Insuring Resources Commentary:
There is no clear path forward, especially since our President displayed an astounding lack of leadership, saying only "I will not quit", and Congress needs to pass health care reform, but providing no actual direction. The next steps Thursday and Friday of this week will be very telling.
In particular I want readers to pay special attention to the health care reform comments by Gov. McConnell in the Republican response after the President's speech.
Please see below and I'll analyze his 3 main points here:
1)Most (Americans) "do not want to turn over the best medical care system in the world to the federal government."
The Democrats proposals do not even come close to "turning the best (actually its #33 in the world) health care system over to the federal gov't." 'Gov't takeover'- its amazing they're still getting way with that rhetoric.
The House plan does include a public plan option.... for about 10% of the market!
2) McConnell- "Republicans in Congress have offered legislation to reform health care, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes."
Yes he's right, it does those things, BUT it would change access to health insurance through tax credits and the plans are high deductible health plans with HSAs. Eventually most Americans would have $5,000 deductibles and pay for most of their care themselves with little if any help from their employers purchasing power reducing risk.
3) "let families and businesses buy health insurance policies across state lines".
The reason why we have state regulated insurance plans is because the public demanded and WANTED mandates like mammograms, birth control coverage, 48-hour minimum hospital stay after giving birth, chiropractic care, and others.
If we allow interstate purchase its going to be a race to the bottom with pared down coverage competing to be the cheapest. That's what's good for business owners, not consumers. Plans sold and barely regulated by the likes of Alabama will pervade the market. Alabama doesn't regulate insurance, they rubber stamp the weakest coverage possible. Where do you want your employer to buy YOUR health insurance.... Alabama... or Wisconsin?
---------------- -------------------------
Here's what the President had to say on health care reform earlier tonight in the State of the Union address: Video link: http://www.cnn.com/video/#/video/politics/2010/01/27/sotu.sot.obama.healthcare.cnn?hpt=C2
Here's what he had to say on Health Care Reform: Obama apologized for not making the case clearer to the public for health care reform and noted that the back room deals involved tarnished the public's view but he concluded by saying, "I will not walk away."
Yesterday the New York Times reported the following:
With no clear path forward on major health care legislation, Democratic leaders in Congress effectively slammed the brakes on President Obama’s top domestic priority on Tuesday, saying they no longer felt pressure to move quickly on a health bill after eight months of setting deadlines and missing them. The Senate majority leader, Harry Reid, Democrat of Nevada, deflected questions about health care. “We’re not on health care now,” Mr. Reid said. “We’ve talked a lot about it in the past.”
And now for the Republican response to Obama's address on health care reform from Gov. McConnell of Virginia:
"While Americans agree that an affordable, high-quality health care system is needed, most of them "do not want to turn over the best medical care system in the world to the federal government."
"Republicans in Congress have offered legislation to reform health care, without shifting Medicaid costs to the states, without cutting Medicare, and without raising your taxes," he said. "We will do that by implementing common-sense reforms, like letting families and businesses buy health insurance policies across state lines, and ending frivolous lawsuits against doctors and hospitals that drive up the cost of your health care."
Wednesday, January 27, 2010
Saturday, January 23, 2010
What a Bipartisan Bill May Look Like.... if we get one at all
Insuring Resources Commentary:
Below is a link to a New York Times article depicting possible items included in a health care reform package. In this NY Times reporter's analysis of conversations with lawmakers, aides and health care policy experts he compiled these items as still doable in the post Super-majority Democratic Senate health care reform era. His list is similar to the blog post I provided a few days ago so you get the benefit of my analysis of what's possible again.
Here's my further analysis of these items:
-No pre-x for children makes sense, this probably has 85-90% support in both houses and would be agreed to easily in any health care bill.
-Dependent coverage up to age 25 is also a given. Wisconsin just approved this in 2009, effective 1/1/2010 for ages up to 27. This too would have substantial bi-partisan support.
-Grants to establish state-based health insurance exchanges for individuals and small businesses. This probably would pass both houses as it would most likely not be mandated for businesses or individuals. This could help alleviate some cost pressures for these groups. If a wide range of coverage options were offered through the Exchanges and states were encouraged to be innovative this could be very positive.
-The fed. gov't offer financial incentives for state Medicaid expansion to cover childless adults and parents. Wisconsin, with its BadgerCare program and other states who have already done this, would not be happy about this measure. In those cases perhaps there can be adjustments or bonuses to state's who go above and beyond the minimum or who have already accomplished it. This too has broad bipartisan support as long as Nebraska doesn't get its Cornhusker Kickback. Special deals cannot be a part of a compromise bill at this point. The public backlash would be too enormous.
-Tax credits for small business purchase of health insurance-- This is very bi-partisan friendly as most GOP health care proposals, including those offered by Rep. Paul Ryan (R-Janesville) and Sen. John McCain (R-Arizona), were centered on tax credit use to purchase health insurance.
This would perhaps get more GOP than Dems supporting it and would pass both houses.
For a lengthy analysis I authored of the Paul Ryan proposal for WPRI
2 years ago go to the web link at the upper left hand sidebar.
-The package could also include changes in Medicare, to reduce the growth in payments to doctors and hospitals while rewarding providers of high-quality, lower-cost care. To help older Americans, it could narrow a gap in Medicare coverage of prescription drugs, sometimes known as a doughnut hole. I don't understand why again the incentives only apply to Medicare for high quality, more efficient care. I just don't get why Congress is so reluctant to address the whole system rather than just Medicare. If they're going to make regulatory changes why sell it short and stop only at Medicare rather than addressing the whole system and the whole cost problem.
See link below to read the whole article
---------------------
From the New York Times article
"A New Search for Consensus on Health Care Bill"
The entire article linked: http://www.nytimes.com/2010/01/22/health/policy/22health.html?ref=todayspaper
By ROBERT PEAR and DAVID M. HERSZENHORN
Published: January 21, 2010
Below is a link to a New York Times article depicting possible items included in a health care reform package. In this NY Times reporter's analysis of conversations with lawmakers, aides and health care policy experts he compiled these items as still doable in the post Super-majority Democratic Senate health care reform era. His list is similar to the blog post I provided a few days ago so you get the benefit of my analysis of what's possible again.
Here's my further analysis of these items:
-No pre-x for children makes sense, this probably has 85-90% support in both houses and would be agreed to easily in any health care bill.
-Dependent coverage up to age 25 is also a given. Wisconsin just approved this in 2009, effective 1/1/2010 for ages up to 27. This too would have substantial bi-partisan support.
-Grants to establish state-based health insurance exchanges for individuals and small businesses. This probably would pass both houses as it would most likely not be mandated for businesses or individuals. This could help alleviate some cost pressures for these groups. If a wide range of coverage options were offered through the Exchanges and states were encouraged to be innovative this could be very positive.
-The fed. gov't offer financial incentives for state Medicaid expansion to cover childless adults and parents. Wisconsin, with its BadgerCare program and other states who have already done this, would not be happy about this measure. In those cases perhaps there can be adjustments or bonuses to state's who go above and beyond the minimum or who have already accomplished it. This too has broad bipartisan support as long as Nebraska doesn't get its Cornhusker Kickback. Special deals cannot be a part of a compromise bill at this point. The public backlash would be too enormous.
-Tax credits for small business purchase of health insurance-- This is very bi-partisan friendly as most GOP health care proposals, including those offered by Rep. Paul Ryan (R-Janesville) and Sen. John McCain (R-Arizona), were centered on tax credit use to purchase health insurance.
This would perhaps get more GOP than Dems supporting it and would pass both houses.
For a lengthy analysis I authored of the Paul Ryan proposal for WPRI
2 years ago go to the web link at the upper left hand sidebar.
-The package could also include changes in Medicare, to reduce the growth in payments to doctors and hospitals while rewarding providers of high-quality, lower-cost care. To help older Americans, it could narrow a gap in Medicare coverage of prescription drugs, sometimes known as a doughnut hole. I don't understand why again the incentives only apply to Medicare for high quality, more efficient care. I just don't get why Congress is so reluctant to address the whole system rather than just Medicare. If they're going to make regulatory changes why sell it short and stop only at Medicare rather than addressing the whole system and the whole cost problem.
See link below to read the whole article
---------------------
From the New York Times article
"A New Search for Consensus on Health Care Bill"
The entire article linked: http://www.nytimes.com/2010/01/22/health/policy/22health.html?ref=todayspaper
By ROBERT PEAR and DAVID M. HERSZENHORN
Published: January 21, 2010
Thursday, January 21, 2010
So What Happens Now--- Forecasting What's Possible
Insuring Resources Commentary:
Now that Senate Democrats have lost their Supermajority and only
have 59 votes they are quickly assessing the art of the possible to save face.
Here's my view of what we'll get:
These are definitely out
Public Option
Employer Mandate
I believe these might be in (Analysis follows)
Elimination of Pre-x exclusions
Individual Mandate
State Pilot Health Insurance Exchanges
Expand Medicaid in states at their option
Reduced tax on Cadillac Plans
Let's assess what I believe might be in from the list above:
Eliminate pre-x conditions- This is a must but insurers must have flexibility to deal with adverse selection of millions of uninsureds suddenly getting tremendous coverage for many for the very first time. Treatment costs may go through the roof and cost-shifting may be drastic upon the employer side.
Individual Mandate See above, but also what penalty will be set and will it be in proper balance to be both a carrot and a stick?
State Pilot Health Insurance Exchanges
I think we'll see Congress want to test this and not go with it nationwide. That will be a compromise both sides may be able to live with and I believe there will be employer "penalties" that they must pay if their employees access coverage through the HIE. Again, those penal;ties must be in the proper balance.
Medicaid Expansion
Ok' let's start with some state examples to set the stage.
Wisconsin: currently covers most adults and children up to 200% of the federal poverty level. Nebraska (which got the 'Cornhusker Kickback' thanks to Senator Nelson only covers up to 100% and the Senate Bill requires 133%. The House bill required 150%.
Louisiana I've heard is far below 100%.
I think the final bill will allow state's to experiment with some additional matching funds from the Feds. Currently most state Medicaid programs are 60% funded by the individual state and then they receive the remaining 40% from the feds. There are some nuances to this but that's the basics. I think the feds may sweeten that match within select pilots and allow a few states to experiment on a limited basis a la BadgerCare, except it might be a better financial deal for states to have waited.
But what about those with existing employer coverage?
I believe there will be a reduced tax on the so-called Cadillac plans as a compromise. Reform will probably include minimum required standard benefit plans which set a floor for the employer market. Employers may also be mandated to provide several options based on how many employees they have.
Employer size for inclusion in the Exchange will be interesting since I don't feel there will be a mandate if a compromise is found in the next few weeks. The impact on small businesses is perhaps the hardest issue to predict. If there's no mandate I think employees without coverage will be allowed in the Exchanges and the employer may face a fee because of that but what level of fee, what amount of payroll might be set for that. All these questions remain.
