislation headed for debate on the House floor this week. But the proposed compromise satisfied neither supporters nor opponents of abortion rights." The Wall Street Journal (11/5, A6, Adamy, Vaughan, subscription required) also notes the GOP gubernatorial wins increased some House Democrats' concerns about voting for the bill, and Democratic leaders did not appear to have 218 votes on Wednesday.

        The Washington Times (11/5, Haberkorn) reports leaders "and at least a handful of pro-life Democrats appear to be close to a deal on language that would assure them that taxpayers would not have to pay for abortions, which is the most significant hurdle to final passage." There are "expected to be conservative Democrats who vote against the bill over worry that it adds to the debt, allows for taxpayer-funded abortion or provides illegal immigrants access to the insurance exchanges."

        The Hill (11/5, Soraghan, Hooper) reports that on Wednesday, lawmakers "started clarifying their positions. Two committee chairmen -- Armed Services Chairman Ike Skelton (D-MO) and Science and Technology Chairman Bart Gordon (D-TN) -- announced they will oppose the bill, and two freshmen who voted against the bill in committee switched to support it." Republicans will "get a chance to offer their substitute, but it appears unlikely that Democrats will get the up-or-down votes many of them want for a Medicare-based public option, a single-payer system, or assurance that no tax dollars will fund abortions."

        Roll Call (11/5, Dennis, subscription required) reports Rules Chairwoman Louise Slaughter (D-NY) "clarified later that final votes could begin around 6 p.m. but may not necessarily be finished by then. She also said there would be five hours of debate on the measure." Slaughter, the "co-chairwoman of the Pro-Choice Caucus, said the rule for the bill would add language proposed by Rep. Brad Ellsworth (D-IN) aimed at beefing up a prohibition on federal funding for abortions."

        AARP to endorse House healthcare bill. The AP (11/5, Werner, Alonso-Zaldivar) reports that in a "coup for House Democrats, AARP will endorse sweeping healthcare overhaul legislation headed for a history-making floor vote, officials told The Associated Press on Wednesday." An announcement "from the 40-million member group is expected Thursday, said officials with knowledge of the group's decision." But "backing the 10-year, $1.2 trillion House bill is a tricky move for AARP. Many retirees are concerned about cuts in Medicare payments to medical providers, which will be used to finance an expansion of health insurance coverage to millions of working families who now lack it."

        Up to 30 Blue Dogs could vote against bill. The Hill (11/5, Allen) reports that many of the 52-member Blue Dog Democratic caucus met with Douglas Elmendorf, the director of the Congressional Budget Office (CBO), "to get an in-person explanation of the differences between the House and Senate healthcare bills." The "number of Blue Dogs leaning toward or committed to 'no' votes could be in the 30s, according to members, although Blue Dog leaders stress that they've done no whip count. But perhaps just as many have strong preferences for the healthcare bill approved by the Senate Finance Committee."

        Bill unlikely to draw any House GOP votes. The Hill (11/5, Hooper) reports deputy GOP Whip Rep. Kevin McCarthy (CA) said Republicans "will overwhelmingly reject the Democrats' healthcare reform measure when it is reaches the House floor." McCarthy "told The Hill that the number of Republicans supporting the sweeping legislation will be 'very, very close to zero.'" The Hill adds moderate GOP Reps. Mark Kirk (IL), Mike Castle (DE) and Joseph Cao (LA) "all say that without significant changes, they will oppose the bill."

The AP (11/4, Espo) reports that Senate Majority Leader Harry Reid (D-NV) "signaled Tuesday that Congress may fail to meet a year-end deadline for passing healthcare legislation, leaving the measure's fate to the uncertainties of the 2010 election season." The statement was "a blow to the White House," according to the AP. In a "weekly closed-door meeting of rank-and-file Democrats," Sen. Reid said, "We're not going to be bound by any timelines. We need to do the best job we can for the American people." Still, "Reid's office revised his remarks" later, saying that Congress could "still send a bill to the president by Christmas."

        ABC News (11/4, Karl) reports that "Senior Congressional Democrats told ABC News [Tuesday] it is highly unlikely that a healthcare reform bill will be completed this year." Citing "a senior Democratic leadership aide" and "two other key Congressional Democrats," ABC notes that the news "may come as an unwelcome surprise for the White House." The Washington Times (11/4, Haberkorn) calls the development "a blow to President Obama's top legislative priority."

        Time (11/4, Tumulty) attributes the delay to Sen. Reid "struggling to line up the 60 votes that are needed to overcome a potential filibuster." On Tuesday Reid "vowed to pass a bill 'as expeditiously as we can,' which is another way of saying it will probably be slow going over the weeks to come."

        According to Fox News (11/4, Turner), "Putting the legislation together has proved exceedingly difficult, and most aides now say there is virtually no way a bill can get to Obama's desk this year." Democrats echoing Reid's "shift in position" include Sen. Chuck Schumer (D-NY), who said, "We will move with all deliberate speed." Fox calls his comments "a far departure from last week when he said that a healthcare bill would get done by Christmas."

