Senate Begins Debate on Health Bill

Earlier this afternoon in the Capitol, the Senate began debate on and offering amendments to its landmark health reform bill. Among those offering amendments were Senators John McCain (R-AZ), Barbara Mikulski (D-MD), and Bob Casey (D-PA).

Just prior to that, Senate majority leader Harry Reid (D-NV) kicked off the debate with a dose of partisanship and baitsmanship. Asking for unanimous floor requests, Mr. Reid seemingly forced Republicans, specifically Mike Enzi (R-WY), into a trap by accusing them of blocking attempts at government transparency. Find the complete article at the New York Times Prescriptions blog.

This afternoon, just before Mr. Reid opened the debate, Sen. Evan Bayh (D-IN) received a letter from the CBO that discusses how the proposed bill will affect premium costs. They report that individuals who qualify for subsidies (those earning less than 400% FPL), not surprisingly, will experience a premium drop. But, those who don't receive subsidies will pay 10 to 13 percent more. Large employers are estimated to not see marked reductions in the number of employees they cover and premiums are expected to hold steady or drop 3 percent.

Read the complete Kaiser Health News article here.

Health Savings Could Start in the Cafeteria

In the business section of yesterday's Sunday New York Times, columnist Melanie Warner examines how employers' health care costs can potentially be shaved in their cafeteria and in what their employees eat. The article features Safeway, an industry trailblazer in containing corporate health costs, and a Massachusetts start-up, Full Yield, that helps employers cut costs via better food choices.

Read the complete article by clicking here.

Shopping Around for Health Care - New York Times

In today's New York Times, the Patient Money column examines the rising trend of shopping for health care costs, largely in part because of the increasing number of people insured with high deductible health plans.

Find the complete article by clicking here.

The Cost of Dying - CBS's 60 Minutes

Airing on the November 22nd edition of CBS's 60 Minutes, "The Cost of Dying" explores the extraordinary amount of money spent on people at the very end of their lives. Research funded in part by the Robert Wood Johnson Foundation (RWJF) was cited and Dr. Eliot Fisher from the Dartmouth Institute for Health Policy and Clinical Practice explained how many patients end up dying in intensive care units because it is the "path of least resistance" - the easiest way for doctors to manage them.

Find the article by clicking here.

Watch the video by clicking this link.

Senate Health Bill Details

Information on the recently released Senate health reform bill, The Patient Protection and Affordable Care Act, is available on the Senate Democrats' website. The website, run by the Democratic Policy Committee, features PDF files on the full text of the bill, fact sheets related to the sections of the bill, long and short summaries of the bill, and fact sheets on how the bill will help/benefit Americans.

To access the site, click this link.

Senate Moves Health Bill to Floor Debate

This evening, the Senate voted 60-39 - along party lines - for a motion to proceed, thus propelling the recently released Senate health reform bill to the full Senate floor for weeks of debate and amendments. Recent holdouts Joe Lieberman (I-CT), Mary Landrieu (D-LA), Blanche Lincoln (D-AR), and Ben Nelson (D-NE) all voted for the motion to proceed, but indicated clearly that today's vote wasn't a guarantee of their support for the final bill. Mrs. Lincoln, for instance, has said that she won't vote for a final bill that includes a public option.

Of note to employers, the Senate bill contains a provision that would not explicitly require employers to provide coverage, but would penalize employers with 50 or more employee $750 for each full-time worker in the company. The House bill, in contrast, mandates employer coverage and penalizes non-compliant employers (only those with an annual payroll over $500,000) with an 8% wage tax.

The full New York Times article can be found by clicking here.

A Consumers' Guide to Health Reform

Kaiser Health News today answers some of the most commonly asked questions about the proposed health reform bills in their A Consumers Guide to the Health Reform Bills. Among the topics addressed are taxes, mandates, out-of-pocket costs, and the public option.

Find the complete article by clicking here.

