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Health Care Reform Archives

April 2, 2012. Supreme Court arguments in the challenge to health care reform bill closed on March 29. The final decision is very uncertain, as the justices appeared split on whether the entire law could stand without the individual insurance mandate. The court had 48 hours to vote on the trial, but the news likely won't be made public until June, after the Justices have handed in their final decisions and written briefs for and against the prevailing vote.

The recordings and transcripts are available at the court's web site at

March 26, 2012. March 23 marked the two-year anniversary of the Affordable Care Act. In sync with the anniversary, President Obama has released a new campaign video aimed at putting a face on the story of how health insurance reform became the law of the land. The film titled “The Story of the Affordable Care Act: From an Unmet Promise to Law of the Land,” highlights provisions that are individually popular (e.g. banning the concept of pre-existing conditions) then pivots to demonstrate what is at risk in the 2012 campaign. In an effort to put a face on the law, the campaign has also launched a new website and series of videos highlighting personal stories of American families who say they are already reaping the benefits.

The 2012 GOP presidential candidates have made rolling back the new health care law a central promise of their campaigns. Front-runner Mitt Romney, campaigning in Louisiana a day ahead of that state's Republican presidential primary, used the health care anniversary to forge ahead with his strategy of focusing on the White House instead of his GOP rivals.

To view the new website, visit and to view the new campaign video, visit

March 19, 2012

High Court Prepares for the PPACA

Preparations are currently being made for the Supreme Court to hear the challenge to the Patient Protection and Affordable Care Act (PPACA). The case is scheduled for March 26, 27 and 28, will include six hours of oral arguments.

On Day 1, the court will hear arguments on whether a case can be brought at all. Tax lawyers argue that a law called the Tax Anti-Injunction Act forbids the federal courts from hearing suits aimed at restraining the assessment or the collection of any tax. Under that law, a plaintiff must first pay the tax and then challenge it in court by demanding a refund. Tax experts claim that since the penalty for not having insurance will not be collected by the Internal Revenue Service until 2015, the plaintiffs must wait until then to go to court. Opponents argue that the "penalty" is not a tax and therefore not subject to the Tax Anti-Injunction Act.

Day 2 will focus on the main complaint — that the individual mandate violates the Commerce Clause by forcing people to buy a product they do not want. This, opponents argue, is not regulating commerce. Supporters contend that people without insurance use emergency rooms making the public responsible for the bill, and that the negative economic impact of that action is in fact commercial. Opponents argue that the mandate forces healthy people to purchase coverage they do not need in order to subsidize insurers.

On Day 3, the justices will hear arguments on "severability." Some opponents argue that if the individual mandate is declared unconstitutional, the entire act must fall because Congress did not write a severability clause into the law.

On Capitol Hill: Congressional Health Care for Seniors Act

A group of Senate Republicans have introduced legislation that would end traditional Medicare and sign seniors up for the same private healthcare plans received by members of Congress. The "Congressional Health Care for Seniors Act" would allow seniors to choose from the array of plans currently offered to the four million federal employees and their dependents in the Federal Employee Health Benefit program, starting in 2014. It would also gradually increase the eligibility age for Medicare from 65 to 70 over a 20-year period.

The bill was introduced by Senator Rand Paul of Kentucky. South Carolina Senators Lindsey Graham and Jim DeMint are co-sponsors, along with Senator Mike Lee of Utah. Their goal is to save Medicare from bankruptcy and ensure seniors have affordable, high-quality health care. According to the sponsors, allowing seniors access to the Federal Employee Health Benefit (FEHB) program, which members of Congress and federal employees use, will give them more choices and lower their out-of-pocket costs.

According to a synopsis from Senator Paul's office, the bill would:

  • Slash the deficit by $1 trillion over the first 10 years and reduce Medicare's 75-year unfunded obligation by almost $16 trillion;

  • Offer seniors "richer benefits, higher quality health care, and better access to doctors and providers" while cutting their premiums to $1,900 per year — less than the $3,500 seniors currently pay for Medicare benefits and supplemental insurance, or Medigap;

  • Charge seniors the same premium regardless of their health status or pre-existing conditions; 

  • Subsidize three-quarters of the cost of the average plan while offering additional premium assistance and cost-sharing through the Medicaid program for low-income seniors; 

  • cap total out-of-pocket costs; and

  • Create a new high-risk pool for the highest-cost patients within the FEHB program.

As soon as the bill was unveiled the National Active and Retired Federal Employees Association expressed concerns that the bill would destabilize the federal workers' program. In addition, Association President Joseph Beaudoin explained that starting in 2014, members of Congress will no longer be covered by the FEHBP but will be in state-based health care exchanges.

January 10, 2012

Health Care Law Legal Briefs 

President Obama's administration and opponents of the Health Care law are preparing for a late March hearing when the justices will consider challenges to the legislation.

The first round of legal briefs was due last Friday, with the administration defending an individual mandate requiring Americans to obtain health coverage or pay a fine. The National Federation of Independent Businesses (NFIB) also argued that if the mandate is struck down, the rest of the law will topple as well. On Tuesday, 27 states also challenging the law are expected to submit their arguments for why they say the law’s Medicaid expansion is unconstitutional.

As all sides prepare for three days of oral arguments, at stake are precedent-setting issues about what Congress can regulate and the reach of federal power. The challengers fear that if the individual mandate is upheld, there will be no limits on how far Congress can regulate, while the administration says the mandate is crucial to closing the uninsured gap and curbing the cost of health care.

The hottest points of friction center on the individual mandate and the Medicaid expansion. Offering a three-prong defense of the mandate, the administration is arguing that it helps solve a problem of national concern, the commerce clause gives Congress authority to regulate economic behavior and Congress can use its taxing power to impose a penalty for failing to purchase coverage.

The administration’s defense required it to argue that the penalty for failing to purchase coverage is a tax. Officials also emphasized a core piece of their argument: If the law didn’t require all Americans to obtain coverage, banning insurers from denying coverage wouldn’t work — largely because fewer healthy Americans would enroll, leaving companies with a disproportionate share of high-risk patients.

The NFIB focused its Friday arguments on the question of severability, also arguing that as the law’s centerpiece, the mandate is essential to accomplishing other major goals of the legislation, like extending coverage to some 50 million uninsured Americans and lowering the cost of health care.

December 20, 2011

The Department of Health and Human Services (HHS) has released a bulletin outlining proposed policies that will give states more flexibility and freedom to implement the Affordable Care Act. The bulletin describes an inclusive, affordable and flexible proposal and informs stakeholders about the approach that HHS intends to pursue in rulemaking to define essential health benefits.

Under the Department’s intended approach, states would have the flexibility to select an existing health plan to set the “benchmark” for the items and services included in the essential health benefits package. States would choose one of the following health insurance plans as a benchmark:

  1. One of the three largest small group plans in the state;

  2. One of the three largest state employee health plans;

  3. One of the three largest federal employee health plan options; and

  4. The largest HMO plan offered in the state’s commercial market. 

The proposed policy would give states the flexibility to select a plan that would be equal in scope to the services covered by a typical employer plan in their state. States and insurers would retain the flexibility to evolve the benefits package with the market as innovative plan designs are developed and advancements in care become available, and meet the needs of their citizens.

The bulletin issued addresses only the services and items covered by a health plan, not the cost sharing, such as deductibles, copayments, and coinsurance. The cost-sharing features will be addressed in future bulletins and cost-sharing rules will determine the actuarial value of the plan.  

For a fact sheet on the essential health benefits bulletin, visit:

October 31, 2011

Secretary of Health and Human Resources, Dr. Bill Hazel, recently announced that a selection has been made for a vendor to manage the statewide Health Information Exchange (HIE).

Community Health Alliance, a non-profit Virginia-based organization, will be responsible for the creation and governance of the statewide HIE, a secure, confidential, electronic system where a patient’s records will be accessible to other health care providers throughout the nation if a patient chooses to participate. Once implemented, the statewide HIE will improve the speed in which patients receive care, especially if the patient is receiving care from a physician other than their primary care provider. 

The Health Information Technology Advisory Commission was charged with ensuring broad stakeholder engagement and providing the governor guidance for the most effective use of the $11.6 million in federal funds to promote this effort. The Commission, which is chaired by Secretary Hazel, enlisted the support of private citizens, clinicians, health care professionals, and hospital and insurance executives to assist in building a collaborative model for a statewide HIE. 

The Virginia Department of Health’s Office of Information Management and Health Technology will be responsible for administering the program.

October 3, 2011

The U.S. Department of Health and Human Services (HHS) has announced a series of initiatives that will help over 900 community health centers and community-based organizations to enhance the quality and coordination of health care services across the country.

A total of $47 million, made available by the Affordable Care Act, was awarded in every state and will help improve quality and access to services for millions of Americans. They will also support better primary care and behavioral health services for people with mental and substance abuse disorders.

Both the HHS Health Resources and Services Administration (HRSA) and the Substance Abuse and Mental Health Services Administration (SAMHSA) are releasing awards in an effort to better coordinate care across the health care spectrum. HRSA will be releasing $32 million to 904 community health centers nationwide. These resources will provide upfront assistance to existing health centers as they try to achieve recognition as a patient-centered medical home. Activities will include care planning, support for team-based models of service delivery, and system upgrades.

SAMHSA is announcing $15 million in grants to support and promote better primary care and behavioral health services for individuals with mental and substance use disorders. These grants are funded by the Affordable Care Act’s Prevention and Public Health Fund to improve health status by improving the coordination of healthcare services delivered in publicly funded community-based behavioral health settings, including community mental health centers and public health departments in cities from Anchorage, Alaska to Norfolk, Virginia.  

Together, these announcements will help provide quality, patient-centered primary care to some of our country’s most vulnerable populations in every state across the country. In the Richmond City area, the Daily Planet and Vernon J. Harris East End Community Health Center both received $35,000.

To view the complete list of grantees receiving Health Center Quality Improvement and Patient Centered Medical Home Supplemental Funding from HRSA, visit HERE. To view a list of grantees receiving Primary and Behavioral Health Integration awards from SAMHSA, visit HERE.

September 26, 2011

U.S. Department of Health and Human Services (HHS) has announced Affordable Care Act grant awards of $109 million to 28 states and the District of Columbia that will help fight unreasonable premium increases and protect consumers. HHS has also released a new report entitled Rate Review Works detailing how previous rate review grants are fighting premium hikes and helping make the health insurance marketplace more transparent.

As of September 1, 2011, the Affordable Care Act requires health insurers seeking to increase their rates by 10 percent or more in the individual and small group market to submit their request to experts to determine whether the rates are unreasonable. The Affordable Care Act also requires insurance companies to publicly justify unreasonable premium rate increases. These provisions will bring greater transparency, accountability, and, in many cases, lower costs for families and small business owners who struggle to afford coverage.

The grants awarded help to create a more level playing field by improving how states review proposed health insurance rates and holding insurance companies accountable for disclosing information about unjustified rate increases. States are proposing to use Cycle II grant funds in the following ways:

  • Introduce legislation – Seven states are introducing legislation to strengthen their authority to review and/or publicize proposed rate increases.

  • Expand scope of rate review – Nineteen states and the District of Columbia are proposing to use grant funds to expand the scope of rate review, for example, by reviewing rates in new markets or by reviewing rates for new products.

  • Improve rate filing requirements – All 28 states and the District of Columbia are proposing to use grant funds to improve rate filing requirements, such as requiring insurers to provide additional information on administrative costs and requiring insurers to file rate increases in a standardized format.

  • Improve transparency and consumer interfaces – All 28 states and the District of Columbia are proposing to use grant funds to improve consumer interfaces, such as developing a Rate Review Home Page at the Department of Insurance Website and providing opportunities for consumers to comment on proposed rate hikes via the website.

  • Hire new staff – Twenty-three states and the District of Columbia are proposing to hire new staff during Cycle II to help review rates and protect consumers.

  • Improve IT – Twenty-seven states and the District of Columbia are proposing to use grant funds to enhance IT capacity through the development of new or improved rate reporting systems designed to collect more robust rate data and allow for advanced analysis of rate filings.

Virginia is using grant funds to target rate reviews with specific companies, conduct an extensive premium trend analysis, and create templates to allow for standardized rate filing submission. Rate and form filings are now available on the State’s website HERE.

For the full Rate Review Works report, visit HERE and to view a fact sheet on the awards recently announced, visit HERE.