        The Hill (11/4, Rushing) notes, "Asked point-blank if a healthcare bill was possible by the end of the year, Reid told reporters he is pushing for a vote 'as expeditiously as we can.'" With Majority Whip Dick Durbin (D-IL), Reid "said their hands are tied until the CBO releases its cost estimate of the Senate bill."

        CQ Today (11/4, Ota, subscription required) reports that "unresolved questions" to be addressed after the CBO report still include "how to pay for the overhaul, how the plan's costs will be tallied and what kind of subsidies should be provided to low-income uninsured Americans," according to Sen. Durbin. He also "blamed Republicans for stalling action and pointed to several other legislative matters that he said must be resolved."

        AFP (11/4) notes that "pushing the fight to 2010 could complicate the delicate coalition-building needed to pass the bill because it is a midterm election year, when the entire House and one third of the Senate are up for reelection." Moreover, "Democrats face unique hurdles in the Senate, where they appear short of the 60 votes needed to overcome parliamentary delaying tactics and pass the bill." The Wall Street Journal (11/4, A5, Adamy, Yoest, subscription required), Bloomberg News (11/4, Litvan), and CongressDaily (11/4, subscription required) also cover the story.

10/31/09

CMS announces physician payment cuts.

The Wall Street Journal (10/31, Favole, subscription required) reported that the Center for Medicare and Medicaid Services announced new rules to cut

payments for physicians who use expensive medical-imaging equipment. Under the rules, the use of equipment for MRIs and CT scans to screen for diseases

will result in cuts of up to 38 percent for physicians who are paid under the Medicare Physician Fee Schedule.

        Bloomberg News (10/31, Nussbaum) reported that CMS also announced a "21.5 percent cut for all physicians" with "lower reimbursements for specialists." The "reductions will be made over four years rather than imposed at once in 2010." According to Allen S. Lichter, chief executive officer of the American Society of Clinical Oncology, "cancer-care doctors will see a six percent reduction over four years." Meanwhile, Jack Lewin, chief executive officer American College of Cardiology, noted that "the phase-in means 'a slow death' for heart doctors," adding that most cardiologists will "elect to leave the

practice."

        Lewin noted that "the rule puts into effect policy proposals that will unacceptably reduce payments for cardiovascular-related services," CQ HealthBeat (10/31, Reichard, subscription required) reported. Jonathan Blum, director of the CMS Center for Medicare Management, said however, that CMS "is removing drug expenditures from a calculation used to set doctor payment rates, which won't affect 2010 payments but "will have a positive effect on future payment updates." James J. Rohack, president of the American Medical Association, urged Congress to "fix the payment formula once and for all this year."

        In a separate article, CQ HealthBeat (10/31, Reichard, subscription required) reported that CMS also announced that "hospital outpatient departments will receive a 2.1 percent increase in Medicare payments in 2010 unless they failed to report data on the quality of their services," while "ambulatory surgery centers will see a 1.2 percent inflation update next year."

10/28/09

Democratic moderates appear to balk at Reid's health reform bill.

One day after Senate Majority Leader Harry Reid (D-NV) announced his healthcare overhaul plan, some Senate Democrats appeared uneasy about key provisions regarding the public option. Analysts say the potential defections call into question whether Democrats will be able to defeat an expected GOP filibuster. The Washington Post (10/28, Murray, Montgomery) reports that "lawmakers said that if moderates' concerns do not prevent the Senate bill from

advancing next month, the opt-out provision could be ditched on the floor. Some moderate Democrats are more comfortable with the 'trigger' approach that Sen. Olympia J. Snowe (R-ME) has advocated." Sen. Snowe has al already indicated that she will not back Reid's bill.

        The New York Times (10/28, A20, Herszenhorn, Pear), meanwhile, reports that while the "continuing apprehension" of some lawmakers "indicated substantial uncertainty," Democrats "expressed growing confidence that a version of the healthcare bill would be adopted," either "with or without a public option."

        AFP (10/28) notes that "Reid needs 60 votes to carry a procedural measure to move to the healthcare debate, and then 60 more to end debate and hold a final up-or-down ballot." The AP (10/28, Espo) reports that "Reid is expected eventually to secure all 60 Democratic votes on the critical first test to bring the bill to the Senate floor." However, Democratic "Sens. Ben Nelson of Nebraska, Mary Landrieu of Louisiana, Evan Bayh of Indiana, and Blanche Lincoln of Arkansas all declined to say on Tuesday how they would vote."

        Complicating matters for Reid, McClatchy (10/28, Lightman, Talev) reports, "Sen. Joseph Lieberman (ID-CT)...said he'd back a filibuster to prevent a public option from coming to a final vote." And, "while the Democrats, including Lieberman, are expected to vote with their party leadership at least to allow debate to begin, there are serious questions about whether they'll provide the votes needed to end debate over specific parts of the bill or, in the end, to approve the legislation." That, notes The Hill (10/28, Bolton), "means that as things now stand, Democrats will not have enough votes to pass healthcare reform with a so-called public option unless" Reid "can pick up unexpected GOP votes." USA Today (10/28, Fritze) similarly notes that "without Lieberman, Reid must find

support from Republicans, none of whom say they back the idea."

