The Power of A

While House and Senate Democratic leaders try to cobble together enough votes to pass their health care legislation, both chambers had votes on components of reform that could signal what smaller issues could impact the passage of a larger bill.

The Senate vote was a 53-47 vote against a motion to proceed on a Medicare bill that would permanently prevent Medicare payment cuts to doctors.  Currently, payments are scheduled to fall 21% next year, and traditionally Congress has chosen to enact temporary one year fixes.  The Senate majority, however, tried to move a separate bill to freeze the reimbursement rates at the current year’s level for a decade.  The vote against cloture saw 13 Democrats vote with a united Republican caucus mainly over concerns for the cost.  The bill, which would have cost $247 billion over ten years, was not offset and was specifically excluded from a larger health care bill for that reason.  Senator Majority Leader Harry Reid (D-NV) indicated that the Senate would consider a short-term fix.

On the House side, the Judiciary Committee voted 20-9 to pass a bill out of committee that would remove the federal exemption for insurance companies from antitrust laws.  The issue has gained momentum in Congress after America’s Health Insurance Plans (AHIP) released a study critical of the Senate Finance Committee’s proposed health care bill.  The antitrust language is expected to be included in the House comprehensive bill, and the Senate will debate similar language in the coming weeks.

Quick Hits

Some House Democratic leaders say that they have the 218 votes (subscription) needed to pass comprehensive health care reform, others says they just have 218 votes in favor of a strong public option… A former US Trade Representative comes out against banning lobbyists from serving on federal commissions and advisory boards… The FCC Chairman revises his net neutrality plan (subscription) to make it more amenable to Republican commissioners… The House debates amendments to the Consumer Financial Protection Agency Act.

The Senate Finance Committee yesterday released the legislative language for its health care reform proposal.  The massive 1,502 page bill contains few surprises, reflecting the Finance Committee mark-up earlier this month and technical corrections made to the language.

Of note to the nonprofit community is the legislative language on the small employer subsidy the bill would give for providing insurance.  Previously, the draft had indicated that only 501(c)(3) organizations would be eligible to receive a partial withholding tax credit if they offered credible insurance, had 25 or fewer employees, and had an average salary of under $40,000.  The new legislative language expands the number of organizations eligible to receive the credit:

“TAX-EXEMPT ELIGIBLE SMALL EMPLOYER.-For purposes of this section, the term ‘tax-exempt eligible small employer’ means an eligible small employer which is any organization described in section 501(c) which is exempt from taxation under section 501(a).”

While there are few surprises, there is still controversy surrounding the legislation.  The bill contains a 40% tax on so-called high-end insurance plans as the major revenue raiser for the bill.  Such a tax has raised opposition from liberal Senate Democrats and a majority of the House Democratic caucus.  Currently, Majority Leader Reid (D-NV) and other key Senate Democrats are working on merging the Finance and HELP committee bills for floor consideration.

Quick Hits

The Finance Committee changes eligibility for insurance subsidy to being based on “modified gross income” (subscription)… America’s Health Insurance Plans (AHIP) responds to complaints about their study on the impact of the Senate Finance bill… Could the public option make its way into the Senate health care bill?

Today, beginning at 10 AM, the Senate Finance Committee will vote to pass its version of health care reform.  If the bill passes committee (as it is expected to do) it will be merged by the Senate Majority Leader with the Senate HELP bill for Senate floor consideration.  There are some storylines the media are following leading up to the vote, including:

-  Whether Senator Olympia Snowe (R-ME) will vote for the bill: Senator Snowe is the only Republican on the committee who has indicated she could vote for the health care bill.  Finance Chair Baucus has been working with her to ensure some of her provisions have been included in the legislation, but Senator Snowe still has not indicated whether she will vote for it.  Politico breaks down the impact of her vote either way.

-  Will any Democrats vote against the bill: Senator Rockefeller (D-WV) does not like that the bill does not have a public option.  Senator Wyden (D-OR) wanted the insurance exchange open to more individuals, not just small businesses.  Senator Lincoln (D-AR) has expressed concern over the cost of the legislation.  The loss of more than one of these Senators with no Republican votes would defeat the bill.

