More Updates from NAHU (Nat'l Assoc Hlth Underwriters

	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. [back to the top]

	What's Going On With the Actual Bill on the Table—Amendment Process And Timeframe To-Date
Beyond the compromise discussions, the Senate has continued its work this week on amendments to the original bill, H.R. 3590. Earlier this week, a bipartisan amendment proposed by Senators Ben Nelson (D-NE) and Orrin Hatch (R-UT), which would have prohibited public financing of abortion-related services through the subsidies offered in the exchange (and was very similar to the Stupak amendment which ensured the passage of the House-passed health reform bill) was tabled by a 54-45 vote, which effectively killed it from further consideration. Nelson has repeatedly warned the Senate leadership that without the amendment he could vote against ending debate on the overall bill. Currently, the Senate is locked up over an amendment on the reimportation of prescription drugs offered by Senator Bryon Dorgan (D-ND). This amendment, which is opposed by NAHU and many others on both economic and safety grounds, does have bipartisan support. However, the Democratic leadership is worried that it would upset the deal the White House and Senate Finance Committee reached earlier this year with PHRMA and the pharmaceutical companies to voluntarily find $80 billion in cost-savings over time in exchange for their support of reform efforts. Yesterday, Senator Carper (D-DE) announced he had a hold on the Dorgan importation amendment, effectively blocking it from getting a roll call vote for the time being. The Senate also rejected a measure offered by Senator John Thune (R-SD) that would have stripped the CLASS Act provisions out of the bill to create a new long-term care insurance program, but did approve a measure that ensures premiums collected for the proposed long-term care insurance program are set aside to ensure the program's solvency. A proposal by Senator Blanche Lincoln (D-AR) to limit the tax deduction for executive pay for health insurers who participate in Medicare to $400,000 from $500,000 was rejected and one to cover mammograms and other preventive health screening for women at no cost to patients was accepted. They have also accepted measures to ensure that Medicare cost savings in the bill will be used to shore up the solvency of program, lower premiums and improve the quality and to theoretically ensure that the legislation will not reduce or eliminate guaranteed benefits in Medicare. In terms of timeframe, there continues to be a tremendous push to get something passed by the Senate before Christmas, and House leadership has sent signals that they may be amenable to adopting the Senate-passed legislation in order to truncate the conference committee process. However, it is unclear how the still-to-be finalized Senate bill, without a true public option and the Stupak public financing of abortion language, would sit with both the progressive and moderate members of the fractious House democratic caucus. Other complicating factors include other bills on the Senate schedule, such as the Transportation Appropriations Conference Report and other spending bills that have been passed by the House. They also need to address the debt ceiling. Furthermore, the lengthy CBO scoring process, potential concerns with the Democratic caucus about the “compromise deal,” and continued concerns about controversial issues like the abortion financing could derail the Christmas plans. It is still anyone’s guess as to whether or not the Christmas deadline will happen, but it is important to note that the Senate leadership has yet to meet a deadline it has set for itself! [back to the top]

