Pelosi Signs Reconciliation Bill, Puts Punctuation Mark on Debate

Congressional Democrats put a punctuation mark on the over year-long health care reform debate when House Speaker Nancy Pelosi (D-CA) signed the reconciliation "fixes" bill Thursday after it was approved by a 220-207 vote.

Members of Congress now leave Washington for a two week district work period where Democrats will be selling (and trying to explain) the benefits of the new legislation and Republicans are predicted to malign aspects of the bill as part of their campaign to win back the majority.

For more, click here to access the New York Times story.

Senate Passes Reconciliation Bill: Now Heads Back to House

Following an hours long "vote-o-rama", Senate Democrats approved the health care reconciliation "fixes" bill by a vote of 56-43, with Republicans unanimously opposed. Republicans successfully challenged some provisions related to the higher education portions of the bill, and thus were struck out by the Senate parliamentarian. One struck provision would have prevented any annual decrease in the maximum amount of Pell grants for students from low-income families. Democrats indicated they would omit the disputed provisions and expressed overall happiness with the outcome of the debate because they were able to successfully hold back 40 Republican amendments.

The legislation nonetheless will advance through Congress and now heads back to the House for one final vote, which is expected to occur Thursday evening. Final approval from the House is needed, in this case, because changes were made to the reconciliation package they approved.

For more, click here for a New York Times article.

President Obama Signs Health Reform Bill

At a ceremony in the White House this morning, President Obama signed into law the Senate health reform bill that was passed by the House of Representatives late Sunday night by a vote of 219-212. The bill is expected to cost $940 billion over the next ten years and is estimated to cover 32 million additional Americans by 2019.

The reconciliation bill that was passed by the House following the passage of the Senate reform bill is now headed to the Senate for debate. Because the measure is a reconciliation bill, special Senate debate rules apply. First, debate is limited to only 20 hours and filibusters are prohibited. Second, the Byrd Rule applies, which states that any provision that does not relate directly to the federal budget must be stricken from the bill. If Republicans are successful in challenging the bill through either a point of order or with an amendment, the bill will be sent back to the House for a final vote.

To read more about today's White House signing ceremony, click here.

New CBO Score on Health Reform Bill

The non-partisan Congressional Budget Office (CBO) this morning released a cost analysis of Democrats' recently revised health reform package. Keeping in step with President Obama's commitment to keep the price of reform below $1 trillion, this package, set to be advanced through Congress using the budget reconciliation process, is estimated to cost $940 billion over 10 years and reduce the federal deficit by $130 billion.

House Democrats are expected to use a "deem and pass" parliamentary tactic that would allow House members to avoid giving an "up or down vote" on the reform bill. By using this maneuver, the original Senate-passed health reform bill would automatically be considered passed if the reconciliation bill is passed. A memo released by the Senate parliamentarian earlier this week indicated that this tactic is indeed valid in this particular case, angering Republicans who have characterized this strategy as unrepresentative of fair and proper parliamentary procedure. The next step in enacting the health reform package would be to introduce the reconciliation bill in the Senate where only a simple majority of 51 votes would be needed to approve it. Senate Republicans are expected to delay the momentum of the bill by introducing numerous amendments and having the Senate clerk read each one.

Click here for more from the New York Times.
Additional coverage is provided by The Hill and can be accessed by clicking here.

March 18 Health Reform Deadline in Question

House Majority Leader Steny Hoyer (D-MD) yesterday pushed back against the President's insistence that an "up or down vote" on health reform be made before Mr. Obama leaves for an overseas trip on March 18th. In a story in The Hill newspaper, Hoyer is reported as claiming that the March 18th deadline imposed by the White House will be difficult to meet, but is not by any means an absolute deadline.

For more, click here.

How to Pass Reform, According to Nancy Pelosi

In an interview last week with the newspaper Politico, House Speaker Nancy Pelosi indicated that the path to passing health reform legislation would take two tracks. First, incremental changes that are mirrored in both bills, such as restricting insurance underwriting practices, establishing a Medicare hospital value-based purchasing program, and providing tax credits to small businesses, will be advanced through Congress as soon as feasible. Other issues of contention will be advanced at a later time, or not at all. These include the establishment of health insurance exchanges, taxes on high cost benefit plans, and new taxes.

Click here to read the HealthLeaders Media story.

US Representative Charles Rangel to Speak at NYBGH Event

During this year's February Congressional District Work Period, U.S. Representative Charles B. Rangel (D-NY) will be speaking about health reform at an NYBGH legislative event. Representing New York's 15th Congressional district, which comprises Northern Manhattan, Harlem, and parts of Queens, Representative Rangel is the chairman of the House Ways and Means Committee, the principle Congressional body responsible for issues related to government revenue.

