The Power of A

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What was last week touted as a potential breakthrough for the Senate health care bill is today being labeled as potentially another failed compromise.  Yesterday, Senator Joe Lieberman (I-CT) publicly stated that a health care bill which would extend Medicare coverage to people over the age of 55 was legislation he could not support, and he would vote to continue a filibuster on the Senate legislation.

The proposal was floated last week as a compromise/replacement for the public option language in the Senate comprehensive health care bill.  The provision would allow Americans as young as 55 with no insurance to be eligible to buy into Medicare, the federal insurance plan for the elderly.  Additionally, the bill would grant the Office of Personnel Management (OPM) the ability to create a national pool for health insurance by contracting with private insurance companies and offering reduced rates to the uninsured.  The idea is similar to the current health care system for federal government employees.  The expected savings provided by these two proposals would allow the Senate to increase the subsidies given through Medicaid to people at 150% of the federal poverty limit, up from 133% currently in the legislation.

The Senate was awaiting a Congressional Budget Office (CBO) score that could come as early as today - something some Senate Democrats will use as a marker to support the legislation.  However, losing the support of Lieberman would prevent Senate Democrats from corralling the 60 votes needed for passage.  If no Republicans indicate their intent to vote for a Medicare-expanded bill, the majority will need to find a new compromise or pursue reconciliation.

Quick Hits

Democrats are working on compromise language on abortion in the Senate health care bill… The Senate passes an omnibus appropriations bill over the weekend, sending it to the president for his signature… The Supreme Court will delay a decision on a major election law case until 2010 at the earliest… USA Today analyzes the pros and cons of the Medicare expansion compromise.

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.

What do you think (vote your opinion)?
When will Congress send the President a comprehensive health care bill to sign?(polls)

Reports this morning from the Senate cast doubt on whether the chamber will be able to pass its version of comprehensive health care reform in the current calendar year. Senate Majority Leader Harry Reid (D-NV) is still waiting for the Congressional Budget Office (CBO) to send him scores of his draft health care proposals, a step the caucus feels is necessary before it can begin to consider any legislation. Reports are that the score could come out as early as the end of the week.

The problem facing Democratic leadership in both the Senate and House is an increasingly unfriendly calendar. Neither chamber will be in November 11-13 in honor of Veterans’ Day and Congress will recess the last week of November for Thanksgiving. December debates will have to be scheduled around the various holidays and religious observances.

Further complicating matters in the Senate are reports that Reid does not have the 60 votes necessary to end a filibuster on the legislation. When he does introduce a bill, he has pledged ample time for the Senate to review the bill before holding any votes. A Republican aide told CongressDaily AM that the rumor is Reid would put the bill out for review before Thanksgiving and begin preliminary debate, pausing for the Thanksgiving break, with the expectation of a vote before Christmas.

On the House side, the Democratic leadership is confident it is close to reaching an inter-caucus compromise on their bill’s abortion and citizenship language, which would lead to debate on the bill beginning Friday and an expected vote before Veterans Day.

Quick Hits

The rule on the health care bill will allow House Republicans to offer a substitute amendment – here is their outline… Senator Lieberman backs off his “no” vote comments from the weekend… Senate Environment and Public Works Committee could lack Republicans during its climate change debate.

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.

1.  The Congressional Budget Office (CBO) scores a modified Health Education Labor and Pension (HELP) Committee health care proposal at $611.4 billion, but the bill would still leave 34 million Americans without insurance.

2.  The plan includes a public option and an employer mandate with a $750-per-employee penalty for the uninsured.

3.  Read the Kennedy/Dodd letter to the committee here.

4.  Senator Charles Schumer (D-NY) continues to modify his public plan proposal.

5.  American Medical Association supports “an American Model” of public and private insurance companies.

6.  President Obama held a health care roundtable in Annandale, Virginia yesterday to promote reform legislation.

The “employer mandate” issue is one of the most controversial aspects of comprehensive health care reform, and yesterday the Senate Health Education Labor and Pension (HELP) Committee released two proposals that it sent to the Congressional Budget Office (CBO) for cost scoring.

The proposal (which can be seen here) has two options.  The first would require employers to pay a flat amount for each employee that is not covered under the employer’s plan at an adequate level.  The fee would help offset the cost of credits for insurance provided through the bill’s health insurance exchange.  The second targets employers that can afford to provide coverage but chose not to do so.  The concept would be the federal government recouping the cost of providing Medicaid coverage for eligible employees.  Both plans would exempt “small business,” which is currently undefined.

Noticeably absent is a proposal that would tax a percentage of a company’s payroll, or the “pay or play model”.  The Bureau of National Affairs (BNA) quotes a Democratic aide as saying that while the pay or play proposal was sent to the CBO for scoring, it is no longer considered a viable option.

On the House side, the Energy and Commerce Committee will hold another hearing on the “Tri-Committee” comprehensive health care bill.  Associations testifying before the committee include America’s Health Insurance Plans, American Academy of Family Physicians, American College of Cardiology, American Health Care Association, American Nurses Association, Medical Association of Georgia, National Association of Community Health Centers, and National Association of Health Underwriters.

Quick Hits

Baucus proposes a scaled-back version (subscription) of the plan to limit charitable deduction… The Obama family will join five nonprofits today at Fort McNair as part of their United We Serve effort… The President held his health care town hall last night… Members of Congress invoke their own health care stories to color their position on the debate… Controversy over a Senate Commerce Committee report on insurers’ charges for out-of-network treatments.