Tag Archive for reform

Research Team Member | September 6, 2010
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Health care reform and buying coverage across state lines

I hope you all had a wonderful Thanksgiving. Now that that’s over, Congress is back in session, and the Senate is tackling the health care reform issue.

One of the things that is being discussed in reforming our health insurance system is allowing people to buy insurance plans from other states where they might be able to find less expensive plans. I’m not sure how this is supposed to work, and here’s why.

One reason the cost of plans is lower in some states than is others is the number of mandated services a health plan is required to cover. The more a plan is required to cover, the higher the cost of coverage. For example, California has 56 required services that each plan must cover.  By contrast, Idaho has 13 state mandates. We aren’t at the top of the list by any means; Virginia has 60 mandates and Maryland has 66. Want to check out what kinds of things are mandated, click here.

Another area that needs to be addressed is how physicians and others are paid. HMO plans in California tend to be more expensive than PPO plans in the individual market, but you have lower out of pocket costs when obtaining care on an HMO plan. (The opposite is usually true in group health insurance.) The reason this can be is through very specific networks of contracted doctors. Most people know that you don’t have coverage if you go outside the HMO network unless it’s an emergency. So maybe you just don’t offer HMOs between states.  But PPOs have networks too. If you see a contracted doctor you are covered at a higher level than non-contracted doctors. So if you are in California and buy a plan from Kansas, would you always be covered at the lower reimbursement rates?  Larger carriers like United Healthcare and Aetna have networks in most states, but what about the smaller, regional carriers without networks in other states? How would that work?

Another aspect of provider payment that affects premiums is how much providers are paid. Care in some states is less expensive than others, so how do you pay providers in the ‘expensive’ states versus the less expensive, and what will that do to the cost of insurance in those states where lower costs of care are factored into the cost of insurance? You could still end up with the problem of some people being ‘under insured’ depending on how reimbursement is worked out.

So be careful what you ask for, you may gt it. The more you want covered in a plan, the more it’s going to cost. Just remember the old marketing adage, if it sounds too good to be true, it usually is.

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Research Team Member | September 6, 2010
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Health Insurance Reform Immediate Actions

While the majority of health insurance reform provisions go into effect in 2014, there are a number of provisions that take effect in 2010. Here’s an overview of the provisions that become effective this year: Read more at http://www.easytoinsureme.com/

Health insurance quotes

Immediately at enactment

Grandfathering – Plans and individuals that “renew” their coverage are exempt from any provisions of the law. These “grandfathered plans” must comply, however, with the following provisions of the law: extend dependent coverage through age 26, prohibit rescissions, eliminate waiting periods greater than 90 days, and eliminate pre-existing condition exclusions for children
Small employer tax credits – provides premium subsidies for small groups with 25 or fewer employees and average salaries of $40K or less

Less than six months

High-risk pool program – establish a temporary national high-risk pool for individuals with pre-existing medical conditions. (effective 90 days post enactment through January 1, 2014)
Temporary reinsurance for employer retirees – Creates a temporary reinsurance for employers providing health insurance coverage to retirees over 55 who are not eligible for Medicare (effective 90 days post enactment through January 1, 2014)

Six months plus

No lifetime limits – Eliminates all lifetime limits on the dollar value of coverage (effective six months post enactment)
Restrictions on rescissions – Prohibits insurers from rescinding coverage except in the cases of fraud (effective six months post enactment)
No pre-existing conditions for children – Eliminate pre-existing condition exclusions for children under 19 (effective six months post enactment)
Dependent age 26 – Extends dependent coverage to age 26 (effective six months post enactment)
Preventive care with no cost sharing – Eliminates cost-sharing for certain preventive services (effective January 1, 2011)
Appeals process – Individuals  have access to an  internal and external appeals process to appeal decisions by their health insurance plan.

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Research Team Member | September 6, 2010
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Colorado’s 2 senators criticize closed-door talks on health care reform

Democrats’ strategy for merging health care reform bills began to unravel under growing attacks Wednesday, including unexpected criticism from Colorado’s two Democratic senators.

Final negotiations on merging the bills began in earnest Wednesday as congressional leaders spent more than eight hours behind closed doors at the White House using a process that bypasses a formal conference committee and cuts out Republican participation.

They dug into a series of sticky issues that separate the two versions of the bill passed by the House and the Senate — including abortion, access to health insurance by illegal immigrants, and how to pay for the sweeping legislation, which will insure an estimated 37 million Americans over the next decade.