There also appears to be little impact on self-funded employer plans except in the areas of multi-state regulations, standard benefit plan offerings and a few other items that may or may not be included. If an employer's self-funded plan is deemed a Cadillac plan there may be a tax on the benefits.
What should happen but most likely won't
>Large Lean Efficiency pilots in multiple states- I won't harp on my pet issue again today.
Change health care reimbursement to episode of care basis, not fee-for-service.
-------------------------------------
Obama Weighs Options
1/21/10- The Wall Street Journal
Inside the White House, top aides to the president said Mr. Obama had made no decision on how to proceed, and insisted that his preference was still to win passage of a far-reaching health care measure, like the House and Senate bills, which would extend coverage to more than 30 million people by 2019.
On Capitol Hill, Democratic leaders said they were weighing several options. But some lawmakers in both parties began calling for a scaled-back bill that could be adopted quickly with bipartisan support, and Mr. Obama seemed to suggest that if he could not pass an ambitious health care bill, he would be willing to settle for what he could get. In the interview with ABC, he cited two specific goals: cracking down on insurance industry practices that hurt consumers and reining in health costs.
“We know that we need insurance reform, that the health insurance companies are taking advantage of people,” Mr. Obama said. “We know that we have to have some form of cost containment because if we don’t, then our budgets are going to blow up, and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements to this bill.”
Republican Congressional aides said a compromise bill could include new insurance industry regulations, including a ban on denying coverage based on pre-existing medical conditions, as well as aid for small businesses for health costs and possible steps to restrict malpractice lawsuits. But as Mr. Obama noted on ABC, a pared-down package imposing restrictions on insurers might make coverage unaffordable, which is one reason he prefers a broad overhaul.
As the full Congress returned to Washington to start a new legislative year on the first anniversary of Mr. Obama’s inauguration options were limited and there were signs of a divide between the White House and Democrats on Capitol Hill. House leaders signaled that they had effectively ruled out the idea of adopting the Senate bill, which would send it directly to the president for his signature. Yet close advisers to the president said such a move was still on the table.
Mr. Brown’s victory in Massachusetts on Tuesday denies Democrats the 60th vote that they need to surmount filibusters and advance a revised health measure. Senate leaders said they would not risk antagonizing voters by trying to rush a bill through before Mr. Brown could be sworn in, and Mr. Obama agreed.
“People in Massachusetts spoke,” the president told ABC. “He’s got to be part of that process.”
Another option considered by Democrats would be to use the procedural maneuver known as reconciliation to pass chunks of the health care bill attached to a budget measure, which requires only a simple majority. But there appeared to be little appetite for such a move on Capitol Hill.
Senior Republicans showed little new willingness to collaborate with the Democrats. Asked where he might be willing to work across the aisle, the Senate Republican leader, Mitch McConnell of Kentucky, offered praise for Mr. Obama’s strategy in Afghanistan but not a single example on domestic policy.
Mr. McConnell was asked if the health care bill was dead. “I sure hope so,” he said.
Senator Susan Collins, Republican of Maine, said she was eager to work with Democrats in devising an alternative to the health care bill passed four weeks ago by the Senate on a party-line vote.
“What I hope the White House will do is start from scratch and, instead of pushing this bill through the House, work with a bipartisan group of senators to achieve a consensus bill that would have widespread support,” Ms. Collins said. “There are many provisions of the bill that have bipartisan support. And I believe the president would be wise to draft a new bill that he could get through both the House and the Senate with supermajority votes.”
Robert Pear contributed reporting.
Now that Senate Democrats have lost their Supermajority and only
have 59 votes they are quickly assessing the art of the possible to save face.
Here's my view of what we'll get:
These are definitely out
Public Option
Employer Mandate
I believe these might be in (Analysis follows)
Elimination of Pre-x exclusions
Individual Mandate
State Pilot Health Insurance Exchanges
Expand Medicaid in states at their option
Reduced tax on Cadillac Plans
Let's assess what I believe might be in from the list above:
Eliminate pre-x conditions- This is a must but insurers must have flexibility to deal with adverse selection of millions of uninsureds suddenly getting tremendous coverage for many for the very first time. Treatment costs may go through the roof and cost-shifting may be drastic upon the employer side.
Individual Mandate See above, but also what penalty will be set and will it be in proper balance to be both a carrot and a stick?
State Pilot Health Insurance Exchanges
I think we'll see Congress want to test this and not go with it nationwide. That will be a compromise both sides may be able to live with and I believe there will be employer "penalties" that they must pay if their employees access coverage through the HIE. Again, those penal;ties must be in the proper balance.
Medicaid Expansion
Ok' let's start with some state examples to set the stage.
Wisconsin: currently covers most adults and children up to 200% of the federal poverty level. Nebraska (which got the 'Cornhusker Kickback' thanks to Senator Nelson only covers up to 100% and the Senate Bill requires 133%. The House bill required 150%.
Louisiana I've heard is far below 100%.
I think the final bill will allow state's to experiment with some additional matching funds from the Feds. Currently most state Medicaid programs are 60% funded by the individual state and then they receive the remaining 40% from the feds. There are some nuances to this but that's the basics. I think the feds may sweeten that match within select pilots and allow a few states to experiment on a limited basis a la BadgerCare, except it might be a better financial deal for states to have waited.
But what about those with existing employer coverage?
I believe there will be a reduced tax on the so-called Cadillac plans as a compromise. Reform will probably include minimum required standard benefit plans which set a floor for the employer market. Employers may also be mandated to provide several options based on how many employees they have.
Employer size for inclusion in the Exchange will be interesting since I don't feel there will be a mandate if a compromise is found in the next few weeks. The impact on small businesses is perhaps the hardest issue to predict. If there's no mandate I think employees without coverage will be allowed in the Exchanges and the employer may face a fee because of that but what level of fee, what amount of payroll might be set for that. All these questions remain.
There also appears to be little impact on self-funded employer plans except in the areas of multi-state regulations, standard benefit plan offerings and a few other items that may or may not be included. If an employer's self-funded plan is deemed a Cadillac plan there may be a tax on the benefits.
What should happen but most likely won't
>Large Lean Efficiency pilots in multiple states- I won't harp on my pet issue again today.
Change health care reimbursement to episode of care basis, not fee-for-service.
-------------------------------------
Obama Weighs Options
1/21/10- The Wall Street Journal
Inside the White House, top aides to the president said Mr. Obama had made no decision on how to proceed, and insisted that his preference was still to win passage of a far-reaching health care measure, like the House and Senate bills, which would extend coverage to more than 30 million people by 2019.
On Capitol Hill, Democratic leaders said they were weighing several options. But some lawmakers in both parties began calling for a scaled-back bill that could be adopted quickly with bipartisan support, and Mr. Obama seemed to suggest that if he could not pass an ambitious health care bill, he would be willing to settle for what he could get. In the interview with ABC, he cited two specific goals: cracking down on insurance industry practices that hurt consumers and reining in health costs.
“We know that we need insurance reform, that the health insurance companies are taking advantage of people,” Mr. Obama said. “We know that we have to have some form of cost containment because if we don’t, then our budgets are going to blow up, and we know that small businesses are going to need help so that they can provide health insurance to their families. Those are the core, some of the core elements to this bill.”
Republican Congressional aides said a compromise bill could include new insurance industry regulations, including a ban on denying coverage based on pre-existing medical conditions, as well as aid for small businesses for health costs and possible steps to restrict malpractice lawsuits. But as Mr. Obama noted on ABC, a pared-down package imposing restrictions on insurers might make coverage unaffordable, which is one reason he prefers a broad overhaul.
As the full Congress returned to Washington to start a new legislative year on the first anniversary of Mr. Obama’s inauguration options were limited and there were signs of a divide between the White House and Democrats on Capitol Hill. House leaders signaled that they had effectively ruled out the idea of adopting the Senate bill, which would send it directly to the president for his signature. Yet close advisers to the president said such a move was still on the table.
Mr. Brown’s victory in Massachusetts on Tuesday denies Democrats the 60th vote that they need to surmount filibusters and advance a revised health measure. Senate leaders said they would not risk antagonizing voters by trying to rush a bill through before Mr. Brown could be sworn in, and Mr. Obama agreed.
“People in Massachusetts spoke,” the president told ABC. “He’s got to be part of that process.”
Another option considered by Democrats would be to use the procedural maneuver known as reconciliation to pass chunks of the health care bill attached to a budget measure, which requires only a simple majority. But there appeared to be little appetite for such a move on Capitol Hill.
Senior Republicans showed little new willingness to collaborate with the Democrats. Asked where he might be willing to work across the aisle, the Senate Republican leader, Mitch McConnell of Kentucky, offered praise for Mr. Obama’s strategy in Afghanistan but not a single example on domestic policy.
Mr. McConnell was asked if the health care bill was dead. “I sure hope so,” he said.
Senator Susan Collins, Republican of Maine, said she was eager to work with Democrats in devising an alternative to the health care bill passed four weeks ago by the Senate on a party-line vote.
“What I hope the White House will do is start from scratch and, instead of pushing this bill through the House, work with a bipartisan group of senators to achieve a consensus bill that would have widespread support,” Ms. Collins said. “There are many provisions of the bill that have bipartisan support. And I believe the president would be wise to draft a new bill that he could get through both the House and the Senate with supermajority votes.”
Robert Pear contributed reporting.
Wednesday, January 20, 2010
Health care reform divide grows deeper
Insuring Resources Commentary
I attended the Wisconsin Insurance Commissioner's Health Insurance Advisory Committee yesterday where we received an update on health care reform from the Nat'l Assoc. of Insurance Commissioners. I am an appointed member of the committee.
With the Massachusetts Senate victory by the GOP last night the next two weeks will define what happens with health care reform. The legislative options depicted by NAIC were not pretty and we'll see if they can compromise to improve U.S. health care. The Democrats need a Republican to pass it and that's unlikely. Hopefully they get past the rhetoric and enact true bipartisan reform that focuses on quality and efficiency while ending pre-exisitng condition exclusions and covering the majority of the uninsured.
Its ironic, for me anyway, that at the same OCI meeting we also heard an update from WHIO--- the Wisconsin Health Information Organization http://www.wisconsinhealthinfo.org/. They have established a database of 7.3 million episodes of care for 1.5 million Wisconsinites from their insurer, provider and employer health care purchasing partners. As you've heard me say before, episodes of care reimbursement is how we should reform U.S. health care to emphasize quality and efficiency and create true cost competition on both the health care and health insurance sides of the equation. Through the WHIO database providers quality and efficiency can be compared against their peers and national standards to improve health outcomes and efficiency.
I've attached the article below as it illustrates the health care debate specifically in Wisconsin and the impact of Tea Party's and the anti-gov't backlash of doing health care reform incorrectly.
--------------- -----------------
From the Jan. 19th Milwaukee Journal Sentinel
Jeff Uhlir, an accountant from Manitowoc, opposes the health care reform legislation making its way through Congress and wants more competition among private insurers to drive down costs.