September 19, 2011

Recommendations for Virginia’s Health Benefit Exchange. On Friday, September 9, the Virginia Health Reform Initiative (VHRI) Advisory Council met to discuss recommendations that will be provided to Governor McDonnell as the best options for the creation of the Virginia Health Benefit Exchange (HBE). The Council also discussed the governance and duties of the HBE, as well as what policy decisions should be left to the General Assembly. In addition, which decisions should be delegated to the Exchange Board and which decisions should be delegated to the Executive Director of the Exchange were discussed.

Council members decided to make the following recommendations to the Governor’s Administration:

  • Virginia’s Health Benefit Exchange should be housed in a newly created, quasi–government agency, similar to the structure of the Virginia Department of Housing;

  • The number and length of the term of the members of the HBE Board should be decided by the General Assembly;

  • The Board should be able to hire the Executive Director of the Exchange who should in turn, hire staff;

  • Allow the Exchange to run more like a business than a state agency by not subjecting it to procurement and personnel laws;

  • The Exchange will be subject to some transparency requirements (i.e. meetings conducted by the Exchange be subject to Freedom of Information Act (FOIA) requirements); and

  • The self sustainability of the Exchange, as required by federal law, will be financed through fees assessed on the insurance providers and consumers.

While the Commonwealth continues to wait for the federal guidelines that define what essential or mandatory benefits insurance companies in the Exchange must provide to consumers, the Advisory Council will recommend the state also require insurance companies to continue providing all mandated benefits to consumers. If insurance companies are required to provide additional mandated benefits in the commercial market, those benefits should be mandated in the Exchange, as well.

The VHRI Advisory Council recommendations will be presented to the Governor in a report by October 1, 2011, and will potentially become a part of the Governor’s legislative package for the 2012 General Assembly session. It is very likely that members of the General Assembly will also propose legislation to develop Virginia’s HBE.

September 12, 2011

4th Circuit Court of Appeals Makes Ruling. Last week, a federal appeals court dismissed the Commonwealth’s challenge to the healthcare reform law.

Considered as one of the highest-profile cases, the 4th Circuit Court of Appeals said Attorney General Ken Cuccinelli does not have a legal right to sue over the law's requirement that most people buy insurance. The court vacated a lower court's ruling in the case and instructed the lower court to dismiss the suit.

Unlike the 26 other states, Attorney General Cuccinelli sued on the grounds that enforcing the mandate would violate Virginia law. As Congress moved closer to passing healthcare reform, Virginia enacted a law that says state residents cannot be forced to purchase insurance. The 4th Circuit panel, however, said Virginia does not have standing to sue over the mandate because it lacks a "personal stake" in the issue. The judges seemed concerned during oral arguments that allowing the suit to proceed would essentially allow the states to exempt themselves from whatever federal laws they might choose.

The mandate has a mixed record in federal appeals courts. The 6th Circuit upheld the requirement in a June decision, while the 11th Circuit — which heard the high-profile challenge filed by 26 state attorney generals — ruled that the mandate is unconstitutional.

The Supreme Court is almost certain to have the final say on whether the coverage mandate is constitutional. Most legal observers expect the court to hear arguments during the term that begins in October, and rule in the summer of 2012.

Attorney General Cuccinelli is expected to appeal the 4th Circuit Court’s decision to the Supreme Court.

September 6, 2011

Oversight on Insurance Premium Increases. Health insurers will have to start publicly justifying rate hikes, according to a new requirement of the federal healthcare law.

The new rule, which went into effect last week, will mandate insurers post on their websites explanations of premium increases exceeding 10 percent and submit the hikes to state and federal regulators, who also will post them starting this year. The rule does not give state and federal regulators new authority to block rate hikes, even if government officials find the increases to be unjustified.

Some states already have such power, and several states routinely make insurers lower their rate increases after determining that proposed hikes are unjustified. Even in less activist states, some regulators have been beefing up oversight of insurance companies with the help of federal grant money made available by the healthcare law President Obama signed last year.

The Obama administration plans to rely on state insurance regulators to scrutinize insurance rates, but "Office of Consumer Information and Insurance Oversight (CIIO) within the HHS Office of the Secretary, will handle insurance oversight in states where the administration has determined that state supervision is inadequate, including Alabama, Arizona, Louisiana, Missouri, Montana, Pennsylvania, Wyoming and Virginia.

In Virginia, the Office determined that while Virginia’s Bureau of Insurance creates a report of rate increases in the small employer market, the CIIO determined the Bureau’s review and ability to control rate increases was not strong enough. The Bureau is now working with federal officials to address their concerns.

The administration plans to work with states to set individual state-by-state thresholds for rate hikes that will require public explanation from insurance companies.

August 22, 2011

The Departments of Health and Human Services (HHS), Labor, and the Treasury recently proposed new rules under the Affordable Care Act that will enable consumers to easily understand their health coverage and determine the best health insurance options for themselves and their families. Likewise, these proposed rules will assist employers in finding the best coverage for their business and their employees. Under the proposed rules announced, health insurers and group health plans will provide consumers with clear, consistent and comparable information about their health plan benefits and coverage. The new forms, scheduled to be available in 2012, will be a critical resource for more than 180 million health insurance consumers with private health insurance coverage.

The rules proposed will enable consumers both to more easily understand the coverage they already have and, when purchasing new coverage, to make apples-to-apples comparisons of available options. Specifically, the proposed regulations would ensure consumers have access to two forms that will help them understand and evaluate their health insurance choices, including:

  • An easy to understand Summary of Benefits and Coverage; and

  • A uniform glossary of terms commonly used in health insurance coverage, such as “deductible” and “co-pay”.

For more information about the proposed regulation, visit HERE and to view the proposed template for the Summary of Benefits and Coverage, visit HERE.

August 15, 2011

On Friday, the 11th Circuit Court of Appeals in Atlanta ruled on a 2-1 vote that the individual mandate in the Obama administration’s healthcare law is unconstitutional. The decision affirmed part of a January ruling by U.S. District Judge Roger Vinson of Florida, who also ruled the health-insurance mandate unconstitutional. The decision, however, overturned the portion of Judge Vinson's ruling that voided the entire health-care law. According to the Atlanta court, the unconstitutional insurance mandate could be severed from the rest of the law, with other provisions remaining "legally operative."

Several legal challenges are working their way through the nation's courts, but this most recent ruling came in the highest-profile lawsuit bought by 26 governors and attorney generals from states including Florida, Ohio and Texas.

The decision directly conflicts with a different ruling issued in June by the 6th Circuit Court of Appeals in Cincinnati that upheld the law on a 2-1 vote. A ruling on the constitutionality of the law is expected soon from the 4th Circuit in Richmond, Virginia. At issue in that case are two challenges, including one brought by Attorney General Ken Cuccinelli and the other by Liberty University.

Minutes from the July 15 Virginia Health Reform Initiative (VHRI) meeting and the final of three background memorandums designed to solicit written public comments on potential options and recommendations on a Virginia Health Benefit Exchange (HBE), have been released.

Secretary Hazel along with the State Corporation Commission’s Bureau of Insurance continues to work with the Virginia General Assembly, relevant experts and stakeholders to provide recommendations regarding the governance and structure of the Virginia HBE for consideration by the 2012 Session of the General Assembly. Final options and recommendations are due to the Governor and General Assembly members by October 1, 2011.

For a copy of the July 15 meeting minutes and the most recent background memorandum, visit the VHRI website HERE. Please note that comments are due by 5 p.m. on August 26, 2011.

The September 9 meeting details are as follows:

  • Time - 9:00 a.m. to 5:00 p.m.

  • Location - Virginia Department of Health Professions (located at the Perimeter Center), 2nd floor Board room in the Commonwealth Conference Center, 9960 Mayland Drive, Henrico, Virginia 23233

July 18, 2011

Last week, the U.S. Department of Health and Human Services (HHS) proposed a framework to assist states in building Affordable Insurance Exchanges; state-based competitive marketplaces where individuals and small businesses will be able to purchase affordable private health insurance and some believe have the same insurance choices as members of Congress. Starting in 2014, Exchanges will make it easy for individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for tax credits for private insurance or health programs like the Children’s Health Insurance Program (CHIP), and enroll in a health plan that meets their needs.

HHS proposed new rules offering states guidance and options on how to structure their Exchanges in two key areas:

  • Setting standards for establishing Exchanges, setting up a Small Business Health Options Program (SHOP), performing the basic functions of an Exchange, and certifying health plans for participation in the Exchange, and;

  • Ensuring premium stability for plans and enrollees in the Exchange, especially in the early years as new people come in to Exchanges to shop for health insurance.

These proposed rules set minimum standards for Exchanges, give states the flexibility they need to design Exchanges that best fit their unique insurance markets, and are consistent with steps states have already taken to move forward with Exchanges. Forty-nine states, the District of Columbia and four territories accepted grants to help plan and operate Exchanges. In addition, over half of all states are taking additional action beyond receiving a planning grant such as passing legislation or taking Administrative action to begin building exchanges. States will continue to implement exchanges on different schedules through 2014.

For more information on Exchanges, including fact sheets, visit HERE.

July 11, 2011

The U.S. Department of Health and Human Services (HHS) recently announced three new initiatives to help states improve the quality and lower the cost of care for the approximately nine million Americans who are eligible for both Medicare and Medicaid. The announcement comes as part of the Obama Administration’s ongoing efforts to provide states with flexibility and resources to better serve high-need, high-cost enrollees. Initiatives include:

  • A technical resource center available to all states to help them improve care for high-need high-cost beneficiaries.  

States and the federal government spend more than $300 billion each year to care for Americans eligible for Medicare and Medicaid. In Medicaid, these individuals represented 15 percent of enrollees and 39 percent of all Medicaid expenditures. In Medicare, they represented 16 percent of enrollees and 27 percent of program expenditures.

For more information about these initiatives, visit HERE and to see a blog posting on this topic by Dr. Don Berwick, CMS Administrator, visit HERE.

July 5, 2011

Last Wednesday, a three-judge panel from the United States Court of Appeals for the Sixth Circuit held that it was constitutional for Congress to require that Americans buy health insurance.

The ruling by the Cincinnati court is the first of three opinions to be delivered by separate courts of appeals that heard arguments in the health care litigation in May and June. Opinions are expected soon from panels in the Fourth Circuit in Richmond and the 11th Circuit in Atlanta.

Attorneys on both sides of the case widely expect the Supreme Court to take one or more of the cases, perhaps as soon as its coming term, which starts in October. The speed of the Sixth Circuit ruling could help ensure that timing.

The Sixth Circuit majority held that the mandate was “facially constitutional under the Commerce Clause” for two reasons. First, the provision regulates economic activity that Congress had a rational basis to believe has substantial effects on interstate commerce. Second, Congress had a rational basis to believe that the provision was essential to its larger economic scheme reforming the interstate markets in health care and health insurance.
The court directly addressed whether a choice to go without health insurance qualifies as an “activity” that substantially affects interstate commerce, which is the standard set in prior Supreme Court decisions. The majority emphasized that the case should not hang on distinctions about whether the failure to buy insurance should be defined as activity or inactivity, a question the Supreme Court has never considered.

June 27, 2011

The Obama administration recently announced it is changing the way it approves waivers to the healthcare reform law given to health plans. Instead of approving a new batch of year-long waivers every month, the Centers for Medicare and Medicaid Services (CMS) announced that plans have until September 22, 2011 to apply for a waiver that will carry through 2013. Starting in 2014, all plans will have to comply with the provisions of the law and the waivers will be moot.

The waivers are for a single provision of the healthcare reform law which includes the requirement that health plans spend a minimum amount on medical coverage every year before cutting off benefits. This amounts to $750,000 in 2011. The administration to date has granted 1,372 waivers, covering 3.1 million people.

The monthly reports of the waivers have led to criticism of the Obama administration, however, a recent Government Accountability Office report found nothing suspicious about the way they've been awarded.

June 20, 2011

VHRI Memorandum #2 Released. Minutes from the May 26 Virginia Health Reform Initiative (VHRI) meeting and the second of three background memorandums designed to solicit written public comments on potential options and recommendations on a Virginia Health Benefit Exchange (HBE), have been released.

Secretary Hazel along with the State Corporation Commission’s Bureau of Insurance continues to work with the Virginia General Assembly, relevant experts and stakeholders to provide recommendations regarding the governance and structure of the Virginia HBE for consideration by the 2012 Session of the General Assembly. Final options and recommendations are due to the Governor and General Assembly members by October 1, 2011.

For a copy of the May 26 meeting minutes and the most recent background memorandum, contact the Office of Government Relations at Also, visit the VHRI website HERE.

Please note that comments are due by 5 p.m. on June 29, 2011. Prior to the next meeting on July 15, VHRI staff will resend a copy of the second memorandum and a compilation of all received written public comments. At the next meeting, information received will form the basis of discussions. Time will be allotted for a public comment period.

