The Power of A

Amid the over 2,000 pages of the Senate health care bill, there are two nonprofit governance issues contained that should be of note to all associations.  While they do not impact association governance, the issues are sure to remain in the political discussion even after the fate of the bill is decided.

The first deals with the Internal Revenue Service’s “community benefit standard” and hospitals.  The Senate bill uses the Senate Finance Committee language amending the tax code and creating four specific recommendations that nonprofit hospitals must satisfy to retain their nonprofit status.  These recommendations would include new billing and collections procedures, financial assistance policies for the underprivileged, stipulations on charges, and new community health needs assessments.   The goal for proponents is to ensure that nonprofit hospitals provide the community with benefits (hence the name) and do not act as for-profit hospitals with a tax protection.  Neither the Senate HELP Committee bill nor the House legislation contained community benefit language.

The American Hospital Association - the national organization that represents and serves all types of hospitals, health care networks, and their patients and communities - has created an issues paper on the community benefit standard and how nonprofit hospitals are currently complying with the standards.  It can be read here.

A second issue is the new requirement specifically aimed at nonprofit Blue Cross/Blue Shield (BC/BS).  While not a traditional nonprofit, some BC/BS plans were given nonprofit status because they provided specific types of community services and programs for the underprivileged.  However, with insurers under increased scrutiny due to rising premiums, BC/BS is singled out in the health care bill with their own community benefit standard: in order to maintain their nonprofit status the plans must spend at least 85 cents of every premium dollar on health services.  The District of Columbia passed a similar bill earlier this year designed to increase Capital Area Carefirst’s contribution to the DC community.

Quick Hits

The Senate opened debate (subscription) on the health care bill yesterday, with Sen. Mikulski offering an amendment to eliminate co-pays for women’s preventative health screenings and Sen. McCain offering an amendment to remove the $400 billion Medicare reduction… The CBO says the Senate bill would result in no premium increases for group plans, but increases for individual purchasers (not taking into account any subsidies)… Democrats have still not ruled out reconciliation for the health care bill… Seven interesting provisions in the Senate bill, according to Kaiser Health News… Democrats still wrestling with funding health care reform… New blogger disclosure rules go into effect today.

According to multiple sources, Senate Majority Leader Harry Reid (D-NV) told Senate Finance Committee Chair Max Baucus (D-MT) to stop trying to negotiate with committee Republicans and to begin pushing his health care bill out of committee.

Reid expressed concerns that Baucus’s proposed legislation would not have a public plan but would include language removing the deduction for employer-based health care coverage.  Public plan proponents have been increasingly vocal this week, with House Democrats yesterday criticizing White House Chief of Staff Rahm Emanuel over comments suggesting the public plan was not a mandatory part of health care reform.

Reports of the criticism came after yesterday’s weekly Democratic leadership meeting.  Roll Call reports that Reid’s message was delivered through an intermediary after the majority leader had consulted with the caucus leaders.  The newspaper also reports that Reid’s message told Baucus the lack of a public plan would cost his bill 10-15 Democratic votes, and that losing so many in the caucus was not worth the effort to gain a few Republican votes.

Additionally, concern has been raised in the Democratic caucus over the employer-deduction proposal after polling shows 70% of Americans are opposed to removing the deduction.  An idea being discussed is a surtax on families with income above $250,000 as an alternative to pay for the reform legislation, but there is a general uncertainty as to what is going to be used to pay for the Finance Committee’s legislation.  Senator Baucus acknowledged as much by saying: “It’s a very complex bill.  People are getting skittish all around.”

If you were a member of Congress, how would you propose to pay for health care reform?

Quick Hits

The American Hospital Association, Catholic Health Association, and Federation of American Hospitals will announce with Vice President Joe Biden $155 billion in health care savings over 10 years… Washington Post examines the idea of “rationing” in health care reform… Congressional Budget Office scores the House Tri-Committee health care bill (subscription) at $1.5 trillion over ten years, House leaders expected to announce their revenue raisers today… the HELP Committee finishes debate on the long-term care sections of their health care bill.

Earlier this week, representatives of several organizations and associations with a stake in health care reform were called to the White House to provide their perspectives on reforming the health care system and reducing costs.

“[W]e have joined together in an unprecedented effort, as private sector stakeholders—physicians, hospitals, other health care workers, payors, suppliers, manufacturers, and organized labor—to offer concrete initiatives that will transform the health care system,” wrote the collective leaders of six health care organizations.

This joint effort is exactly what ThePowerofA.org seeks to demonstrate — that, combined, associations are problem solvers with the experience, expertise and resources needed to tackle the toughest challenges our country faces.

That President Obama called our country’s associations to the center of the debate is strong evidence that associations and their members are (and will be) critically important resources as this administration works toward health care reform.

Not every association, however, will have the opportunity to have the ear of the President on every issue.  That’s where ThePowerofA.org comes in.  In a previous post, ASAE CEO John Graham asked readers and association members, “Imagine if you were sitting across the table today with a member of the Obama administration or a legislative director for a member of Congress. What would you want them to know about your association and your members that might assist them in crafting good policy?”

Leaders of several associations had the privilege of answering that question this week.  It’s a question that’s as critical now as ever.  To give your answer, click ‘get involved‘ to give your answer or comment below and let us know what you think about the recent Health Care summit.

Chris Vest
Director, Public Policy
ASAE