"I think Americans, given the opportunity and freedom, will get their own health insurance," said Uhlir, who recently attended a tea party rally.
Barbara Aho, a self-employed landscape designer from Milwaukee, wants health care reform and wants it now.
"I don't know any health insurance company that has gone broke," she said.
The fight over health care has divided the country for nearly a year, and rather than losing steam, it appears to be reaching a fever pitch locally and nationally.
In Wisconsin, several thousand people turned out Saturday for an anti-tax "tea party" rally in Racine County. People in the movement oppose key planks of the Obama agenda, including health care reform.
And U.S. Sen. Russ Feingold, a Democrat, has been getting blistered at recent listening sessions, which he holds regularly across the state. Last week, a standing-room-only crowd at Waukesha County Technical College in Pewaukee, a Republican stronghold, overwhelmingly opposed Obama's health care effort. They questioned in particular how Feingold could champion transparency in government while negotiations on the health care legislation continue behind closed doors. Several in the crowd told Feingold that if he voted for the health care bill, he should be voted out of office. Feingold faces re-election in the fall.
Tuesday, Feingold was on Democratic home turf, holding a listening session at Washington High School in Milwaukee. The crowd there was more supportive of health care reform. If anything, several of the speakers voiced displeasure that Democrats didn't go further in the legislation by introducing a so-called public option, allowing people to buy health insurance from the government.
"I'm not surprised by the Milwaukee meeting being more favorable toward the president's plan and the Waukesha meeting being less favorable," Feingold told reporters. "I wouldn't know much about Wisconsin if I didn't know that."
Nevertheless, Rep. Jim Sensenbrenner of Menomonee Falls put in a total of 25 town hall meetings and office hour events during the recent long holiday weekend, and said people are angrier than ever over health care legislation. Compared with the comments he heard in September and October, "these were more heated, more emphatic and more concerned" as a possible final vote looms while people become more familiar with what is in the bill, he said. Sensenbrenner said people are particularly angry about the sweet deals certain lawmakers were able to carve out for their own states, such as an exemption that would allow Florida seniors to keep their Medicare Advantage plans.
Even "the few people who spoke up in favor of the bill said it had its problems," he said.
Regarding the feedback Feingold has been getting at town hall meetings, Sensenbrenner said: "I don't think he had a good two weeks."
2010 midterm impact
Even if the Democrats do get their reform bill through Congress - and to President Barack Obama's desk for signature - the issue will likely continue to resonate with the public all the way to the 2010 midterm elections.
The bill's opponents have criticized everything from what's in the bill to how it was created to the fact it was passed in the Senate on Christmas Eve. The bill's supporters have said the reform measure will insure up to 30 million people who don't currently have insurance.
And get this: According to a Jan. 8-10 Gallup survey, Americans want their member of Congress to vote for health care legislation by a margin of 49% to 46%. Yet a recent Pew Center survey found 39% favored the health care bills before Congress while 49% opposed them.
"If you think all of those people that say they don't want the bill, are people that don't want health reform - there's a good chunk of them who want a much stronger bill," Feingold said. "I think the largest group is probably the people that are for the bill. The second largest group is the people that are against the bill because they don't think they want to do anything. And then there is a third group, which is significant because they want a stronger bill."
Feingold supported the Senate version of the bill, which he said "is a reasonable compromise. It is not a government takeover of health care."
Candice Owley, a local labor leader and former nurse from Milwaukee, said two of her sons are in the restaurant business, and only one of them has health care.
"People's lives are on the line," she said later, explaining why she supported reform legislation. "We have to get moving and get the bill passed."
But Lynne Wallis, a saleswoman from Whitefish Bay, told Feingold that she supported him in previous Senate races but won't back him this fall because of his support for the Senate health care bill.
"The government does not belong in health care," she said.
Feingold responded that Medicare and the health system for veterans are government programs.
Later, Wallis said that if a vote of the American people were taken now, the reform bill "would not pass."
The next closest thing may have happened Tuesday in Massachusetts. Republican Scott Brown defeated Democrat Martha Coakley in a special election to fill the Senate seat held by the late Ted Kennedy. Brown, who opposes the reform legislation, will become the Republicans' 41st senator, smashing the Democrats' filibuster-proof supermajority in the Senate.
That could change everything, and give added fuel to the opposition.
"I can't go grocery shopping or fill up my gas tank without my neighbors asking how we can stop this train wreck and encouraging me to keep up the fight against this," Rep. Paul Ryan of Janesville said in a statement. "These aren't just Republicans. Independents and Democrats even are fed up with Washington, sick of being shut out of the process, and genuinely worried with just how quickly the federal government is encroaching into their lives."
I attended the Wisconsin Insurance Commissioner's Health Insurance Advisory Committee yesterday where we received an update on health care reform from the Nat'l Assoc. of Insurance Commissioners. I am an appointed member of the committee.
With the Massachusetts Senate victory by the GOP last night the next two weeks will define what happens with health care reform. The legislative options depicted by NAIC were not pretty and we'll see if they can compromise to improve U.S. health care. The Democrats need a Republican to pass it and that's unlikely. Hopefully they get past the rhetoric and enact true bipartisan reform that focuses on quality and efficiency while ending pre-exisitng condition exclusions and covering the majority of the uninsured.
Its ironic, for me anyway, that at the same OCI meeting we also heard an update from WHIO--- the Wisconsin Health Information Organization http://www.wisconsinhealthinfo.org/. They have established a database of 7.3 million episodes of care for 1.5 million Wisconsinites from their insurer, provider and employer health care purchasing partners. As you've heard me say before, episodes of care reimbursement is how we should reform U.S. health care to emphasize quality and efficiency and create true cost competition on both the health care and health insurance sides of the equation. Through the WHIO database providers quality and efficiency can be compared against their peers and national standards to improve health outcomes and efficiency.
I've attached the article below as it illustrates the health care debate specifically in Wisconsin and the impact of Tea Party's and the anti-gov't backlash of doing health care reform incorrectly.
--------------- -----------------
From the Jan. 19th Milwaukee Journal Sentinel
Jeff Uhlir, an accountant from Manitowoc, opposes the health care reform legislation making its way through Congress and wants more competition among private insurers to drive down costs.
"I think Americans, given the opportunity and freedom, will get their own health insurance," said Uhlir, who recently attended a tea party rally.
Barbara Aho, a self-employed landscape designer from Milwaukee, wants health care reform and wants it now.
"I don't know any health insurance company that has gone broke," she said.
The fight over health care has divided the country for nearly a year, and rather than losing steam, it appears to be reaching a fever pitch locally and nationally.
In Wisconsin, several thousand people turned out Saturday for an anti-tax "tea party" rally in Racine County. People in the movement oppose key planks of the Obama agenda, including health care reform.
And U.S. Sen. Russ Feingold, a Democrat, has been getting blistered at recent listening sessions, which he holds regularly across the state. Last week, a standing-room-only crowd at Waukesha County Technical College in Pewaukee, a Republican stronghold, overwhelmingly opposed Obama's health care effort. They questioned in particular how Feingold could champion transparency in government while negotiations on the health care legislation continue behind closed doors. Several in the crowd told Feingold that if he voted for the health care bill, he should be voted out of office. Feingold faces re-election in the fall.
Tuesday, Feingold was on Democratic home turf, holding a listening session at Washington High School in Milwaukee. The crowd there was more supportive of health care reform. If anything, several of the speakers voiced displeasure that Democrats didn't go further in the legislation by introducing a so-called public option, allowing people to buy health insurance from the government.
"I'm not surprised by the Milwaukee meeting being more favorable toward the president's plan and the Waukesha meeting being less favorable," Feingold told reporters. "I wouldn't know much about Wisconsin if I didn't know that."
Nevertheless, Rep. Jim Sensenbrenner of Menomonee Falls put in a total of 25 town hall meetings and office hour events during the recent long holiday weekend, and said people are angrier than ever over health care legislation. Compared with the comments he heard in September and October, "these were more heated, more emphatic and more concerned" as a possible final vote looms while people become more familiar with what is in the bill, he said. Sensenbrenner said people are particularly angry about the sweet deals certain lawmakers were able to carve out for their own states, such as an exemption that would allow Florida seniors to keep their Medicare Advantage plans.
Even "the few people who spoke up in favor of the bill said it had its problems," he said.
Regarding the feedback Feingold has been getting at town hall meetings, Sensenbrenner said: "I don't think he had a good two weeks."
2010 midterm impact
Even if the Democrats do get their reform bill through Congress - and to President Barack Obama's desk for signature - the issue will likely continue to resonate with the public all the way to the 2010 midterm elections.
The bill's opponents have criticized everything from what's in the bill to how it was created to the fact it was passed in the Senate on Christmas Eve. The bill's supporters have said the reform measure will insure up to 30 million people who don't currently have insurance.
And get this: According to a Jan. 8-10 Gallup survey, Americans want their member of Congress to vote for health care legislation by a margin of 49% to 46%. Yet a recent Pew Center survey found 39% favored the health care bills before Congress while 49% opposed them.
"If you think all of those people that say they don't want the bill, are people that don't want health reform - there's a good chunk of them who want a much stronger bill," Feingold said. "I think the largest group is probably the people that are for the bill. The second largest group is the people that are against the bill because they don't think they want to do anything. And then there is a third group, which is significant because they want a stronger bill."
Feingold supported the Senate version of the bill, which he said "is a reasonable compromise. It is not a government takeover of health care."
Candice Owley, a local labor leader and former nurse from Milwaukee, said two of her sons are in the restaurant business, and only one of them has health care.
"People's lives are on the line," she said later, explaining why she supported reform legislation. "We have to get moving and get the bill passed."
But Lynne Wallis, a saleswoman from Whitefish Bay, told Feingold that she supported him in previous Senate races but won't back him this fall because of his support for the Senate health care bill.
"The government does not belong in health care," she said.
Feingold responded that Medicare and the health system for veterans are government programs.
Later, Wallis said that if a vote of the American people were taken now, the reform bill "would not pass."
The next closest thing may have happened Tuesday in Massachusetts. Republican Scott Brown defeated Democrat Martha Coakley in a special election to fill the Senate seat held by the late Ted Kennedy. Brown, who opposes the reform legislation, will become the Republicans' 41st senator, smashing the Democrats' filibuster-proof supermajority in the Senate.
That could change everything, and give added fuel to the opposition.
"I can't go grocery shopping or fill up my gas tank without my neighbors asking how we can stop this train wreck and encouraging me to keep up the fight against this," Rep. Paul Ryan of Janesville said in a statement. "These aren't just Republicans. Independents and Democrats even are fed up with Washington, sick of being shut out of the process, and genuinely worried with just how quickly the federal government is encroaching into their lives."
Monday, January 18, 2010
America's #1 job- The Actuary... no seriously I mean it
Insuring Resources Commentary:
Health care reform is serious business so I thought I'd post this article on the unheralded, til now, Actuary, to lighten the mood a bit.
