The Power of A

Despite the seeming setback dealt to the Democrats comprehensive health care reform efforts this weekend by Senator Lieberman (I-CT) and Ben Nelson (D-NE), Senate Democrats are planning a procedural move to set-up a December 23 vote on their health care legislation and have indicated they are close to 60 votes.

Over the weekend, Senator Lieberman publicly stated he would not vote for a bill with a “public option” or the compromise “Medicare buy-in” provision; that left the Democratic caucus with less than 60 votes needed to pass the bill over a filibuster.  However, after a closed-door caucus meeting and a meeting with the president, the Democratic leadership is moving forward with a bill without a public option or Medicare buy-in and expects to have 60 Senators voting for the legislation.

Senate journalists expect Majority Leader Reid (D-NV) to announce the final bill’s language today, have the Senate debate and vote on the Defense Department appropriations bill the rest of the week, and file for cloture on the health care bill Friday.  This would set up the chamber procedurally for a vote as early as the 23^rd.

A few outstanding issues remain:

-          The Congressional Budget Office has not yet released a revised score of the Senate legislation, but that score is expected to be released today.  Some fiscally conservative Democratic Senators have said they will not publicly support the bill until they see that the legislation does not increase the deficit.

-          Senator Ben Nelson, Senator Reid, Senator Robert Casey (D-PA) and the White House are continuing to negotiate over the abortion language in the bill.  An amendment offered by Nelson on abortion was defeated last week, but he has withheld support until the issue is resolved.  The expected compromise will likely include strict segregation of what funds insurance companies can use to cover abortion, as well as subsidies and financial support for a series of pregnant women support programs.

-          Some of the chamber’s public-option supporters have publicly expressed their discontent with a bill lacking a government-run insurance offering.  What remains to be seen is if any of these Senators will vote against a bill without a public option.

Quick Hits

The House agenda is packed today: pass the Defense Department appropriations bill, increase the federal debt limit, pass a jobs bill using left-over TARP money, and pass a continuing resolution to allow the Senate to pass the Defense appropriations bill… Senate Democrats are lining up votes to prevent the estate tax from expiring this year… How will the US find enough conduits for more broadband expansion?  The National Association of Broadcasters and CTIA weigh in at a House Energy and Commerce Communications Subcommittee hearing.

Cooper/CBS

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.

Registration is now open for American Associations Day 2010, the only legislative fly-in for association professionals and leadership volunteers to discuss association issues.  On March 23-24, 2010, association executives, staff, and volunteer leaders are encouraged to join their colleagues from across the country in educating Congress about the importance of associations to society, advocating for important association issues, and networking with their colleagues.  You can register for the event at www.asaecenter.org/flyin10.

Last year, attendees of American Associations Day visited their Congressional delegations to discuss health care reform, the value of association to economic recovery, and the importance of association business meetings to the country.  These issues have been hot topics in Congressional debate this year, and the association professionals who attended were able to influence the debate by sharing an association viewpoint.

This year ASAE will unveil new components of its Power of A campaign at the fly-in, including new informational materials and an emphasis on the power of associations as a force for positive economic and social change.  Keep checking www.thepowerofa.org for more details on these changes.  In addition to the unveiling, this year’s program will feature an interactive and informative session on year-round grassroots advocacy, as well as enhanced meet-and-greet opportunities with fellow association executives and members of Congress.  For more information on this year’s event as well as a review of last year, please visit www.asaecenter.org/flyin.

ASAE is committed to ensuring that the cost of travel is not a reason association professionals cannot attend; ASAE is offering a number of $300 reimbursement travel scholarships to defray some of the travel costs for attendees.  Attendees also have access to discounted room rates in the headquarters hotel and a one-day program that allows participants to receive a travel scholarship by attending only one day of the program.

For more information on the event, visit http://www.asaecenter.org/flyin or call 202.626.2703.  For those on Twitter, ASAE is encouraging you to use the hashtag #asaeflyin when tweeting about the event.

Quick Hits

The Medicare/public option switch seems satisfactory to most Senate Democrats… but some are still waiting for the final price tag before committing to voting for the change… Lawmakers are working with communications associations to expand the use of cell phones in subway systems… An important agreement is reached in the House on the Consumer Financial Protection Agency Act.

In an effort to gain the 60 votes needed for passage, moderate Democratic Senators leaked a potential compromise yesterday that would remove the public option from the Senate health care bill and replace it with a larger Medicare pool.

The proposal would be to replace the public option language in the bill with a provision allowing Americans as young as 55 with no insurance to be eligible to buy into Medicare, the federal insurance plan for the elderly.  The advantage to this plan is that it takes an in-existence federal government insurance option (like the public plan) and makes it available to more people.  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.

