Insuring Resources Commentary:
As President Obama has reiterated throughout this process, ad nauseum at times, the insurance companies no longer have a free ride. Or at least in paraphrasing-- he has used language like that. And perhaps its true, not in Wisconsin, but perhaps for most of the country. In Wisconsin, I'd bet that little will change comparatively. Through our insurers and our Medicaid program we'll still cover more residents than almost every other state and we'll still regulate insurers like its a matter of life and death, because here it always has been serious business. In Wisconsin we'll continue to have insurers and providers push the envelope toward better quality and efficient care, because, that's what we do.
So bring on the scrutiny, Wisconsin will continue to excel and we'll continue to light the way for states like Alabama, Louisiana, and Georgia. Regulators, the state Medicaid programs, and domiciled insurers alike are scared stiff in the South, and they should be. Ever wonder why they are screaming and suing the federal gov't saying this federal health reform and the individual mandate are unconstitutional? Because down there insurance regulations and Medicaid coverage are virtually non-existent. The PPACA ends that and starts an era of accountability.
But yes, I agree with Milliman and their analysis that follows below. Scrutiny is going to be intense and is yet another reason I'm upset with Wisconsin's Congressional delegation. Now, Rep. Ron Kind (D-LaCrosse) and Sen. Herb Kohl have tried to add a Wisconsin flavor to health care reform. For the most part, I believe, they tried diligently but failed to convince their colleagues. Congress had a chance to expand our quality and efficient care processes nationwide, but didn't.
Sen. Feingold, Rep's. Baldwin, Obey, Petri, Sensenbrenner, Kagen and Moore were virtually non-existent in the debate and ideas process. Rep. Ryan in contrast has plenty of ideas and has provided a thoughtful counter proposal to the process. Although I disagree with most of Ryan's HSA and tax credit ideas I applaud his effort.
As for the Milliman analysis below I've highlighted in bold the portions I want you to pay the most attention to...... but again we're way ahead of the game.
-------------- --------- --------
Milliman: Expect The PPACA Package To Lead To Intense Regulatory Scrutiny
The health insurance industry will face intense regulatory scrutiny due to the new Patient Protection and Affordable Care Act and its companion, the Health Care and Education Reconciliation Act of 2010, according to Milliman Inc.
PPACA was created by H.R. 3590 and HCERA, which was signed into law today, was created by H.R. 4872.
“While new regulation does not necessarily go into effect immediately, it is clear that health insurers now face increased scrutiny and a new layer of regulatory complexity,” researchers at Milliman, Seattle, write in an analysis of the new laws. “Health plans will have to focus on minimum loss ratios and administrative efficiency and will have to balance challenging cost dynamics against the need for affordable policies.”
PPACA would create a new system of health insurance exchanges that would help individuals and small businesses buy subsidized, standardized packages of health benefits. The new exchanges will change the level competition, the researchers say. The effects will be different in each state, and they may include reduction of distribution costs and potentially tempering of rate increases in the individual and small group insurance markets, the researchers add.
Also, due to an influx of an estimated 30 plus million new people into the insurance and Medicaid markets, “insurers will face unique pricing and risk-mix challenges,” the researchers write.
Some of the other considerations the researchers have identified:
- Cost effectiveness will be central, as in provider risk-sharing methods and evidence-based medicine. However, the researchers also note that “a new emphasis on prevention has uncertain cost implications.”
- New requirements—such as minimum loss ratios for insurers and the new tax on health insurers that sell relatively expensive "Cadillac plans," which is set to take effect in 2018--will affect plan design.
- Medicare Advantage plans will become less attractive to consumers and carriers, and the plans will face difficult questions about efficiency and benefits mix.
- Enterprise risk management will become essential.
- Strategic considerations will be influenced by local dynamics, including geographic cost variation and the existing regulatory environment in each state.
Showing posts with label Medicaid. Show all posts
Showing posts with label Medicaid. Show all posts
Tuesday, March 30, 2010
Friday, March 26, 2010
Wisconsin Physicians Weigh in on the PPACA
Insuring Resources Commentary:
So what do Wisconsin physicians think of the newly enacted health insurance reform law of the land- the Patient Protection Affordable Care Act (PPACA)? Well, for the most part they like it, but they too, would like to see more emphasis on quality and efficiency. That speaks volumes doesn't it? Please see the statement below from the Wisconsin Medical Society.
I hope readers don't see this is as self-serving when I post opinions that agree with my take on this legislation. If you look back at the beginning of this blog in August 2009 you'll see that I have been a consistent advocate for payment reform and for Wisconsin's quality and efficient care.
As I've noted all along Wisconsin is in a pretty good place overall when it comes to our health care and health insurance systems.
1) We have numerous health plans that focus on quality and efficiency that are seen as national models.
2) We have a very low number of uninsured persons due to Wisconsin's BadgerCare program which provides greater Medicaid access to low-income individuals than the PPACA.
3) We have perhaps the strongest set of proactive insurance regulations in the nation.
4) We possess additional safety net programs like our Health Insurance Risk Sharing Program (www.hirsp.org) and Medicaid Purchase Plan (http://dhs.wi.gov/medicaid/Publications/p-10071.pdf) that together cover more than 30,000 Wisconsinites.
Wisconsin is a national model for how reform should be done. Its a pity our Congressional leaders couldn't expand Wisconsin's models nationwide.
********** ********** ***********
Reaction to health care reform legislation mixed
Madison (March 22, 2010)—“Members of the Wisconsin Medical Society have advocated for access to high quality health care for all patients in Wisconsin since the organization’s inception in 1841. Yesterday’s passage of health system reform (Patient Protection Affordable Care Act) by the U.S. House of Representatives extends coverage to millions of Americans who are currently uninsured, eliminates both lifetime caps on coverage and insurers’ ability to deny coverage for children because of pre-existing conditions. These are definitely steps in the right direction.
“At the same time, many issues remain unresolved, such as national lawsuit reform and the permanent fix of Medicare’s flawed payment formula, which penalizes cost-efficient states such as Wisconsin and threatens access to care for our seniors.
“Wisconsin physicians have been recognized nationally for providing the highest quality care at a low cost, and we support payment efforts such as those championed by Rep. Ron Kind that focus on value, not volume. Because Wisconsin’s health care safety net is already severely stressed, we are concerned about how this legislation and the subsequent reconciliation bill will impact the delivery of care in our state.”
Statement attributable to Robert Jaeger, MD, President, Wisconsin Medical Society.
So what do Wisconsin physicians think of the newly enacted health insurance reform law of the land- the Patient Protection Affordable Care Act (PPACA)? Well, for the most part they like it, but they too, would like to see more emphasis on quality and efficiency. That speaks volumes doesn't it? Please see the statement below from the Wisconsin Medical Society.
I hope readers don't see this is as self-serving when I post opinions that agree with my take on this legislation. If you look back at the beginning of this blog in August 2009 you'll see that I have been a consistent advocate for payment reform and for Wisconsin's quality and efficient care.
As I've noted all along Wisconsin is in a pretty good place overall when it comes to our health care and health insurance systems.
1) We have numerous health plans that focus on quality and efficiency that are seen as national models.
2) We have a very low number of uninsured persons due to Wisconsin's BadgerCare program which provides greater Medicaid access to low-income individuals than the PPACA.
3) We have perhaps the strongest set of proactive insurance regulations in the nation.
4) We possess additional safety net programs like our Health Insurance Risk Sharing Program (www.hirsp.org) and Medicaid Purchase Plan (http://dhs.wi.gov/medicaid/Publications/p-10071.pdf) that together cover more than 30,000 Wisconsinites.
Wisconsin is a national model for how reform should be done. Its a pity our Congressional leaders couldn't expand Wisconsin's models nationwide.
********** ********** ***********
Reaction to health care reform legislation mixed
Madison (March 22, 2010)—“Members of the Wisconsin Medical Society have advocated for access to high quality health care for all patients in Wisconsin since the organization’s inception in 1841. Yesterday’s passage of health system reform (Patient Protection Affordable Care Act) by the U.S. House of Representatives extends coverage to millions of Americans who are currently uninsured, eliminates both lifetime caps on coverage and insurers’ ability to deny coverage for children because of pre-existing conditions. These are definitely steps in the right direction.
“At the same time, many issues remain unresolved, such as national lawsuit reform and the permanent fix of Medicare’s flawed payment formula, which penalizes cost-efficient states such as Wisconsin and threatens access to care for our seniors.