A White House statement said they had made “significant progress in bridging the remaining gaps” between the bills.

Republicans have been howling about the process for nearly two weeks — House Minority Leader John Boehner, R-Ohio, called it “a breeding ground for more of the kickbacks” — but now congressional leaders are facing a growing mutiny within their own ranks.

Wednesday, Sen. Mark Udall, D-Colo., suggested the talks lacked transparency and called for televising final negotiations. Sen. Michael Bennet, D-Colo., also said final talks should be open to live cameras.

“I haven’t been in Washington long, but one thing I can tell you is this is one town that can use some fresh air, and some real transparency,” Bennet said. “The outcomes from the negotiations on the health care reform bill are far too important to be done behind closed doors.”

Those criticisms could create significant difficulties for efforts to finish the health care bill and move on to other legislation before the press of this year’s election cycle swamps Congress.

Media organizations and others have said televising final negotiations between the House and the Senate would be natural given the enormous potential impact of the legislation.

Instead, Democrats have created a process under which House and Senate leaders will hammer out key compromises, then send the retooled bill to both chambers.

Those negotiations are expected to go for days, if not weeks, and Democratic leaders have said a conference would only provide Republicans — only one of whom voted for the bills in either chamber — a new chance at obstruction.

“This non-conference conference was a bid to speed this up and bring it to an end. A conference committee seemed one more area where Republicans would attack the Democrats and liberals would get upset with leadership,” said Julian Zelizer, an expert on Congress at Princeton University.

“The problem is it looked bad. Republicans can use that to say health care is being rushed through and done behind closed door because Democrats want to hide something,” he said. “That’s why you’re seeing Democrats now getting nervous about the process as well.”

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Research Team Member | September 6, 2010
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Health Insurance Reform Guide In 2010

Changes occurring in 2010 include:

Young Adults on Parents’ Health Insurance Plans. Young adults may stay on their parents’ health insurance until age 26, effective six months after enactment. Read more at http://www.easytoinsureme.com/

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Prohibition on Pre existing Condition Exclusions for Children. Insurers are prohibited from excluding coverage of any  pre existing condition for children in the individual health insurance market, effective six months after enactment of the bill.

Prohibition Against Plan Rescissions. Carriers providing group or individual coverage are prohibited from rescinding coverage once an enrollee is covered under the plan, except in the case of an individual who has performed an act or practice that constitutes fraud or makes an intentional misrepresentation of the material facts. Effective six months after enactment of the law.

Prohibitions Against Lifetime Maximum Benefit Caps. Carriers providing group or individual coverage are prohibited from setting lifetime maximum limits on the dollar value of benefits and from setting unreasonable annual limits on the dollar value of benefits, effective six months after enactment.

National High Risk Pool. People with pre existing conditions who are uninsurable will be eligible for subsidized coverage through a national high risk pool, beginning 90 days after enactment.

Limits on Share of Private Premiums Insurers Spend on Non Medical Costs. New limits will be set for the percent of premiums that insurers can spend on non medical claim costs.

Annual Review of Health Premium Increases. Effective immediately, the HHS secretary and states will establish a new process for annual review of unreasonable insurance premium increases.

Elimination of Cost Sharing for Preventive Care in Medicare and Private Plans. In 2010, cost sharing for proven preventive care services is eliminated in both Medicare and private plans.

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Research Team Member | September 6, 2010
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Health Insurance Quotes Reform Weekly

CALIFORNIA: The California Department of Insurance (CDI) has announced the release of e-mail notification system that will alert consumers when new individual health insurance rate filings are submitted.  CDI has previously announced that it would begin publicizing rate filings for individual health insurance policies.  Consumers are able to sign up online in the manner used for traditional e-mail updates.  CDI has also developed a consumer website with rate filing information.

NEW JERSEY: Following recent enactment of Governor Chris Christie’s budget, the Democrat-controlled legislature passed supplemental appropriations bills to restore $24 million in funding for state’s uninsured health coverage program, known as FamilyCare, as well as $7.4 million in aid for women’s health and family planning programs. The FamilyCare restoration, if signed into law, would have allowed adults with income between 134 to 200 percent of the federal poverty level to remain in the program. Despite bipartisan support in the Senate, Governor Christie vetoed the legislation, saying that the state has reset spending to a level that taxpayers can afford. Legislative leadership has indicated they may try to override the governor’s veto. Overriding the governor’s veto would require a two-thirds majority in both houses.