-  The AHIP report: Yesterday, America’s Health Insurance Plans (AHIP) released a report stating the Finance Committee bill would end up costing families $4,000 more for insurance by 2019.  You can find the report here.  The White House yesterday accused insurance groups of playing politics with the timing and content of their report.  Today’s vote could show if the new information has an impact on anyone’s vote in committee.

Quick Hits

PBS’s The News Hour holds a conversation with the White House Office of Health Reform’s Nancy DeParle and AHIP’s Karen Ignagni… Senators John Kerry (D-MA) and Lindsay Graham (R-SC) write a New York Times editorial on climate change legislation… The Supreme Court is considering major case that could impact campaign financing for all corporations.

The Senate Finance Committee yesterday continued to debate the list of amendments to its comprehensive health care reform legislation, but conspicuously absent from the discussion were any amendments tied to the major issues being discussed by members of Congress and the media, according to Politico.  At the beginning of yesterday’s hearing, the first amendment discussed was Senator John Kerry’s (D-MA) changes to the tax on “Cadillac” insurance plans.  However, the discussion was quickly ended when Kerry stated his intention to withdraw his amendment, stopping the debate over a major proposal to pay for health care reform.  Instead, it looks like he will reintroduce the amendment on the Senate floor.  Public option alternative amendments by Senators Carper and Snowe, which have been discussed by Senate leadership in recent days as major proposals, are also not scheduled to be debated by the committee.

The result is that the Finance Committee markup will be completed by the end of the week, allowing for the merging of the Finance and HELP Committee legislation.  Senate Majority Leader Reid yesterday told reporters he was cancelling the Columbus Day recess, setting aside that time for a floor debate on health care.  It seems likely that it is during that debate that we will see (depending on the content of the merged bill) debates on a version of the public option (or a trigger for the public option) as well as ways to pay for the Senate legislation.

Debate yesterday instead focused mostly on social issues, including abortion and immigration.  A list of all amendments and the votes can be found at the America’s Health Insurance Plans website, but some amendments of note include:

-          The Ensign/Carper amendment that would allow employers to adjust health care premiums based on the workers’ healthy or unhealthy behavior (Passed 19-3).

-          A Grassley amendment to remove the $6 billion fee on insurance companies (Failed 10-13).

-          A Nelson amendment to allow seniors to claim a tax deduction if their catastrophic insurance costs exceeds 7.5% of their income (Passed 14-9).

Quick Hits

The U.S. Chamber of Commerce urges its members to oppose Wyden amendment C-1 that requires large employers to offer at least two health care plans to employees…  CBO failed to include an exemption for hospitals in the Finance bill’s Medicare cost-cutting commission, skewing the score (subscription)… The White House tax reform panel holds its first public hearing yesterday and hears from some associations… Senators Kerry and Boxer introduce the Senate climate change legislation… The Washington Post tries to define a “Cadillac” plan.

Bloomberg News is reporting this morning that House Energy & Commerce Chair Henry Waxman (D-CA) sent letters to six insurance companies demanding information on their small business plans and specifically a response to allegations that the insurers routinely drop small businesses when their premiums increase due to employee illness.

The letters, which were sent to insurers including WellPoint and Aetna (seen here), demanded that the insurers produce relevant documents explaining their small business plans, policies to determine when to raise rates as well as drop coverage, and the maximum rate increase.  Congressman Bart Stupak (D-MI), a co-signer on the letter and chair of the committee’s oversight subcommittee, has promised hearings into the alleged purges of small businesses.

“As part of our ongoing investigation, we are now looking into the practice of health insurance companies terminating the coverage of small businesses when their employees become ill and their health insurance claims increase,” said Waxman in a statement. “We need to better understand how widespread this harmful and destructive practice has become, and how it is impacting small businesses and their employees across the country.”

A spokesperson for America’s Health Insurance Plans (AHIP), which represents the major insurance companies, called the letters a “fishing expedition.”  “This is just a continuation of a politically timed and politically motivated fishing expedition in an attempt to justify a new government-run plan,” said Robert Zirkelbach, a spokesman for AHIP. “Health plans are already highly regulated at both the federal and the state level, and the overwhelming majority of Americans are satisfied with their current health care coverage.”

Quick Hits

HHS and nonprofit Sesame Workshop create videos to help children stay healthy during flu season (see videos here)… House Democratic leadership plans new messaging with the health care bill… Contrasting views of passing a Senate Finance Committee health care bill from the Chair and Ranking Member… Who will be the new chair of the Senate HELP Committee?