June 6, 2011

Federal Appeals Court Jurisdiction. Attorney’s involved in lawsuits over the health care law recently argued a federal statute that generally bars lawsuits challenging taxes before they are paid does not prohibit a federal appeals court from reaching a decision in the cases here in the Commonwealth. The Justice Department, Attorney General’s office and Liberty University took the same position in supplemental briefs filed last week with the 4th U.S. Circuit Court of Appeals.

A three-judge panel of the appeals court heard arguments in the cases on May 10, 2011, and then asked for additional briefs. Specifically, the judges asked whether the federal Anti-Injunction Act strips the court of jurisdiction to decide the lawsuits. The 1867 federal law says a tax can be challenged only after it is paid and the taxpayer unsuccessfully seeks a refund. The question arose because the new health care law requires citizens to buy health insurance starting in 2014 or pay a penalty. The Justice Department, citing the penalty provision, confirms the health care law is a valid exercise of congressional taxing authority. However, the state and Liberty University argue the penalty is not a tax.

The Justice Department is appealing U.S. District Judge Henry E. Hudson’s decision striking down the insurance mandate and Liberty is appealing U.S. District Judge Norman Moon’s ruling upholding the health care law. The two judges disagreed on the central question in both cases, which is, whether Congress exceeded its constitutional authority under the Commerce Clause in passing the minimum coverage requirement.

A decision by the appeals panel is expected in a few weeks. Attorneys on both sides have said the cases ultimately will be decided by the U.S. Supreme Court.

Meanwhile, 11th U.S. Circuit Court of Appeals will hear arguments Wednesday on whether to reverse a Florida judge's ruling that struck down vast portions of the law. Attorneys representing 26 states challenging the law will face off against the Justice Department in the Court of Appeals. The Justice Department argues the legislative branch had the authority to enact the Affordable Care Act while the state’s attorneys will argue Congress exceeded its power and tread on states' domain.

May 31, 2011

General Governance Model. The Virginia Health Reform Initiative Advisory (VHRI) Council met last week to make a preliminary recommendation on the general governance model the Commonwealth would pursue for its health insurance exchange. While a final decision of where the exchange will be housed was delayed until the Council’s next meeting on July 15th, a straw poll of Council members indicated that the majority of members favored the idea of establishing the exchange as an independent, quasi-public entity analogous to the Virginia Housing Development Authority.

The council also expressed a strong preference for a governing board model where the board (initially appointed by the Governor and General Assembly) would do the following:

  • Have authority to hire an executive director and ensure the entity met its objectives;
  • Be composed of 11-15 members representing necessary expertise and key stakeholders;
  • Be transparent in its operations but not tied to public procurement or employee compensation systems; and
  • Elect its own leadership.

The next meeting of the VHRI Advisory Council will be held July 15 and will focus on strategies for ensuring effective competition within the exchange. Details of the federal requirements for state exchanges are still not known, but one clear expectation written in the health reform legislation is the exchanges must be self-sufficient by 2017. For more information, visit VHRI’s website HERE.

May 16, 2011

4th U.S. Circuit Court of Appeals. Last Tuesday, a panel appointed by the 4th U.S. Circuit Court of Appeals in Richmond heard testimony from attorneys in separate lawsuits brought by the Commonwealth and Liberty University, challenging the 2010 health care law. The panel of judges included The Honorable Diana Gribbon Motz, The Honorable Andre M. Davis and The Honorable James A. Wynn Jr.

The U.S. Supreme Court is expected to make the final decision on the law’s constitutionality and cases like Virginia’s are the first to be argued at the appeals level. Liberty and the state which is represented by Attorney General Cuccinelli, maintain Congress overstepped its authority under the Commerce Clause by enacting the insurance mandate requiring nearly every American to purchase insurance by 2014 or face a penalty.

In June, a separate case filed by 26 states is scheduled for oral argument in Atlanta, Georgia and includes individuals who would be affected by the law as well as the National Federation of Independent Business, representing small employers who must abide by the law’s mandate that employers provide health insurance in 2014.

Courthouse aides report the 4th Circuit Court takes 45 days on average to reach a decision and a ruling may come as soon as July.

May 9, 2011

Governor McDonnell’s Request to Ease Healthcare Mandates. Governor Bob McDonnell has sent a letter to President Barak Obama, his Administration and leaders in Congress calling upon them to repeal provisions in the federal healthcare stimulus program that require states to maintain Medicaid eligibility levels at previous rates. The Maintenance of Eligibility (MOE) provisions in the mandate restrict Virginia and other states from reducing the number of citizens eligible for Medicaid by lowering maximum income standards for participation in the program. According to the Governor, the federal directive regarding MOE increases Virginia healthcare costs by $460 million. To view a copy of the letter, visit HERE.

May 2, 2011

Request to the Supreme Court. Last week, the U.S. Supreme Court rejected Attorney General Ken Cuccinelli’s request to expedite the state’s lawsuit challenging federal health care law. Although the case will likely end up before the Supreme Court eventually, Mr. Cuccinelli asked the Justices in February to redirect it out of federal appeals court and resolve questions about its constitutionality more quickly. With the court’s denial of his request, the case will remain on its current schedule to be heard May 10, 2011, in the 4th U.S. Circuit Court of Appeals in Richmond. Historically, the Supreme Court rarely has granted such requests and Attorney General Cuccinelli predicts the case will reach the Supreme Court by June 2012, after winding its way through several appeals courts.

While all of the lawsuits challenge the constitutionality of the entire health care legislation, the most controversial part is a mandate that requires all individuals to purchase health insurance by 2014 or pay a penalty. It also requires states to set up health-care exchanges, requires insurance companies to cover children up to age 26 and dramatically expands Medicaid.

Right now, Virginia’s lawsuit is separate from a similar challenge filed by former Florida Attorney General Bill McCollum and signed on to by 25 other states. However, the two lawsuits could get rolled together before the Supreme Court next year.

The Commonwealth is currently moving ahead with the federal health care law as it stands. Secretary Bill Hazel along with the members of the Advisory Committee of the Virginia Health Reform Initiative (VHRI), the State Corporation Commission’s Bureau of Insurance are working with the General Assembly and stakeholders to provide recommendations regarding the governance and structure of the Virginia Health Benefit Exchange for consideration by the 2012 General Assembly session.

April 25, 2011

Virginia Health Benefit Exchange. The first of three background memorandums designed to solicit written public comments on potential options and recommendations on a Virginia Health Benefit Exchange (HBE) has been posted on the Virginia Health Reform Initiative (VHRI) website. Secretary Hazel along with the State Corporation Commission’s Bureau of Insurance will work with the Virginia General Assembly, relevant experts and stakeholders to provide recommendations regarding the governance and structure of the Virginia HBE for consideration by the 2012 Session of the General Assembly. Final options and recommendations are due to the Governor and General Assembly members by October 1, 2011. To view the memorandum and for more details, visit HERE.

April 11, 2011

Health Benefit Exchange Activity. Last Wednesday, Dr. Bill Hazel, Secretary of Health and Human Resources, held a conference call regarding Virginia Health Reform Initiative (VHRI) activities and next steps for 2011. The call included an update on 2011 VHRI related legislation and budget items, a description of the process for the planning for the Health Benefit Exchange and an update on Task Force activities.

October 1, 2011 is the deadline for coming up with recommendations for consideration of the Governor and the 2012 General Assembly regarding the structure and governance of the Health Benefit Exchange (also the end of the federal planning grant). Based on legislation, the recommendations should address the following at a minimum:

  • Whether to create the Exchange within an existing governmental agency, as a new governmental agency, or as a not-for-profit private entity;
  • The make-up of the governing board for the Exchange;
  • An analysis of resource needs and sustainability of such resources for the Exchange;
  • A delineation of specific functions to be conducted by the Exchange; and
  • An analysis of the potential effects of the interactions between the Virginia Exchange and relevant insurance markets or health programs, including Medicaid.

Cindi Jones, Director of the Virginia Health Reform Initiative, is the lead for the planning of the Health Benefit Exchange. Dr. Len Nichols from George Mason University has agreed to continue to work with Virginia on Exchange planning activities. DMAS staff will continue to play an integral role on the project team and Jackie Cunningham, Commissioner, Bureau of Insurance and her team will continue to offer guidance and support to the project. Three meetings with the VHRI Advisory Council on key Exchange issues have been scheduled. For more information on Council activities and meetings, please visit the VHRI web site.

March 28, 2011

Patient Protection and Affordable Care Act. Last week marked the one-year anniversary of President Obama signing the federal health care law. Several federal agencies, including the U.S. Departments of Labor, Education, Justice, and Health and Human Services (HHS), have started the implementation process for the federal Patient Protection and Affordable Care Act (PPACA). In addition, state legislatures and regulatory branches are charged with implementing some of the reforms, including the creation of state-run health care exchanges. Some provisions of the law took effect in September 2010, six months after its passage, including:
·Extending the age of adult children eligible for coverage under their parents’ health care plan to age 26.
·Prohibiting individual and group health plans from placing lifetime limits on the dollar value of coverage.
·Preventing health insurers from rescinding coverage (except in cases of fraud).
·Prohibiting health insurers from imposing pre-existing condition exclusions for children.
·Mandating coverage for recommended immunizations and preventive care.

PPACA has also established new offices and programs at HHS such as the Office of Consumer Information and Insurance Oversight (OCIIO) and the Patient-Centered Outcomes Research Institute (PCORI).

March 7, 2011

Federal Health Reform, State’s Options. Federal court rulings against the health care overhaul have received a lot of attention.  While states continue to differ on implementation and delivery, President Obama now supports legislation that would let states opt out of the health law.  The measure (S 248) would allow states to seek waivers from the law sooner than 2017, which is now the earliest date under which they can set up systems different from the federal approach. The waivers would be in effect for five years and could be renewed.  Administration aides report the President does not plan to compromise on his goal to make sure millions more Americans get health insurance.  If such a measure is passed, the nation’s governors would still be forced to deliver on the law’s goals.

Not every state government is against the law and some are even moving ahead with efforts to support its implementation.  According to the National Conference of State Legislatures (NCSL), over 370 state bills related to the Affordable Care Act have been introduced during this year’s legislative sessions.

On February 16 the U.S. Department of Health and Human Services awarded seven cooperative agreements aimed at assisting a group of states designated as "Early Innovators" in creating the infrastructure to operate health insurance exchanges.  $241 million will be divided among Kansas, Maryland, New York, Oklahoma, Oregon, Wisconsin and a multi-state entity led by the University of Massachusetts Medical School that consists of Connecticut, Maine, Massachusetts, Rhode Island, and Vermont.

It is important to mention that Virginia has taken a responsible approach to health care reform implementation.  The Virginia Health Reform Initiative (VHRI) Advisory Council approved a broad set of 27 recommendations for the Governor, designed to improve health care quality, expand capacity, improve efficiency and lower cost trends in the Commonwealth.

February 14, 2011. On February 9, Governor Bob McDonnell along with 27 Republican governors sent a letter to President Obama requesting him to direct the United States Department of Justice to support an expedited appellate process for the pending healthcare lawsuits to reach the United States Supreme Court as soon as possible.  Governor McDonnell has been an outspoken proponent of expediting the appeal of the health care litigation since the Commonwealth’s decision.  The Governor has worked with the Republican Governors Association (RGA) leadership and the Governors of Florida and South Carolina to coordinate the letter by a majority of states supporting an expedited appeal. 

To view a copy of the letter, visit the following address:

February 8, 2011. A federal judge’s recent decision to declare the new health care law unconstitutional prompted immediate questions about what might happen to the law’s implementation — suggesting to some a scenario in which 26 states could sit back and wait to see what happens as the case is appealed up to the Supreme Court.

U.S. District Judge Roger K. Vinson of Florida declined to “sever” the overhaul’s individual mandate, which requires most Americans to have health insurance or pay a fine.  Instead, he ruled that the entire overhaul is unconstitutional.

While the whole law doesn’t go fully into effect until 2014, most states are moving ahead on planning for Medicaid expansion, state-based exchanges and new medical payout standards and other provisions.  In addition, parts of the law are currently in effect.  For example, seniors already have received payments for prescription drug assistance and young adults have been added to their families’ insurance plans. 

In an earlier decision here in Virginia, U.S. District Court Judge Henry E. Hudson severed the individual mandate and separately ruled it unconstitutional, allowing the rest of the law to stand.  Congressional opponents of the measure who are pushing for repeal say their hand is strengthened by the similar rulings.

White House officials have characterized Vinson’s decision as out of the mainstream of judicial thought and report it will be appealed to the U.S. Court of Appeals for the 11th Circuit.   

