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Health Care Reform Archives

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.

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 Move-On.org.

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:

June:
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.

July:
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.

August/September:
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). 

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 Don Gehring (dcgehrin@vcu.edu) or Mark Smith (mesmith@vcu.edu). Our office phone number is: 804-828-1235.

Virginia Commonwealth University | Government Relations
Date Last Modified: June 30, 2008
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