“Wisconsin physicians have been recognized nationally for providing the highest quality care at a low cost, and we support payment efforts such as those championed by Rep. Ron Kind that focus on value, not volume. Because Wisconsin’s health care safety net is already severely stressed, we are concerned about how this legislation and the subsequent reconciliation bill will impact the delivery of care in our state.”
Statement attributable to Robert Jaeger, MD, President, Wisconsin Medical Society.
Thursday, February 18, 2010
You do realize we already have a public plan, right?
Insuring Resources Commentary:
The House health care reform bill includes a public plan option, meaning its a plan that would compete against insurers. This story is about the public plan that is the last available option, Medicaid, for many folks.
The attached story below is about the huge expansion nationwide of state Medicaid programs in the wake of the recession. During these tough times, Wisconsin has expanded its Medicaid program while most others have seen their enrollment expand without trying. But Wisconsin has expanded Medicaid through its BadgerCare program to cover more low-income uninsured persons... many of whom ARE employed. Wisconsin now covers uninsured persons with and WITHOUT kids up to 200% of fpl if they don't have employer coverage. For a family of four that's about $37,000 annually. The expanded group do pay a subsidized premium. Do you know a family on BadgerCare? I bet you know several. I'd bet several of my son's elementary school classmates are covered by it.
So for those who talk and warn about the "government takeover of health insurance", please get your head out of the sand. Its been happening for awhile.
By most estimates in 2009 we had between 45-47 million uninsured in the US. So now we have a roughly equal amount, according to Kaiser 46.9 million, on Medicaid programs.
Guess what folks, fewer and fewer of us have employer-based coverage- the last number I saw, for 2008, was 59%. You know that's lower now, right? By the way, in 2000 69% of us had employer-based coverage.
Isn't it time for an overhaul?
-----------------------
Kaiser Analysis Finds Record Medicaid Enrollment Growth in 2009
Largest Ever One-Year Increase Illustrates Medicaid's Role In Covering People During Economic Downturns But Further Strains Tight State Budgets
WASHINGTON, Feb. 18 /PRNewswire-USNewswire/ --
With the country mired in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June, according to a new analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. It was the biggest ever one-year increase in terms of absolute numbers, and boosted the June monthly Medicaid enrollment by 7.5 percent to 46.9 million people nationally.
It was the first time in decades that every state experienced an increase in Medicaid enrollment, and in 32 states enrollment grew at least twice as fast as the year before, according to the analysis, which includes data breakouts by state.
"State Medicaid programs have been able to help millions of Americans who have nowhere else to turn in a recession," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of KCMU. "But the states obviously face significant fiscal pressures as increases in enrollment push up costs at a time when state budgets are already severely constrained."
The increase in enrollment reflects the role that Medicaid plays in reducing the numbers of people who become uninsured when the economy falters, with many people turning to the program for help after being laid off and losing their employer-based health insurance. Millions more who were not eligible for Medicaid likely joined the ranks of the nation's uninsured.
A new Kaiser survey of state Medicaid directors finds that 44 states and the District of Columbia are experiencing higher than expected program enrollment, resulting in increased spending for fiscal year 2010. At least 29 states say they are considering additional mid-year cuts in provider rates and program benefits.
Enhanced federal matching money for Medicaid provided through the American Recovery and Reinvestment Act of 2009 has proved critical in helping states maintain coverage. But that money is scheduled to expire on Dec. 31, 2010, which will increase the strain on state fiscal year 2011 budgets, Medicaid directors reported.
Although Medicaid enrollment is on the rise, costs of the program as measured on a per-person basis are not climbing at a faster rate than health costs more generally. (See "An Actuarial Rorschach Test" [link to http://www.kff.org/pullingittogether/021610_altman.cfm]). Moreover, in past recessions, after the economy has improved, Medicaid enrollment growth has slowed and sometimes contracted, suggesting that the record rate of enrollment growth seen in 2009 will eventually subside.
UA-10096920-2
The House health care reform bill includes a public plan option, meaning its a plan that would compete against insurers. This story is about the public plan that is the last available option, Medicaid, for many folks.
The attached story below is about the huge expansion nationwide of state Medicaid programs in the wake of the recession. During these tough times, Wisconsin has expanded its Medicaid program while most others have seen their enrollment expand without trying. But Wisconsin has expanded Medicaid through its BadgerCare program to cover more low-income uninsured persons... many of whom ARE employed. Wisconsin now covers uninsured persons with and WITHOUT kids up to 200% of fpl if they don't have employer coverage. For a family of four that's about $37,000 annually. The expanded group do pay a subsidized premium. Do you know a family on BadgerCare? I bet you know several. I'd bet several of my son's elementary school classmates are covered by it.
So for those who talk and warn about the "government takeover of health insurance", please get your head out of the sand. Its been happening for awhile.
By most estimates in 2009 we had between 45-47 million uninsured in the US. So now we have a roughly equal amount, according to Kaiser 46.9 million, on Medicaid programs.
Guess what folks, fewer and fewer of us have employer-based coverage- the last number I saw, for 2008, was 59%. You know that's lower now, right? By the way, in 2000 69% of us had employer-based coverage.
Isn't it time for an overhaul?
-----------------------
Kaiser Analysis Finds Record Medicaid Enrollment Growth in 2009
Largest Ever One-Year Increase Illustrates Medicaid's Role In Covering People During Economic Downturns But Further Strains Tight State Budgets
WASHINGTON, Feb. 18 /PRNewswire-USNewswire/ --
With the country mired in a deep recession, nearly 3.3 million more people were enrolled in state Medicaid programs in June 2009 compared to the previous June, according to a new analysis by the Kaiser Family Foundation's Commission on Medicaid and the Uninsured. It was the biggest ever one-year increase in terms of absolute numbers, and boosted the June monthly Medicaid enrollment by 7.5 percent to 46.9 million people nationally.
It was the first time in decades that every state experienced an increase in Medicaid enrollment, and in 32 states enrollment grew at least twice as fast as the year before, according to the analysis, which includes data breakouts by state.
"State Medicaid programs have been able to help millions of Americans who have nowhere else to turn in a recession," said Diane Rowland, Executive Vice President of the Foundation and Executive Director of KCMU. "But the states obviously face significant fiscal pressures as increases in enrollment push up costs at a time when state budgets are already severely constrained."
The increase in enrollment reflects the role that Medicaid plays in reducing the numbers of people who become uninsured when the economy falters, with many people turning to the program for help after being laid off and losing their employer-based health insurance. Millions more who were not eligible for Medicaid likely joined the ranks of the nation's uninsured.
A new Kaiser survey of state Medicaid directors finds that 44 states and the District of Columbia are experiencing higher than expected program enrollment, resulting in increased spending for fiscal year 2010. At least 29 states say they are considering additional mid-year cuts in provider rates and program benefits.
Enhanced federal matching money for Medicaid provided through the American Recovery and Reinvestment Act of 2009 has proved critical in helping states maintain coverage. But that money is scheduled to expire on Dec. 31, 2010, which will increase the strain on state fiscal year 2011 budgets, Medicaid directors reported.
Although Medicaid enrollment is on the rise, costs of the program as measured on a per-person basis are not climbing at a faster rate than health costs more generally. (See "An Actuarial Rorschach Test" [link to http://www.kff.org/pullingittogether/021610_altman.cfm]). Moreover, in past recessions, after the economy has improved, Medicaid enrollment growth has slowed and sometimes contracted, suggesting that the record rate of enrollment growth seen in 2009 will eventually subside.
UA-10096920-2
Wednesday, February 17, 2010
White House Summit may Include Unveiling of New Plan
Insuring Resources Commentary:
Stay tuned for my analysis as soon as the bill is released, but in the meantime I'll offer my wish list:
1) eliminate pre-x conditions,
2) mandate individual coverage by offering a catastrophic, inexpensive health plan,
3) expand Medicaid to 150% FPL but eliminate the special deals like the Cornhusker Kickback and provide Medical Home operation incentives for states,
4) create incentives for provider transition to episode of care based reimbursement to be fully operational by 2015,
5) create efficiency and lean operation incentives and NOT just for Medicare,
6) Create 10 regional Health Insurance Exchanges to cover small businesses with less than 25 employees and individuals without employer access-- include multiple plan options
----------------
Details from multiple news sources----------
Kaiser News: White House officials "hinted on Tuesday that President Obama might post his own [health care] bill on the Internet before the bipartisan health care summit he is planning" next week, The New York Times reports. "In the nearly a year since Congress began debating a health care overhaul, Mr. Obama has yet to make his own priorities explicit. He said at the outset that he would set broad parameters for the measure and leave the details to lawmakers." Obama said last week that hoped to post to the Internet a merged bill that would address costs and expand coverage. "But Mr. Obama may be running out of time. His press secretary, Robert Gibbs, was asked Monday if the president would simply post his own bill if the House and the Senate cannot come to terms. 'Stay tuned,' Mr. Gibbs said" (Stolberg, 2/16).