----------------------
Top ranked job is – surprise – the unheralded actuary
By Bill Glauber of the Journal Sentinel
Posted: Jan. 18, 2010
They are the odds-makers of life.
With computers, calculations and curiosity they place a financial value on risk and can run the numbers on everything from health insurance to pensions to hurricanes.
They are actuaries.
"We are kind of at the bottom of the geek chain. Unfortunately, the accountants try to make fun of us," said Steve Sperka, an actuary who is vice president of the Long-Term Care Department at Northwestern Mutual.
These days, actuaries are riding high.
The profession got a boost recently when actuary was ranked as the No. 1 job in America according to a study for CareerCast.com The study attempted to rank 200 jobs by measuring environment, income, hiring outlook, physical demands and stress.
Actuary was placed ahead of software engineer, computer systems analyst, biologist and historian. Roustabout was No. 200, falling behind lumberjack, ironworker, dairy farmer and welder.
The news caused a brief stir in the actuarial profession when the survey was publicized by the Wall Street Journal.
Suddenly, workers who labor behind-the-scenes had something to crow about.
Well, not too loudly; they are actuaries, after all.
"We're rated the No. 1 job," Sperka said, "the No. 1 job that most people have never heard of and those who have heard of it don't understand what we do."
It's a very serious and very important job.
Sperka said he tells people that "actuaries are the engineers of the insurance industry."
"If you think about what an engineer does with a car, makes sure everything fits, the doors work, an actuary does the exact same thing with insurance products," he said.
Karen Ferguson, a recent college graduate who works as an actuarial associate with Northwestern Mutual, is even more succinct.
"We predict the future," she said. "That's what we try to do, using different statistics and probabilities."
When they do their job well, actuaries make the insurance world run smoothly.
But when they miss, trouble looms.
Milwaukee County sued its actuary for the controversial pension deal that crippled the county's budget. Last year, Mercer Inc. reached a $45 million settlement with the county with no admission of wrongdoing.
Actuary is not a job people fall into.
Some hear about the profession from relatives. Others are pointed to the profession by mathematics teachers.
In this job, you really need to like calculus.
Being an actuary calls for strength in mathematics, agility in business problem solving and solid communication skills. A college degree is just one step on the actuary ladder.
Actuaries must also pass a series of exams to earn professional designations. They work in life insurance, health insurance, pensions and property and casualty.
"If you have a life insurance plan, it's the actuaries who design the features of the plan and come up with the price," said Marjorie A. Rosenberg, chair of the University of Wisconsin-Madison Actuarial Science Department. "It's the actuaries that follow that insurance policy and payments so enough money is held in liability when you have a claim. That would be for life and health.
"The pension people help employers design pension plans so people have enough money at retirement."
Rosenberg said there are about 200 students in her program, which is lodged in the business school. There are another 35 students in the UW-Milwaukee actuarial science program, which is housed in the mathematics department.
Eric Key, co-director of the actuarial science program at UWM, said he wasn't surprised that actuary rated highly among American jobs since the profession usually ranks in the top 10.
"It's sort of self-selecting," he said. "This is not an easy thing to do, so the people who are likely to want to do it are inclined to like it in the first place."
Key said almost every student who graduates from the program manages to quickly nab a job. He doesn't worry that publicity for the profession will lead to a surplus of actuaries.
"You would think that whatever happens with health care reform, that will create work for actuaries," he said. "If there is any kind of radical change to how health care is delivered in the U.S., someone will have to tell you how much it will cost."
Health care reform is serious business so I thought I'd post this article on the unheralded, til now, Actuary, to lighten the mood a bit.
----------------------
Top ranked job is – surprise – the unheralded actuary
By Bill Glauber of the Journal Sentinel
Posted: Jan. 18, 2010
They are the odds-makers of life.
With computers, calculations and curiosity they place a financial value on risk and can run the numbers on everything from health insurance to pensions to hurricanes.
They are actuaries.
"We are kind of at the bottom of the geek chain. Unfortunately, the accountants try to make fun of us," said Steve Sperka, an actuary who is vice president of the Long-Term Care Department at Northwestern Mutual.
These days, actuaries are riding high.
The profession got a boost recently when actuary was ranked as the No. 1 job in America according to a study for CareerCast.com The study attempted to rank 200 jobs by measuring environment, income, hiring outlook, physical demands and stress.
Actuary was placed ahead of software engineer, computer systems analyst, biologist and historian. Roustabout was No. 200, falling behind lumberjack, ironworker, dairy farmer and welder.
The news caused a brief stir in the actuarial profession when the survey was publicized by the Wall Street Journal.
Suddenly, workers who labor behind-the-scenes had something to crow about.
Well, not too loudly; they are actuaries, after all.
"We're rated the No. 1 job," Sperka said, "the No. 1 job that most people have never heard of and those who have heard of it don't understand what we do."
It's a very serious and very important job.
Sperka said he tells people that "actuaries are the engineers of the insurance industry."
"If you think about what an engineer does with a car, makes sure everything fits, the doors work, an actuary does the exact same thing with insurance products," he said.
Karen Ferguson, a recent college graduate who works as an actuarial associate with Northwestern Mutual, is even more succinct.
"We predict the future," she said. "That's what we try to do, using different statistics and probabilities."
When they do their job well, actuaries make the insurance world run smoothly.
But when they miss, trouble looms.
Milwaukee County sued its actuary for the controversial pension deal that crippled the county's budget. Last year, Mercer Inc. reached a $45 million settlement with the county with no admission of wrongdoing.
Actuary is not a job people fall into.
Some hear about the profession from relatives. Others are pointed to the profession by mathematics teachers.
In this job, you really need to like calculus.
Being an actuary calls for strength in mathematics, agility in business problem solving and solid communication skills. A college degree is just one step on the actuary ladder.
Actuaries must also pass a series of exams to earn professional designations. They work in life insurance, health insurance, pensions and property and casualty.
"If you have a life insurance plan, it's the actuaries who design the features of the plan and come up with the price," said Marjorie A. Rosenberg, chair of the University of Wisconsin-Madison Actuarial Science Department. "It's the actuaries that follow that insurance policy and payments so enough money is held in liability when you have a claim. That would be for life and health.
"The pension people help employers design pension plans so people have enough money at retirement."
Rosenberg said there are about 200 students in her program, which is lodged in the business school. There are another 35 students in the UW-Milwaukee actuarial science program, which is housed in the mathematics department.
Eric Key, co-director of the actuarial science program at UWM, said he wasn't surprised that actuary rated highly among American jobs since the profession usually ranks in the top 10.
"It's sort of self-selecting," he said. "This is not an easy thing to do, so the people who are likely to want to do it are inclined to like it in the first place."
Key said almost every student who graduates from the program manages to quickly nab a job. He doesn't worry that publicity for the profession will lead to a surplus of actuaries.
"You would think that whatever happens with health care reform, that will create work for actuaries," he said. "If there is any kind of radical change to how health care is delivered in the U.S., someone will have to tell you how much it will cost."
Friday, January 15, 2010
Sen. Grassley says costs will increase with health reform
Insuring Resources Commentary:
Yet another opinion, on how the health care reform bills before us do not address the cost issue. This time a Republican Congressman- Sen. Grassley- cites the Congressional Budget Office and the Chief Actuary at the Dept. of Health and Human services who have analyzed the legislation and find that costs will increase.
Grassley was a key Republican in most of the Senate bill formulation talks in the fall but voted against the bill in committee and on the Senate floor because it did not address or attempt to control spiraling health care costs.
The bills do not create incentives for sustainable efficiency in the health care system. we need fundamental health care payment reform that incents efficiency based on quality health outcomes through episode of care based reimbursement. Drs and hospitals need to be paid based on outcomes not per procedure on a fee-for-service basis.
If reform does not address the cost issue the system will deteriorate further and premiums will increase.
----------------------- -------------------------
From the New York Times blog: Jan. 14, 2010
by DAVID M. HERSZENHORN
At the crux of the debate over major health care legislation is the question of why health care in America is so expensive – or to be more precise, why the cost of medical care has been growing far faster than the cost of everything else. It is far outpacing regular inflation and threatening to bust not only the federal budget but the finances of individuals and families as well.
Earlier this week the Prescriptions blog asked two experts of differing political perspectives to address two simple questions: Why is health care in American so expensive? And will the legislation emerging in Washington take sufficient steps to control costs? The experts, Joseph R. Antos, health policy researchers at the conservative American Enterprise Institute, and Jacob S. Hacker, a liberal proponent of a government-run insurance plan at Yale University, agreed – though for very different reasons – that the legislation would not do enough to control cost. You can read their responses here.
Next, Senator Max Baucus, Democrat of Montana, chairman of the Finance Committee and a leading architect of the legislation, weighed in with his own view that the bill incorporates virtually every idea put forward in the last 50 years to improve the health care system. Read the Baucus post.
Today, we hear from Mr. Baucus’s counterpart, Senator Charles E. Grassley of Iowa, the senior Republican on the Senate Finance Committee.
For months, Mr. Grassley was part of a small group of senators working to develop the legislation, but he ended up turning against the bill and opposing it both on the finance panel and on the Senate floor.
Mr. Grassley, who enjoys using Twitter to communicate with his constituents, offered the most succinct answer to the cost question so far.
“High costs come from flawed payment systems and defensive medicine,” Mr. Grassley wrote. “The system contains incentives that many times provide too much care and the wrong care, and there’s too much waste, fraud and abuse.”
Mr. Grassley’s opposition to the Democrats’ health care legislation is well known. Asked to elaborate on the reasons that he feels the bill will increase rather than decrease health care expenses, he offered the following.
A major goal for comprehensive health care reform was to lower spiraling costs, so it’s regrettable and really pretty unbelievable how the $2.5 trillion legislation that’s been passed fails to reduce rising costs. That judgment isn’t mine. It comes from the independent experts.
The nonpartisan Congressional Budget Office said on Dec. 19, “Under the legislation, federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care. The net increase in that commitment would be about $200 billion over that 10-year period.” The Congressional Budget Office and the Joint Committee on Taxation also estimated, on Nov. 30, that “the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law.”
Separately, the chief actuary for the Department of Health and Human Services said on Jan. 8 that under the Senate bill “total national health expenditures . . . would increase by an estimated total of $222 billion during calendar years 2010-2019.” In the same report, the chief actuary anticipated “an increase in overall national health expenditures ranging from $5.8 billion in 2011 to $13.8 billion in 2019.” The actuary said the Senate bill also would bend the spending growth curve upward for federal spending on health care, increasing it by $279 billion from 2010-2019.