Reid Unveils Senate Health Bill

Yesterday evening, Senate majority leader Harry Reid (D-NV) released the Senate's version of a health reform bill, the "Patient Protection and Affordable Care Act". A cost analysis from the Congressional Budget Office (CBO) puts the price tag of the bill at $848 billion over 10 years while expanding coverage to an additional 31 million Americans and is expected to reduce projected federal budget deficits by $130 billion over a decade.

Now, Senator Reid is faced with the task of moving the bill to debate on the full Senate floor through a procedural move called a "motion to proceed", which is expected to happen on Saturday. This motion, along with passage of the bill itself, requires 60 votes. Senators Joseph Lieberman (I-CT) and Bernard Sanders (I-VT) are two Independents who caucus with the Democrats, but have not yet confirmed their support of the bill. If Lieberman and Sanders do not vote for the bill, Democrats will fall short of the required 60 votes by 2.

Full articles on the bill are available by clicking on the following links:

• New York Times
• Wall Street Journal
• The Hill

The full bill text can be found by clicking here. And, a searchable version of the bill, courtesy of the New York Times, is available here.

A talking points look at the Joint Committee on Taxation's revenue analysis can be accesses by clicking here.

The CBO score is available here.

Summary of House Health Bill

Detailed summaries of the House health reform bill (H.R. 3962), broken down into plain English and sectioned off by issue, are available on the House of Representatives and Kaiser websites.

The provisions most affecting employers, as detailed by the House are:

"Employers must provide health insurance to their employees or make a contribution to help fund affordable health insurance [the Health Insurance Exchange Trust Fund]. Employers that choose to offer coverage contribute at least 72.5 percent of premium for workers, 65 percent for families. However, if the coverage is unaffordable for low-wage workers, that worker can choose subsidized coverage in the Exchange and the employer makes a contribution to the Exchange. Employers who do not offer qualified coverage contribute 8 percent of their payroll to help cover expenses of employees who seek coverage through the Exchange. "

Bullet points on these issues can be found on the Kaiser website by clicking here.
Find the House summary by clicking here.

CMS Actuary Releases Cost Analysis of House Health Bill

The health reform bill recently approved by the House will cost $289 billion over the next ten years, according to the chief actuary at the Centers for Medicare and Medicaid Services (CMS). This analysis, however, is not an apple-to-apples comparison of the Congressional Budget Office and Joint Committee on Taxation's cost analyses because CMS doesn't take into account the various tax provisions baked into the legislation.

Additionally, the report claims that the bill falls short of house Democrats' reform goals:

"With the exception of the proposed reduction in Medicare... the provisions of H.R. 3962 would not have a significant impact on future healthcare cost growth rates."

Read the complete story at The Hill by clicking here.

The report from CMS's Chief Actuary can be found by clicking here.

GINA in the New York Times

Today's New York Times features an article about the newly released Genetic Information Non-Discrimination Act (GINA) regulations that will be in effect next weekend.

From the Times article:

"The biggest change resulting from the law is that it will — except in a few circumstances — prohibit employers and health insurers from asking employees to give their family medical histories. The law also bans group health plans from the common practice of rewarding workers, often with lower premiums or one-time payments, if they give their family medical histories when completing health risk questionnaires."

The act takes effect Nov. 21 for all employers with 15 or more employees. It applies to group health insurers whose plan years begin on or after Dec. 7, and it took effect for individual health insurance plans last May. The act does not apply to life insurers.

Read the complete article by clicking here.

Employer Reactions to House Bill

Employee Benefit News's blog writes on three employer and health plan associations' views on the recently passed House health reform bill:

Read the blog here.

EBRI Report on Account-Based Health Plans

In their November edition of EBRI Notes, the Employee Benefit Research Institute reports on the availability, contributions, account balances, and rollovers in account-based health insurance plans from 2006 to 2009. They report that enrollment in consumer-driven health plans (CDHPs) continues to rise; the percentage of individuals with employment-based health insurance eligible for enrollment in a CDHP has increased; and three-quarters of workers with family coverage receive employer contributions of over $1,000.

Find the complete report by clicking here.