Supporters continue to emphasize that doing away with the law would mean doing away with popular consumer protections. They note that the health care reform law is already helping middle-class families, seniors and small businesses with savings and providing Americans more control over their health care choices. 

January 24, 2011. The House voted 245 to 189 to repeal the health care law passed last year, sending the bill to the Senate where it will likely be blocked. Three Democrats backed the repeal effort: Reps. Dan Boren of Oklahoma, Mike McIntyre of North Carolina and Mike Ross of Arkansas.

In voting for repeal, the new Republican majority in the House of Representatives is keeping faith with promises made during the 2010 election.  GOP representatives feel that their chances for re-election depend on keeping those promises.  Instead, the Democratic Party continues to dismiss the GOP efforts as they feel the repeal action will have little, if any effect on the actual debate.

On January 25, 2011, President Obama will deliver the annual address to a joint session of Congress from the House Chamber at the U.S. Capitol. The State of the Union gives the President an opportunity to not only report on the condition of our Nation, but also to outline his legislative agenda and priorities to Congress and the American people.

January 10, 2011. In the future, the new Republican majority in the House is expected to take up H.R. 2, which would repeal the new health care reform law.  The prospects for such legislation are good in the House, but less likely in the Senate.  President Obama has signaled he would veto the bill.

December 20, 2010. Judge Henry Hudson of the Federal District Court in Richmond ruled that the health care reform law’s provision requiring individuals to maintain certain levels of health insurance coverage is unconstitutional. This decision sets the stage for a protracted legal struggle in the Supreme Court; however, the Justice Department is expected to challenge the judge's findings in a federal appeals court.  Attorney General Cuccinelli has requested an expedited path to the Supreme Court bypassing the next level of judicial review, but this is not likely to occur. Consequently, resolution of the case will still take time and the reform law as currently structured remains in effect.  A Justice Department spokeswoman has expressed confidence the administration will eventually win the legal fight.

July 23, 2010. New regulations were released on Thursday, making it easier for consumers to appeal denials or other decisions made by insurers.  The rule would apply to the self-insured market, which in the past, has not been subjected to external-review requirements. 

June 25, 2010. The White House unveiled new regulations on Tuesday to mark the first 90 days since healthcare reform legislation was signed.  The regulations will apply to most health plans and include guaranteed coverage for children with pre-existing health problems; phasing out annual and lifetime coverage limits; prohibiting insurers from cancelling the policies of individuals who become sick; and a guaranteed choice of primary care doctors and pediatricians from a network. 

May 14, 2010. The Congressional Budget Office (CBO) announced this week that the recently passed healthcare reform legislation would cost approximately $115 billion more over the next decade than previously anticipated. 

The United States Department of Health and Human Services issued an interim final rule on Monday that provides details on the obligation group health plans have under the health care reform law to cover the children of employees until their 26th birthday.

  • For each child age 19 to 26 added to a parent’s employer-sponsored health plan, the expected annual premium cost is $3380 in 2011, $3500 in 2010 and $3690 in 2013. 

  • For parents purchasing their own independent coverage, the estimated additional annual premium costs are expected to be $2360 per adult dependent in 2011, $2400 in 2010 and $2480 in 2013.

  • Beginning 2014, unmarried and married children up to age 26 will be allowed to stay on their parent’s employer plan regardless of whether or not they are offered employer-based coverage.

May 7, 2010. Last Friday was the deadline for each state to advise the federal government on whether or not it would create a high-risk insurance pool.  Governor Bob McDonnell notified Secretary of Health and Human Services Kathleen Sebelius that Virginia would be opting out, citing that the $113 million in federal funds set aside for the high-risk pool creation would only be sustainable until 2012. 

As previously reported, Virginia joined other states in filing suit against the federal government, challenging the constitutionality of the newly passed healthcare reform law.  Late last week, a scheduling order was issued by the Eastern District Court of Virginia, giving the federal government until May 11th to respond to the initial complaint.  It is expected that the suit will proceed quickly through the district and appellate court systems before ultimately being decided by the United States Supreme Court. 

April 16, 2010. Late Thursday night, the President signed HR 4851, the Continuing Extension Act of 2010.  The bill provides an extension (until June 1, 2010) of unemployment benefits, including COBRA health insurance, and freezes the 21% Medicare payment cuts for doctors.  The 21% reduction officially took effect on April 1st, but the Centers for Medicaid and Medicare Services (CMS) placed a hold on processing physician payments for 10 business days (until April 15th).  If not enacted, VCUHS could have potentially seen a loss of $5 million/year for our physicians.  In addition, this legislation also included language expanding the types of physicians eligible for health information technology (HIT) payments under the American Recovery and Reinvestment Act (ARRA). 

April 9, 2010. Late last week, Secretary of Health and Human Services Kathleen Sebelius sent a letter to governors and state insurance commissioners regarding the creation of high-risk insurance pools.  The Patient Protection and Affordable Care Act recently signed into law by President Obama (Public Law 111-148) mandates the creation of high-risk insurance programs to cover uninsured individuals until 2014 (when the newly created government-regulated insurance exchanges go into effect).  The law appropriates $5 billion to fund the new high risk pool program beginning July 1, 2010.  Additional information about different options for state participation and statutory requirements can be seen here.

April 2, 2010. President Obama signed the Health Care and Education Affordability Reconciliation Act of 2010 (HR 4872) into law on Tuesday.  The legislation includes the package of changes to healthcare reform adopted earlier in March (HR 3590) and also includes education related provisions concerning financial aid funding.

The Office of Government Relations and Health Policy will be analyzing the healthcare reform legislation and will be updating the VCU community on the impact.  To find a timeline of particular provisions included in the legislation, please click here.

In a letter sent to Secretary of Health and Human Services Kathleen Sebelius this week, health insurers agreed to fully comply with new regulations that children with pre-existing medical problems would be fully covered beginning this year.  The newly signed legislation was unclear as to whether the coverage for children would begin in 2010 or under the law’s broad ban of denying coverage on pre-existing conditions beginning 2014. 

March 26, 2010. After almost a year of partisan combat on the Hill, President Obama signed the first of two healthcare reform bills into law on Tuesday. First, the House approved the healthcare bill passed by the Senate in late December 2009.  The Patient Protection and Affordable Care Act (HR 3590) was approved on a 219 to 212 vote, with all 178 Republicans and 34 Democrats voting against the measure. 

Second, the House passed a package of changes to HR 3590 to amend the legislation to make it acceptable to House Democrats.  The legislation also includes education related provisions regarding the distribution of federally subsidized student loans under the Federal Family Education Loan Program and supplements funding for Pell Grants.  The Health Care and Education Affordability Reconciliation Act of 2010 (HR 4872) was approved on a 220 to 211 vote, with all 178 Republicans and 33 Democrats voting against the measure.  When sent to the Senate, the Republicans discovered two minor parliamentary issues with the bill, forcing Senate Democratic leaders to send the measure back to the House for a revote on Thursday.  The Senate passed HR 4872 on a 56 to 43 vote on Thursday (both Senators Warner and Webb voted for the bill) and sent it back to the House where it was later passed again on a vote of 220 to 207. 

The Office of Government Relations and Health Policy will provide a detailed analysis of healthcare reform legislation once additional information on the finalized language contained in the bills becomes available.

Moments after the first healthcare legislation was signed into law by President Obama, Virginia joined 13 other states in filing suit against the federal government.  The lawsuit challenges the constitutionality of the new law based on the premise that the Patient Protection and Affordable Care Act individual mandate violates the Commerce Clause of the United States Constitution.

March 19, 2010. House Democrats announced on Thursday that their healthcare reform bill will cost $940 billion over the next decade while extending healthcare coverage to 32 million uninsured people, keeping in line with the target goals set for reform by President Obama.  Here are several preliminary highlights of what is included:

  • Individual Mandate.  Modifies the assessment for individuals who don't comply with the insurance mandate to $325 in 2015 (from $495), $695 in 2016 (from $750), or can be paid by percentage of income - 1% in 2014, 2% in 2015 and 2.5% in 2016 and thereafter. 

  • Administrative Costs.  Provides $1 billion to Secretary of Health and Human Services to finance the administrative costs for healthcare reform.

  • Medicare Part D. Closes the Medicare prescription drug "donut hole."

  • Medicare Advantage (MA).  Freezes MA payments in 2011.  Every year after, the provision reduces MA benchmarks relative to current levels. 

  • Disproportionate Share Hospital Payments.  Medicare DSH cuts will start in 2014 and the 10-year estimate was reduced by $3 billion. Medicaid DSH cuts will begin in 2014 as well.  Legislation reduces DSH cuts from $18.1 billion to $14.1 billion. 

  • Medicaid Expansion.  Pays the following percentages for the newly eligible Medicaid beneficiaries:  100% in 2014, 2015, and 2016; 95% in 2017; 94% in 2018; 93% in 2019; and 90% thereafter.  Strikes the Nebraska language. 

  • Medicaid Payments to Primary Care Physicians.  Requires that Medicaid payments to primary care physicians for primary care services be no less than 100% of Medicare payment rates in 2013 and 2014.  Provides 100% of funding for states to meet this requirement. 

  • Premium Tax.  Provides exemptions for nonprofit health insurance providers whose business is 80% or more of its revenues is received from the Social Security Act programs (i.e. Medicaid). 

  • 340B.  Repeals the underlying 340B expansion to inpatient drugs and exempts orphan drugs from the required discounts.

Speaker of the House Nancy Pelosi is considering a procedural tactic to pass healthcare legislation in the House.  The “self-executing rule” allows the House to vote on a series of amendments to the Senate bill, with passage of the amendments deemed approval of the underlying Senate legislation.  A vote is expected to occur on Sunday. 

In terms of where the Virginia Congressional Delegation stands, all five House Republicans (Congressmen Cantor, Forbes, Goodlatte, Wolf and Wittman) are firmly opposed to the legislation while the House Democrats are somewhat less unified.  It is anticipated that Congressmen Moran and Scott will vote for healthcare reform legislation while Congressmen Boucher, Connolly, Nye and Perriello are still undecided. 

March 12, 2010. Congressional Democratic leaders continue to hold ongoing discussions with White House officials concerning the passage of healthcare reform legislation.  House Democrats are reluctant to approve the Senate-passed healthcare measure unless there is a guarantee of a follow-up measure with changes in a budget reconciliation bill.  The House and Senate do not agree on certain provisions including insurance coverage of abortions.  Under consideration is having the House approve the original Senate healthcare legislation with both the House and Senate adopting a budget reconciliation bill that includes changes, with both measures sent to the President.  A side by side comparison of the Senate Reform Bill (HR 3590) and President Obama’s Plan (which he released in late February) can be seen here

March 5, 2010. The status of healthcare reform legislation remains unclear, with some reports suggesting that Democrats have imposed a deadline of early April to pass healthcare reform legislation.  The President stated this week that he would support congressional Democrats if they used a maneuver known as reconciliation to pass healthcare reform legislation on a simple majority vote. 

In the meantime, a series of smaller bills known as “extenders” are before Congress.  On Tuesday, the Senate passed HR 4691, “The Temporary Extension Act of 2010” on a 78 to 19 vote and it was later signed by President Obama.  The bill provides an extension for several healthcare related provisions, including:

  • Extending the 65% COBRA premium subsidy for terminated workers through December 31, 2010.

  • Delaying the 21% fee reduction for physician Medicare reimbursement.  It is believed that the Centers for Medicare and Medicaid Services (CMS) will immediately begin to process claims without the 21% cut. 

While HR 4691 is a temporary fix, a more semi-permanent measure (HR 4213) is currently under consideration by the Senate.  Several amendments of interest have been introduced, including one providing for an extension of the SGR formula to prevent the 21% Medicare reimbursement reduction through September 2010, and a second amendment that would extend the delay in the 21% cut to the end of December 2010.  The bill also includes a six-month extension of the enhanced Federal Medical Assistance Percentage (FMAP) made available to states in the American Recovery and Reinvestment Act of 2009 (ARRA). This bill could be voted on as early as this Tuesday. 

February 26, 2010. On Monday, President Obama announced an almost $950 billion healthcare reform proposal that would increase coverage subsidies, require greater accountability for health insurance companies and directs the federal government to cover the cost for a deep expansion of Medicaid.  The proposal does not include a government insurance public option.  Highlights include:

  • Makes it illegal for insurance companies to deny coverage for children due to a pre-existing medical condition and prevents insurance companies from dropping insurance coverage.

  • Creates a new insurance pool for Americans with pre-existing conditions.

  • Provides that new plans must cover an enrollee’s dependent children until age 26.