NEW MEXICO: The Public Regulation Commission (PRC) has appointed John G. Franchini as the new Superintendent of Insurance, a position that has been vacant since the May 4 resignation of his predecessor, Morris Chavez.  Franchini was selected from among five finalists and will assume his new duties in mid-August.

OHIO: While the Strickland Administration has advised state agencies to begin planning for the next biennium at both current levels and with a 10 percent cut in funding levels, the Budget Planning and Management Commission has been conducting hearings preparing for Ohio’s biennial budget adoption. The current budget ends on June 30, 2011 and is billions in the red. Testimony before the Commission has focused on increasing efficiencies by combining certain administrative functions of local and state governments and utilizing performance audits to determine if tax dollars are being spent efficiently. The Center for Community Solutions suggested to legislators that principal stakeholders in Medicaid (such as managed care companies and hospitals) be given budget targets and be asked to come up with ways to slow the growth of Medicaid. Conversely, the Health Policy Institute of Ohio guided legislators to the possibility of Ohio “rebalancing” its long-term care spending to shift utilization from long-term care facilities to home and community-based services.

While PPACA-related budget priorities will take place after the next biennial budget is adopted, it was previously determined that the federal expansion of Medicaid eligibility as part of health care reform will cost the state $190 million in 2014 –rising to $332 million by 2019. Absent any federal law changes, annual costs will rise substantially in 2020 and beyond, as the federal government’s match for new enrollees will drop to 90 percent of the total cost. The total state cost of Medicaid expansion from 2014 to 2019 is projected to be $1.45 billion.

OKLAHOMA: The Department of Insurance (DOI) announced last week that a final contract for the new temporary high-risk pool has been signed and sent back to HHS.  The DOI is in the process of drafting the application that will be used with the pool.  Oklahoma was awarded $60 million for use over 40 months.  Several candidates are being interviewed to be the High Risk Pool Manager.  Open enrollment will begin August 1 with an effective date of September 1.  Additionally, Oklahoma was the only state to request an open enrollment period for the PPACA provision requiring coverage of children under 19 in the individual market.  HHS has decided open enrollment periods will be permitted at the discretion of insurance companies.  On a separate issue, the Oklahoma Supreme Court has scheduled oral arguments to take place on August 4 in the lawsuit filed by Commissioner Kim Holland, on behalf of the DOI, challenging the constitutionality of a new 1 percent claims-paid fee passed by the legislature in late May.  The bill is scheduled to take effect August 27, absent court intervention.

 

http://www.easytoinsureme.com/

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Research Team Member | September 5, 2010
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Health-Care Reform to Dump Poor Kids?

Oleta Fitzgerald, director of the Children’s Defense Fund’s Southern Regional Office, says she is concerned over the welfare of Mississippi children if either of the two health-care reform packages considered by the U.S. House and Senate ever make it into law.

The House passed H.R. 3962 earlier this month, and Senate Democrats managed to beat back the threat of a Republican filibuster a few weeks ago, allowing the Senate to move forward with debate on the Patient Protection and Affordable Care Act, H.R. 3590. Both bills promise big reforms in the health-care and health-insurance industries. The Association for American Medical Colleges states that nearly 15 million people will be newly eligible for Medicaid and the Children’s Health Insurance Program under H.R. 3590, at an estimated cost of $374 billion over 10 years.

Fitzgerald says both bills contain huge holes regarding CHIP coverage for Mississippi children: “Right now, the fight over health-care reform in the House and Senate is all about abortion and the public option, but the children are getting lost in this discussion,” Fitzgerald said.

The issue, she said, centers on Mississippi’s unconventional requirement for CHIP eligibility.

Many states recently expanded their Medicaid program requirements to accept people who are a little further from the federal standard for poverty. Eleven states recently extended CHIP-eligible families’ income levels up to 200 percent of the federal poverty level, or higher. ($20,800 for an individual or $35,200 for a family of three).

But instead of expanding Medicaid, Mississippi set up a new health insurance program that contracts with private insurance companies. The states that expanded Medicaid will continue to receive federal support for those programs under both the bills under discussion in the House and Senate. But in Mississippi, all children and their families over 150 percent of the federal poverty level ($16,245 a year for an individual and $27,465 a year for a family of three) would go into an insurance exchange created by the House and Senate bills. The Senate bill plans to put CHIP-eligible kids in an exchange by the year 2019, while the House bill has them transferred by 2013.