These facts back up the majority opinion at the grassroots that health care bills passed by the House and Senate would make things worse, not better. Instead of sending this legislation to the president’s desk, Congress should work on the fundamental problems in the health care system and pass common sense medical malpractice reform to stop wasting so much money on defensive medicine, end pre-existing condition exclusions and waiting periods, start paying for value rather than volume, and empower consumers to shop around for health care and lower costs with competition, just like with other services we buy. Congress should make market reforms that help small businesses and the self-employed access health insurance.
Yet another opinion, on how the health care reform bills before us do not address the cost issue. This time a Republican Congressman- Sen. Grassley- cites the Congressional Budget Office and the Chief Actuary at the Dept. of Health and Human services who have analyzed the legislation and find that costs will increase.
Grassley was a key Republican in most of the Senate bill formulation talks in the fall but voted against the bill in committee and on the Senate floor because it did not address or attempt to control spiraling health care costs.
The bills do not create incentives for sustainable efficiency in the health care system. we need fundamental health care payment reform that incents efficiency based on quality health outcomes through episode of care based reimbursement. Drs and hospitals need to be paid based on outcomes not per procedure on a fee-for-service basis.
If reform does not address the cost issue the system will deteriorate further and premiums will increase.
----------------------- -------------------------
From the New York Times blog: Jan. 14, 2010
by DAVID M. HERSZENHORN
At the crux of the debate over major health care legislation is the question of why health care in America is so expensive – or to be more precise, why the cost of medical care has been growing far faster than the cost of everything else. It is far outpacing regular inflation and threatening to bust not only the federal budget but the finances of individuals and families as well.
Earlier this week the Prescriptions blog asked two experts of differing political perspectives to address two simple questions: Why is health care in American so expensive? And will the legislation emerging in Washington take sufficient steps to control costs? The experts, Joseph R. Antos, health policy researchers at the conservative American Enterprise Institute, and Jacob S. Hacker, a liberal proponent of a government-run insurance plan at Yale University, agreed – though for very different reasons – that the legislation would not do enough to control cost. You can read their responses here.
Next, Senator Max Baucus, Democrat of Montana, chairman of the Finance Committee and a leading architect of the legislation, weighed in with his own view that the bill incorporates virtually every idea put forward in the last 50 years to improve the health care system. Read the Baucus post.
Today, we hear from Mr. Baucus’s counterpart, Senator Charles E. Grassley of Iowa, the senior Republican on the Senate Finance Committee.
For months, Mr. Grassley was part of a small group of senators working to develop the legislation, but he ended up turning against the bill and opposing it both on the finance panel and on the Senate floor.
Mr. Grassley, who enjoys using Twitter to communicate with his constituents, offered the most succinct answer to the cost question so far.
“High costs come from flawed payment systems and defensive medicine,” Mr. Grassley wrote. “The system contains incentives that many times provide too much care and the wrong care, and there’s too much waste, fraud and abuse.”
Mr. Grassley’s opposition to the Democrats’ health care legislation is well known. Asked to elaborate on the reasons that he feels the bill will increase rather than decrease health care expenses, he offered the following.
A major goal for comprehensive health care reform was to lower spiraling costs, so it’s regrettable and really pretty unbelievable how the $2.5 trillion legislation that’s been passed fails to reduce rising costs. That judgment isn’t mine. It comes from the independent experts.
The nonpartisan Congressional Budget Office said on Dec. 19, “Under the legislation, federal outlays for health care would increase during the 2010-2019 period, as would the federal budgetary commitment to health care. The net increase in that commitment would be about $200 billion over that 10-year period.” The Congressional Budget Office and the Joint Committee on Taxation also estimated, on Nov. 30, that “the average premium per person covered (including dependents) for new nongroup policies would be about 10 percent to 13 percent higher in 2016 than the average premium for nongroup coverage in that same year under current law.”
Separately, the chief actuary for the Department of Health and Human Services said on Jan. 8 that under the Senate bill “total national health expenditures . . . would increase by an estimated total of $222 billion during calendar years 2010-2019.” In the same report, the chief actuary anticipated “an increase in overall national health expenditures ranging from $5.8 billion in 2011 to $13.8 billion in 2019.” The actuary said the Senate bill also would bend the spending growth curve upward for federal spending on health care, increasing it by $279 billion from 2010-2019.
These facts back up the majority opinion at the grassroots that health care bills passed by the House and Senate would make things worse, not better. Instead of sending this legislation to the president’s desk, Congress should work on the fundamental problems in the health care system and pass common sense medical malpractice reform to stop wasting so much money on defensive medicine, end pre-existing condition exclusions and waiting periods, start paying for value rather than volume, and empower consumers to shop around for health care and lower costs with competition, just like with other services we buy. Congress should make market reforms that help small businesses and the self-employed access health insurance.
Thursday, January 14, 2010
Fifteen states may sue over 'Cornhusker Kickback'
Insuring Resources Commentary:
Most backroom deals never asee the light of day, or at least not the immediate backlash this has received. Sen. Nelson secured a deal worth billions for Nebraqska's Medicaid program for his one vote which allowed the passage of the senate health care reform bill on Christmas Eve. Every other state should be suing over this, not just the 15.
One of Wisconsin's senators, Herb Kohl, in contrast tried and failed to get an amendment added that would create a demonstration program to implement and test Lean processes in health care which could SAVE billions in making health care more efficient. Priorities.
WASHINGTON (Reuters) - More than a dozen U.S. state attorneys general visited Washington on Wednesday threatening to sue the U.S. government if the so-called "Cornhusker Kickback," a special subsidy offered to Nebraska, is included in pen1ding healthcare reform legislation.
The subsidy, which was included in the Senate version of the bill, is "capricious and arbitrary treatment of Nebraska," said South Carolina's Republican Attorney General Henry McMaster, who has organized a group of 15 attorneys to pursue a lawsuit.
The group includes two Democrats, one from Oklahoma and one from American Samoa.
Many states are outraged by the caveat, which would have the federal government cover increases in Nebraska's obligations for Medicaid, the healthcare program for the poor jointly funded by the 50 states and federal government.
Medicaid already consumes large parts of states' budgets and would require even more funding under the reform plan, which would allow greater numbers of people to enroll in the program.
If the provision is removed they will not sue, McMaster said, but the attorneys are discussing where to file a suit and if the Supreme Court would have to hear the case.
McMaster wrote to Senate Majority Leader Harry Reid and House of Representatives Speaker Nancy Pelosi in December urging them to remove the provision as they hammer the bills into a single piece of legislation for President Barack Obama to sign into law.
He has yet to hear back from them. He has spoken to Sen. Bill Nelson, who represents Nebraska and who inserted the provision. Nelson has said he is fighting to ensure all states receive equal treatment to the Cornhusker State in the final law.
Meanwhile, the White House has said Obama is discussing how to handle Medicaid
and the states.
Removing that provision may not stop other lawsuits, McMaster warned. He has joined another group of attorneys general who are concerned that an "individual mandate," or requirement that citizens buy health insurance, violates a clause in the Constitution about regulating interstate commerce.
Most backroom deals never asee the light of day, or at least not the immediate backlash this has received. Sen. Nelson secured a deal worth billions for Nebraqska's Medicaid program for his one vote which allowed the passage of the senate health care reform bill on Christmas Eve. Every other state should be suing over this, not just the 15.
One of Wisconsin's senators, Herb Kohl, in contrast tried and failed to get an amendment added that would create a demonstration program to implement and test Lean processes in health care which could SAVE billions in making health care more efficient. Priorities.
WASHINGTON (Reuters) - More than a dozen U.S. state attorneys general visited Washington on Wednesday threatening to sue the U.S. government if the so-called "Cornhusker Kickback," a special subsidy offered to Nebraska, is included in pen1ding healthcare reform legislation.
The subsidy, which was included in the Senate version of the bill, is "capricious and arbitrary treatment of Nebraska," said South Carolina's Republican Attorney General Henry McMaster, who has organized a group of 15 attorneys to pursue a lawsuit.
The group includes two Democrats, one from Oklahoma and one from American Samoa.
Many states are outraged by the caveat, which would have the federal government cover increases in Nebraska's obligations for Medicaid, the healthcare program for the poor jointly funded by the 50 states and federal government.
Medicaid already consumes large parts of states' budgets and would require even more funding under the reform plan, which would allow greater numbers of people to enroll in the program.
If the provision is removed they will not sue, McMaster said, but the attorneys are discussing where to file a suit and if the Supreme Court would have to hear the case.
McMaster wrote to Senate Majority Leader Harry Reid and House of Representatives Speaker Nancy Pelosi in December urging them to remove the provision as they hammer the bills into a single piece of legislation for President Barack Obama to sign into law.
He has yet to hear back from them. He has spoken to Sen. Bill Nelson, who represents Nebraska and who inserted the provision. Nelson has said he is fighting to ensure all states receive equal treatment to the Cornhusker State in the final law.
Meanwhile, the White House has said Obama is discussing how to handle Medicaid
and the states.
Removing that provision may not stop other lawsuits, McMaster warned. He has joined another group of attorneys general who are concerned that an "individual mandate," or requirement that citizens buy health insurance, violates a clause in the Constitution about regulating interstate commerce.
Wednesday, January 13, 2010
Employer health mandate may be dropped: AP
Below is an AP article detailing the latest Senate / House health care reform negotiations attempting to create a compromise bill that 60 Senators can live with and 50% + 1 in the House of Reps.
--------- ---------- -----------
AP article:
House and Senate negotiators working on President Barack Obama's health overhaul bill appear likely to drop a proposed income tax increase on high-wage earners and possibly jettison a requirement for large businesses to offer coverage to their employees, Democratic officials said Tuesday.
Negotiators are considering extending the Medicare payroll tax, which now applies only to income from wages, to cover some of the investment earnings of couples making more than $250,000 a year, and individuals earning above $200,000. That could make up lost revenue from dropping the high-wage income tax and scaling back a proposed tax on high-value insurance plans, which is strongly opposed by organized labor and House Democrats.
On another high-profile issue, the negotiators are discussing a hybrid of a proposed national insurance exchange contained in the House bill and the state-by-state approach favored by the Senate. House Democrats are pressing for a national system to apply pressure to the insurance industry after their proposal for a new government-run insurance option was ruled out due to opposition from Senate moderates.
These officials also said key lawmakers and the White House were hoping to include more money to protect state governments from the cost of an expansion of the federal-state Medicaid insurance program for the poor. That issue flared after Sen. Ben Nelson, D-Neb., the critical 60th vote for the health care bill in the Senate, got a deal for the federal government to pay the full cost of Medicaid expansion in his state forever, whereas other states would have to pick up part of the tab after a few years.
The officials spoke on condition of anonymity, saying they were not free to disclose details of the negotiations.
The developments came as the pace of negotiations on health care legislation quickened with House members returning to Washington on Tuesday from a holiday recess. The White House wants a final bill for Obama to sign in time for his State of the Union address early next month.
House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid and other Democratic leaders were scheduled to meet with Obama at the White House on Wednesday to narrow the numerous issues that remain unresolved. The president has weighed in forcefully in recent days, telling lawmakers he wants at least a pared-down tax on high-cost insurance plans as well as a commission with authority to order cuts to Medicare spending under limited circumstances - both measures designed to hold down spiraling health care costs.