  • Expands Medicaid coverage beginning January 1, 2014, to include all low-income, non-elderly and non-disabled individuals up to 133% FPL.  The federal government will provide 100% of the cost of newly eligible people between 2014 and 2017, 95% of the costs between 2018 and 2019 and 90% matching beyond 2019.

  • Preserves the State Children’s Health Insurance Program (SCHIP) and requires states to maintain income eligibility levels for SCHIP through September 30, 2019 with funding extended through FY 2016.  Starting FY 2016, states receive a 23% increase to their SCHIP matching rate.

  • Reduces Disproportionate Share Hospital (DSH) payments to states for uncompensated care.

Additional information on the President’s proposal can be found here.  The plan served as a starting point for discussion at the bipartisan healthcare reform summit at the White House that was held on Thursday.

February 19, 2010. The White House is convening a bipartisan healthcare reform summit on February 25th in order to further negotiations and discuss how to pass legislation this year. 

The Senate Finance Committee released the “Hiring Incentives to Restore Employment Act” jobs bill last week.  However, Senate Majority Leader Harry Reid removed a provision from the legislation that would have postponed a 21% cut in physician Medicare payments until September 30th.  The Senate is expected to take up separate “extenders bill” measures when it returns after the President’s Day recess. 

February 12, 2010. President Obama announced this week that on February 25th, the White House would be holding a bipartisan health reform summit that will be broadcast live.  It is widely believed by Republican and Democratic leaders alike that the summit will not make any real impact in reaching a compromise in the healthcare negotiations currently underway.

Senate Democrats circulated a jobs bill around Capitol Hill this week that primarily focuses on tax breaks for new hires, but also includes an extension of benefits and health insurance subsidies for the unemployed and postpones a 21% cut in physician Medicare payments until September 30th.  The legislation, which has yet to be introduced, is expected to be less costly and have more bipartisan support than a similar measure that passed the House in December 2009.

February 5, 2010. The status of healthcare reform legislation continues to remain unclear in Congress; though Senate Majority Leader Harry Reid hopes Democrats will come to a decision by next week on moving the healthcare bill forward.  The use of a procedural maneuver known as reconciliation (which would allow the Senate to pass a House approved bill with just 51 votes) is still under consideration by both chambers.

Speaker of the House Nancy Pelosi is scheduling a vote next week on the first of a series of smaller healthcare bills that would end an anti-trust law exemption for health and medical malpractice insurers. 

January 29, 2010. The push for healthcare reform remains uncertain this week, as Democratic House and Senate leaders discuss the options for passage.  One option is using a parliamentary maneuver known as reconciliation to allow Democrats to override a Republican filibuster to approve healthcare legislation with a simple majority of 51 votes in the Senate (instead of 60 votes).  Some Democrats stated this week that they anticipate the earliest action on healthcare reform would be pushed back to late February at the earliest.

January 22, 2010. In a blow to federal health reform efforts, Republican Scott Brown defeated Democrat Martha Coakley in the Massachusetts race to fill the late Senator Ted Kennedy's seat.  The election of Senator Brown will cost Senate Democrats their 60 to 40 advantage, which is needed to surmount an almost certain Republican filibuster on healthcare reform.  Democrats are now faced with the decision of whether to abandon healthcare reform (which is unlikely) or scale back reform measures.

The White House and Congressional Democrat leaders have been working to reconcile the differences between the House and Senate healthcare reform measures.  Speaker of the House Nancy Pelosi indicated this week that she does not have the necessary 218 votes in the House to pass the Senate healthcare bill. 

January 15, 2010. Healthcare negotiators are working toward resolving differences between the House and Senate healthcare reform bills.  It is likely that a final bill will not be ready until February, according to House Democratic leaders.  On Wednesday, President Obama met with House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid, and other House and Senate representatives for a day-long session of negotiations.  The President, Vice President Biden and other top White House officials worked with the Congressional leaders to broker an agreement on the outstanding issues between the House and Senate bills.  A side-by-side comparison of the House and Senate bills with issues relating to VCU can be seen here

January 8, 2010. The Senate passed HR 3590 on December 24th.  During the month of January, House and Senate leaders will be working together to combine the Senate bill with the House healthcare reform bill (HR 3962).   Please see a side-by-side of both proposals with issues relating to VCU here.  House and Senate leaders have indicated that they want to pass the final bill before the President’s Day recess in mid-February.

Several points of contention between the House and Senate versions must be resolved during the negotiation process, including:

  • Public Health Insurance Plan

  • Financing Healthcare Reform

  • Abortion

  • Coverage for Illegal Immigrants

December 18, 2009. This week the Senate continued debate on healthcare reform with almost 500 amendments offered to the Senate’s current version.  On Monday, Senate Majority Leader Harry Reid indicated that he would be dropping the Medicare buy-in provision for individuals aged 55 to 64.  The provision, offered as a replacement to the government-run health insurance option, was opposed by several Senate Democrats whose votes are needed to pass healthcare reform legislation. 

One proposed amendment gathering interest is a proposal that would allow people eligible for employer coverage the option of buying cheaper coverage from the new insurance exchanges and collecting the difference in cost.  The proposal, gathering support from moderates in both parties, would reward consumers for choosing cost-efficient care.

President Obama met with Senate Democrats at the White House on Tuesday to continue to urge them to pass healthcare reform legislation before the end of the year.  Democrats are still waiting to receive a cost estimate from the Congressional Budget Office (CBO); without the estimate, it will be difficult to lock down votes in support of passing the bill. 

Democrats have imposed the Christmas deadline for a Senate vote to allow for the bill to be moved through a joint House-Senate conference committee and to be delivered to the President before the 2010 State of the Union address in late January or early February.  Republicans are using procedural tactics to delay proceedings on the legislation to decrease the likelihood that the bill will pass out of the Senate. 

VCU communicated with members of the Virginia Congressional Delegation this week on the University and Health System position on topics pertaining to healthcare reform, including Disproportionate Share Hospital (DSH) payments, premium taxes on Medicaid-only health plans, Graduate Medical Education (GME), 340 B pharmaceutical discounts, the inclusion of a public option and the expansion of Medicaid and Medicare. 

December 11, 2009. This week the Senate continued debate on healthcare reform with more than 325 amendments offered to the Senate’s current version.  The Senate narrowly rejected the Nelson Anti-Abortion amendment with a vote of 54 to 45.  The measure restricted abortion coverage for people who receive subsidies for insurance. 

On Tuesday, Virginia Senator Mark Warner and ten freshman Senate colleagues announced a package of amendments to encourage innovation and accountability and to implement cost-cutting measures in healthcare reform.

The Senate reached agreement Tuesday evening, in concept, to expand insurance coverage without creating a new government-run public option program.  This would eliminate the public option from the healthcare bill and instead offer a new government-administered national insurance plan similar to the Federal Employee Health Benefits Plan.  The proposal would also offer a Medicare buy-in for individuals between the ages of 55 and 64 and would expand Medicaid coverage to cover individuals with incomes 150% Federal Poverty Level (FPL) as opposed to the 133% FPL currently under the Senate bill. 

Several other proposals were included within the compromise plan, including a reauthorization of the Children’s Health Insurance Program and requiring insurers to spend at least 90% of premium money on medical care (as opposed to administrative costs or profit).  The Senate is waiting on a cost-analysis from the Congressional Budget Office regarding the compromise.

Members of the Senate are anticipating a long December ahead to finish debate on healthcare reform and possibly bring the bill to a final vote by the end of the year.  Senate Majority Leader Harry Reid has stated that he may call the Senate back into session the week between Christmas and New Year’s, if the additional time is needed. 

December 4, 2009. The Senate passed a cloture motion on Saturday, November 21st to move forward HR 3590, the Senate version of healthcare reform.  Since formal debate began on Monday, more than 90 amendments have been proposed to the legislation.  Votes have been delayed due to Republican objections.  As a result of the objections, Democrats are forced to either file cloture on each amendment (requiring 60 votes) or move to table the amendments (requiring 51 votes but not viewed favorably by the senators).  Senate leaders voted Thursday on four measures concerning health benefits for women and proposed Medicare cuts over the next decade impacting older Americans.  Two of the measures were agreed to, including Senate Amendment 2791, which specifies that the Health Resources and Services Administration (HRSA) would determine what women’s services would be exempt from co-pays. 

Senate Democrats have stated that they are prepared to keep the Senate in session until Christmas or beyond in order to complete the legislative process on healthcare reform by the end of 2009. 

The Senate is expected to unveil a new public option next week.  The measure would replace Senate Majority Leader Harry Reid’s public option plan allowing for states to opt out of participating.  It was speculated that Reid’s public option plan would not garner the necessary 60 votes to pass the Senate.  Under the leadership of Senator Tom Carper, a junior member of the Senate Finance Committee, one potential solution being considered is a “hammer public option.”  The hammer option would be enacted for states where insurance companies fail to meet standards of availability and affordability of plans and would potentially allow states to opt in even if the standards are met. 

The Congressional Budget Office (CBO) released an analysis of the impact on health insurance premiums under HR 3590, which can be seen here.  Additionally, the CBO revised the figures for HR 3962, the “Affordable Health Care for America Act” as passed by the House of Representatives in November, which can be seen here

November 20, 2009. The Senate finished merging the Finance Committee and the Health, Education, Labor and Pensions (HELP) Committee bills and unveiled their long-awaited healthcare reform package late Wednesday.  The “Patient Protection and Affordable Care Act,” is an $848 billion dollar healthcare package which expands health coverage to 94% of Americans under age 65.  Key components of HR 3590 include:

  • The creation of a government regulated insurance exchange in 2014 where private insurers would compete with a government run public option. States would be permitted to opt out of the public option by passing a law to refuse it.  Illegal immigrants would be barred from purchasing insurance from the exchange.

  • Medicaid would be significantly expanded to cover individuals making 133% Federal Poverty Level (FPL) or below.  Individuals between 133% and 300% FPL would be eligible to receive subsidies and individuals between 133% and 400% FPL would also receive annual caps on premiums and out-of-pocket expenses as a percentage of income.

  • Increased regulations on the ability of insurance companies to deny coverage or care, cancel policies for the sick or vary premiums on age, health status, gender and other factors.

  • All individuals would be required to have health coverage through private insurers, a government run plan or the newly created exchange or face penalties. Employers will be required to offer insurance to employees or face penalties.

  • The healthcare reform measure would be paid for in part by $400 billion in cuts on   payments to medical providers for Medicare spending.  Additionally, the bill calls for $371.9 billion in new taxes over 10 years, primarily from a 40% excise tax on the value of health insurance plans above $8,500 for individuals and $23,000 for families.  Also, the Medicare payroll tax for high-income earners (more than $200,000 for individuals or $250,000 for families) would be increased by 0.5% to 1.95% of adjusted gross income. 

  • Medicare Disproportionate Share Hospital (DSH) payments will be reduced by 75% over 10 years (totaling $20 billion) starting in 2015.  In addition, the legislation cuts Medicaid DSH by 50% over 10 years, only if the number of uninsured decreases by 50%. 

The Senate will convene most likely Saturday for a procedural vote required to start debate.  All 40 Republicans in the Senate are expected to block the legislation from advancing, necessitating that all 60 Democrats vote in favor of cloture. 

On the House side, last Friday the Centers for Medicare and Medicaid Services (CMS) released a cost analysis of HR 3962, stating that the estimated financial impact of “America’s Affordable Health Choices Act of 2009” would have a cost increase of $289 billion over the years 2010 to 2019.  Additionally, the report predicted that the legislation would expand Medicaid eligibility to over 60% of the uninsured and cut Medicare by approximately $571 billion.

For a comparison on key differences between the House and Senate healthcare plans, please go here.

November 13, 2009. Democrats in the House of Representatives narrowly passed sweeping health care reform legislation Saturday night.  HR 3962 passed 220 to 215 with 39 Democrats voting against the bill, and only one Republican supporting the bill.  Virginia Democrats voting for the measure included Congressmen Bobby Scott, Tom Perriello, Jim Moran and Gerry Connolly.  Congressmen Rick Boucher and Glenn Nye were the only Virginia Democrats to break rank with their party and join all five Virginia Republicans (Congressmen Rob Wittman, Randy Forbes, Robert Goodlatte, Eric Cantor and Frank Wolf) in voting against the legislation. 

Due to the overwhelming time and attention given to passing healthcare reform legislation in the House, House Majority Leader Steny Hoyer released an updated House vote schedule on Wednesday.  According to the calendar, lawmakers are scheduled to be in session until December 18th with votes scheduled for December 21st through December 23rd (if necessary).