Insurance exchanges do not promise the reliability of a government health program, Fitzgerald warns.

“Going into the exchange could require co-pays and premiums, the children would get lumped in with adults, and it’s not clear what requirements the insurance companies would have for their benefit packages,” she said.

There is also the question of permanence. Exchanges like the ones proposed by the House and Senate bills have not always been long-lasting. Texas, Florida, North Carolina and California all attempted—and failed—to create enduring insurance exchanges, primarily because private insurers tampered with the market.

A July report issued by the California HealthCare Foundation tried to pinpoint some of the factors that killed the California insurance exchange, which closed its doors in 2006. According to the report, the California exchange became too expensive when the clients it served became too costly. An exchange requires a certain number of healthy individuals to complement the more sickly participants of the exchange’s customer base; otherwise the cost of participation becomes too high for all participants.

But insurance companies in California lured healthy customers with lower premiums and steered the more sickly individuals into the exchange, creating a disproportionately expensive customer base.

“People involved in operations of the California exchange agreed that when there is competition for the same customers within and outside the exchange, the exchange is in ‘extreme peril’ of becoming a victim of adverse selection,” the report states. “If an exchange attracts a disproportionate share of higher risk individuals and groups as the California exchange did at various times, it cannot succeed.”

Fitzgerald said Mississippi’s eagerness to boot CHIP-eligible children from the program to keep down state costs is another factor complicating the new bills.

“Another problem is enrollment. We need enrollment in the exchanges to be simplified, because enrolling in state health programs have a history of being anything but simple in Mississippi,” Fitzgerald said, referencing a Medicaid policy championed by Republican Gov. Haley Barbour, which requires Medicaid recipients to meet Medicaid personnel “face-to-face” to be considered for program renewal.

CDF is working with its national office in trying to insert an amendment in the Senate bill though Democratic Sens. Robert Casey and Jay Rockefeller, which would keep all children up to 300 percent of the federal poverty level in the CHIP program until the new insurance exchange is thoroughly vetted.

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Research Team Member | September 5, 2010
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Brown Vows To Send Health Care Reform ‘back To The Drawing Board’

Republican Scott Brown, fresh off his victory in the Massachusetts race for U.S. Senate, called on the secretary of state to send him to Washington immediately, saying Wednesday that he wants to send health insurance reform “back to the drawing board.”

Though the state typically waits at least 10 days to collect absentee ballots before certifying, the senator-elect said he’s “confident” his margin of victory — 5 points and nearly 110,000 votes — was greater than the number of outstanding ballots.

Brown is champing at the bit to be sworn in since he would become the 41st Republican in the Senate, breaking the Democrats’ 60-vote supermajority and potentially scuttling health care reform if it returns to the chamber for a final vote.

“Since the election is not in doubt, I’m hopeful that the Senate will seat me on the basis of those unofficial returns,” Brown said, adding that he’s already spoken to members of the state’s congressional delegation, including Sen. John Kerry, and will travel to Washington Thursday. “I think it’s important that we hit the ground running because there’s some very important issues facing our country.”

On health care reform, he said he wants “everyone” to have some form of health care coverage, but questioned plans to slash Medicare and raise taxes to do it.
video
Brown Ready to Hit Ground Running

Brown ready to hit ground running

“I think we can do it better,” he said.

The Republican senator-elect said he was focused on moving to Washington as soon as possible to try to free up some of the political gridlock there.

“I have always just wanted to go down and solve the problem regardless of party,” Brown told NBC’s “Today” Show.

“While they’re in Washington talking about what someone said in a book and what this happened, we have some very serious problems when it comes to over-taxation, overspending and Al Qaeda who are trying to kill us. So we need to get back to the basics and start solving problems that affect every person in this country,” he said.

Brown’s insurgent candidacy has forced Democrats to rethink the basics on several matters, including the massive health insurance reform bill that is tagged to cost nearly $1 trillion over 10 years. They are also reconsidering agenda items they plan to use in November’s midterm election campaigns.

By winning the Senate seat in Massachusetts by nearly the same margin that President Obama defeated Sen. John McCain in November 2008, Brown takes away Democrats’ filibuster-proof majority and can pull a reverse-Obama — claiming a mandate to defeat the health care legislation now stuck in Congress.