The House-passed bill included an income tax increase on individuals making more than $500,000 a year and couples making over $1 million, as well as a requirement for large businesses to cover their workers. The Senate bill contained neither. It included a tax on high-value insurance plans and a modest increase in the Medicare payroll tax. Instead of requiring employers to offer health coverage, the Senate bill penalized businesses if any of their workers obtained government-subsidized health care.
The move away from the House approaches is a bow to the influence of moderates in the Senate, who oppose those and other liberal priorities and are critical to Reid's fragile majority in support of the bill.
Officials said Obama has indicated support for a national version of the exchange - a clearinghouse where consumers could shop for health coverage. He also is signaling support for ending the decades-old antitrust exemption enjoyed by insurance companies. On those two issues the president is siding with House Democrats over their Senate counterparts.
The legislation passed by both chambers before Christmas is similar in many respects, including expanding Medicaid and imposing a first-time requirement for almost everyone to purchase insurance. Both bills would extend health coverage to more than 30 million uninsured Americans over the next decade.
--------- ---------- -----------
AP article:
House and Senate negotiators working on President Barack Obama's health overhaul bill appear likely to drop a proposed income tax increase on high-wage earners and possibly jettison a requirement for large businesses to offer coverage to their employees, Democratic officials said Tuesday.
Negotiators are considering extending the Medicare payroll tax, which now applies only to income from wages, to cover some of the investment earnings of couples making more than $250,000 a year, and individuals earning above $200,000. That could make up lost revenue from dropping the high-wage income tax and scaling back a proposed tax on high-value insurance plans, which is strongly opposed by organized labor and House Democrats.
On another high-profile issue, the negotiators are discussing a hybrid of a proposed national insurance exchange contained in the House bill and the state-by-state approach favored by the Senate. House Democrats are pressing for a national system to apply pressure to the insurance industry after their proposal for a new government-run insurance option was ruled out due to opposition from Senate moderates.
These officials also said key lawmakers and the White House were hoping to include more money to protect state governments from the cost of an expansion of the federal-state Medicaid insurance program for the poor. That issue flared after Sen. Ben Nelson, D-Neb., the critical 60th vote for the health care bill in the Senate, got a deal for the federal government to pay the full cost of Medicaid expansion in his state forever, whereas other states would have to pick up part of the tab after a few years.
The officials spoke on condition of anonymity, saying they were not free to disclose details of the negotiations.
The developments came as the pace of negotiations on health care legislation quickened with House members returning to Washington on Tuesday from a holiday recess. The White House wants a final bill for Obama to sign in time for his State of the Union address early next month.
House Speaker Nancy Pelosi, Senate Majority Leader Harry Reid and other Democratic leaders were scheduled to meet with Obama at the White House on Wednesday to narrow the numerous issues that remain unresolved. The president has weighed in forcefully in recent days, telling lawmakers he wants at least a pared-down tax on high-cost insurance plans as well as a commission with authority to order cuts to Medicare spending under limited circumstances - both measures designed to hold down spiraling health care costs.
The House-passed bill included an income tax increase on individuals making more than $500,000 a year and couples making over $1 million, as well as a requirement for large businesses to cover their workers. The Senate bill contained neither. It included a tax on high-value insurance plans and a modest increase in the Medicare payroll tax. Instead of requiring employers to offer health coverage, the Senate bill penalized businesses if any of their workers obtained government-subsidized health care.
The move away from the House approaches is a bow to the influence of moderates in the Senate, who oppose those and other liberal priorities and are critical to Reid's fragile majority in support of the bill.
Officials said Obama has indicated support for a national version of the exchange - a clearinghouse where consumers could shop for health coverage. He also is signaling support for ending the decades-old antitrust exemption enjoyed by insurance companies. On those two issues the president is siding with House Democrats over their Senate counterparts.
The legislation passed by both chambers before Christmas is similar in many respects, including expanding Medicaid and imposing a first-time requirement for almost everyone to purchase insurance. Both bills would extend health coverage to more than 30 million uninsured Americans over the next decade.
Sunday, January 10, 2010
Healthcare overhaul could save money and boost jobs, researchers say
Insuring Resources Commentary:
I have shared with readers recently my thoughts and numerous reports that suggest the health care reform bills under consideration would raise insurance premiums and not curtail the increases we've seen in health care costs.
In contrast, the report below argues that the health care reform bills will cut costs and lead to job growth.
Here's my analysis of their review:
This article lacks details but here is the full length report if you're interested:
http://www.americanprogress.org/issues/2010/01/pdf/health_care_jobs.pdf
***Note: I took items 1 and 2 below from the full length report***
For me, it is hard to believe that the taxes on cadillac health plans will have a positive effect so I agree with the Heritage Foundation on that point, as the article shows their viewpoint below. In addition the phased in penalties for businesses with payrolls over $500,000 annually could be a huge detriment to job growth in the all-important small business sector. The phased-in penalties will be key. If they are properly indexed they should have little effect, but if the penalties do not follow incremental and appropriate steps, the effect could be harsh for small business job growth.
In looking at the full length study here are some of the findings:
1) The study estimates that "insurance exchanges should lower average employer-paid premiums by about 2 percent".
2)"Aspects of the health reform legislation now before Congress that would promote more efficient care include bundling payments for different health care providers to encourage practice of more coordinated care, increased use of pay-for-performance systems for providers rather than the pay-per-visit system used by most insurers, and greater funding to support health care transitions, such as between hospitals and outpatient care, and for so-called medical homes, a primary care model that emphasizes coordinated care for the patient. These reforms would initially be implemented within the Medicare program, but are expected to extend to privately insured patients as reforms take hold, as has happened in the past."
The authors estimate cost reductions from these initiatives of about 0.75 percentage points annually after a phase-in period, or 6 percent by 2019. "Other work suggests savings as high as 1.5 percentage points annually are feasible. These cost reductions will enable employers who gain from these increased efficiencies to hire more workers and enable employees to seek higher wages as rising health care costs slow down."
My Final analysis: The authors acknowledge that the bundling cost savings an other reforms begin in Medicare, but they expect that they will be expanded to the rest of the health care system "as has happened in the past."
Here's the problem-- we have no idea when or if that will happen BECAUSE there is no timeframe for it in the bill. Saying it will happen is wishful thinking at best.
As I've argued from the beginning of this blog in August: payment reform and incentivizing lean processes is essential now for the whole system. Voluntary, Medicare programs will not get it done.
Details below from the Harvard/ USC study
--------------------------------
Healthcare overhaul could save money and boost jobs, researchers say
In a report to be released January 8, 2010, Harvard and USC economists say legislation being considered would slow cost increases and free up money for companies to raise wages and hire more workers.
National healthcare legislation in Congress could slow the growth of medical costs, allowing employers to create 250,000 to 400,000 new jobs a year over the next decade, economists from Harvard University and USC are predicting.
Wading into the hotly debated issue of whether the legislation is a job creator or a job killer, researchers from the two universities say that the reforms under consideration would slow the rate of cost increases and free up money for companies to raise wages and hire more workers.
Specifically, healthcare savings could be achieved through proposals for greater competition in insurance markets, better coordination of care and shrinking administrative expenses, they said in a report to be released today. With those changes, employers could then reallocate money now spent on ever-growing premiums to other business priorities.
"We could achieve huge productivity gains," said Harvard economist David Cutler, one of the study's authors and a senior fellow at the Center for American Progress, a liberal think tank.
But conservative economists and many business leaders contend that the proposed legislation would drive up costs by imposing billions of dollars in new taxes and penalties, killing jobs and hurting the economy as the financial burden of healthcare shifts to employers and workers.
One analysis from the conservative Heritage Foundation determined that higher taxes levied on the wealthiest Americans -- a proposal in the healthcare bill approved by the House in November -- would eliminate more than 450,000 jobs over the next decade.
The foundation and other critics of the healthcare overhaul say such taxes would have a particularly harmful effect on small businesses, which operate on smaller margins but have historically played key roles in renewing economic growth after recessions.
"If small businesses are not hiring, you'll have higher unemployment and slower wage growth," said Rea Hederman Jr., a senior policy analyst at the foundation.
Several California employers said they found the Harvard-USC study hard to believe, given that the average employer has paid double-digit annual increases in insurance premiums for several years and experienced other escalating business costs.
Santa Monica attorney Jeffrey Lee Costell, for one, says he will probably hold off hiring additional clerical workers if provisions remain in the healthcare legislation that require companies like his -- those with payrolls exceeding $500,000 -- to pick up the bulk of insurance premiums or face penalties.
"It's going to have a chilling effect," Costell said. "We're getting penalized because we are productive entrepreneurs."
Members of Congress are preparing to hash out a compromise between House and Senate healthcare bills. The measures would, among other things, require most Americans to have health insurance, expand coverage for the poor and stop insurers from denying coverage for preexisting conditions.
The bills also would impose billions of dollars in new taxes on the insurance industry, with the Senate bill including the "Cadillac tax" on more expensive healthcare plans.
The Harvard-USC report could be a boost for President Obama, who has made the economic benefits of health reform a top selling point in his administration's efforts to forge public support for the overhaul.
The president's Council of Economic Advisors said healthcare reform would increase domestic growth, raising family incomes substantially and leading to significant new hiring.
The Harvard-USC economists concluded that industries with high rates of employer-sponsored insurance -- including manufacturing, utilities and financial services -- would see some of the largest employment gains.
"If you have a strong bill that will promote control of healthcare costs, there will be an effect on the number of jobs," said Neeraj Sood, director of international programs at USC's Schaeffer Center for Health Policy and Economics.
How to achieve the savings remains a matter of heated debate in Congress and other quarters. Insurance industry executives maintain that reining in premiums without also addressing surging costs of hospitals and doctors will do little to stem medicine's drag on the economy.
"Unless you have the entire system reduce costs, you won't get premium relief," said Jay Gellert, chief executive of Woodland Hills-based Health Net Inc.
Relief can't come soon enough for San Francisco business owner Scott Hauge, who has seen health premiums for his 30-employee insurance brokerage rise 14% annually over the last seven years.
Hauge, president of advocacy group Small Business California, said he didn't expect much relief from Congress -- at best a slowdown in his costs, as the Harvard-USC economists predict. He said he might use any savings to replace computers, to pay employee bonuses or perhaps to help pick up insurance costs.
He is closely watching the legislation in Congress but can't get any firm sense of how the healthcare overhaul would affect his bottom line.
"There are a whole lot of unknowns out there right now," he said.
I have shared with readers recently my thoughts and numerous reports that suggest the health care reform bills under consideration would raise insurance premiums and not curtail the increases we've seen in health care costs.
In contrast, the report below argues that the health care reform bills will cut costs and lead to job growth.