        The Los Angeles Times (10/28, Hook, Levey) reports, "A senior Democrat said that there were about 10 Democratic senators whose support had yet to be nailed down." Reid "has been meeting one on one with balky Democrats, and made a plea for party unity at the Democrats' weekly closed-door strategy lunch Tuesday. But so fraught are the politics of the debate, some Democrats emerged from that meeting saying they were not sure they would vote even to bring the bill to the floor, let alone vote for its passage." The Washington Times (10/28, Haberkorn) runs a similar story.

        In House, "more liberal" public option under 218 votes. The Hill (10/28, Allen, Soraghan) reports, "House Democratic leaders on Tuesday sought to capture some of the momentum created by the inclusion of a public health insurance option" in the Senate "by locking down as many members as possible on which public option they could support in the House healthcare bill." According to "Democratic leaders...a House bill could be unveiled as early as Wednesday, and go to the floor for a vote next week." But, "the leftward momentum in the Senate doesn't appear to have won the day for the most liberal alternative. After weeks of lobbying by liberals and House Speaker Nancy Pelosi herself, the more liberal, Medicare-based option had a clear majority of House Democrats, but

not the 218 needed to pass it." CQ Today (10/28, Epstein, subscription required) also covers the story.

10/27/09

Reid says Senate bill will include public option with state opt-out.

The CBS Evening News (10/26, story 2, 2:15, Cordes) reported, "For months, the public option was declared dead in the Senate," but on Monday, Senate Majority Leader Harry Reid (D-NV) "announced that the contentious government plan would be the cornerstone of the new Senate healthcare reform bill." Sen. Reid said, "The public option can achieve the goal of bringing meaningful reform to our broken system." NBC Nightly News (10/26, story 5, 1:15, O'Donnell)

reported, "Leaders of both parties had predicted that a public option was dead. But tonight it is back, and Senate Majority Leader Harry Reid is taking a risk." But "for more liberal Democrats, this kind of public option or any kind of public option is considered a victory."

        On ABC World News (10/26, story 5, 2:45, Gibson), George Stephanopoulos said Reid "still may not have the votes to get this to the Senate floor. But what the Senate leader saw is that he would have a lot more trouble with the majority of Democrats if he didn't include the public option in the bill than if he did."

        USA Today (10/27, Fritze) reports the "latest iteration of the public option would give millions of Americans who are not covered through their employer the option to buy insurance run by the government. States would have until 2014 to decide whether to withdraw from the public program, which Reid says would drive down rates." According to Bloomberg News (10/27, Litvan, Rowley), Reid "said the so-called public option with the opt-out provision is the 'fairest way to go' to ensure competition for private insurers."

        The New York Times (10/27, A1, Pear, Herszenhorn) reports in a front page story that Reid "sided with his party's liberals," but the announcement "set the stage for a test of Democratic party unity. With Republicans united for now in opposition to any bill including a public option, Mr. Reid needs support from all members of his caucus -- 58 Democrats and two independents -- to take up the legislation. Aides said Monday that he appeared to be short of that goal, lacking firm commitments from several members of the caucus." The Los Angeles Times (10/27, Levey) reports the "'opt-out' compromise is still two votes shy of the 60 Reid needs to overcome a Republican filibuster, according to a senior Democratic aide on Capitol Hill who requested anonymity when discussing the

plan."

        AFP (10/27, Knox) says that Reid "said the public option was 'not a silver bullet' but pointed to recent public opinion polls that showed a majority of Americans support the option to pick a government-backed insurance plan." The Senate debate "on the bill, a compromise between legislation from two Senate committees, will begin as soon as congressional budget analysts formally estimates how much the measure will cost -- most likely later this week -- according to

Reid."

        The Washington Times (10/27, Haberkorn) reports that Sen. Olympia Snowe (R-ME) "said she was 'deeply disappointed' with Mr. Reid's decision and would not support the bill." The Hill (10/27, Young) likewise reports Reid's decision "could cost him the support of" Sen. Snowe, "the only Republican to support a healthcare bill in Congress this year." With or "without Snowe, Reid said he's going ahead with the opt-out public option, though he voiced hope that

Snowe could still be convinced."

        The Washington Post (10/27, Murray, Montgomery), McClatchy (10/27, Lightman), the Wall Street Journal (10/27, A1, Hitt, Adamy, subscription required), the Oregonian (10/27, Pope), and Roll Call (10/27, Drucker, subscription required) also cover the story.

        Lieberman says he's motivated by deficit, not insurers' interests. The Hill (10/27, Rushing) reports Sen. Joe Lieberman (I-CT), "one of a handful of Senate wild cards in this fall's healthcare reform debate, says his concern about the Senate bill is based on the national deficit -- not the insurers that dominate his state." Lieberman "told The Hill he may support a bill that taxes insurers or cuts into their profits, but only if the federal deficit won't balloon as a result." Lieberman said, "Insurers aren't my biggest concern -- I sued them once when I was attorney general, and I'm not afraid to end anti-trust exemptions. I am really worried about what this could do to the deficit."