At the event, Rep. Rangel is expected to speak about the prospects for health reform as well as how reform will affect tri-state area employers.

The event will be held on Wednesday, February 17th from 8:30am to 10:30 am at a location to be determined.

Please stay tuned for more information.

Congressional & Administration Leaders Close to Health Care Deal

Throughout the week, top White House officials, Congressional Democratic leaders, and Democratic committee chairmen have been furiously working on negotiating a final health care reform bill. At issue and receiving significant mainstream media attention are, among other things, disagreements over the role of states in health insurance exchanges, subsidy levels to make insurance more affordable for middle-class Americans, an excise tax on high-priced insurance plans, the ability of the bills to contain overall health costs, and the Massachusetts special election to replace the late Sen. Ted Kennedy.

On Thursday, January 14th, media outlets reported that House Democrats had issued statements that a deal on the financing portions of the bill had been struck. The revised bill is slated to be sent to the Congressional Budget Office on Saturday to receive a cost analysis. Congressional Democrats are increasingly feeling a sense of urgency over next week's special election in Massachusetts. Republican State Senator Scott Brown, as of today, holds a slight lead, albeit within the margin of error, over his Democratic opponent, Massachusetts Attorney General Martha Coakley. Mr. Brown has indicated that if elected and present for the vote on the health bill, he would vote against it, thereby foiling Democrats' hopes of passing historic health reform.

To read more, click here for the story from The Hill.

Late Thursday, labor leaders reported that a deal had been struck on the proposal to tax high-priced "Cadillac plans". According to The New York Times, in a conference call with reports, AFL-CIO President Richard Trumka provided additional details:

• The threshold for the tax would be $24,000 for families and $8,900 for individuals. The Senate bill called for a threshold of $23,000 for families and $8,500 for individuals.
• The threshold would be increased each year by the amount of the rise in the Consumer Price Index plus 1 percent — that’s the same rate of indexation called for in the Senate bill.
• The formula will be adjusted for inflation from 2010 to 2013. The initial inflation threshold period will be adjusted upward if inflation increases above current assumptions.
• For high risk professions, the threshold would increase to $27,000.
• There would also be adjustments creating higher thresholds for employee groups whose health premiums are higher because the groups contain a disproportionate percentage of older workers and women. Those two groups tends to have higher health premiums than other workers. There would also be adjustments for those living in high-cost states.
• As of 2015, dental and vision costs would not be counted toward the threshold.
• Collective bargaining plans were to have been excluded from the exchange. Starting in 2017, collective bargaining agreements at all levels will be able to participate in the exchanges.

The New York Times also reports that "workers covered by collective bargaining agreements, as well as state and local employees, will be exempted from the tax until 2018."

For more on this, click here to access The New York Times story.

Health Insurance Exchanges - Point, Counterpoint

Today's USA Today provides a point counterpoint take on the proposed health insurance exchanges in the pending health reform legislation. As both chambers of Congress head into committee to resolve differences between the two pieces of legislation, health insurance exchanges seem to be a mainstay, but intergovernmental issues are at issue. Some argue that state-based exchanges are the way to go, while others rail that one federal-based exchange would be best suited for best meeting the legislation's intent.

To access the pro-state-based argument, click here. The pro-federal-based argument can be found by clicking here.

For more information on HealthPass, a health insurance exchange in downstate New York operating for more than 10 years and covering more than 30,000 lives, click here.

COBRA Extension Bill Up for Vote

Around 1:00am Friday morning, the Senate voted to limit debate on the 2010 defense spending bill (H.R. 3326). Buried deep inside the bill are provisions that would extend federal COBRA subsidies to February 28, 2010. A full Senate vote is expected at 7:30am Saturday morning.

Current law provides subsidies only to those who are involuntary terminated and lose health insurance coverage by December 31, 2010. Proposed in the defense spending bill are provisions that would extend the 65% subsidy to 15 months and would be offered to those who become eligible by February 28, 2010. Other provisions of the bill include:

• Clarification that only the date of the qualified event relating to the COBRA coverage (e.g. the involuntary termination of employment) will determine eligibility for the COBRA subsidy - and not the date the individual becomes covered by COBRA

• An opportunity for those individuals who lost eligibility for the subsidy (i.e. when the subsidy expired on November 1, 2009) and then lost COBRA coverage due to non-payment of premiums, to retroactively continue COBRA coverage and the subsidy by paying the premium within the later of 60 days from the date of enactment, or 30 days from notification. This also extends to those individuals who lost eligibility for the subsidy but retained their COBRA coverage by paying the full premium

• New and updated notification requirements, including providing a notification within 60 days of enactment that describes the new subsidy provisions to those individuals who were assistance eligible individuals (AEIs) or became AEIs on or after October 31, 2009. In the case of a qualifying event that occurs after enactment, this notice will be provided as part of the COBRA election notice

• Treating the new requirements as having been included as part of the original language contained in the American Recovery and Reinvestment Act of 2009.