Here's my analysis of their review:
This article lacks details but here is the full length report if you're interested:
http://www.americanprogress.org/issues/2010/01/pdf/health_care_jobs.pdf
***Note: I took items 1 and 2 below from the full length report***
For me, it is hard to believe that the taxes on cadillac health plans will have a positive effect so I agree with the Heritage Foundation on that point, as the article shows their viewpoint below. In addition the phased in penalties for businesses with payrolls over $500,000 annually could be a huge detriment to job growth in the all-important small business sector. The phased-in penalties will be key. If they are properly indexed they should have little effect, but if the penalties do not follow incremental and appropriate steps, the effect could be harsh for small business job growth.
In looking at the full length study here are some of the findings:
1) The study estimates that "insurance exchanges should lower average employer-paid premiums by about 2 percent".
2)"Aspects of the health reform legislation now before Congress that would promote more efficient care include bundling payments for different health care providers to encourage practice of more coordinated care, increased use of pay-for-performance systems for providers rather than the pay-per-visit system used by most insurers, and greater funding to support health care transitions, such as between hospitals and outpatient care, and for so-called medical homes, a primary care model that emphasizes coordinated care for the patient. These reforms would initially be implemented within the Medicare program, but are expected to extend to privately insured patients as reforms take hold, as has happened in the past."
The authors estimate cost reductions from these initiatives of about 0.75 percentage points annually after a phase-in period, or 6 percent by 2019. "Other work suggests savings as high as 1.5 percentage points annually are feasible. These cost reductions will enable employers who gain from these increased efficiencies to hire more workers and enable employees to seek higher wages as rising health care costs slow down."
My Final analysis: The authors acknowledge that the bundling cost savings an other reforms begin in Medicare, but they expect that they will be expanded to the rest of the health care system "as has happened in the past."
Here's the problem-- we have no idea when or if that will happen BECAUSE there is no timeframe for it in the bill. Saying it will happen is wishful thinking at best.
As I've argued from the beginning of this blog in August: payment reform and incentivizing lean processes is essential now for the whole system. Voluntary, Medicare programs will not get it done.
Details below from the Harvard/ USC study
--------------------------------
Healthcare overhaul could save money and boost jobs, researchers say
In a report to be released January 8, 2010, Harvard and USC economists say legislation being considered would slow cost increases and free up money for companies to raise wages and hire more workers.
National healthcare legislation in Congress could slow the growth of medical costs, allowing employers to create 250,000 to 400,000 new jobs a year over the next decade, economists from Harvard University and USC are predicting.
Wading into the hotly debated issue of whether the legislation is a job creator or a job killer, researchers from the two universities say that the reforms under consideration would slow the rate of cost increases and free up money for companies to raise wages and hire more workers.
Specifically, healthcare savings could be achieved through proposals for greater competition in insurance markets, better coordination of care and shrinking administrative expenses, they said in a report to be released today. With those changes, employers could then reallocate money now spent on ever-growing premiums to other business priorities.
"We could achieve huge productivity gains," said Harvard economist David Cutler, one of the study's authors and a senior fellow at the Center for American Progress, a liberal think tank.
But conservative economists and many business leaders contend that the proposed legislation would drive up costs by imposing billions of dollars in new taxes and penalties, killing jobs and hurting the economy as the financial burden of healthcare shifts to employers and workers.
One analysis from the conservative Heritage Foundation determined that higher taxes levied on the wealthiest Americans -- a proposal in the healthcare bill approved by the House in November -- would eliminate more than 450,000 jobs over the next decade.
The foundation and other critics of the healthcare overhaul say such taxes would have a particularly harmful effect on small businesses, which operate on smaller margins but have historically played key roles in renewing economic growth after recessions.
"If small businesses are not hiring, you'll have higher unemployment and slower wage growth," said Rea Hederman Jr., a senior policy analyst at the foundation.
Several California employers said they found the Harvard-USC study hard to believe, given that the average employer has paid double-digit annual increases in insurance premiums for several years and experienced other escalating business costs.
Santa Monica attorney Jeffrey Lee Costell, for one, says he will probably hold off hiring additional clerical workers if provisions remain in the healthcare legislation that require companies like his -- those with payrolls exceeding $500,000 -- to pick up the bulk of insurance premiums or face penalties.
"It's going to have a chilling effect," Costell said. "We're getting penalized because we are productive entrepreneurs."
Members of Congress are preparing to hash out a compromise between House and Senate healthcare bills. The measures would, among other things, require most Americans to have health insurance, expand coverage for the poor and stop insurers from denying coverage for preexisting conditions.
The bills also would impose billions of dollars in new taxes on the insurance industry, with the Senate bill including the "Cadillac tax" on more expensive healthcare plans.
The Harvard-USC report could be a boost for President Obama, who has made the economic benefits of health reform a top selling point in his administration's efforts to forge public support for the overhaul.
The president's Council of Economic Advisors said healthcare reform would increase domestic growth, raising family incomes substantially and leading to significant new hiring.
The Harvard-USC economists concluded that industries with high rates of employer-sponsored insurance -- including manufacturing, utilities and financial services -- would see some of the largest employment gains.
"If you have a strong bill that will promote control of healthcare costs, there will be an effect on the number of jobs," said Neeraj Sood, director of international programs at USC's Schaeffer Center for Health Policy and Economics.
How to achieve the savings remains a matter of heated debate in Congress and other quarters. Insurance industry executives maintain that reining in premiums without also addressing surging costs of hospitals and doctors will do little to stem medicine's drag on the economy.
"Unless you have the entire system reduce costs, you won't get premium relief," said Jay Gellert, chief executive of Woodland Hills-based Health Net Inc.
Relief can't come soon enough for San Francisco business owner Scott Hauge, who has seen health premiums for his 30-employee insurance brokerage rise 14% annually over the last seven years.
Hauge, president of advocacy group Small Business California, said he didn't expect much relief from Congress -- at best a slowdown in his costs, as the Harvard-USC economists predict. He said he might use any savings to replace computers, to pay employee bonuses or perhaps to help pick up insurance costs.
He is closely watching the legislation in Congress but can't get any firm sense of how the healthcare overhaul would affect his bottom line.
"There are a whole lot of unknowns out there right now," he said.
Health bill 'loophole' could allow rate hikes
Insuring Resources Commentary:
The key provision being addressed in the article below is one that allows employers to establish "workplace wellness" programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels. Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more.
The advocates do have a point but, including incentives for Wellness is an important way to achieve cost savings for employer plans while improving employee health outcomes. While it may create two-tier pricing it does provide incentives for greater health. Perhaps it can be expanded beyond body mass and blood sugar so that it doesn't just impact those with diabetes.
------------------
Progressives, health groups say health bill 'loophole' could allow rate hikes
WASHINGTON (AP) -- Advocacy groups lobbied President Barack Obama and Congress on Thursday, trying to eliminate what they called a "loophole" in Senate health care legislation they said could allow insurers to raise rates on customers based on their weight or blood sugar levels.
The groups said that would contradict one of the main goals of the congressional health care overhaul, which is to eliminate insurance company practices such as charging more, or denying coverage, based on health status.
The push came amid intense behind-the-scenes negotiations on Capitol Hill and at the White House to reconcile sweeping health care legislation passed by the House and Senate into a final bill Obama could sign before his State of the Union address in early February.
House Democrats held a conference call during which a number of lawmakers vented frustration over provisions in the Senate bill they don't want to be forced to accept, most prominently a tax on high-value insurance plans that House Democrats fear could hurt middle-class workers and union members.
Obama will meet with union leaders on the issue Monday, union officials said. Aiming to build consensus on Capitol Hill over that issue and others, Obama met Thursday with key Senate architects of the health care bill, Democrats Max Baucus of Montana and Chris Dodd of Connecticut. Also, Health and Human Services Secretary Kathleen Sebelius convened a conference call of Democratic governors, some of whom have raised concerns about issues including costs to their state of a proposed Medicaid expansion.
That's been an irritant from some state officials because Sen. Ben Nelson, D-Neb., the Democrats' crucial 60th vote for the Senate health bill, got a deal to permanently exempt Nebraska from paying any cost of a Medicaid expansion in the bill. Nelson said Thursday he was working to extend the same deal to other states.
The so-called loophole is separate issue. It's a provision that allows employers to establish "workplace wellness" programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels.
Current law allows employers to vary costs for workers based on whether they can hit those targets by as much as 20 percent. The Senate bill would raise that to 30 percent, with the possibility of a further increase to 50 percent at the discretion of government officials.
Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more, even though some of them may not be physically able, through no fault of their own, to reach the goals.
"There could be an inclination to say, 'Let's raise everyone's costs and just lower them for the 15 percent that can meet the standards,'" Sue Nelson, a vice president at the American Heart Association, said in an interview.
"There's going to be a lot of people on that more expensive tier, I'm afraid. A lot of American adults."
The Senate bill also sets up a test wellness program beginning in 2014 for individuals and small businesses who buy insurance directly from insurance companies. Most Americans under age 65 are covered through their employers.
Separate provisions in the legislation would allow insurers to charge more to people who smoke and to older people.
Insurance companies generally support wellness provisions.
"Promoting prevention and wellness is a critical component of health care reform," Robert Zirkelbach, spokesman for America's Health Insurance Plans, said in a statement. He said the programs should have clear guidelines - something advocacy groups say is lacking in current law and the Senate bill - and noted they were often negotiated between employers and unions.
The wellness provision is not part of the House health care bill. Jim Manley, a spokesman for Senate Majority Leader Harry Reid, D-Nev., declined comment except to say the issue would be discussed with the House and the Obama administration during discussions for a final bill.
The key provision being addressed in the article below is one that allows employers to establish "workplace wellness" programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels. Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more.
The advocates do have a point but, including incentives for Wellness is an important way to achieve cost savings for employer plans while improving employee health outcomes. While it may create two-tier pricing it does provide incentives for greater health. Perhaps it can be expanded beyond body mass and blood sugar so that it doesn't just impact those with diabetes.
------------------
Progressives, health groups say health bill 'loophole' could allow rate hikes
WASHINGTON (AP) -- Advocacy groups lobbied President Barack Obama and Congress on Thursday, trying to eliminate what they called a "loophole" in Senate health care legislation they said could allow insurers to raise rates on customers based on their weight or blood sugar levels.
The groups said that would contradict one of the main goals of the congressional health care overhaul, which is to eliminate insurance company practices such as charging more, or denying coverage, based on health status.
The push came amid intense behind-the-scenes negotiations on Capitol Hill and at the White House to reconcile sweeping health care legislation passed by the House and Senate into a final bill Obama could sign before his State of the Union address in early February.
House Democrats held a conference call during which a number of lawmakers vented frustration over provisions in the Senate bill they don't want to be forced to accept, most prominently a tax on high-value insurance plans that House Democrats fear could hurt middle-class workers and union members.