House Passes Health Bill

Late Saturday night, the House of Representatives passed their version of health care reform by a slim margin of 220-215, with only one Republican vote, that of Anh "Joseph" Cao from Louisiana.

The full New York Times article can be found by clicking here.
The roll call, as tallied by the New York Times is found by clicking here.
The Wall Street Journal article can be found by clicking here.

Report Indicates that Health Reform May Benefit Small Businesses

A recently released report by the New York State Health Foundation and the Small Business Majority, indicates that inaction on health reform would be a worst-case scenario for small businesses. Using a model developed by MIT economist Jonathan Gruber, a number of scenarios were examined. Among them are:

• Two shared responsibility schemes that would expand public programs, mandate coverage for children, provide tax credits to employers who offer coverage, and require employers who do not offer coverage to pay a fee. These arrangements are similar to those under active consideration by Congress.
• A market reform scenario, which would include tax credits, a pooling of New York's highest-risk individuals, and an easing of State health insurance regulation.
• A single-payer plan in which the government would provide health insurance to everyone-employed or unemployed-and employers and employees share in a 10% payroll tax.

Click here to read the article from the Albany Times Union.

For the complete report, click here.

GOP Releases Health Reform Bill

Today, House Republicans released a 230-page health reform bill that essentially is a substitute for the House Democratic bill released last week. The GOP bill includes principles such as:

• Establishing universal access programs to guarantee access to affordable health care for those with pre-existing conditions
• Ending junk lawsuits
• Prevent insurers from unjustly canceling a policy
• Encourage small business association health plans
• Encourage innovative state-level programs
• Allowing the purchase of insurance across state lines
• Promoting healthier lifestyles
• Enhancing Health Savings Accounts (HSAs)
• Allowing dependents to remain on their parents' policies until age 25

The executive summary of the bill can be found by clicking here.

The full text of bill can be found by clicking here here.

The NPR health blog story is here.

Coverage from the New York Times can be found here.

Rep. Dingell's Manager's Amendments to House Bill

Late Tuesday, House Democrats, led by Rep. John Dingell (D-MI) released a manager's amendment to the recently released House bill, H.R. 3962.

The Wall Street Journal reports:

The appearance of the amendment, which contains an array of minor changes to the bill as it was originally written, means that Democrats have posted all legislative text related to the bill online. In keeping with their pledge to allow 72 hours for citizens and lawmakers to examine the bill, House Democrats could now bring up the measure for a vote later this week.

Included in the amendment is a provision to raise $24 billion by shutting down a biofuels tax credit, which helps fill a revenue hole that will keep the bill budget-neutral over 10 years.

Read the complete WSJ article here.

The text of the manager's amendment can be found here.

The Third School for Controlling Health Costs

In a perspective by Drew Altman, Kaiser Family Foundation President and CEO, a third school of health reformers are discussed. These Systems Reformers believe "that the best way to bend the cost curve is not through external market incentives or regulatory controls, but from the inside out, by creating a smarter health care system with the information base, new delivery models and payment incentives that will improve quality and lower costs." This school of thought is in contrast to the previously two dominant ones, Regulators and Marketeers. Regulators are those who believed that the best way to slow increasing costs was to control the total resources going into the health care system: putting limits on the supply of medical professionals, technology and facilities; setting payment rates; or putting enough purchasing power in the hands of government to drive the right bargain with the health care industry. Marketeers, on the other hand, believed that competing health plans and information-empowered, prudently-purchasing consumers would drive down costs, especially if insurance were restructured to give people the right incentives.

Previously relegated to respected academic journals and conferences, Systems Reformers have gained hold of policymakers' attention and have infiltrated Washington, D.C. and its reform process.

Read the complete article at: http://www.kff.org/pullingittogether/102909_altman.cfm

Financing Health Reform - CBO Style

In a post to the New York Times' Economix blog, Princeton economist Uwe Reinhardt writes on how the Congressional Budget Office (CBO) calculates the cost of financing the various health reform bills floating around Congress.

Find the article at http://economix.blogs.nytimes.com/2009/10/30/the-magic-of-financing-health-care-reform/