The text of the bill can be read on the House Appropriations Commitee website at http://appropriations.house.gov/.

Source: USI Insurance, Littler Mendelson "Washington DC Employment Law Update"

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.

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.

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.

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.

House Democrats Unveil Health Reform Bill

Yesterday, House Democrats released their 1,990-page version of health reform legislation. With the Senate bill set to be released soon, both chambers of Congress are now preparing set for a heated and momentous debate. The non-partisan Congressional Budget Office (CBO) estimates that the House bill will provide coverage to 36 million people, cost $1.05 billion over 10 years, and cut the budget deficit by $104 billion over ten years. Of note, the public option plan, if passed in its current form, will negotiate rates with providers instead of using Medicare reimbursement rates and imposes an income tax surcharge on families making over $1 million.

The Hill reports on more details of the bill here.

The following articles provide more detailed information:

• New York Times
• Wall Street Journal
• The Hill
  

Health Care Reform - House Bill to Reach Floor Soon

House Majority Leader Steny Hoyer (D-Md.) is reportedly set to introduce the health care reform bill that will make it to the full House floor, according to The Hill newspaper. House Democrats want to bring it to the floor so it can be voted on next week. Because they pledged to give 72 hours notice to review the bill, House leaders are expediting their progress. Hill staffers indicate however that a CBO score of the bills need to be released before a bill could formally be introduced.

Read the complete story here: http://thehill.com/homenews/house/64941-house-dems-on-verge-of-bringing-health-bill-to-floor

Health Care Reform - Congressional Documents Reveal Health Costs

Kaiser Health News has obtained documents prepared by the House Ways and Means Committee that illustrate how the House Tri-Committee Health Reform Bill (America's Affordable Health Choices Act) will affect premium and cost-sharing maximums for low- and moderate-income families and individuals. Under this plan, premiums will be drastically reduced and out-of-pocket limits will decline. The documents only list families whose incomes are up to four times the federal poverty level: $88,200. These are the people who would be eligible for government subsidies.

The documents can be seen at: http://www.kaiserhealthnews.org/Stories/2009/September/04/House-Bill-Premiums.aspx#Families

Health Care Reform - Splitting the Bill

Rumor has it that Democrats in Congress are beginning to ruminate on the idea of splitting health reform legislation into two parts. One part would include aspects related to budgetary issues and would be the most expensive provisions (e.g. subsidies for low-income individuals to purchase health insurance and an expansion of Medicaid) of the proposed legislation. This would likely pass solely with Democratic votes through a parliamentary budgetary maneuver called reconciliation. This requires only 51 votes - in contrast to the 60 votes usually required to pass legislation in the Senate. The second part of the reform legislation would involve insurance regulation and includes aspects such as mandates and caps on out-of-pocket expenses and would likely require heavy negotiating with Republicans and conservative Democrats.

A Wall Street Journal article about this can be found at: http://online.wsj.com/article/SB125072573848144647.html

Goodbye to ERISA?

In Monday's Wall Street Journal, an opinion article on the Tri-Committee House health reform bill discusses the possible fate of ERISA pre-emption for employer-based health benefits.

Check out the article here.

Health Care Reform - House Democrats Release a Plan

Yesterday, House Democrats released their proposal for sweeping health reform. The bill includes higher taxes on the rich, expands coverage, and penalizes all but the tiniest employers. Main points of the bill include:

• A tax surcharge ranging from 1% to 5.4% for individuals making over $280,000/yr and families making over $350,000/yr

• Employers not providing insurance to workers will have to pay a fee - equal to 8% of wages for an employers with an annual payroll over $400,000/yr - to the government to subsidize coverage. Employers with annual payrolls greater than $250,000 but less than $400,000 will pay a smaller fee.
  

• Has the potential to reduce the rolls of uninsured by 37 million, leaving approximately 17 million still uninsured

A copy of the bill can be found here.

The WSJ article can be found here and the New York Times article can be found here.