Obama will meet with union leaders on the issue Monday, union officials said. Aiming to build consensus on Capitol Hill over that issue and others, Obama met Thursday with key Senate architects of the health care bill, Democrats Max Baucus of Montana and Chris Dodd of Connecticut. Also, Health and Human Services Secretary Kathleen Sebelius convened a conference call of Democratic governors, some of whom have raised concerns about issues including costs to their state of a proposed Medicaid expansion.
That's been an irritant from some state officials because Sen. Ben Nelson, D-Neb., the Democrats' crucial 60th vote for the Senate health bill, got a deal to permanently exempt Nebraska from paying any cost of a Medicaid expansion in the bill. Nelson said Thursday he was working to extend the same deal to other states.
The so-called loophole is separate issue. It's a provision that allows employers to establish "workplace wellness" programs giving financial incentives to workers who meet certain health or fitness criteria such as maintaining body mass or blood sugar levels.
Current law allows employers to vary costs for workers based on whether they can hit those targets by as much as 20 percent. The Senate bill would raise that to 30 percent, with the possibility of a further increase to 50 percent at the discretion of government officials.
Groups including the American Heart Association and Health Care for America Now held a conference call to argue that could create two-tiered health plans in which workers who are able to hit certain fitness targets pay less, subsidized by other workers who pay more, even though some of them may not be physically able, through no fault of their own, to reach the goals.
"There could be an inclination to say, 'Let's raise everyone's costs and just lower them for the 15 percent that can meet the standards,'" Sue Nelson, a vice president at the American Heart Association, said in an interview.
"There's going to be a lot of people on that more expensive tier, I'm afraid. A lot of American adults."
The Senate bill also sets up a test wellness program beginning in 2014 for individuals and small businesses who buy insurance directly from insurance companies. Most Americans under age 65 are covered through their employers.
Separate provisions in the legislation would allow insurers to charge more to people who smoke and to older people.
Insurance companies generally support wellness provisions.
"Promoting prevention and wellness is a critical component of health care reform," Robert Zirkelbach, spokesman for America's Health Insurance Plans, said in a statement. He said the programs should have clear guidelines - something advocacy groups say is lacking in current law and the Senate bill - and noted they were often negotiated between employers and unions.
The wellness provision is not part of the House health care bill. Jim Manley, a spokesman for Senate Majority Leader Harry Reid, D-Nev., declined comment except to say the issue would be discussed with the House and the Obama administration during discussions for a final bill.
Wednesday, January 6, 2010
Effect on business- Senate and House health bill comparison
Insuring Resources Comparison:
The House and Senate Democrats are currently negotiating a compromise between the two health care reform bills that have passed. The result will most likely be a hybrid of the two on many issues, especially those impacting small business employer-sponsored health coverage. It is instructive, however, to look at those differences while the negotiations take place.
Both bills expand Medicaid in most states, but not in Wisconsin as we have BadgerCare Plus and Core which already expand coverage to families and childless adults up to 200% of the federal poverty level. The Senate and House bills only expand coverage up to 133% and 150% respectively.
The Senate Bill includes:
REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but companies with more than 50 employees would pay a fee of $750 per employee if the government ends up subsidizing employees' coverage.
BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage. The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent.
The House bill includes:
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt – a change from the original $250,000 level to accommodate concerns of moderate Democrats – and the penalty is phased in for companies with payrolls between $500,000 and $750,000.
Small businesses – those with 10 or fewer workers – get tax credits to help them provide coverage.
SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013, through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.
BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of-pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.
Background material source: The Huffington Post
The House and Senate Democrats are currently negotiating a compromise between the two health care reform bills that have passed. The result will most likely be a hybrid of the two on many issues, especially those impacting small business employer-sponsored health coverage. It is instructive, however, to look at those differences while the negotiations take place.
Both bills expand Medicaid in most states, but not in Wisconsin as we have BadgerCare Plus and Core which already expand coverage to families and childless adults up to 200% of the federal poverty level. The Senate and House bills only expand coverage up to 133% and 150% respectively.
The Senate Bill includes:
REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but companies with more than 50 employees would pay a fee of $750 per employee if the government ends up subsidizing employees' coverage.
BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage. The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent.
The House bill includes:
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt – a change from the original $250,000 level to accommodate concerns of moderate Democrats – and the penalty is phased in for companies with payrolls between $500,000 and $750,000.
Small businesses – those with 10 or fewer workers – get tax credits to help them provide coverage.
SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013, through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.
BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of-pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.
Background material source: The Huffington Post
Health bills would shift Medicare money to Marshfield, Mayo and other 'high-value' hospitals
Insuring Resources Commentary:
This article details a huge win for many hospitals including Marshfield Clinic here in Wisconsin and Mayo Clinic. The House and Senate bills both include a revised Medicare formula that helps efficient hospital systems. This is an important efficiency incentive that will provide the necessary inducements to create efficiency's nationwide.
The article states- "Hospitals now have little incentive to be parsimonious, because Medicare revenue is based on the number of procedures performed at a facility. But supporters say a value index -- by rewarding hospitals that spend less per patient -- would provide an incentive to limit procedures."
Hopefully this can also be expanded beyond just Medicare in the future.
----------------------
Link to article:
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/05/AR2010010503572.html
As House and Senate lawmakers start to reconcile their health-care bills with an eye to final passage, a little-noticed provision is already prompting celebration from a small group of influential hospitals that stand to gain millions in Medicare dollars
Language in both the House and Senate bills would reward hospitals for efficiency in their Medicare spending, a dramatic change in the formula for parceling out the public dollars, which can account for as much as half of a hospital's budget. That could prove to be a windfall for some hospitals but a significant loss of funding for others, mostly those in big cities and the South.
A revised Medicare formula represents a major lobbying victory for a coalition of hospitals based in the upper Midwest, led by the Mayo Clinic. Their leaders sent a letter to House members in July demanding Medicare reform, as well as objecting to a government-run insurance plan, or "public option." Even the smallest in the group mobilized lobbyists and sent their leaders to Capitol Hill to press their case.
Mayo leaders met with White House officials several times in recent months, convincing them that "paying for value" was key to slowing the growth in health-care costs. Throughout, President Obama has praised Mayo and "high-value" care.
We are extremely pleased," said Karl Ulrich, president of the Marshfield Clinic in Wisconsin, a member of the coalition. He predicted a period of transition "that will be difficult for other providers to adapt to" but added: "We just think it's the way to go."
But those on the losing end are criticizing the provision as a brazen money grab. They predict that, instead of saving taxpayer money, it will simply take funding from areas with more poverty and racial minorities and send it to more homogenous communities that tend to have fewer health problems.
"The people in Minnesota are just going to say, 'We want our money,' " said J. Thomas Rosenthal, chief medical officer of the UCLA Medical System. "It's just 'Give us your money. You people are wasteful and we're not, and we deserve it.' "
Regional differences
Medicare payment rates are based on a mix of factors, including regional differences in the cost of living. Doctors and hospitals across the country have argued that the system underpays them for their services, but those in the Midwest, Mountain West and Northwest have been particularly aggrieved.
Hospitals in those regions perform well in oft-cited rankings by Dartmouth College researchers, which measure per-patient Medicare spending. And many of those hospitals also rank high in the quality of their care, suggesting it is possible to restrain the volume of medical procedures without affecting care.
Meanwhile, Dartmouth's surveys find that hospitals in some areas -- led by Miami, Los Angeles, New York City, and much of Texas and the South -- spend far more per Medicare patient than hospitals elsewhere.
That type of measurement is at the heart of the language in the health-care bills, which would introduce a "value index" or "payment modifier" to reward more efficient providers.
Just how much money is at stake depends on how the index is crafted. But even before the details are ironed out, many health policy experts say the provision may be one of the strongest cost-control tools in the legislation.
This article details a huge win for many hospitals including Marshfield Clinic here in Wisconsin and Mayo Clinic. The House and Senate bills both include a revised Medicare formula that helps efficient hospital systems. This is an important efficiency incentive that will provide the necessary inducements to create efficiency's nationwide.
The article states- "Hospitals now have little incentive to be parsimonious, because Medicare revenue is based on the number of procedures performed at a facility. But supporters say a value index -- by rewarding hospitals that spend less per patient -- would provide an incentive to limit procedures."
Hopefully this can also be expanded beyond just Medicare in the future.
----------------------
Link to article:
http://www.washingtonpost.com/wp-dyn/content/article/2010/01/05/AR2010010503572.html
As House and Senate lawmakers start to reconcile their health-care bills with an eye to final passage, a little-noticed provision is already prompting celebration from a small group of influential hospitals that stand to gain millions in Medicare dollars
Language in both the House and Senate bills would reward hospitals for efficiency in their Medicare spending, a dramatic change in the formula for parceling out the public dollars, which can account for as much as half of a hospital's budget. That could prove to be a windfall for some hospitals but a significant loss of funding for others, mostly those in big cities and the South.
A revised Medicare formula represents a major lobbying victory for a coalition of hospitals based in the upper Midwest, led by the Mayo Clinic. Their leaders sent a letter to House members in July demanding Medicare reform, as well as objecting to a government-run insurance plan, or "public option." Even the smallest in the group mobilized lobbyists and sent their leaders to Capitol Hill to press their case.
Mayo leaders met with White House officials several times in recent months, convincing them that "paying for value" was key to slowing the growth in health-care costs. Throughout, President Obama has praised Mayo and "high-value" care.
We are extremely pleased," said Karl Ulrich, president of the Marshfield Clinic in Wisconsin, a member of the coalition. He predicted a period of transition "that will be difficult for other providers to adapt to" but added: "We just think it's the way to go."
But those on the losing end are criticizing the provision as a brazen money grab. They predict that, instead of saving taxpayer money, it will simply take funding from areas with more poverty and racial minorities and send it to more homogenous communities that tend to have fewer health problems.
"The people in Minnesota are just going to say, 'We want our money,' " said J. Thomas Rosenthal, chief medical officer of the UCLA Medical System. "It's just 'Give us your money. You people are wasteful and we're not, and we deserve it.' "
Regional differences
Medicare payment rates are based on a mix of factors, including regional differences in the cost of living. Doctors and hospitals across the country have argued that the system underpays them for their services, but those in the Midwest, Mountain West and Northwest have been particularly aggrieved.
Hospitals in those regions perform well in oft-cited rankings by Dartmouth College researchers, which measure per-patient Medicare spending. And many of those hospitals also rank high in the quality of their care, suggesting it is possible to restrain the volume of medical procedures without affecting care.
Meanwhile, Dartmouth's surveys find that hospitals in some areas -- led by Miami, Los Angeles, New York City, and much of Texas and the South -- spend far more per Medicare patient than hospitals elsewhere.
That type of measurement is at the heart of the language in the health-care bills, which would introduce a "value index" or "payment modifier" to reward more efficient providers.
Just how much money is at stake depends on how the index is crafted. But even before the details are ironed out, many health policy experts say the provision may be one of the strongest cost-control tools in the legislation.
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