Most moderate Democratic Senators have expressed tepid support, but will wait until the Congressional Budget Office has a chance to score the compromise before commenting.

Critics of the proposal reply that increasing the number of people in both Medicare and Medicaid would actually increase government expenditures in health care.  They also note that the increased number of enrollees could add to the funds’ solvency issues and drive up the rates for current enrollees.

Do you think the Medicare/Medicaid idea is a viable public option compromise?

Quick Hits

Politico on the health care policies of the National Restaurant Association and CEO Dawn Sweeney… The Nelson/Hatch abortion amendment will receive a vote today… The “tanning bed tax” (subscription) could soon join the “Botox tax” in the Senate health care bill… The American College of Cardiologists “Hospital to Home” program is used as a model for Medicare patient hospitalization resolution.

For only the fifteenth time since 1861, the Senate was in session on a Sunday.  And while over the weekend the number of amendments considered was few, Senate leadership was optimistic that they were close to securing the compromises needed to gain 60 votes and passage.

Over the past few days the Senate has debated and voted on a few amendments, including the major ones below:

• The Mikulski amendment (#2791) removing a co-payment requirement for mammograms and preventative women’s health screenings. Passed 61-39
• The Vitter amendment (#2808) to prevent the USPSTF recommendation on mammograms from taking effect. Passed by unanimous consent.
• The Lincoln amendment (#2905) that would limit the executive compensation of insurance company executives. Amendment was withdrawn after not receiving 60 votes.

The two major amendments/issues remaining deal with abortion and the public option.  Senators Ben Nelson (D-NE) and Orrin Hatch (R-UT) will offer an amendment today or tomorrow that would incorporate the House’s abortion language in the Senate bill.  On the public option, Senator Reid (D-NV) has convened a working group of ten Democratic Senators to compose a compromise on the issue.  The latest compromise that seems to be gaining support is the creation of a national health insurance plan administered by the Office of Personnel Management that would be a list of private insurance offerings.  The plan’s appeal is that it would be similar to the current federal government employee health care system.

While the timeline is still uncertain, if compromises can be reached quickly on the outstanding issues the bill could receive a vote before December 25.  However, the key is whether the compromises can be reached and if the Democratic leadership can corral 60 votes for the bill.

Quick Hits

The President visited Capitol Hill yesterday to rally Democratic Senators for the health care bill…  Kaiser Health analyzes the major issues that are slowing passage of the health care bill… The IRS is reporting a marked increase in the number of nonprofit organizations nationwide in the past decade… ASAE has created a document outlining the major similarities and differences between the House and Senate health care bills.

This Friday is the deadline for associations to submit their programs for the ASAE & The Center Associations Advance America (AAA) Awards. Don’t lose out on your opportunity to have your association recognized for the good work it does for society!

The Power of A often posts examples of programs that benefit society, but we want your associations to receive more than a post on this site: we want your association to be honored for its work and receive recognition from the entire association community.

That is the purpose of the ASAE Associations Advance America (AAA) Awards: recognition of association programs that propel American forward - with innovative projects in skills training and development; ethical, technical or professional standards; economic development; business and social innovation; information and knowledge creation; public education and information; civic and community volunteer activities; and citizenship and democracy enhancement.

In the current economy individuals and the government are more reliant than ever on nonprofits organizations to perform important social services and advocacy campaigns.  Your association is doing exactly that - why not take a few moments to enter it for a AAA Award?  Six of the AAA Award winners at the end of the year will be recognized as Summit Award winners - the highest honor that can be given to an association program.

Join associations like the Iowa Dental Association, Women’s Basketball Coaches Association, and the School Nutrition Association in submitting your association’s contribution to society for an award.

Click here for the online application; click here for more details.

Quick Hits

Senator Collins (R-ME) makes some suggestions for the health care bill that could potentially win her vote… The Carper amendment that would change the public plan opt-out will be ready to be introduced next week… The Afghan war tax may be off the table, signaling the need for a new way to pay for the war.

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.

Within the proposed Senate comprehensive health care legislation, one revenue raiser that was not contained in the House bill is the so-called “Botox tax”, or to some, the “Bo-Tax”.  Specifically, the language would impose a 5% tax on all elective cosmetic surgical procedures that are not done to address deformities due to genetics, accidents, or disfiguring diseases as currently defined in the tax code.   The tax would be paid by the consumer and collected by the doctor.

The tax was originally included in the Senate Finance Committee bill as a way to pay for the legislation.  The Congressional Budget Office (CBO) has estimated the tax would raise $5 billion over 10 years, a significant chunk of money to help keep down the cost of the $849 billion bill.  Majority Leader Harry Reid’s (D-NV) office told the New York Times that the tax does help keep the bill’s cost down by raising revenue within the realm of health care, a goal for his revenue raisers.