Despite the upset, Obama adviser David Axelrod said administration officials will take into account the message voters delivered Tuesday but declined to go further.

“It’s not an option simply to walk away from a problem that’s only going to get worse,” Axelrod said of the health care bill.

Sen. Susan Collins, R-Maine, said one of the many messages coming out of the Massachusetts election is that Americans are sick of partisan gridlock, but voters also had a much more expansive recommendation.

“They want better performance out of Washington, they want us focusing on the troubled economy and the need for more jobs and … they’re tired of sweetheart deals that were sneaked into the health care bill. They want that kind of bill to be negotiated in the open. And they’re tired of politics as usual and they also want controls. They don’t want unfettered, one-party control,” Collins told Fox News.

Collins said she cannot support a bill “that imposes billions of dollars for new taxes, slashes Medicare by $500 billion and would actually cause insurance rates to go up.”

“We really should start from scratch and do a completely bipartisan bill,” she added

But Pennsylvania Gov. Ed Rendell said that Americans oppose the health insurance changes because “the administration and its supporters, myself included, haven’t done a good enough job explaining to people what’s in this bill.”

Rendell said he wants to go back to the drawing board in order to better communicate the message. If that fails, and a filibuster is threatened, then Democrats shouldn’t “just cave” but should make the other side “explain why they’re trying to block the bill with this type of political chicanery.”

“I haven’t heard one good alternative offered by any Republican except let’s start at the beginning, let’s start all over. Start all over to do what?” he asked.

Rendell added that he wants to call the GOP’s bluff.

“Let them filibuster, let them take to the floor and speak endlessly and endlessly about why this is bad for the American people and what the alternative is,” he said.

As the debate continues over whether to scrap the year-long health insurance reform effort, some are also looking at whether Republicans can repeat the feat in Massachusetts in other states.

Seven Senate seats now held by Democrats are now considered toss-ups in November — Nevada, Colorado, Arkansas, Illinois, Pennsylvania, Delaware and Connecticut. Four Republican seats are in the same situation — Missouri, Kentucky, Ohio and New Hampshire.

“I think anybody who’s up for election this November ought to take seriously what the people of Massachusetts had to say in that special Senate election,” said Sen. Joe Lieberman. D-Conn.
Sen. John Cornyn, R-Texas, head of the National Republican Senatorial Committee, said Democrats nationwide should be on notice

“Americans are ready to hold the party in power accountable for their irresponsible spending and out-of-touch agenda.”

But Democratic Senatorial Campaign Committee Chairman Robert Menendez cautioned against “taking a single unique election and extrapolating what it means for the midterms 10 months away.”

Still, Menendez said he doesn’t want to sugarcoat what happened and Democrats will be sorting through the lessons in the days ahead.

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Research Team Member | September 5, 2010
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Federal Health Insurance Reform Future Tasks

The federal health care reform legislation, known as the Patient Protection and Affordable Care Act, signed by the President on March 23, 2010, and the Health Care and Education Reconciliation Act approved by Congress, signed by the President today, will expand the availability of health care coverage to millions of Americans. While some of the measures will be implemented this year, many do not take effect until 2014 and some extend out to 2020.

Below is a high-level overview of the timeline.  It is important to note that many of these reforms and their effective dates are subject to the rules and regulations process both at the state and federal levels – which could alter the intended timing of implementation.

2010

New Programs:
* Temporary retiree reinsurance program is established
* National risk pool is created, small business tax credit is established
* $250 rebate for Medicare members who reach the “doughnut hole”

Insurance Reforms:
* Prohibits lifetime benefit limits – based on dollar amounts
* Allows restricted annual limits on the dollar value of certain benefits
* Coverage rescissions/cancellations are prohibited (except for fraud or intentional misrepresentation)
* Cost-sharing obligations for preventive services are prohibited
* Dependent coverage up to age 26 is mandated
* Internal and external appeal processes must be established
* Pre-existing condition exclusions for dependent children (under 19 years of age) are prohibited
* New health plan disclosure and transparency requirements are created

2011

Insurance Reforms:
* Uniform coverage documents and standard definitions are developed
* Minimum medical loss ratios are mandated

Medicare Reforms:
* Medicare Advantage cost sharing limits effective
* Medicare beneficiaries who reach the doughnut hole will receive a 50% discount on brand name drugs
* A 10% Medicare bonus will be provided to primary care physicians and general surgeons practicing in underserved areas, such as inner cities and rural communities.
* Medicare Advantage plans would begin to have their payments frozen.