Politico: "White House officials have said the president expects a unified House and Senate bill by the Feb. 25 summit. But given the lack of tangible progress on Capitol Hill during the past two weeks, it is hard to see how the president will walk into the summit with a bill that's been agreed to by both chambers" (Budoff Brown, 2/16).
Reuters: According to Gibbs, "'The president will lay out his ideas, and I would expect that Republicans will, and others will, lay out their solutions,' he said." Although Gibbs did not offer a specific timeline for its release, he did make assurances that the measure would be made public "far enough before the meeting to allow it to be reviewed. 'I don't have the exact day yet. But it will be in — in time for — for you and for others around the country to evaluate a plan,' he said" (Zengerle, 2/16).
CNN: Health and Human Services Secretary Kathleen Sebelius said Tuesday that Obama plans to use the already-passed bills as a starting point for the summit next week. "But Sebelius, in an interview with CNN Chief Medical Correspondent Dr. Sanjay Gupta, said the House and Senate bills already incorporate many GOP ideas." Among the specific examples she cited were "provisions to create special pools to make it easier for people with pre-existing illness to purchase insurance, the offering of low-cost insurance plans for young and healthy people, and regulations letting people purchase insurance across state lines —a version of which is included in the Senate bill." The president's plan will not likely include a public option, she said (2/16).
The Associated Press: After some early questions about the health summit, the GOP is now seeing its possible political upside. Although Democrats are likely to focus on expanding affordable health insurance to more people — they offer to cover 30 more million people instead of Republicans who are offering 3 million more covered — Republicans hope that "during a time of ballooning deficits … reining in rising medical costs — not coverage — could resonate with voters in an election year. ... With the summit more than a week away and lawmakers out of town for the Presidents Day recess, Republicans are in the early stages of planning their strategy for the event. … One potential hitch for Republicans is that there is not a single GOP plan" (Werner, 2/17).
Stay tuned for my analysis as soon as the bill is released, but in the meantime I'll offer my wish list:
1) eliminate pre-x conditions,
2) mandate individual coverage by offering a catastrophic, inexpensive health plan,
3) expand Medicaid to 150% FPL but eliminate the special deals like the Cornhusker Kickback and provide Medical Home operation incentives for states,
4) create incentives for provider transition to episode of care based reimbursement to be fully operational by 2015,
5) create efficiency and lean operation incentives and NOT just for Medicare,
6) Create 10 regional Health Insurance Exchanges to cover small businesses with less than 25 employees and individuals without employer access-- include multiple plan options
----------------
Details from multiple news sources----------
Kaiser News: White House officials "hinted on Tuesday that President Obama might post his own [health care] bill on the Internet before the bipartisan health care summit he is planning" next week, The New York Times reports. "In the nearly a year since Congress began debating a health care overhaul, Mr. Obama has yet to make his own priorities explicit. He said at the outset that he would set broad parameters for the measure and leave the details to lawmakers." Obama said last week that hoped to post to the Internet a merged bill that would address costs and expand coverage. "But Mr. Obama may be running out of time. His press secretary, Robert Gibbs, was asked Monday if the president would simply post his own bill if the House and the Senate cannot come to terms. 'Stay tuned,' Mr. Gibbs said" (Stolberg, 2/16).
Politico: "White House officials have said the president expects a unified House and Senate bill by the Feb. 25 summit. But given the lack of tangible progress on Capitol Hill during the past two weeks, it is hard to see how the president will walk into the summit with a bill that's been agreed to by both chambers" (Budoff Brown, 2/16).
Reuters: According to Gibbs, "'The president will lay out his ideas, and I would expect that Republicans will, and others will, lay out their solutions,' he said." Although Gibbs did not offer a specific timeline for its release, he did make assurances that the measure would be made public "far enough before the meeting to allow it to be reviewed. 'I don't have the exact day yet. But it will be in — in time for — for you and for others around the country to evaluate a plan,' he said" (Zengerle, 2/16).
CNN: Health and Human Services Secretary Kathleen Sebelius said Tuesday that Obama plans to use the already-passed bills as a starting point for the summit next week. "But Sebelius, in an interview with CNN Chief Medical Correspondent Dr. Sanjay Gupta, said the House and Senate bills already incorporate many GOP ideas." Among the specific examples she cited were "provisions to create special pools to make it easier for people with pre-existing illness to purchase insurance, the offering of low-cost insurance plans for young and healthy people, and regulations letting people purchase insurance across state lines —a version of which is included in the Senate bill." The president's plan will not likely include a public option, she said (2/16).
The Associated Press: After some early questions about the health summit, the GOP is now seeing its possible political upside. Although Democrats are likely to focus on expanding affordable health insurance to more people — they offer to cover 30 more million people instead of Republicans who are offering 3 million more covered — Republicans hope that "during a time of ballooning deficits … reining in rising medical costs — not coverage — could resonate with voters in an election year. ... With the summit more than a week away and lawmakers out of town for the Presidents Day recess, Republicans are in the early stages of planning their strategy for the event. … One potential hitch for Republicans is that there is not a single GOP plan" (Werner, 2/17).
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.
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.
Thursday, November 19, 2009
Senate, House Democratic Health Bills Compared
Stay tuned for Insuring Resources Commentary soon.
.... in the meantime see an analysis below courtesy of the Associated Press
--------------------- ---------------------------
Senate, House Democratic Health Bills ComparedAssociated Press
November 19, 2009
A comparison of the health care bills before Congress:
The Senate Democratic bill (Patient Protection and Affordable Care Act):
WHO'S COVERED: About 94 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Illegal immigrants would not receive assistance.
COST: Coverage provisions cost $849 billion over 10 years.
HOW IT'S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 1.95 percent on income over $200,000a year for individuals; $250,000 for couples. New 5 percent tax on elective cosmetic surgery. Cuts to Medicare and Medicaid. Excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.
REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750.
REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees' coverage.
SUBSIDIES: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.
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.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.
GOVERNMENT-RUN PLAN: A new federal insurance plan would be offered to compete against private carriers. The government would negotiate -- not dictate -- payment rates for medical providers. Unlike the House bill, states could opt out of the plan. It's not clear the proposal commands enough votes to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally encouraged to keep their work-provided coverage.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.
CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty, which is $29,327 a year for a family of four, for all parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Amendment expected to be offered on the Senate floor to strip the health insurance industry of its antitrust exemption.
____
The House bill (Affordable Health Care for America Act):
WHO'S COVERED: About 96 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.
COST: The Congressional Budget Office says the bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. That's under President Barack Obama's $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.
HOW IT'S PAID FOR: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers' concerns that the taxes would hit too many people and small businesses.
There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.
REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.
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.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.
GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version -- preferred by moderate lawmakers -- would let the HHS secretary negotiate rates with providers.
CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.
.... in the meantime see an analysis below courtesy of the Associated Press
--------------------- ---------------------------
Senate, House Democratic Health Bills ComparedAssociated Press
November 19, 2009
A comparison of the health care bills before Congress:
The Senate Democratic bill (Patient Protection and Affordable Care Act):
WHO'S COVERED: About 94 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Illegal immigrants would not receive assistance.
COST: Coverage provisions cost $849 billion over 10 years.
HOW IT'S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 1.95 percent on income over $200,000a year for individuals; $250,000 for couples. New 5 percent tax on elective cosmetic surgery. Cuts to Medicare and Medicaid. Excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.
REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750.
REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees' coverage.
SUBSIDIES: Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.
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.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.
GOVERNMENT-RUN PLAN: A new federal insurance plan would be offered to compete against private carriers. The government would negotiate -- not dictate -- payment rates for medical providers. Unlike the House bill, states could opt out of the plan. It's not clear the proposal commands enough votes to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally encouraged to keep their work-provided coverage.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.
CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty, which is $29,327 a year for a family of four, for all parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Amendment expected to be offered on the Senate floor to strip the health insurance industry of its antitrust exemption.
____
The House bill (Affordable Health Care for America Act):
WHO'S COVERED: About 96 percent of legal residents under age 65 -- compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.
COST: The Congressional Budget Office says the bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. That's under President Barack Obama's $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.
HOW IT'S PAID FOR: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers' concerns that the taxes would hit too many people and small businesses.
There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.
REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.
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.
INSURANCE INDUSTRY RESTRICTIONS: Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.
GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version -- preferred by moderate lawmakers -- would let the HHS secretary negotiate rates with providers.
CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.
LONG-TERM CARE: New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.
ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.
Wednesday, November 18, 2009
WI Firms Pay 22% More for Health Insurance- with Soultions Offered by Insuring Resources
Insuring Resources Commentary:
Wisconsin business is at a huge disadvantage in the national marketplace because we pay so much more for health insurance, according to new research by Mercer. Part of the reason, I believe, is because Wisconsin health care providers get paid less on average for treating people on Medicare so the costs are shifted on to the private sector side.
Now if health care reform includes a public plan option that covers small businesses and uses Medicare reimbursement rates the situation will get much worse for Wisconsin businesses.
Solution:
Health care reform must
1. level the Medicare reimbursement to bring Wisconsin up where it should be. Wisconsin providers are paid much less by Medicare than the national average.
2.if we have a public plan option that includes coverage for small businesses it must not use Medicare reimbursement rates UNLESS, Medicare can finally start to negotiate rates with providers. Right now, Medicare reimbursement rates are set by the feds, NOT negotiated in the marketplace. With the purchasing power of the federal government insuring tens of millions of people on Medicare this should be a no-brainer.
3. In addition, as I've said all along, providers need reimbursement incentives to make their care more efficient and reduce the waste. The Senate bill includes pilots for this but that doesn't go far enough, we need these efficiency incentives to be standard across the entire system.
4. And finally, Wisconsin cannot be penalized for having a higher rate of insured persons. There are incentives in the House bill that gives grant money to states with higher uninsured pct.s to help them along. This actually hurts states like Wisconsin that have been proactive. For instance- Wisconsin covers childless adults through BadgerCare up to 200% of FPL. Louisiana covers them up to 26% of FPL!!! If the House reform language passes Lousiana gets extra money to bring their insured numbers up to 150% while Wisconsin already surpasses that. By the way-- thanks to Wisconsin DHS Secretary Karen Timberlake for providing the Louisiana stat at a health care forum I attended in Madison yesterday.
----------------------- -----------------------
State firms pay 22% more for health insurance than U.S., survey shows By Rick Romell of the Journal Sentinel
Posted: Nov. 18, 2009 10:14 a.m.
Wisconsinites continue to pay more for health insurance than Americans generally, and the costs here have increased more rapidly, a new survey by benefits consulting firm Mercer shows.
Wisconsin companies and their employees paid an average of $10,888 per worker for health insurance in 2009 - nearly 22% above the national average of $8,945, Mercer found.
And the cost gap between Wisconsin and the rest of the country widened. Nationally, the cost of health benefits for active employees rose 5.5% for the year, the smallest annual increase in a decade. In Wisconsin, costs increased by 6.8%.
Mercer's findings are based on a late-summer survey of more than 2,900 employers with at least 10 employees each. Eighty-eight Wisconsin employers were surveyed.
Wisconsin business is at a huge disadvantage in the national marketplace because we pay so much more for health insurance, according to new research by Mercer. Part of the reason, I believe, is because Wisconsin health care providers get paid less on average for treating people on Medicare so the costs are shifted on to the private sector side.
Now if health care reform includes a public plan option that covers small businesses and uses Medicare reimbursement rates the situation will get much worse for Wisconsin businesses.
Solution:
Health care reform must
1. level the Medicare reimbursement to bring Wisconsin up where it should be. Wisconsin providers are paid much less by Medicare than the national average.
2.if we have a public plan option that includes coverage for small businesses it must not use Medicare reimbursement rates UNLESS, Medicare can finally start to negotiate rates with providers. Right now, Medicare reimbursement rates are set by the feds, NOT negotiated in the marketplace. With the purchasing power of the federal government insuring tens of millions of people on Medicare this should be a no-brainer.
3. In addition, as I've said all along, providers need reimbursement incentives to make their care more efficient and reduce the waste. The Senate bill includes pilots for this but that doesn't go far enough, we need these efficiency incentives to be standard across the entire system.
4. And finally, Wisconsin cannot be penalized for having a higher rate of insured persons. There are incentives in the House bill that gives grant money to states with higher uninsured pct.s to help them along. This actually hurts states like Wisconsin that have been proactive. For instance- Wisconsin covers childless adults through BadgerCare up to 200% of FPL. Louisiana covers them up to 26% of FPL!!! If the House reform language passes Lousiana gets extra money to bring their insured numbers up to 150% while Wisconsin already surpasses that. By the way-- thanks to Wisconsin DHS Secretary Karen Timberlake for providing the Louisiana stat at a health care forum I attended in Madison yesterday.
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State firms pay 22% more for health insurance than U.S., survey shows By Rick Romell of the Journal Sentinel
Posted: Nov. 18, 2009 10:14 a.m.
Wisconsinites continue to pay more for health insurance than Americans generally, and the costs here have increased more rapidly, a new survey by benefits consulting firm Mercer shows.
Wisconsin companies and their employees paid an average of $10,888 per worker for health insurance in 2009 - nearly 22% above the national average of $8,945, Mercer found.
And the cost gap between Wisconsin and the rest of the country widened. Nationally, the cost of health benefits for active employees rose 5.5% for the year, the smallest annual increase in a decade. In Wisconsin, costs increased by 6.8%.
Mercer's findings are based on a late-summer survey of more than 2,900 employers with at least 10 employees each. Eighty-eight Wisconsin employers were surveyed.
Monday, September 21, 2009
5 Facts on the Uninsured
Source- Kaiser News
I think most would agree that this is sobering information on the impact of being uninsured. What this information does not factor is in the resulting impact of non-covered pre-existing conditions once an individual obtains health insurance.
In addition medical related expenses played a key role in more than 700,000 home foreclosures in the U.S. in 2008. In a recent study by the Univ. of Pennsylvania the authors found that compared to a sample of residents in the general public, those in foreclosure were more likely to be uninsured (22 percent compared to 8 percent). Nearly 60 percent reported that they had skipped or delayed meals because they couldn’t afford food, and people undergoing foreclosure were also more likely to have forgone filling a prescription because of the expense during the preceding year (48 percent vs. 15 percent).
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1) Most of the 46 million uninsured are in working families and do not have access to employer-sponsored insurance. Eight in ten of the 46 million uninsured in the U.S. come from working families. Most uninsured workers are self-employed or work for small firms where health benefits are much less likely to be offered.
2)About two-thirds of the uninsured have low incomes, meaning their family income is less than 200% of the poverty level (about $44,050 a year for a family of four or $21,982 a year for a single person in 2008). Moderate income families, those from 200-399% of poverty, comprise 23% of the uninsured (Figure 2). The average annual cost of employer-sponsored family coverage has doubled since 2000. Because the cost of family coverage in 2009 was $13,375, many families can only afford coverage if they receive sizable employer contributions.
3) In 2008, an increase in Medicaid coverage helped to offset declines in private insurance. Medicaid’s role in covering children was particularly important. While about 700,000 children lost employer-sponsored coverage in 2008, more than twice as many (1.7 million) gained Medicaid coverage—decreasing the number of uninsured children by 800,000 in a single year. Some states have expanded Medicaid coverage beyond federal minimums and made more of their low-income population eligible. The number of adults in Medicaid has increased as incomes declined due to the recession. Meanwhile, other states have left most low-income individuals ineligible for public coverage.
4) The uninsured suffer from negative health consequences due to their lack of access to necessary medical care. About one-quarter (24%) of uninsured adults go without needed care each year due to cost. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions, including traumatic injuries, heart attacks, and chronic diseases—and many suffer serious consequences. The uninsured receive less preventive care and recommended screenings than the insured. Adults who have been uninsured for more than one year are three to four times more likely to have not received recommended breast cancer screenings or to have had their blood pressure checked.