	Reform "Compromise" Details Seem to Please No One
The release by Senate Majority Leader Reid of some details of the “compromise” proposal on the public option and other issues agreed to by five Democratic moderates and five liberals earlier this week has ignited a firestorm of criticism from all sides of the debate. Already, confidential sources in the Democratic leadership have indicated they are tweaking the proposal as a result of member concerns. Within the Senate, in addition to blanket opposition by the GOP leadership, several key moderates have announced varying degrees of concern about the proposal, particularly with regard to the proposed buy-in to Medicare for people age 55-64. Moderate GOP member Olympia Snowe (R-ME), who was not consulted in the most recent negotiating process but is still being courted as a potential cross-over vote, said this week that she was disturbed about the potential increase in the cost-shift to private plans, due to the low reimbursement rates Medicare already pays to providers. She explicitly noted that this provision plus others would in all likelihood ensure her final vote in opposition. Senator Joe Lieberman (I-CT), who caucuses with the Democrats but was not included in the recent negotiations either and has repeatedly stated that he would stand with the GOP to block any potential public option, told reporters this week that he was growing “increasingly concerned” about the proposal. “I am worried about what impact it will have on the Medicare program’s fiscal viability and also what effect it will have on the premiums paid by people benefiting from Medicare now.” Senator Ben Nelson (D-NE), who was included in the talks but has remained decidedly independent in this whole process, is still wounded by the defeat earlier this week of his bipartisan amendment to prohibit public financing of abortion services. Nelson, who opposes a public option, noted that the Medicare buy-in has the potential to drive the country toward a single-payer system “which I do not like.” He continued by saying, “I wouldn’t be surprised if this thing does not become a viable option. I think it is going to be the lesser of the popular things, but I am keeping an open mind.” Even much more liberal Senators whose votes are considered to be “safe” have expressed concerns about the lack of detail in the proposal and the lack of a true public option and the potential harm to Medicare. Senator Barbara Mikulski (D-MD) commented on Thursday, “What is the impact on the stability of Medicare? If we are going to expand it to 3 million people, then how are we going to pay for it? One of the ideas of health reform was to ensure the stability and solvency and benefit package of Medicare.” And even Senator Russ Feingold (D-WI), who was one of the five liberal negotiating Senators, has indicated to reporters that he hasn’t let go of the public option entirely and released a statement Tuesday indicating that he has also not signed onto the proposal. In addition to the opinions expressed this week by members of the Senate, many other groups and news media outlets have expressed their strong concerns as well. The private health insurance community is unified in its opposition to the new “plan,” as are key business groups like the U.S. Chamber, the NFIB, the National Retail Federation, the Business Roundtable and others. The compromise is also drawing the ire of leading provider groups. The American Hospital Association, the American Medical Association, the Federation of American Hospitals and the Mayo Clinic are all significant provider organizations that have objected to the new deal as described due to Medicare buy-in provisions and the potential payment reimbursement issue. Even AARP, which has previously endorsed versions of subsidized buy-ins to Medicare and the House-passed reform bill, said it did not know enough about the new initiative to take a position. The labor unions also stepped up their criticism of the proposed bill, with the presidents of the American Federation of Government Employees, the American Postal Workers Union and the National Association of Letter Carriers joining with the Communications Workers of America this week to express their unified opposition to the bill’s proposed excise tax on high-cost health insurance plans. The AFL-CIO also indicated its displeasure with this provision this week. Governors and state legislators are beginning to express their serious concerns, too, particularly over the potential expansion of Medicaid and how it could financially cripple the states, most of which are already facing record budget deficits. In particular, moderate Republican New York City Mayor Michael Bloomberg and Democratic Governor David Paterson, both being previous supporters of the reform effort, sent a joint letter on Dec. 8 to New York’s two senators, Charles Schumer and Kirsten Gillibrand, asking them to address problems with the current health care reform bill. “New Yorkers will more than pay their share for increasing health coverage around the country,” reads the letter. “All of the major financing options—from Medicare cuts, to Medicare tax increases, to excise taxes on higher cost health plans—can be expected to extract more revenue/savings from New Yorkers than the per capita national average. And, yet, New York will receive far less than the national average in federal relief.” The news media has also jumped on the compromise details as they are known. One of the most profound editorials came from the Washington Post which opined on Dec. 10, “…the last-minute introduction of this idea within the broader context of health reform raises numerous questions—not least of which is whether this proposal is a far more dramatic step toward a single-payer system than lawmakers on either side realize.” Finally, and most significantly, the American public’s support for the Senate’s work continues to fall. According to CNN’s survey this week, just 36% favor the Senate bill while 61% oppose it. 79% of Americans surveyed also said the bill would increase the deficit and 85% said the bill would increase their taxes. Fox reports this week that their survey shows that 57% oppose health reforms and 34% favor them. Also, their poll indicates 41% want Congress to pass reform while 54% said they'd rather Congress do nothing. A New York Times survey released this week shows that 34% of the public think the current reform proposals will hurt them versus just 16% who think it will help them. According to the Rasmussen polling organization, for the second week in a row only 41% of U.S. voters favor the health care plan proposed by President Obama and Senate Democrats. These two weeks at 41% approval follow a week of 38% approval over the Thanksgiving holiday—the lowest extended period of support for the plan yet. Rasmussen reports, “With the exception of a few days following nationally televised presidential appeals for the legislation, the number of voters opposed to the plan has always exceeded the numbers who favor it.” This week’s Rasmussen survey also shows that 51% oppose the plan, including 40% who strongly oppose it, with just 23% strongly in favor.