With the House passage of healthcare reform legislation, attention is now directed toward the Senate, which is still waiting on the final cost analysis and coverage implications from the Congressional Budget Office (CBO). Senator Reid advanced the House healthcare bill to the Senate legislative calendar for next week, thereby allowing him to have the Senate bill skip the committee process and go straight to floor debate.  The Senate needs 60 votes to start debate on the floor of this legislation.  Reid stated on Tuesday that he expects to have a final bill to present to President Obama by the end of the year.  To meet that deadline, there is a possibility that the Senate will have six-day workweeks in December and work the weekend before the Thanksgiving recess begins. 

November 6, 2009. According to House leaders, the House is tentatively scheduled to vote on healthcare reform legislation Saturday evening at 6:00 p.m.  The Manager’s Amendment (a package of numerous individual amendments agreed to by both sides) was filed late Tuesday evening, giving House members at least 72 hours to study the legislation.  The Rules Committee is scheduled to meet at 2:00 p.m. on Friday to determine the rules for the final health debate.

Prior to a final vote, an impasse among Democrats must be resolved.  Anti-abortion Democrats want to amend the bill to strengthen its prohibitions against the use of federal funds for abortions and insiders state that they have 40 Democratic votes, enough to keep the healthcare reform bill from reaching the minimum of 218 votes needed to pass the legislation.  Currently, federal law known as the Hyde Amendment prevents the federal funding of abortion.

On Tuesday, House Republicans released a substitute version of healthcare reform legislation.  A summary of the bill outlines key elements including:

  • Lowering the costs of healthcare premiums

  • Creating Universal Access Programs that expand and reform high risk pools and reinsurance programs for individuals with pre-existing health conditions

  • Imposing caps on medical malpractice lawsuits

  • Allowing Americans to purchase insurance across state lines

  • Prohibiting the use of federal funds to pay for abortions

House Republicans will be allowed to offer their plan as an amendment to the Democratic bill when it is brought to the floor, though there is little to no chance of their bill passing.

On the Senate side, Senate Majority Leader Harry Reid is waiting to receive cost estimates from the Congressional Budget Office (CBO) on different variations of his bill, which will most likely not be completed until next week. 

October 30, 2009. Senate leaders reached an agreement between the Finance Committee and the Health, Education, Labor and Pension (HELP) Committee bills and sent the merged legislation to the Congressional Budget Office (CBO) for scoring this week and expect to receive the report by early next week.  Senate Majority Leader Harry Reid announced on Monday that he did include a public insurance option in the Senate healthcare bill that allows an opt-out provision for states.  The opt-out provision would automatically enroll states into the public option plan unless the states choose to opt-out by 2014 (Virginia would need approval by both the General Assembly and Governor to opt-out). 

However, the public option plan was dealt a blow on Tuesday when several centrist Senate members publicly commented that they would join Senate Republicans in blocking the bill.  One potential solution is to replace the opt-out provision with a trigger option that allows a government run plan only if the private market fails to lower costs on their own.  While a Congressional Budget Office cost report has not been completed, the CBO has estimated that a trigger option would save as much as $15 billion over the next decade while providing coverage to 6 million individuals.  A second solution is to implement reconciliation, a procedural maneuver that requires only a simple majority to pass legislation in the Senate.  With so much controversy surrounding the public option component as well as other contentious issues, it is widely believed that floor debate and votes in the Senate could be pushed back to January 2010.

On the House side, Speaker Nancy Pelosi and House leaders finished merging the Tri-Committee legislation and unveiled HR 3962, a $894 billion dollar healthcare package on Thursday.  The “Affordable Health Care for America Act” expands health coverage to 96% of Americans and key components of the bill include:

  • The creation of a government regulated insurance exchange where private insurers would compete with a government run public option.  Moderate income Americans would be provided with subsidies to purchase insurance from the exchange.

  • The new public insurance plan would allow for healthcare providers to negotiate reimbursement rates directly with the federal government.

  • All individuals would be required to have health coverage by 2013 through private insurers, a government run plan or the newly created exchange.  Employers will be required to offer insurance to employees or face penalties.

  • Medicaid would be significantly expanded to cover individuals making 150% Federal Poverty Level (FPL) or below.

  • During the transition years from 2010-2013, a temporary government program would help people turned down by private insurers due to pre-existing medical conditions.  Beginning in 2013, insurers would no longer be allowed to refuse coverage or charge more based on pre-existing conditions.

  • The healthcare reform measure would be paid for in part by taxes on upper-income earners and cutting Medicare payments to insurers, hospitals and other providers.  Specifically, individuals earning more than $500,000 and families earning more than $1 million annually would face a 5.4% income tax surcharge.

The Congressional Budget Office released the HR 3962 preliminary cost analysis report on Friday and House members will be given 72 hours to read the legislation before a vote.  If all goes as expected, the House should begin debating the bill at the end of next week. 

October 23, 2009. In the House, Speaker Nancy Pelosi met with the full Democratic Caucus on Tuesday to announce that the cost of healthcare reform legislation in the House has been reduced to $871 billion over the next 10 years, provided that it includes a public insurance option that reimburses at Medicare rates plus 5%.  A few concerns are being voiced by House Democrats as they continue to merge the Tri-Committee legislation – including cost containment and reducing future impact on the federal budget, relaxing health insurance requirements on individuals and small businesses and strengthening pre-existing abortion bans.  House leaders are working on lining up the necessary 218 votes over the next few weeks and expect legislation to be brought to the House floor in early November. 

On the Senate side, leaders continue to work together to merge the proposals passed by the Senate Finance Committee and the Senate Health, Education, Labor and Pensions (HELP) Committee.

October 16, 2009. On Tuesday, the Senate Finance Committee voted 14 to 9 to advance healthcare reform legislation.  Senator Olympia Snow was the only Republican to vote for the measure.  Over the next few weeks, Senate leadership will combine the Senate Finance Committee legislation with the legislation passed in July by the Senate Health, Education, Labor and Pensions (HELP) Committee in hopes of creating a single bill that can win at least 60 votes in the Senate. The combined bill is expected to be on the floor of the Senate in the next two weeks, and floor debate will run several weeks with a goal of voting before the Thanksgiving recess. 

On the House side, House leadership is actively working to combine the Tri-Committee legislation passed by the House Ways and Means, Energy and Commerce, and Education and Labor Committees.  Like the Senate, the legislation is expected to be on the House floor within the next two weeks, but it is anticipated that floor debate will only last one day. 

Below is a brief comparison between the Senate Finance, Senate HELP and House Tri-Committee legislation, with a more in-depth analysis provided by the National Association of Public Hospital and Health Systems (NAPH) and the Kaiser Family Foundation.


Senate Finance Committee

Senate HELP Committee

House Tri-Committee
(as introduced)

Proposal Name

America’s Healthy Future Act of 2009

Affordable Health Choices Act

America’s Affordable Health Choices Act


$829 billion over 10 years

$645 billion over 10 years

$1.05 trillion over 10 years


94% of all Americans; Illegal immigrants would not receive government benefits.

Aims to cover 97% of Americans.

Approximately 94% of residents under age 65 would be covered.

Government Run Public Option


Yes.  Creates a government run public plan to compete with private insurers.  The plan would negotiate payment rates with providers.

Yes.  Creates a new public plan through insurance exchanges run by the Secretary of Health and Human Services.

Individual Mandate

Requires U.S. citizens and legal residents to have coverage through an employer, on their own or through a government plan.    Creates state-based
Health Insurance Exchanges (HIE) where individuals can purchase coverage, with premium and cost-sharing credits available to
Individuals and families meeting income restrictions.

Individuals are required to have insurance.  Creates state-based American Health Benefit Gateways through which individuals and small businesses can purchase health coverage.
Subsidies will be available to qualifying individuals and families meeting income restrictions.

Requires all individuals to have health insurance.
Creates a Health Insurance Exchange (HIE) through which individuals and smaller employers can purchase health coverage, with premium and cost-sharing credits available to qualifying individuals meeting income restrictions.

Medicaid Changes

Beginning 2014 expands Medicaid to 133% FPL and CHIP eligibility to all children up to 250% FPL.

Expands Medicaid to all individuals with incomes up to 150% FPL.

Beginning 2013 expands Medicaid for the non-elderly up to 133% FPL; provides premium and cost-sharing credits to purchase coverage in new HIE to individuals and families with incomes up to 400% FPL.

October 9, 2009. The Senate Finance Committee delayed the vote scheduled for this past Tuesday on healthcare reform legislation due to the Congressional Budget Office (CBO) needing additional time to “score” (provide updated cost and revenue estimates) the legislation.  Late on Wednesday, the CBO released the revised estimates, predicting that the Senate Finance Committee healthcare reform package, as amended, would cost $829 billion over 10 years and provide coverage to 94% of Americans (excluding illegal residents) and 91% of all United States residents. 

The amended legislation meets President Obama’s target of keeping the cost of healthcare reform under $900 billion and would lower the deficit by $81 billion due to new revenue and spending cuts.  However, there is concern by hospital groups, particularly the Federation of American Hospitals, that the 94% coverage is not sufficient and that the hospital cost-cutting agreement was based on 94% coverage of all residents and 97% coverage excluding illegal immigrants. 

Senate Majority Leader Harry Reid indicated in a floor speech on Thursday that the Finance Committee will vote on its healthcare bill next Tuesday morning.

After the Senate Finance Committee votes on its measure, the Democratic leadership in the House and Senate will each work to create a proposal for floor debate in their respective chambers.  The House requires 218 (out of 435) votes while the Senate needs 60 votes (to avoid a filibuster) to pass healthcare reform legislation.  This week, the Congressional Progressive Caucus informed House Democrats that the group had 208 of the 218 votes needed, though this number remains unconfirmed.

Once both the House and Senate pass their respective versions of the legislation, a conference committee would negotiate a final version to be approved by both chambers before going before President Obama for his signature.

On Monday at the White House, President Obama was joined by doctors from all 50 states to continue to push for healthcare reform legislation.  He spoke about features of the plans including capping patient costs, creating an open marketplace for health plans and requiring insurance companies to cover preventative health costs.  A copy of the President’s remarks can be seen here.

October 2, 2009. The Senate Finance Committee on Tuesday rejected two amendments to include a government run public health insurance option with votes of 15 to 8 and 13 to 10.  The amendments were opposed by all 10 Republicans on the committee and several Democrats.  Democratic proposals passed by the Senate Health, Education, Labor and Pensions (HELP) Committee and three House committees all include the public insurance option.  Senate Finance is finished its mark-up early Friday morning.  A vote on the bill from the full committee is expected next week after further evaluation by the Congressional Budget Office (CBO) is completed.  The bill will then be merged with the legislation passed by the Senate HELP Committee.  Senate leaders are hopeful that full Senate debate will occur in mid to late October, and it has been speculated on the Hill that the Senate may forgo the Columbus Day recess week in order to continue advancing health care reform legislation to the Senate floor.

Democratic leaders in both the House and the Senate are emphasizing the need for floor votes this fall.  House Democratic leaders planned a series of meetings beginning Tuesday in order to merge the three versions of health care legislation passed out of House committees.  Additionally, the House leaders hope to reduce the overall cost of the House proposals by $200 billion, to bring the total amount under $900 billion over the next 10 years – in line with the Senate bills.

September 25, 2009. The Senate Finance Committee began the final mark-up of its healthcare reform bill this week.  The bill is expected to cost $774 billion over the next decade.  The debate continues on how to pay for this, and we are carefully monitoring the impact of the proposal on safety net hospitals.  More than seven hundred amendments to the bill have already been proposed, with Republicans seeking to change or eliminate the proposed $500 billion in Medicare changes, the fine imposed on Americans without health insurance, and the new industry fees that Republicans fear will be passed on to consumers. Democrats, on the other hand, are primarily interested in expanding subsidies.

As for the House Tri-Committee bill, the House Energy and Commerce Committee continued their mark-up this week.  Speaker Nancy Pelosi is hoping to consolidate the three different committee versions of this legislation and advance it to the floor in mid-October.  Again, the point of contention revolves around the public option. 

On Monday, Congressmen Eric Cantor and Bobby Scott co-hosted a discussion on healthcare reform at the Richmond Times-Dispatch downtown office, drawing a maximum capacity crowd of 225 people for the event.