5) The uninsured pay for more than one-third (35%) of their care out-of-pocket. They are typically billed for any care they receive, often paying higher charges than the insured. Medical bills can put great strain on the uninsured and threaten their physical and financial well-being. The uninsured are nearly three times as likely (14% versus 5%) as those with health insurance coverage to be unable to pay for basic necessities due to medical bills (Figure 5). Additionally, 20% of the uninsured report having used up all or most of their savings because of medical bills. The average uninsured household also has no net assets.
I think most would agree that this is sobering information on the impact of being uninsured. What this information does not factor is in the resulting impact of non-covered pre-existing conditions once an individual obtains health insurance.
In addition medical related expenses played a key role in more than 700,000 home foreclosures in the U.S. in 2008. In a recent study by the Univ. of Pennsylvania the authors found that compared to a sample of residents in the general public, those in foreclosure were more likely to be uninsured (22 percent compared to 8 percent). Nearly 60 percent reported that they had skipped or delayed meals because they couldn’t afford food, and people undergoing foreclosure were also more likely to have forgone filling a prescription because of the expense during the preceding year (48 percent vs. 15 percent).
------------------ ----------------- ---------------
1) Most of the 46 million uninsured are in working families and do not have access to employer-sponsored insurance. Eight in ten of the 46 million uninsured in the U.S. come from working families. Most uninsured workers are self-employed or work for small firms where health benefits are much less likely to be offered.
2)About two-thirds of the uninsured have low incomes, meaning their family income is less than 200% of the poverty level (about $44,050 a year for a family of four or $21,982 a year for a single person in 2008). Moderate income families, those from 200-399% of poverty, comprise 23% of the uninsured (Figure 2). The average annual cost of employer-sponsored family coverage has doubled since 2000. Because the cost of family coverage in 2009 was $13,375, many families can only afford coverage if they receive sizable employer contributions.
3) In 2008, an increase in Medicaid coverage helped to offset declines in private insurance. Medicaid’s role in covering children was particularly important. While about 700,000 children lost employer-sponsored coverage in 2008, more than twice as many (1.7 million) gained Medicaid coverage—decreasing the number of uninsured children by 800,000 in a single year. Some states have expanded Medicaid coverage beyond federal minimums and made more of their low-income population eligible. The number of adults in Medicaid has increased as incomes declined due to the recession. Meanwhile, other states have left most low-income individuals ineligible for public coverage.
4) The uninsured suffer from negative health consequences due to their lack of access to necessary medical care. About one-quarter (24%) of uninsured adults go without needed care each year due to cost. Studies repeatedly demonstrate that the uninsured are less likely than those with insurance to receive preventive care and services for major health conditions, including traumatic injuries, heart attacks, and chronic diseases—and many suffer serious consequences. The uninsured receive less preventive care and recommended screenings than the insured. Adults who have been uninsured for more than one year are three to four times more likely to have not received recommended breast cancer screenings or to have had their blood pressure checked.
5) The uninsured pay for more than one-third (35%) of their care out-of-pocket. They are typically billed for any care they receive, often paying higher charges than the insured. Medical bills can put great strain on the uninsured and threaten their physical and financial well-being. The uninsured are nearly three times as likely (14% versus 5%) as those with health insurance coverage to be unable to pay for basic necessities due to medical bills (Figure 5). Additionally, 20% of the uninsured report having used up all or most of their savings because of medical bills. The average uninsured household also has no net assets.
564 amendments proposed to Baucus plan
Highlights, not all 564, are listed below
Source: Bloomberg.com
Sept. 21 Senate Finance Committee members signaled an aggressive effort to reshape health-care legislation proposed by Chairman Max Baucus, drafting 564 amendments for consideration when the panel meets this week.
Members of both parties want to make a host of changes to legislation designed to lower costs and expand coverage to the uninsured that Baucus introduced last week. They include expanding tax subsidies for low-income people to buy coverage, eliminating a proposed $215 billion tax on high-value health plans, and setting up a government-run insurance program to compete with private industry.
Baucus Plan Overview
Requires almost all Americans to have insurance or pay a penalty, expand Medicaid and provide subsidies to help millions of low-income people get coverage through an online exchange.
The nonpartisan Congressional Budget Office says his plan would lower the budget deficit over 10 years. It utilizes nonprofit cooperatives rather than a government program to compete against insurers, and drops a mandate that all employers provide health care to workers.
To pay for his plan, Baucus seeks savings in programs such as Medicare, the federal insurance plan for the elderly, and new taxes. He’s proposing a levy on costly “Cadillac” health plans and about $13 billion in fees on insurers, medical-device manufacturers, drugmakers and clinical laboratories.
Amendments proposed
Senator Olympia Snowe, a Maine Republican would create a government entity to provide insurance in any state unless coverage is deemed affordable to at least 95 percent of the residents. Coverage is judged unaffordable if the cost of premiums exceeds a percentage of a person’s income, ranging from 3 percent for those at 133 percent of the poverty level to 13 percent for those at 300 percent of the poverty level and above.
Public Option
Senator Jay Rockefeller, a West Virginia Democrat, is proposing to replace the nonprofit cooperatives with a government-run plan. Democratic senators Charles Schumer of New York and Maria Cantwell of Washington favor setting up a public program, with rules that require the Medicare-like system to compete on a more level playing field with private industry.
Rockefeller also wants to require that a series of insurance market regulatory changes -- including a ban on coverage exclusions for pre-existing conditions -- apply to plans offered by self-insured employers.
He wants to increase the number of uninsured who would qualify for Medicaid coverage. Baucus supports boosting the threshold for coverage to 133 percent of the poverty level; Rockefeller wants to lift that to 150 percent.
Tax Subsidies
Democratic Senator Ron Wyden of Oregon is seeking tax subsidies for insurance purchases available to those earning as much as 400 percent of the federal poverty level, rather than 300 percent as in the Baucus plan. Poverty guidelines for 2009 are $10,830 for an individual and $22,050 for a family of four, according to the Department of Health and Human Services.
Senator Robert Menendez, a New Jersey Democrat, is joining three other Democrats in a proposal to ensure that anyone below the 400 percent threshold who is utilizing either a subsidy or tax credit will pay no more than 10 percent of their income before getting the aid. Baucus has a maximum of 13 percent of income for some consumers at the top end of a sliding scale.
Baucus’s proposed new tax on high-valued insurance plans would be pared back under a proposal by Senator John Kerry, a Massachusetts Democrat. While Baucus imposes a 35 percent excise tax on plans valued at $8,000 for individuals and $21,000 for family coverage, Kerry wants to raise the threshold to $9,800 for individuals and $25,000 for families. He would offset the lost revenue by raising the excise tax to 40 percent and closing corporate tax loopholes.
Republican Changes
On the Republican side, lawmakers are taking aim at tax increases and industry fees. Senator Charles Grassley of Iowa, the top Republican on the committee, wants to eliminate $13 billion in fees that would be imposed on the insurance, pharmaceutical, clinical laboratory and medical-device sectors. He would offset that by tapping funds approved as part of this year’s economic-stimulus measure that haven’t yet been spent.
Senator Mike Enzi, a Wyoming Republican, wants to block any expansion of Medicaid that results in cost increases for states. Senator Orrin Hatch, a Utah Republican, wants to cut the Medicaid expansion altogether, as well as the cooperatives -- which under Baucus’s proposal get $6 billion in federal start-up funds.
Jon Kyl of Arizona is offering a requirement that legal immigrants show proof they have lived in the U.S. for at least five years before getting government help to buy insurance.
Baucus has the benefit of numbers in his favor. The committee is comprised of 13 Democrats and 10 Republicans. He and two other Democrats -- Kent Conrad of North Dakota and Jeff Bingaman of New Mexico -- could be a decisive swing bloc of votes against changes if many of the matters are otherwise decided on party lines.
Source: Bloomberg.com
Sept. 21 Senate Finance Committee members signaled an aggressive effort to reshape health-care legislation proposed by Chairman Max Baucus, drafting 564 amendments for consideration when the panel meets this week.
Members of both parties want to make a host of changes to legislation designed to lower costs and expand coverage to the uninsured that Baucus introduced last week. They include expanding tax subsidies for low-income people to buy coverage, eliminating a proposed $215 billion tax on high-value health plans, and setting up a government-run insurance program to compete with private industry.
Baucus Plan Overview
Requires almost all Americans to have insurance or pay a penalty, expand Medicaid and provide subsidies to help millions of low-income people get coverage through an online exchange.