Other:
* Employers are required to report the value of health care benefits on employees’ W2 tax statements.
* Annual industry fee for pharmaceutical manufacturers of brand name drugs.
* Voluntary long term care insurance program would be made available to provide cash benefit for assisting disabled individuals to stay in their homes or cover nursing home costs. Benefits would start five years after people begin paying a fee for coverage.
* Funding for community health centers would be increased to provide care for many low income and uninsured people.

2012

* Hospitals, physicians, and payers would be encouraged to band together in “accountable care organizations.”
* Hospitals with high rates of preventable readmissions would face reduced Medicare payments.

2013

* Individuals making $200,000 a year or couples making $250,000 would have a higher Medicare payroll tax of 2.35% on earned income —up from the current 1.45%. A new tax of 3.8% on unearned income, such as dividends and interest, is also added.
* Medical expense contributions to flexible spending accounts (FSAs) limited to $2,500 a year—indexed for inflation. In addition, the thresholds for claiming itemized tax deduction for medical expenses rise from 7.5% to 10% of income.
* Medical device manufacturers would have a 2.9% sales tax on medical devices; devices such as eyeglasses, contact lenses, and hearing aids would be exempt.
* Eliminates deduction for expenses allocable to Medicare Part D subsidy for employers who maintain prescription drug plans for their Medicare Part D eligible retirees.

2014

Coverage Mandates & Subsidies:
* Individual and employer coverage responsibilities are effective. 
* Individual affordability tax credits are created and small business tax credits are expanded.

Health Insurance Exchange & Insurance Reforms:
* State individual and small group health insurance exchanges operational.
* Guaranteed issue, guaranteed renewability, modified community rating and minimum benefit standards (“essential benefits” plan) effective. 
* Lifetime and annual dollar limits are prohibited for essential benefits.
* Pre-existing condition exclusions are prohibited.

Taxes & Fees:
* Addition of new taxes on health insurers

Medicaid and Medicare Reform:
* Medicaid expanded to cover low income individuals under age 65 up to 133% of the federal poverty level—about $28,300 for a family of four.
* Minimum medical loss ratio of 85% required for Medicare Advantage plans

2018

Taxes & Fees:
* Tax (“Cadillac tax”) imposed on employer sponsored health insurance plans that offer policies with generous levels of coverage.

2020

Medicare Reform:
* Doughnut hole coverage gap in Medicare prescription benefit is fully phased out. Seniors continue to pay the standard 25% of their drug costs until they reach the threshold for Medicare catastrophic coverage.

Author  Resource: Easy To Insure ME http://www.easytoinsureme.com/

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Research Team Member | September 4, 2010
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This Week In Health Insurance Reform Easytoinsureme.com

January 27, 2010

This Week in Health Reform–Federal Legislative Overview

House and Senate
Republican Scott Brown’s victory over Massachusetts Attorney General Martha Coakley (D) in the January 19 special election to fill the seat of the late Senator Edward Kennedy (D) is proving to be a game-changer for the health care reform debate.  It is now unclear what Democrats can do to pass President Obama’s most important legislative agenda item.  Even though the Democrats held a majority in the House and Senate this year, they failed to coalesce around a strategy to pass this legislation.  Initially after Brown’s win, there were two options under discussion for moving forward on the current legislation.

Have the House take up the Senate-passed bill and use the “reconciliation” bill process to “fix” several of the provisions the House finds unacceptable (e.g., the “Cadillac” tax, etc.).  If the House passes the Senate bill, it will go directly to the President for his signature, with no further action needed in the Senate.  A “reconciliation” bill, which would need only 51 votes in the Senate, could be passed either in tandem with the Senate bill or follow soon after.
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Scale back the health care reform bill. A scaled-back bill could include health insurance reforms, exchanges, as well as several other provisions and possibly could attract bipartisan support.  While many Democrats are likely to view this approach as a major lost opportunity, leadership may determine this is the most viable approach.

However, Speaker of the House Nancy Pelosi (D-CA) publicly stated on January 21 that the House does not have the 218 votes needed to pass the Senate version of the health care reform bill, which takes option number one (above) off the table.