Senator Warner joined nine other freshman Senators on the Senate floor on Wednesday to discuss the cost of inaction for healthcare reform.  You can find his remarks here

September 18, 2009. The chairman of the Senate Finance Committee, Max Baucus, unveiled a 220-page healthcare reform proposal on Wednesday.  The "America's Healthy Future Act of 2009" proposal would cost $856 billion over the next decade and would include the following:

  • Reduces Medicaid Disproportionate Share Hospital (DSH) allotments by 25% for low-DSH states and 50% for all others, which only goes into effect once the states uninsurance rate decreases by 50% (cost savings of $25 billion)

  • Cuts Medicare DSH payments by 75% starting in 2015.  Additional payments to hospitals could be made for those hospitals with the highest amount of uncompensated care costs (cost savings of $23 billion) 

  • Expands Medicaid eligibility to 133% of the Federal Poverty Level (FPL) in 2013

  • Incentivizes Medicare and Medicaid bundling pilots/demonstrations

  • Reduces Medicare payments to hospitals with preventable readmissions above the 75th percentile for a limited number of conditions

  • Recognizes Medicare Accountable Care Organizations beginning in 2012

  • Prevents a 21% reduction to Medicare physician payments for FY2010 and provides for a 0.5% increase

  • Establishes a Medicare Commission, separate from MedPAC, with a sole purpose of finding ways to reduce excess cost growth

  • Funded by more than $500 billion in spending reductions, $350 billion in new taxes and fees; $6 billion in new fees for insurers while another $4 billion would be financed by the medical device manufacturing sector. 

The Senate Finance Committee will begin discussions on the Chairman’s mark this Tuesday.

September 11, 2009. Congress returned from the August recess this week and is once more taking up the issue of healthcare reform.  During the recess, Congressional members across the country hosted healthcare reform town hall meetings in their districts, meetings that were highly attended and contentious at times. 

The Chairman of the Senate Finance Committee, Max Baucus (D-Mont) revealed his bipartisan healthcare proposal on Wednesday.  Two highlights of the bill that would potentially cause concern for Republicans include new taxes on high end insurance plans and the creation of nonprofit insurance cooperatives as alternatives to a government run public plan.  Other items in the proposal which could positively or negatively affect VCUHS include:

  • Creation of state-level health insurance exchanges

  • Increased funding for state high risk pools

  • Interstate sale of insurance

  • Small business and individual tax credits

  • Individual and employer mandates for coverage

  • Increased Medicaid eligibility up to 133% FPL

  • 50% reduction in Disproportionate Share Hospital (DSH) payments only if 50% of the uninsured have been covered

  • Redistribution of unused Graduate Medical Education (GME) slots to primary care services

  • Medicare physician payment increase of 0.5% instead of 21% reduction

  • New requirement for hospitals to be designated as non-profit

Also on Wednesday, President Obama addressed a joint session of Congress to urge for the passage of healthcare reform legislation.  In his speech, the President offered an outline for reform measures, including an individual health insurance mandate, requiring businesses to offer healthcare coverage to workers or contribute towards the cost of obtaining coverage, and defending his proposal for a government-run public health insurance option.  The President's remarks can be seen or a transcript read online at the White House website. The full Obama Plan referenced in his remarks can be seen here.

September 4, 2009. Both Senator Mark Warner and Congressman Bobby Scott hosted healthcare reform town hall meetings on Thursday.  In addition, several area healthcare reform rallies were held in Richmond this week by the Democratic National Committee grassroots organization, Organizing for America and

As the recess draws to an end, questions continue surrounding the ability of Congress to pass healthcare reform legislation.  The support of the fiscally conservative Blue Dog Coalition will be imperative to passing legislation in the House. Several legislators in the group have recently expressed reluctance about supporting the public insurance option and overall price tag of healthcare reform proposals.

President Obama will address a joint session of Congress on Wednesday, September 9th regarding healthcare reform.

August 28, 2009. Senator Ted Kennedy, chief architect of the Health, Education, Labor and Pensions (HELP) committee’s health reform bill, passed away this past week at the age of 77.  Senator Chris Dodd, who has been interim chair of the committee in Kennedy’s absence, is still debating if he should relinquish his chairmanship of the Senate Banking Committee to assume this post on a permanent basis.

President Obama’s health advisors held an hour long conference call Tuesday night with close to 3,000 physicians and officials of the American Medical Association (AMA).  The discussion revolved around Obama’s healthcare plan and the need for physician advocacy and involvement. 

Congressman Bobby Scott will be hosting several town hall forums on healthcare reform, including one in Richmond at the General Assembly Building Senate Room A on Thursday, September 3rd at 7:00 p.m.  Additionally, Congressman Rob Wittman and Congressman Tom Perriello are hosting several town hall forums over the next few weeks as well.

August 21, 2009. President Obama and Secretary of Health and Human Services Sebelius have both publicly stated that they think the public plan should still be considered but the healthcare reform legislation doesn’t need to be based on that one concept.  Obama said that his priorities are that the final legislation does not increase the deficit, controls costs, creates an insurance exchange and prevents health plans from denying coverage because of pre-qualified conditions.

Members of Congress have scheduled town hall meetings around the state to discuss the current healthcare reform proposals.  At this time, none have been scheduled in Richmond. 

August 7, 2009. The bipartisan negotiators from the Senate Finance Committee known as the "Gang of Six" have been holding daily negotiating sessions to advance health care legislation. Senate Finance Committee Chairman Max Baucus (D-Mont.) has set a deadline of mid-September for negotiating a bipartisan deal, while Senate Majority Whip Dick Durbin (D-Ill.) and Senator Chuck Schumer (D-NY) have endorsed a firm deadline of September 15th.

When Congress reconvenes in September, the House will have to reconcile all health care reform legislation into one uniform bill, and the Senate will need to reconcile the two Senate bills into one bill.

It was recently announced by the United States Census Bureau that the highest percentages of Virginians lacking health insurance are those living in college towns. Virginia had 1,034,424 people (15.5 percent of the population) without health insurance in 2006, the most recently available data.

July 31, 2009. Senator Max Baucus, Chair of the Senate Finance Committee, announced on Thursday that the Committee’s health reform bill will not be ready until after the recess. Several Senators from both parties felt the process was moving too fast and are striving for a bipartisan bill. Negotiations on bill language will take place over the August recess, and the Committee hopes to vote on the mutually-agreed upon legislation when they return in early September.

Senator Mark Warner (D-VA), along with eight other freshman Senators, sent Senator Max Baucus a letter commending the efforts of Baucus and the committee members in achieving bipartisan support for healthcare reform legislation and to emphasize the continued need to focus on cost reduction and expanded coverage in healthcare reform legislation. To view a copy of the letter sent by Senator Warner and his colleagues, please click here.

The House Energy and Commerce Committee struck a deal late last night which will allow them to vote on the House Healthcare Reform Bill today. This committee is the last of the three House committees to consider this bill before it goes to the floor in early September. The final agreement between the leadership and the Blue Dog Democrats on the committee does include a change to the public plan language. Instead of the public plans reimbursing at Medicare rates, these plans would need to negotiate fair rates with providers.

President Obama hosted a town-hall meeting in Bristol, Virginia on Wednesday to discuss healthcare reform with employees at a Kroger grocery store. In addition, the First Lady was in Bowling Green, Virginia this week for the opening of a community health center built with a $1.3 million grant from the stimulus package.

July 24, 2009. Health care reform remains stalled in the House Energy and Commerce Committee due to contention between the Democratic leadership and a group of fiscally conservative Democrats known as the Blue Dog Coalition. The bill has already been approved by the House Ways and Means Committee as well as Education and Labor.  On the Senate side, the Senate Finance Committee is still working out the details of their health care reform legislation.  Senate Majority Leader Harry Reid stated on Thursday that a vote on health care reform in the Senate will not happen until after the August recess.  House Speaker Nancy Pelosi concurred with Senator Reid about postponing action on the bill until September. 

As reported last week, the Congressional Budget Office (CBO) estimated the House Tri-Committee Health Reform Bill would cost $1 trillion over a ten year span, resulting in a net increase in deficit spending of $239 billion during that time.  After pressure from the House, this week the CBO re-evaluated the bill and found that it is now budget neutral.

Both federal and state Virginia lawmakers have recently weighed in on health care reform.  House of Delegates member Jennifer McClellan addressed the need for health care reform at a press conference at the Fan Free Clinic.  Delegate McClellan, along with volunteers and Obama supporters across the country, began a nationwide grassroots push for congressional action.  Additional information on the event can be found here.  Meanwhile, Senator Mark Warner believes that health care reform is too focused on increasing access to health coverage and not enough attention has been given to driving costs down.  Additional comments on health care reform by Senator Mark Warner, Senator Jim Webb and Congressman Bob Goodlatte can be seen here.

July 17, 2009. The House of Representatives released revised health care reform legislation this week, which now includes financing details and amends proposals contained in the earlier draft of the legislation. Changes in the revised bill include Medicare and Medicaid provider payments, the creation of a public health insurance option, Medicaid eligibility expansion, a requirement that individuals to hold some level of health coverage and would levy fees against employers that don't offer insurance. The bill now includes $20 billion in Medicare and Medicaid DSH savings that would begin in 2017. This is considerably less than the $50 billion in DSH savings included in the agreement between the Senate Finance Committee and the American Hospital Association, expected to begin in 2015. Click here for the full text of the legislation and here for a guide to the major changes in the legislation.

The Congressional Budget Office estimates that the House's version of a health reform bill will cost approximately $1 trillion over a 10-year period and cover approximately 97% of the population by 2019. The House spent the latter part of the week marking up the reform legislation and has set a goal of passing the bill before the August recess.

Also this week, the Senate Health, Education, Labor and Pensions (HELP) committee voted 13-10, along party lines, to pass a $600 billion health care reform measure that expands health coverage to 21 million uninsured people over the next decade by requiring an individual health insurance mandate and requiring employees to contribute to the cost.

Douglas Elmendorf, director of the Congressional Budget Office, warned this week that the proposed health care reform measures would raise costs instead of lowering them. While testifying before the Senate Finance Committee on Thursday, Elmendorf explained that subsidies to help uninsured people would raise federal health care spending and that the Medicare and Medicaid cuts proposed to pay for coverage expansion are not large enough to offset the current cost trend.

July 10, 2009. On Monday, the American Hospital Association, the Federation of American Hospitals, and the Catholic Health Association reached an agreement with the White House and the Senate Finance Committee to help finance health care reform over the next decade. The joint statement on the health care reform agreement can be seen here. Key highlights of the agreement include:
· No GME/IME cuts
· A permanent ban on physician self-referral
· Reductions to Disproportionate Share Hospital (DSH) payments
· Reductions delayed until 2015
· Reductions would only go into effect (10% per year) if the number of uninsured is reduced by 50%

As more individuals are insured, there will be less of a reliance on DSH payments. With a trigger mechanism in place along with a delay in reduction, the AHA proposal is well thought out and has lessened the impact on the Health System of the automatic DSH reduction as proposed by President Obama.

This is only an agreement among parties and not actual legislation. This is one proposal of many being discussed on Capitol Hill and hundreds of amendments have already been filed for the first Senate bill.

In other health care reform news, senior lawmakers are concerned about the ability of the Senate to pass a bill by the August recess, as they originally hoped to do. Democratic leaders had set an aggressive goal for the health care reform timetable, hoping to vote before the August recess and reach a compromise on the House and Senate versions in the autumn and sending a bill to President Obama before the end of the year. Delays include an inability to compromise on the inclusion of a government run public plan and whether to tax employee health benefits. An additional delay comes as a result of the confirmation hearings for Supreme Court justice nominee, Sonia Sotomayor.

The Senate Finance Committee is expected to release its own draft of health reform legislation today. We will keep you apprised of what is included in this bill as this is being touted as the Senate vehicle for health care reform. The delay in action from the Senate Finance Committee has been due to debates over a public plan option, the original price tag of the bill at $1.6 trillion, and also the committee’s aspiration of a bipartisan bill.

July 3, 2009. The Senate Health, Education, Labor and Pensions (HELP) committee has drafted a proposal that includes a government run plan to compete with private insurers through exchanges (new insurance purchasing pools). The HELP Committee public plan proposal is one of four to be debated after lawmakers return next week. Additional information on the options can be found here.

During this recess, legislators will be holding health care reform talks around the country to discuss the current proposals and contentious issues surrounding health care reform. These issues include the overall cost, whether or not to create a government run plan to compete with private health plans, taxing workers' benefits and whether to penalize employers not offering coverage to their employees. Several town hall meetings discussing health care reform were held around the state this week, including one hosted by President Obama and Governor Kaine at Northern Virginia Community College and one held at the VCU Student Commons by several health care interest groups and attended by Congressman Bobby Scott.

