From the Desk of Don Gehring                                            November 20, 2009

Federal Highlights:
Healthcare Reform.  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.

Medicare Physician Reimbursement.  Late Thursday, the House voted to pass HR 3961, the “Medicare Physician Payment Reform Act of 2009.”  The bill eliminates the 21.2% reduction in Medicare physician payments that was scheduled to take place on January 1, 2010 and also blocks a cumulative 40% cut over the next six years.  The bill permanently replaces the Sustainable Growth Rate (SGR) formula with a more stable system.

Read more: http://www.allheadlinenews.com/articles/7017053163#ixzz0XPNeQSMK

On the Hill.  The U.S. Preventive Services Task Force came out with recommendations on Monday concerning breast cancer screening.  The task force, an independent, government-appointed panel, also recommended:

• Against routine screening mammography in women aged 40 to 49 years.

• Biennial screening mammography (as opposed to annual screening) for women aged 50 to 74 years.

• That there is insufficient evidence to continue mammograms past age 74.

• Against teaching women breast self-examination (BSE) or continuing clinical breast examination (CBE) beyond screening mammography.

• That there is insufficient evidence to utilize digital mammography or magnetic resonance imaging (MRI) instead of film mammography.

On Wednesday, Senator Robert Byrd became the longest-serving Member of Congress in history, having served in the House from 1953 to 1959 and the Senate from 1959 to the present, for a total of 56 years. 

State Highlights:
Post-Election Transition.  Governor-Elect McDonnell met with members of the House Democratic Caucus over the weekend to discuss economic development, job creation, improving schools and the 2011 redistricting process.  Additional appointments to the McDonnell Transition Team and Staff were also announced over the weekend and can be seen here.  One notable appointment is Michel Zajur, a former VCU student who serves as founder, President and CEO of the Virginia Hispanic Chamber of Commerce. The McDonnell Transition Team also appointed inaugural co-chairs to serve as ambassadors for the Inaugural Celebration.

House Leadership Update.  Over the weekend, members of the Virginia House of Delegates Democratic and Republican caucuses elected leadership for the 2010 General Assembly session.  On the Democratic side, Ward Armstrong will remain House minority leader and Ken Plum was elected caucus chairman with Jennifer McClellan as first vice chairwoman. 

The Republican Caucus re-elected William Howell as Speaker of the House, which will need to be voted on by the full House of Delegates during the General Assembly in January.  Additionally, the Republicans voted to keep Sam Nixon as caucus chair and Kirk Cox as majority whip. 

In other news, Delegate Phil Hamilton, who was defeated in the November election by Democrat Robin Abbott, resigned his seat on Monday.  The seat will remain vacant until Abbott is sworn into the House in January.

House Appropriations Committee.  The House Appropriations Committee convened this week for its annual two day retreat, affording state lawmakers the opportunity to explore a variety of issues, many of which inevitably will be addressed during the 2010 General Assembly Session.  The primary focus was on the budgetary outlook of the Commonwealth, but additional presentations of interest included a review and comparison of state retirement systems and the impact of healthcare reform on providers and states.  The state retirement presentations can be seen here and here; and the healthcare reform presentations can be seen here and here. 

Senate Finance Committee.  The Senate Finance Committee also held its annual two day retreat this week.  Like the House Appropriations Committee, the primary focus was on the budget and revenue outlook.  Additional presentations of interest included an update on state employee compensation, health and human resources and higher education issues.

Mandated Health Benefits.  The Special Advisory Commission on Mandated Health Insurance Benefits met on Tuesday to decide whether to recommend to the General Assembly HB 2191, a bill that would mandate that health insurance companies reimburse for telemedicine.  The Commission decided to delay a recommendation and to study this issue over the next year. 

Appointment.  John Duval, CEO of MCV Hospitals, was appointed chairman-elect of the Virginia Hospital and Healthcare Association.

Due to the Thanksgiving holiday recess, the next edition of the legislative highlights is scheduled for Friday, December 4th.

To be added to the weekly legislative highlights email distribution list, please send an email to govrel@vcu.edu.