The nonpartisan Congressional Budget Office says his plan would lower the budget deficit over 10 years. It utilizes nonprofit cooperatives rather than a government program to compete against insurers, and drops a mandate that all employers provide health care to workers.
To pay for his plan, Baucus seeks savings in programs such as Medicare, the federal insurance plan for the elderly, and new taxes. He’s proposing a levy on costly “Cadillac” health plans and about $13 billion in fees on insurers, medical-device manufacturers, drugmakers and clinical laboratories.
Amendments proposed
Senator Olympia Snowe, a Maine Republican would create a government entity to provide insurance in any state unless coverage is deemed affordable to at least 95 percent of the residents. Coverage is judged unaffordable if the cost of premiums exceeds a percentage of a person’s income, ranging from 3 percent for those at 133 percent of the poverty level to 13 percent for those at 300 percent of the poverty level and above.
Public Option
Senator Jay Rockefeller, a West Virginia Democrat, is proposing to replace the nonprofit cooperatives with a government-run plan. Democratic senators Charles Schumer of New York and Maria Cantwell of Washington favor setting up a public program, with rules that require the Medicare-like system to compete on a more level playing field with private industry.
Rockefeller also wants to require that a series of insurance market regulatory changes -- including a ban on coverage exclusions for pre-existing conditions -- apply to plans offered by self-insured employers.
He wants to increase the number of uninsured who would qualify for Medicaid coverage. Baucus supports boosting the threshold for coverage to 133 percent of the poverty level; Rockefeller wants to lift that to 150 percent.
Tax Subsidies
Democratic Senator Ron Wyden of Oregon is seeking tax subsidies for insurance purchases available to those earning as much as 400 percent of the federal poverty level, rather than 300 percent as in the Baucus plan. Poverty guidelines for 2009 are $10,830 for an individual and $22,050 for a family of four, according to the Department of Health and Human Services.
Senator Robert Menendez, a New Jersey Democrat, is joining three other Democrats in a proposal to ensure that anyone below the 400 percent threshold who is utilizing either a subsidy or tax credit will pay no more than 10 percent of their income before getting the aid. Baucus has a maximum of 13 percent of income for some consumers at the top end of a sliding scale.
Baucus’s proposed new tax on high-valued insurance plans would be pared back under a proposal by Senator John Kerry, a Massachusetts Democrat. While Baucus imposes a 35 percent excise tax on plans valued at $8,000 for individuals and $21,000 for family coverage, Kerry wants to raise the threshold to $9,800 for individuals and $25,000 for families. He would offset the lost revenue by raising the excise tax to 40 percent and closing corporate tax loopholes.
Republican Changes
On the Republican side, lawmakers are taking aim at tax increases and industry fees. Senator Charles Grassley of Iowa, the top Republican on the committee, wants to eliminate $13 billion in fees that would be imposed on the insurance, pharmaceutical, clinical laboratory and medical-device sectors. He would offset that by tapping funds approved as part of this year’s economic-stimulus measure that haven’t yet been spent.
Senator Mike Enzi, a Wyoming Republican, wants to block any expansion of Medicaid that results in cost increases for states. Senator Orrin Hatch, a Utah Republican, wants to cut the Medicaid expansion altogether, as well as the cooperatives -- which under Baucus’s proposal get $6 billion in federal start-up funds.
Jon Kyl of Arizona is offering a requirement that legal immigrants show proof they have lived in the U.S. for at least five years before getting government help to buy insurance.
Baucus has the benefit of numbers in his favor. The committee is comprised of 13 Democrats and 10 Republicans. He and two other Democrats -- Kent Conrad of North Dakota and Jeff Bingaman of New Mexico -- could be a decisive swing bloc of votes against changes if many of the matters are otherwise decided on party lines.
Thursday, September 17, 2009
Dems and GOP Agree- Baucus bill appears to be DOA
I guess Sen. Baucus has achieved what few others have. He's gotten Democrats and Republicans to agree... this is a horrible healthcare bill... except for widely different reasons.
Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.
Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.
Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.
By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.
The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.
Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104
Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.
On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.
If enacted, this bill in present form will make the system more costly than what we have today.
--------------- -------------------- -----------------
From today's Milwaukee Journal Sentinel
Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.
His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.
For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.
He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.
More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.
"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.
Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."
Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.
The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.
Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.
Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.
Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.
AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."
Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.
Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."
House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."
Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."
Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."
More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.
At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.
Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.
Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.
Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.
The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.
And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."
Republicans are against tax increases (even though there is no employer mandate) and subsidizing "socialist" care for the poor. On the second point, I guess they still don't understand Medicare and Medicaid. On the first point, Baucus caves to their whims and still they're unhappy.
Many Democrats don't like that he didn't incorporate a true public plan, among numerous other issues which are far too lengthy to list.
Disabilities
In my own read of the 223 page bill I was dumbfounded to see no discussion or improvements on health care for people with disabilities. Apparently reform is discrminatory just like health care itself, and we're suppose to keep disabled folks in a separate health care program (Medicaid) that for the most part doesn't provide integrated care or care about quality with no serious ideas for improvement. Apparently Sen. Baucus doesn't want to improve health outcomes since he included yet another pilot Medical Home project. We've had enough of small-time pilots, medical homes work, they should be the essence of the program, not an underfunded, low enrollment step-sister.
By the way, Baucus decides to cut Medicare and Medicaid by $500 billion ovet the next 10 years to help pay for the expanded uninsured coverage. That's what I mean about discrimination.
The only substantial (I hesitate to even call it that) disability item is continued funding of a great idea- Aging and Disability Resource Centers- in the amount of $10 million for an additional five years.
Waste? Baucus says let's Demonstrate and Pilot, Not Fix it On the subject of reducing waste and cutting costs, there is virtually nothing substantial. For in depth analysis of those proposals go to this blog at the Center for Health Care Value- http://www.createhealthcarevalue.com/blog/post/?bid=104
Baucus proposes Medicare demonstrations and volunteer provider programs with incentives to "study" the potential of waste reduction. discussion around incentivizing providers to eliminate waste and practice efficiently. On this point I actually agree with Republican Sen. Enzi, not that he's proposed an alternative to achive cost efficiency. Again, on this point Baucus provides pilots.
On Co-ops- Sen. Rockefeller (D-W.V.) says thay are "untested and unsubstantiated." He's wrong. Wisconsin alone has three very successful coops in existence and there are dozens of others in the U.S. Its amazing how many components of this our legislators (on both sides) simply do not understand. The Co-ops proposed by Baucus must be integrated models so at least he got that right. What he gest wrong though is that integrated models should be used nation-wide with incentives given for providers and health plans to implement them.
If enacted, this bill in present form will make the system more costly than what we have today.
--------------- -------------------- -----------------
From today's Milwaukee Journal Sentinel
Washington — Senate Finance Committee Chairman Max Baucus' $856 billion plan to overhaul the nation's health care system - a package that lacks the public option that President Barack Obama favors - was greeted Wednesday largely with skepticism and sometimes disdain, even among fellow Democrats.
His package, which would create health care co-ops, raise taxes on insurers and require companies to offer coverage to nearly everyone, is the latest effort to find bipartisan agreement on Obama's top domestic priority.
For months, the Democratic senator from Montana and five other committee members, three from each party, struggled to craft bipartisan legislation. They finally gave up, and Baucus went his own way.
He still worked Wednesday to woo Republican support, but only Sen. Olympia Snowe (R-Maine) seemed hopeful. "The bill is a work in progress," she said.
More typical was the view of Sen. Michael Enzi of Wyoming, the top Republican on the Senate Health Committee, who said he was "deeply disappointed" that the group of six, of which he was one, couldn't agree.
"The proposal released today still spends too much and it does too little to cut health care costs for those with health insurance," he said.
Four other committees - three in the House and the Senate health panel - have written health care bills. All were authored almost entirely by Democrats, and all back a "public option."
Baucus thinks that such a plan can't pass the Senate. He stressed Wednesday that he made compromises aimed at winning passage.
The biggest change from the other bills is the co-op idea, which veers away from Obama's plea to include a public option.
Instead, Baucus proposed a system of co-ops that can operate at the state, regional or national level as nonprofit, member-run health plans. He proposed spending $6 billion in federal money to get them started.
Supporters of co-ops maintain that negotiating rates with hospitals, doctors and other providers collectively would reduce health care costs, "without putting the government in charge of health care," as Sen. Kent Conrad (D-N.D.), another one of the group of six, put it. He estimated that Baucus' plan would cover about 94% of Americans.