Comprehensive health care reform, if enacted, will impact every aspect of American society.  For many associations, the impact will be more direct; as the debate progresses many medical, business, and consumer associations are working to ensure their voice is heard during the discussion.

The American Medical Association (AMA), the association for American doctors, yesterday issued a press release endorsing the House comprehensive health care bill, HR 3200 “America’s Affordable Health Care Choices”.  “The status quo is unacceptable,” said J. James Rohack, MD, president of AMA. “We support passage of H.R. 3200, and we look forward to additional constructive dialogue as the long process of passing a health reform bill continues.”  AMA’s annual meeting last month included a nationally-televised address by President Barack Obama thanking the medical community for its work on health care legislation and pledging to work with them on pressing issues, including medical liability reform.

On the insurance side of the debate, America’s Health Insurance Plans (AHIP), a national association representing nearly 1,300 members providing health benefits to more than 200 million Americans, is voicing concerns from an insurance perspective.  Politico reported this morning that the association will begin an advertising campaign next week to “set the record straight about the industry’s support for reform and make sure the American people understand that there is a path to reform that does not include a government-run plan.”  AHIP was the organization in the 1990s that ran the “Harry and Louise” ads credited with helping defeat the Clinton health care proposal.

The actors portraying Harry and Louise will be reappearing on television next week, but it was announced yesterday that their new ads would be in support of the Senate HELP Committee bill.  The National Journal reported that yesterday the actors appeared at a press conference supporting the bill and their new ads, sponsored in part by the Pharmaceutical Research and Manufacturers of America, will begin running this weekend.  The actors have appeared in ads in the past year sponsored by the American Hospital Association, Catholic Health Association, and National Federation of Independent Business on various health care issues.

Many associations, such as Volunteers of America, the National Association of Chain Drug Stores, and numerous beverage associations, are providing their members’ valuable perspectives to the health care debate.  How is your association contributing to the health care reform debate?

Quick Hits (Senate)

The Senate Finance Committee failed to release a draft of their bill yesterday, but members are continuing to work out their disagreements over the weekend… CBO Director Elmendorf testified before the Budget Committee that the proposed health care legislation would not provide the promised long-term federal budget savings….will Elmendorf’s testimony kill health care reform?… Is the White House putting too much pressure on the Finance Committee?

Quick Hits (House)

The House Ways and Means Committee voted HR 3200 out of their committee a little after midnight last night.  Three Democrats voted with all committee Republicans against the bill… The Education and Labor Committee debated and adopted some amendments to HR 3200: expanding the definition of small business who can enter the exchange, including infant-care in the basic benefits package, and changing the deadline for prohibiting preexisting conditions to six months after the bill’s enactment.  The bill was passed this morning on a 26-22 vote.

On the same day the White House Council of Economic Advisors warned that any economic turn-around must include addressing health care costs, the health insurance companies’ trade association released a detailed plan of how to reduce the cost of providing health care from their industry.

America’s Health Insurance Plans (AHIP) and five other medical groups sent a letter to the White House yesterday with specific details for the promises made at the White House in the beginning of May to find savings in the health care system.  AHIP proposes the creation of standard online forms for claims submissions, eligibility, claims status, payment, and remittance.  The forms would be universal for all private insurers and use would be mandatory.  Pilot programs for the new system are currently being run in New Jersey and Ohio.

In addition, the insurance industry has pledged to develop a model for personal health records, allowing seamless transition in care when a patient switched hospitals.“The effect throughout the health-care industry would be similar to the effect of ATMs being introduced throughout the banking system,” AHIP wrote in the letter.

While AHIP’s proposals pledged a series of new ways to streamline health care, the other organizations proposed continuing cost savings they had already begun implementing.  The letter was not met with universal regard, however; House Ways and Means ranking member Dave Camp (R-MI-4) requested the Congressional Budget Office score the letter’s cost-saving ideas.

The idea to create a standard on-line form for all health insurance needs would seem to save association and business employees’ time and hassle.

What do you think?  Will this actually create health care savings (in time and money) or is this just a good idea that fails to address the major costs in health care?

Robert Hay
Manager, Public Policy
ASAE

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