A group of Richmond business, health insurers and other healthcare groups met on Monday with Sr. Policy Advisor, Sheryl Jaeger from Congressman Cantor’s Whip Office and Aryana Khalid, the Health Policy Legislative Aide to Senator Mark Warner to discuss the current Healthcare Reform ideas of the House and Senate. The topics discussed were the public plan option, insurance mandates for employers and individuals, how to fund healthcare reform and geographic disparities in Medicare payments across the country.

June 26, 2009. Health care reform continues to remain a contentious issue in Congress, and members of the Senate are becoming increasingly concerned that compromise will not be reached on health care reform in 2009. The primary obstacle impeding bipartisanship is whether or not to include a government run insurance option in the legislation, along with the cost of health care reform.

It was announced this week that the $1.6 trillion health care reform plan sponsored by Senate Democrats is now expected to cost approximately $1.2 trillion (a reduction of $4 billion). One change impacting the total cost is a reduction in subsidies to help the uninsured purchase coverage.

Hospital representatives, including the American Hospital Association, the American Medical Association, the Federation of American Hospitals and the Catholic Heath Association, are involved in negotiations with lawmakers over approximately $200 billion in potential cuts. These cost-cutting measures for health care reform savings include the Medicare and Medicaid disproportionate-share payment programs. The hospital industry is expected to come to an agreement with lawmakers and the Obama Administration similar to the Pharmaceutical Research Manufacturers of America deal with Senate Finance Chairman Max Baucus and the White House. The PhRMA deal could save the government $80 billion by expanding the Medicare prescription drug program.

June 19, 2009. Health care reform continues to be a hot topic in Washington D.C. and there are several pieces of legislation proposed by different interest groups in the House and Senate.  This week, House Republicans offered a plan that includes regulatory relief, an individual tax break for purchasing health insurance and limits on malpractice lawsuits.  Highlights of the House Republican plan also include allowing Medicaid users to transfer the value of their benefits to a private health care plan and encouraging employers to automatically sign workers up for health insurance, forcing employees to opt out if it was not wanted.

The two health care reform bills in the Senate are facing difficulties and potential delays due to financial concerns and inability to agree on several key components of the legislation.  The Senate Finance Committee will be slowing down action on the legislation and it is foreseeable that committee action could be stalled until after the July recess.  One reason for the delay is the expense of the reform legislation - the Congressional Budget Office estimated this week that the proposal would cost $1.6 trillion.  The Senate Health, Education, Labor and Pensions (HELP) Committee proposal is also facing delays of its own, though the committee members remain confident that the bill will continue to move forward through the committee process.  One key reason for the delays is the size and volume of the health care reform proposals - the Senate HELP legislation weighs in at more than 600 pages and with almost 400 amendments just from committee members. 

Lastly, three former Senate majority leaders unveiled their own health care reform proposal this week.  The bipartisan plan, with an estimated cost of $1.2 trillion, was created by Democrat Tom Daschle and Republicans Bob Dole and Howard Baker and includes an individual health insurance mandate and a public insurance plan option.  The plan can be seen in its entirety here.

June 12, 2009. This week, the Senate Health, Education, Labor & Pensions (HELP) committee revealed their legislative proposal for health care reform. Highlights include prohibiting insurance companies from denying coverage or charging more due to medical history, a health insurance mandate requiring all individuals to have insurance, and the creation of a government sponsored insurance plan to compete with private insurers. The National Association of Public Hospitals and Health Systems (NAPH) summarized key components of the legislation, including:

  • The extension of 340B pricing to include inpatient drugs;

  • The reauthorization of a $200 million Trauma Care Center Grant Program, which stabilizes existing trauma centers, particularly safety net providers;

  • The establishment of state operated, but federally controlled, health insurance exchanges – called Health Benefit Gateways; and

  • The establishment of cost sharing limits and sliding scale credits for individuals who do not qualify for Medicaid to purchase insurance. These credits would be available for individuals up to 500 percent of the federal poverty level.

Next week, the HELP Committee will hold discussions and begin the official mark-up process of the legislation.

Three House chairmen - Charles Rangel (D-NY), Chair of the Ways and Means Committee; George Miller (D-CA), Chair of the Committee on Education and Labor; and Henry Waxman (D-CA), Chair of the Energy and Commerce Committee, are working together to draft a single health care reform bill, which was summarized at a House Democratic Caucus meeting on Tuesday. The House proposal, similar to the Senate HELP legislation, would require an individual health insurance mandate and create a government-run insurance program to compete with private insurance companies. A formal copy of the legislation is expected to be released next week and finalized in July. Both plans have a public insurance option, which is opposed by the American Medical Association (AMA), who released a statement this week. They believe that the introduction of a new public plan threatens to restrict patient choice by driving out private insurers.

June 5, 2009. The Senate Health, Education, Labor and Pensions Committee (HELP) is expected to release its initial version of health reform legislation in the next couple of days. This plan will include a public run plan that would compete with the private insurance market. The HELP Committee Plan differs dramatically from the Senate Finance Committee Plan, as the HELP Committee only deals with policy decisions and not the funding strategy.

An ambitious timeline has been set regarding the process for healthcare reform:

o First Week - The Senate Health, Education, Labor and Pensions (HELP) Committee will publish their plan for healthcare reform.
o Week of June 16 – Both Senate bills will be marked up by the Senate Finance Committee as well as the Senate HELP Committee.

o Before July 4th Recess - A single bill will be produced on the Senate side.
o Last two weeks of July – Floor discussion will take place on both Senate and House Healthcare Reform Bills.
o Bills will be initially voted on and will most likely go into conference.

o A single healthcare bill will be produced as a compromise of both the House and Senate.
· October
o President Obama has stated that he would like to see a bill on his desk that he can sign by October 1st.

The Senate will be the first to initiate and react to any healthcare reform legislation. The House is inclined to produce their own legislation after the Senate version is published. In the House, the bill will have to go through three committees: Ways and Means; Education and Labor; and Energy and Commerce. The rules of the House allow for a more streamlined and faster process of passing a bill, especially through a reconciliation process.

May 29, 2009. For this week’s legislative highlights, I thought it best to compare and contrast the various plans by President Obama, the Senate Finance Committee and also the Patients’ Choice Act of 2009 (the Republican Plan). 


President Obama

Senate Finance Committee

Patients’ Choice Act of 2009

Date of Plan

February 26, 2009

April – May 2009

May 20, 2009

Approach to Healthcare Reform

8 Principles to Healthcare Reform:

·   Reduce long-term growth of healthcare costs

·   Protect families from debt and rising healthcare costs

·   Guarantee access to doctors and health plans

·   More preventative care

·   Improve quality of care and patient safety

·   Make health coverage affordable

·   Portability of healthcare coverage

·   Eliminate denial of coverage for those with pre-existing conditions

The Senate Finance Committee has released three white papers regarding:

·   Delivery of Healthcare

·   Access to Healthcare

·   Financing of Healthcare

The committee is requesting feedback to these very broadly written papers.  A couple of recurring themes were:

·   Everyone has health insurance

·   Health Insurance Exchange

·   Expand Medicaid and Children’s Health Insurance Program (CHIP)

·   Medicare Buy-in

To counter the work of the Senate Democrats, the Republicans have also issued a white paper outlining their priorities for healthcare reform.  Most of the ideas revolve around creating a state-based health insurance exchange.  Some other priorities are:

·   Tax credits ($2,300 for individual, $5,700 for family) to help offset the costs of insurance

·   More Medicaid for those with disabilities

·   Taxing employer-provided health benefits

Individual Mandate

·   The plan must cover all Americans

·   Requires all individuals to have a minimum standard of healthcare coverage

·   Exemptions will be granted for financial hardship

·   No requirement

Employer Requirements

·   No requirement

Two proposals:

·   Require employers with more than $500,000 in employee compensation to contribute at least 50% of the premium or pay an assessment

·   No employer mandate/assessment 

·   No requirement

Expansion of Public Programs/Public Plan

·   President signed the CHIP Reauthorization bill

·   Individuals with income up to 115% FPL would be eligible for Medicaid

·   These individuals could be enrolled in private plans through the Health Insurance Exchange if it was cheaper

·   Another option would be for childless adults (who are not currently covered) to receive tax credits, but not necessarily be enrolled in Medicaid.

·   Expand CHIP eligibility to 275% FPL after September 30, 2013

·   Medicare buy-in option for those 55-64 years old

·   Creation of a public plan that could be offered through the Exchange

·   Restructure Medicaid to only apply to those low-income individuals with disabilities

·   Those without disabilities would join a private plan and would receive a tax credit to pay for this

·   Allow private facilities to compete with VA hospitals to provide care to veterans

Tax Credits

·   No requirement

·   Provide tax credits to individuals with incomes between 100% FPL and 400% FPL

·   Provide tax credits to small employers who purchase insurance for their employees

·   Tax credit of $2,300 for individuals and $5,700 for families

Cost Containment

·   More preventative care measures

·   Reduce administrative costs and control fraud and abuse

·   More use of Health Information Technology (HIT)

·   Increase funding for anti-fraud activities

·   Restructure payments to Medicare Advantage (MA) plans to promote quality

·   More Accountable Care Organizations created and funded

·   Cover more preventative services

·   Bundling of payments

·   Establish a 30-day readmission rule for Medicare

·   More use of HIT and personal health records

·   National Strategic Prevention Plan

·   Lower premiums to Medicare enrollees who adopt healthier lifestyles

·   More Accountable Care Organizations

·   Competitive bidding for MA plans

·   Create “health courts”

Quality/Health System Performance

·   Plan must implement better patient safety and quality measures

·   Include more HIT

·   Increase use of primary care providers

·   Comparative clinical effectiveness research

·   Bundling of payments for acute, inpatient hospital services

·   Value-based purchasing program

·   Create new Health Care Services commission to establish uniform measures for reporting price and quality information


·   Earmarked $630 billion over 10 years in a Health Reserve Fund in his introduced budget

·   Considering a range of taxes (alcohol, soda taxes)

·   Eliminating the federal tax-exempt status of non-profit hospitals

·   Plan is revenue neutral

·   Will pay for some of it by taxing employer-sponsored health benefits


·   Promote wellness

·   Promote wellness by state grant system

·   Change the Medicaid FMAP rates to take into effect the economic situation of the country

·   Reform GME to incentivize more primary care doctor residencies

·   Determine a defined allotment individual enrolled in Medicaid for long-term care services.  Medicare should pay for cost-sharing, deductibles and premiums for low-income Medicare beneficiaries

























































May 22, 2009. On Monday, May 18th, Senate Finance Committee Chair Max Baucus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa) issued the third and final paper on Health Care Reform. This specific paper dealt primarily with financing the health care system. Included in the paper were options to restructure the way in which the federal government allocates Disproportionate Share Hospital (DSH) and Graduate Medical Education (GME) payments to hospitals. Unlike the previous two documents, this paper does examine ways to fund this reform. Options for funding included utilizing savings achieved through reduced spending levels, reevaluating health tax subsidies and possibly increasing taxes on alcohol and sweetened beverages (soda tax).

Republicans have presented their own plan, entitled the "Patients' Choice Act,” which mostly centers on building health insurance exchanges at the state level. The revenue-neutral legislation would create a new tax credit ($5,700 for families, $2,200 for individuals) to help pay for healthcare coverage or insurance premiums. The Republicans believe that taxing employer-provided health benefits will help offset some of the funds needed for the tax credit.

May 15, 2009. Senate Finance Committee Chair Max Baucus (D-Mont.) and Ranking Member Grassley released proposals on Monday for a public health insurance option and a requirement that all U.S. residents obtain health coverage. The proposals in the 63-page "policy options" paper included three options for a public plan. One would be similar to Medicare; another would call for a third-party administrator outside of HHS to oversee and regulate the plan; and a third would allow states to decide whether to create a public option. The paper also gives the option of not including a public plan but instead relying on a "reformed and well-regulated private market."

At a Senate Finance Committee roundtable on May 12th, participants debated various options for financing health care reform, including increasing taxes on alcohol and tobacco products, taxing employer-sponsored health coverage and reducing income tax deductions for individuals. The third and final policy paper on Health Care Reform, which focuses on health care financing, will be published early next week.

May 8, 2009. Senate Finance Committee Chairman Max Baucus (D-Mont.) predicted that President Obama will be the difference-maker in bringing together bi-partisan support for health reform. Some of the larger, more contentious issues, such as whether to create a government-run public plan option to provide health benefits or how to pay for the massive reform bill have yet to be answered. In June, the Finance Committee, along with Senator Edward Kennedy's (D-Mass.) Health, Education, Labor and Pensions Committee and three House panels, will mark up the first drafts of health care reform legislation (The Hill).

If you have questions, contact Mark Rubin ( Our office phone number is: 804-828-1235.