Many not happy
Many other Democrats and their supporters weren't pleased, however, and some were downright angry.
AFL-CIO President John Sweeney said the Baucus plan "absolutely fails to meet the most basic health care needs of working families."
Sen. Russ Feingold (D-Wis.) said, "My goals for health care reform include a strong public option, long-term care reform and reform of the Medicare reimbursement system that has disadvantaged Wisconsin for far too long. I am disappointed that the Finance Committee bill, as written, comes up short on all three fronts.
Sen. Jay Rockefeller of West Virginia, the second-ranking Democrat on the Finance Committee, branded co-ops "untested and unsubstantiated and should not be considered as a national model for health insurance."
House Speaker Nancy Pelosi (D-Calif.), issued a tersely worded statement. "The House bill clearly does more to make coverage affordable for more Americans and provides more competition to drive insurance companies to charge lower premiums and improve coverage," she said, adding that she looked forward to "modifications."
Pelosi made it clear what she wants: "I believe the public option is the best way to achieve that goal."
Others were more circumspect. At the White House, spokesman Robert Gibbs called the Baucus plan "an important building block," while Senate Majority Leader Harry Reid (D-Nev.) said, "Everyone should understand it's a beginning, a good beginning."
More reviews on tap
The Senate Finance Committee, which has 13 Democrats and 10 Republicans, is expected to finish writing its bill by the end of the month. It then would be combined with the Senate health committee measure and be considered by the full Senate.
At roughly the same time, the House is expected to vote on a consolidated bill melded from the three committee drafts. Then comes the hardest part: finding common ground between the House and Senate bills and producing one piece of legislation.
Baucus' proposal got one important boost Wednesday from the nonpartisan Congressional Budget Office and the bipartisan Joint Committee on Taxation.
Their preliminary analysis found that Baucus' plan would mean a net reduction in the deficit of $49 billion over the next 10 years, as new spending is offset by a combination of cuts in federal health programs, notably Medicare, as well as new taxes and fees.
Baucus proposes a nondeductible excise tax, starting in 2013, of 35% on insurance companies and plan administrators for any health insurance plan that charges more than $8,000 for individuals and $21,000 for families. The Joint Taxation Committee estimates that it would raise about $214.9 billion over 10 years.
The plan faces two instant hurdles: House Democratic leaders prefer an income tax surcharge on wealthy taxpayers, which would raise an estimated $544 billion over 10 years, and the House legislation has considerably less in Medicare savings.
And Republicans will oppose almost any tax increase. Senate Republican leader Mitch McConnell of Kentucky set the tone, saying the Baucus bill would "put massive new tax burdens on families and individuals."
Monday, September 14, 2009
Negotiations heating up, Closing in on a deal
The latest compromises and my analysis
- Elimination of pre-x- not mentioned in the article
- Payment reform- not mentioned
- Quality incentives- not mentioned
- Elimination of waste- not mentioned
= The AP and other members of the media continue their E News! style reporting and are failing to address key issues. They remain fixated on the fluff issues like the public plan option, immigrants and abortion. When most media outlets have the attention span of a fruit fly it doesn't help the American people to get informed.
Because of our sound-bite oriented news we now get three days of coverage of "You lie!" versus real reporting on what the various proposals will cover and reform.
Stay tuned as I'll dig for better details when the Baucus plan is released Wednesday.
------
WASHINGTON (AP) -- Senate health care negotiators said Monday they've narrowed their differences on a host of difficult issues with just a day or so left to seal an elusive bipartisan deal that could change the course of the contentious debate.
After months of closed-door negotiations, Finance Committee Chairman Max Baucus said, "We're getting very close." But it remained unclear if the Montana Democrat could strike a bargain to close the deal.
Negotiators pared the cost of their 10-year coverage plan to under $880 billion, and also reported progress on several issues, including health insurance for the poor, restrictions on federal funding for abortions, a verification system to prevent illegal immigrants from getting benefits, and ways to encourage alternatives to malpractice lawsuits.
With or without Republican support, Baucus said he'll have a formal proposal on Wednesday to meet a deadline for moving ahead.
At the same time, he said the bipartisan talks could continue even as his Finance panel begins its formal bill-drafting session next week.
"It's not just tomorrow or the next day," said Baucus. "We're going to keep working."
The three Republicans - Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine - are under intense pressure from leaders of their own party, some of whom have publicly dismissed Baucus' framework as a Democrat's plan. Baucus may not be able to get any of them to agree. But all three have invested much time and energy in the talks, and Baucus seems to have a chance of persuading at least Snowe.
Sen. Kent Conrad, D-N.D., said the negotiators are close on a verification system to prevent illegal immigrants from getting government subsidies to buy health coverage - a big issue for Republicans.
Negotiators also said they've found ways to reduce the cost of a planned expansion of Medicaid to cover more people near the federal poverty line. The issue is critical to winning support from governors, since the states share in the cos.
On medical malpractice, Conrad said the negotiators agreed that the federal government should provide funding for states to experiment with a range of alternatives to lawsuits.
On abortion, the negotiators are trying to come up with language that would extend current restrictions that prohibit federal funding for the procedure, except in cases of rape, incest, or to save the life of the mother.
Baucus' plan would mandate all Americans to get health insurance, either through an employer, a government program, or on their own. New consumer protections would prohibit onerous insurance companies practices, such as denying coverage because of a prior health problem, or charging more to those who are sick.
Even if Baucus can't get Republican support, the plan already reflects some major GOP priorities. For example, Baucus opted not to include a government insurance plan to compete with private carriers.
"I am very optimistic that we are going to be able to pass a bill that will get us to 60 votes," said Sen. Bill Nelson, D-Fla., a Finance member. "I didn't feel it a week-and-a-half ago, but I'm very optimistic now." Obama's speech last week "hit it head on," said Nelson.
- Elimination of pre-x- not mentioned in the article
- Payment reform- not mentioned
- Quality incentives- not mentioned
- Elimination of waste- not mentioned
= The AP and other members of the media continue their E News! style reporting and are failing to address key issues. They remain fixated on the fluff issues like the public plan option, immigrants and abortion. When most media outlets have the attention span of a fruit fly it doesn't help the American people to get informed.
Because of our sound-bite oriented news we now get three days of coverage of "You lie!" versus real reporting on what the various proposals will cover and reform.
Stay tuned as I'll dig for better details when the Baucus plan is released Wednesday.
------
WASHINGTON (AP) -- Senate health care negotiators said Monday they've narrowed their differences on a host of difficult issues with just a day or so left to seal an elusive bipartisan deal that could change the course of the contentious debate.
After months of closed-door negotiations, Finance Committee Chairman Max Baucus said, "We're getting very close." But it remained unclear if the Montana Democrat could strike a bargain to close the deal.
Negotiators pared the cost of their 10-year coverage plan to under $880 billion, and also reported progress on several issues, including health insurance for the poor, restrictions on federal funding for abortions, a verification system to prevent illegal immigrants from getting benefits, and ways to encourage alternatives to malpractice lawsuits.
With or without Republican support, Baucus said he'll have a formal proposal on Wednesday to meet a deadline for moving ahead.
At the same time, he said the bipartisan talks could continue even as his Finance panel begins its formal bill-drafting session next week.
"It's not just tomorrow or the next day," said Baucus. "We're going to keep working."
The three Republicans - Mike Enzi of Wyoming, Chuck Grassley of Iowa and Olympia Snowe of Maine - are under intense pressure from leaders of their own party, some of whom have publicly dismissed Baucus' framework as a Democrat's plan. Baucus may not be able to get any of them to agree. But all three have invested much time and energy in the talks, and Baucus seems to have a chance of persuading at least Snowe.
Sen. Kent Conrad, D-N.D., said the negotiators are close on a verification system to prevent illegal immigrants from getting government subsidies to buy health coverage - a big issue for Republicans.
Negotiators also said they've found ways to reduce the cost of a planned expansion of Medicaid to cover more people near the federal poverty line. The issue is critical to winning support from governors, since the states share in the cos.
On medical malpractice, Conrad said the negotiators agreed that the federal government should provide funding for states to experiment with a range of alternatives to lawsuits.
On abortion, the negotiators are trying to come up with language that would extend current restrictions that prohibit federal funding for the procedure, except in cases of rape, incest, or to save the life of the mother.