While numerous private discussions are reportedly being held on the matter, at the outset it seems that Democrats’ only option for keeping the current legislation alive is to reach across the aisle to their Republican counterparts, most notably, moderate Senator Olympia Snow (R-ME).  That would mean a more conservative bill, which could anger rank and file Democrats who are supportive of the legislation.

Although no plans have emerged for how to move forward, it now looks like Democrats will have to modify their plans.  On the night of Scott Brown’s win in Massachusetts, Rep. Anthony Weiner (D-NY) – one of the biggest proponents for a single-payer health care system – said: “The only way to go forward is to take a step back. If there isn’t any recognition that we got the message and we are trying to recalibrate and do things differently, we are not only going to risk looking ignorant but arrogant.  I don’t think it would be the worst thing to take a step back and say we are going to pivot to do a jobs thing,” and include elements of health care reform in it, he said.

Rep. David Camp (R-MI), Ranking Member on the House Ways and Means Committee, declared Democrats’ health care overhaul legislation “dead” and said that instead of full-scale change Congress should take a “first step toward comprehensive reform” of the nation’s health care system.

Issue Overview: Nebraska Medicaid Deal
While key elements of the health care reform legislation remain in flux, the Congressional Budget Office (CBO) released its cost estimate of the expansion of the State of Nebraska’s Medicaid Deal, negotiated by Senator Ben Nelson (D-NE) who then voted for the Senate’s Patient Protection and Affordable Care Act, HR 3590.

The letter responds to a request from Rep. Paul Ryan (R-WI)), Ranking Member, House Committee on the Budget, asking if the cost estimate of the Senate health reform bill would change if all states received the same level of federal assistance for Medicaid as Nebraska receives under the bill.

The CBO stated on January 21 that the net spending for the Senate legislation would increase by $35 billion over ten years if all states received the same level of assistance as Nebraska.

Under the Senate’s provisions, non-elderly individuals with incomes below 133 percent of the federal poverty level would be eligible for Medicaid beginning in 2014.   The federal government would pay the cost of covering newly eligible enrollees through 2016; and federal spending would be about 90 percent by 2019.  The Senate legislation states that it would pay all Medicaid expansion costs to Nebraska beginning in 2014.

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Research Team Member | September 4, 2010
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Health Care Reform Weekly Easytoinsureme Health Insurance Quotes

Week of January 25, 2010

The sudden halt to health care reform’s steady march forward came as a shock to many who saw an upset win by Republican Senator-elect Scott Brown in Massachusetts as all but impossible. But if many took delight in the election outcome’s impact on health reform legislation, Aetna Chairman Ronald A. Williams made it clear in a New York Times story last week that the country still needs meaningful health care reform – reform that addresses access as well as affordability. Everyone benefits by health reform that gets at the factors driving soaring health care costs and the loss of coverage for so many Americans. While Congress thinks carefully about its next steps, Aetna will continue to support meaningful health care reform and continue to offer responsible solutions to legislative leaders.

Federal

The election of Republican Scott Brown as the new senator from Massachusetts has derailed the Congressional health care reform train, less because Brown denies Democrats the 60th filibuster-proof vote, though that is certainly a major result, and more because it collapsed the Democratic political house of cards by highlighting the power of independent voters and the frustrated anti-incumbent mood of the electorate. Whether Democrats can regroup from this wake-up call will consume their leadership from now until the November off-year elections. How Democrats handle, and how Republicans respond to, health care reform in the short term and other key priorities – such as jobs, the economy, energy and security – over the rest of the session will underscore all Congressional decisions from now until the first Tuesday in November. In short, the 2010 elections started in earnest with Brown’s victory.

Once Democrats get past the shock of losing Kennedy’s seat, they will have to grapple with health care reform, one way or the other. The early favorites, including passing the Senate bill “as is” in the House, have been dropped for now as Democrats recognize the political cost of ramming through something unpopular propelled by political muscle only. Passing a smaller, less invasive and mostly Democratic bill has only a slightly better chance, as Republicans are not too likely to “crossover” quite yet. There is a growing interest in using reconciliation (the 51-vote tactic) down the road to pass a Democratic-only bill, once the House and Senate Democratic leadership can agree to a single bill. And, there is the outside chance that Democrats will see the Massachusetts election as an imperative to craft a bipartisan bill with Republicans that can secure 70-plus votes in the Senate. Wednesday’s State of the Union speech, followed by the party issues retreats later in the week, will go a long way toward determining which path will be pursued.

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