Associations immediately weighed in on the proposal using the expertise and experiences of their members.  The American Society of Plastic Surgeons (ASPS) and the American Society for Aesthetic Plastic Surgery (ASAPS) in their statement on the tax note that 86% of cosmetic surgery is performed on women, almost all of them working age.  A 2005 survey done by ASPS finds that 60% of respondents that planned to have a cosmetic surgical procedure done in the next two years have a household income of $30,000 - $90,000 annually, leading ASPS to point out that the tax would apply primarily to middle class households.

The American Academy of Cosmetic Surgeons, which also opposes the tax, notes in their position paper on the tax that the line between medically necessary and elective surgery is sometimes undefined.  Also, the paper notes that Botox treatments are non-surgical, and questions whether they would actually be covered by the “Botox tax.”

Does your association have a position or statistics on cosmetic or plastic surgery?

Quick Hits

The Senate Democratic leadership begins finding a way to coral 60 votes to pass health care reform… The Wall Street Journal outlines some of the major amendments expected to be introduced for the Senate bill… The Washington Post outlines how some of the health care reforms could be delayed past next year, if passed… Seven issues to watch during the Senate health care debate… Opponents and proponents of the proposed health care reform bills argue about the actual cost savings of the bill… Some airline associations seek an increase in passenger fees to fund infrastructure improvements.

As Americans prepare to celebrate Thanksgiving on Thursday and millions begin to pack their luggage to travel, associations are providing valuable advice and information to ensure that everyone has a safe and less stressful holiday season.

Thanksgiving week is considered the largest travel weekend of the year, with millions of Americans driving and flying to different destinations to celebrate the holiday.  While airlines are expecting fewer delays than last year, the crowds and number of people flying can increase stress among all participants.  The Air Transport Association of America (ATA) estimates that 4 million fewer people will fly this year, but still has a resource page of tips for fliers to minimize their delays and make their air travel smoother.  The American Automobile Association (AAA) is estimating that the number of car travelers will be increasing by over 2% this year, making for more crowded roads.  American Trucking Associations has a list of tips for Thanksgiving drivers to ensure safe travel on the highways, including have an emergency kit for breakdowns, be aware of truck blind spots, and know the local weather.

Of course when most people think Thanksgiving, they think of turkey.  The National Turkey Federation has a Thanksgiving turkey site, which in addition to having recipes for cooking turkey, has information on safe eating and preparation as well as how to contact health officials if you suspect food poisoning.  But if you plan on not cooking this Thanksgiving, you are not alone.  According to the National Restaurant Association, 11% of Americans eat at a restaurant on Thanksgiving, while 53% of consumers use restaurant-prepared takeout dishes as part of their Thanksgiving meal.

Does your association have good tips or information for the Thanksgiving holiday?

Quick Hits

The New York Times analyzes how the “Cadillac” health care plan tax proposal will affect consumers… The American Medical Association and AARP are launching media ads about how health care reform proposals will affect Medicare… The Hill interviews an FCC Commissioner on net neutrality.

Saturday night, the Senate voted to proceed on the debate on S. 1796, the Patient Protection and Affordable Care Act.  Due to Senate rules, a filibustered bill must receive 60 votes for 30 hours of debate to proceed on it, and Senate Majority Leader Harry Reid (D-NV) was able to line up his caucus against a united Republican caucus to get the 60 votes necessary for the motion to pass.  As it currently stands, the Senate is scheduled to consider a series of amendments and debate the legislation with the majority hoping to pass the legislation before the end of December, but that schedule is very fluid.

Some major political issues remain before the bill can be passed.  Although all 58 Democratic and two Democratic-leaning Senators voted on the motion to proceed, some Democratic Senators expressed public opposition to some components of the legislation as currently written.  A major sticking point is the inclusion of an “opt-out” public option; while Senators such as Lieberman (I-CT) and Lincoln (D-AR) have expressed opposition to a strong public plan, other Senators such as Sherrod Brown (D-OH) have said they will vote against any bill with a public option any weaker than the one already in the bill.  And with no Republicans expected to vote for the bill, the majority needs every Democratic vote, or a few Republican defectors, to pass the bill over a filibuster.

Politico outlines some of the major controversies surrounding the bill.

ASAE has also outlined the major provisions of both S. 1796 and the House comprehensive health care reform bill.

Quick Hits

Lawmakers react to the new mammogram guidelines recommended by the USPSTF (Power of A post on association response seen here)… The face of the turkey industry association on Capitol Hill is profiled in Roll Call (subscription)… The American Association of Suicidology is working with local transit systems on an increase in subway-related suicides… The White House is asking nonprofits, as well as media networks and for-profit companies, to promote science and math to school children.