Baucus' plan would mandate all Americans to get health insurance, either through an employer, a government program, or on their own. New consumer protections would prohibit onerous insurance companies practices, such as denying coverage because of a prior health problem, or charging more to those who are sick.
Even if Baucus can't get Republican support, the plan already reflects some major GOP priorities. For example, Baucus opted not to include a government insurance plan to compete with private carriers.
"I am very optimistic that we are going to be able to pass a bill that will get us to 60 votes," said Sen. Bill Nelson, D-Fla., a Finance member. "I didn't feel it a week-and-a-half ago, but I'm very optimistic now." Obama's speech last week "hit it head on," said Nelson.
Thursday, September 10, 2009
Analysis of Obama's Speech
President Obama on Wednesday clearly laid out his vision for health care reform. Although the speech was long he actually succinctly stated his goals and laid out his vision in language that should make it difficult for opponents to mis-represent and lie about.
Cost and Waste issues
On my favorite topic the President had this to say:
"We've estimated that most of this plan can be paid for by finding savings within the existing health care system - a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment - it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid."
He's right but I'm going to be very watchful of the details on this as I hope he is talking about instituting health care reimbursement based on "episodes of care" and I hope the plan includes implementing LEAN processes.
There was no mention of either in the speech. As the President said there are many details that need to be worked out to flesh out the basic proposal he announced.
On Medicare and Medicaid there was little detail but he reassured seniors and people with disabilities that he would protect the programs they need and rely on. I'm sure there are important new ideas that will impact these groups within Obama's and Baucus's plans. Please check back here for that analysis soon.
On the public plan
The President said, "An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up." Taxpayers will not be subsidizing this public insurance option. Obama said, "The public insurance option would have to be self-sufficient and rely on the premiums it collects."
This should clear up the idea of a gov't takeover of health care but I doubt it will and in the end I'd bet that health co-ops are what is implemented as a compromise. I've said that before and I'd bet my mortgage on it being the alternative option.
Individual and Small Business Tax Credits
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
Cost of the plan
The President- "I will not sign a plan that adds one dime to our deficits - either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize." The plan will cost around $900 billion over ten years. Most of these costs will be paid for with money already being spent - but spent badly - in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. Obama reiterated the dire need to curb rising medical costs saying, "if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
As always more and more details will be forthcoming. I will research how the plan addresses the waste issue and the provider payment issues. These are the key components and will make or break any bill that becomes law. Please stay tuned, engage, and provide your comments.
Cost and Waste issues
On my favorite topic the President had this to say:
"We've estimated that most of this plan can be paid for by finding savings within the existing health care system - a system that is currently full of waste and abuse. Right now, too much of the hard-earned savings and tax dollars we spend on health care doesn't make us healthier. That's not my judgment - it's the judgment of medical professionals across this country. And this is also true when it comes to Medicare and Medicaid."
He's right but I'm going to be very watchful of the details on this as I hope he is talking about instituting health care reimbursement based on "episodes of care" and I hope the plan includes implementing LEAN processes.
There was no mention of either in the speech. As the President said there are many details that need to be worked out to flesh out the basic proposal he announced.
On Medicare and Medicaid there was little detail but he reassured seniors and people with disabilities that he would protect the programs they need and rely on. I'm sure there are important new ideas that will impact these groups within Obama's and Baucus's plans. Please check back here for that analysis soon.
On the public plan
The President said, "An additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear - it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5% of Americans would sign up." Taxpayers will not be subsidizing this public insurance option. Obama said, "The public insurance option would have to be self-sufficient and rely on the premiums it collects."
This should clear up the idea of a gov't takeover of health care but I doubt it will and in the end I'd bet that health co-ops are what is implemented as a compromise. I've said that before and I'd bet my mortgage on it being the alternative option.
Individual and Small Business Tax Credits
For those individuals and small businesses who still cannot afford the lower-priced insurance available in the exchange, we will provide tax credits, the size of which will be based on your need. This exchange will take effect in four years, which will give us time to do it right. In the meantime, for those Americans who can't get insurance today because they have pre-existing medical conditions, we will immediately offer low-cost coverage that will protect you against financial ruin if you become seriously ill. This was a good idea when Senator John McCain proposed it in the campaign, it's a good idea now, and we should embrace it.
Cost of the plan
The President- "I will not sign a plan that adds one dime to our deficits - either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize." The plan will cost around $900 billion over ten years. Most of these costs will be paid for with money already being spent - but spent badly - in the existing health care system. The plan will not add to our deficit. The middle-class will realize greater security, not higher taxes. Obama reiterated the dire need to curb rising medical costs saying, "if we are able to slow the growth of health care costs by just one-tenth of one percent each year, it will actually reduce the deficit by $4 trillion over the long term.
As always more and more details will be forthcoming. I will research how the plan addresses the waste issue and the provider payment issues. These are the key components and will make or break any bill that becomes law. Please stay tuned, engage, and provide your comments.
Tuesday, September 8, 2009
Health Compromise Floated Before Obama Speech
Below are excerpts from a NY times article on Sen. Baucus' health care reform compromise. I've edited the article to highlight what Baucus' plan would do, what it wouldn't and what it will cost.
The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste
The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers
------------------------------------
Health Compromise Floated Before Obama Speech
By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.
To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.
Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.
The article as usual does not get into the essential issues- I'll list them again as I see them:
1) payment reform based on quality and episodes of care (rather than fee reimbursement)
2) elimination of individual underwriting and pre-existing conditions
3) requirement to institute LEAN manufacturing techniques to eliminate waste
The article does however layout the essentials of Baucus' compromise-
- no public option, instead using state-based non-profit co-ops
- expansion of Medicaid for low-income uninsured individuals
- lower benefit coverage for those under age 25 without coverage
- fees and additional reporting requirements for insurers
------------------------------------
Health Compromise Floated Before Obama Speech
By JACKIE CALMES and ROBERT PEAR
The New York Times
Published: September 7, 2009
WASHINGTON —
As President Obama and top advisers drafted his eagerly awaited health care speech to Congress, new details emerged Monday about fees and coverage limits under a proposal being floated by the chairman of a crucial Senate committee.
The proposal from the lawmaker, Senator Max Baucus, who heads the Finance Committee, would impose new fees on some sectors of the health care industry, but none on individuals, to help offset initial costs estimated at $880 billion over 10 years, according to officials familiar with the outline.
The plan would:
offer the option of lower-cost insurance, with protection only against the costs of catastrophic illnesses, to those 25 and younger.
provide basic Medicaid coverage to millions of low-income people who are currently ineligible for the program, but the benefits would be less comprehensive than standard Medicaid.
The plan will not be a government-run insurance plan, or include a “public option,” to compete against private insurers.
Solution: Instead, his committee’s group of negotiators has coalesced around the idea of forming nonprofit, member-owned insurance cooperatives in the states.
Republicans oppose the public option, calling it an invitation to a health care system run entirely by the government, and some moderate-to-conservative Democrats are leery as well.
To help pay for his plan:Mr. Baucus would impose fees of $6 billion a year on insurance companies, $4 billion a year on manufacturers of medical devices and $750 million a year on clinical laboratories.
Mr. Baucus has apparently dropped the idea of requiring Medicare beneficiaries to pay 20 percent of the amounts charged for laboratory tests. That will allow him to say his plan does not directly increase costs to beneficiaries.
Mr. Baucus’s proposal would offer low-cost catastrophic insurance as an option for people 25 and younger. Policy experts say many people in this age group cannot afford comprehensive coverage or see no need for it.
“Mr. Baucus’s plan would also expand Medicaid, starting in 2014, to cover millions of low-income people, including many childless adults who never qualified before. Benefits offered to such newly eligible adults would generally be less generous than the comprehensive benefits available to other Medicaid recipients.
For years, governors have wanted more discretion to tailor Medicaid benefits to the needs of different population groups. But Jocelyn A. Guyer, co-executive director of the Center for Children and Families at Georgetown University, expressed concern. “Low-income people without children tend to have extensive health care needs — higher rates of mental illness, physical disability and chronic conditions,” she said.
Mr. Baucus’s proposal would also require health insurance companies to report the proportion of premium dollars spent on things other than medical care. Hospitals would be required to list standard charges for all services.
The information could be useful to consumers. But insurance companies say the data on their expenses can be misleading because the costs of some activities that benefit patients, like “disease management” and the use of health information technology, may be classified as administrative rather than medical.
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