Medicaid and Medicare

Posts Tagged ‘Reform’

December 17, 2009

It appears that the U.S. Senate will vote to close debate on its version of federal health care reform as early as this weekend. Whether or not you have contacted your senators previously, now is the time for you to consider contacting both of your senators and encourage them to continue debate and to improve the legislation.

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It is difficult to overstate the negative implications of Senate Majority Leader Harry Reid’s (D-NV) proposal. According to the Congressional Budget Office, this legislation – if enacted – will have a significant, negative impact on the cost and nature of coverage for our customers. The administration’s chief actuary for Medicare and Medicaid Services has determined that if the Senate health care bill became law, it would increase national health care spending more than if we did nothing. Our own analysis concurs with these assessments and further indicates that Sen. Reid’s proposal will likely lead to higher premiums for many of our customers without reducing the growth in underlying health care costs.

A new Washington Post-ABC News poll indicates that 53% of Americans understand that their personal costs will increase under this proposal and only 37% believe that their personal health care will improve under this legislation. The Senate needs to set aside this version of health care reform and construct a proposal that has broad and deep public support.

Throughout the health care reform debate, our company has sought to partner with our elected leaders in both parties to pursue responsible, sustainable reform that lowers costs and increases access. The current legislation does not meet these goals and Congress needs to hear from individuals who are concerned about the consequences of well-intended but flawed reforms.

While we continue to support health care reform, we cannot support reform that fails to address the cost and quality issues in our health care delivery system and undermines the bipartisan consensus for responsible and sustainable reform.

The holiday season is a busy time for all. Now is the time to get involved today.

The Senate needs to hear from you and time is short.

Healthcare Reform- Not Destruction!

I am all for healthcare REFORM and I am for any and ALL REFORM that truly is REFORM. Are you getting the sense of what I am saying here? As I look at nearly everything that GOVERNMENT tries to REFORM it makes it worse! Way back in 1913 the Federal Reserve was established to bring reform to our financial system and PROTECT the US$, which has lost 98% of its value in the last 95 years! 

Need we look any further back than the Cash For Clunkers program?

Do we need to review our bankrupt social security program, the fiscal failure of Medicare and Medicaid? Has the postal system or Amtrak been successful? Can you imagine how much worse off the automobile industry is going to be now that it’s RUN by the U.S. government. But, let’s take a look at healthcare specifically.

Healthcare in America NEEDS REFORM! What we don’t need is the government to take it over. REFORM, not destruction!

Why don’t we take LESSONS from those who have gone this route before us? The Canadian national healthcare system is a shambles and getting worse by the month- by their own admission. And what we’re seeing in England who has been working a national healthcare system the longest is more than scary! Thousands of women in the UK are having to give birth outside maternity wards because of a lack of midwives and hospital beds. The lives of mothers and babies are being put at risk as births in locations ranging from lifts to toilets – even a caravan – went up 15 per cent last year to almost 4,000.

We want this? 

Health chiefs in England admit a lack of maternity beds is partly to blame for the crisis, with hundreds of women in labor being turned away from hospitals because they are full. Latest figures show that over the past two years there were at least:

>63 births in ambulances and 608 in transit to hospitals
>117 births in A&E departments
>115 births on other hospital wards
>399 in parts of maternity units other than labor beds

We’re just talking about one area of medical needs.

REFORM yes! But yet another government run MESS? Hell no!

Health Care Reform, the Medical Community and You

There is a tremendous effort by the President and the Democratic Party to swiftly replace our current system of health care insurance with a government sponsored insurance program designed to bring health insurance coverage to all Americans. Of course, this sounds like a wonderful idea, however, after understanding the details outlined in the proposed legislation, many may want to reconsider their position.

There are a few facts you just can’t get around. When more than 47 million uninsured Americans are added to a system that currently accommodates 260 million Americans, something is going to have to give. Assuming the same patient load, approximately 10,000 more physicians will need to be available or care for the 47 million. Other Americans will need to be delayed or eliminated. This is not unusual in places like England, France and Canada where National Healthcare has been in place for quite some time. Additionally, facilities, resources and support staff will be effected proportionally. The promoters of this legislation can promise all day long that this won’t happen, but unless they have the same capabilities that Christ had when he fed 500 followers with two loaves of bread and seven fish around 2000 years ago, the numbers say it just can’t work without serious health care rationing.

The next issue that stands out is the promise of reforming health care thereby significantly reducing costs. If we look at Medicare and Medicaid as examples and understand the tremendous deficit that is growing due to poor management and excessive fraud, how could we even imagine we could increase the size and responsibility of a program and then believe it would be operated efficiently enough to reduce costs. These are wonderful dreams, but they are just dreams. TARP is operating with little control or knowledge of recipients use of funds, the American Recovery and Reinvestment Act has been unable to disperse funds or lower unemployment as projected and the Cash for Clunkers program was so grossly miscalculated that it ran out of funds in the first week and hasn’t been

able to issue reimbursement payments to auto dealers effectively. We were told these programs would work great and they had to be in place immediately.

But let’s assume for one moment we can some how accommodate the extra 47 million insured and that through some miracle we are able to control costs without reducing the quality or quantity of care. How do we get past the fact that the majority of Americans do not want or support the health care reform legislation being proposed? It appears our elected representatives don’t really care what we want.

Yes, they were elected to represent us, but they represent themselves and their party’s position first. Once they have accommodated them, then they may consider understanding our preferences. Of course, the exception to this position is at election time when every promise is to represent the people that elect them.

Healthcare reform seems to be moving along in Congress. Speaker of the House Nancy Pelosi appears to have a majority of Democratic representatives on board, while Senate Majority Leader Harry Reid is on his way to getting 60 votes in the Senate. However, there is one major issue that has the potential to derail Democrats’ reform efforts: abortion. Some pro-life Democrats in Congress, like Rep. Bart Stupak are worried that the current bill will force the government to pay for abortions. It isn’t a direct payment to providers that they’re concerned with; rather, it’s a seemingly benign subsidy meant to help low-income individuals and families purchase health insurance–either the public option or a private plan. Pro-choice leaders in Congress have already agreed to prevent recipients from using the subsidies specifically to pay for an abortion, instead leaving that expense to employer- or individual-paid premiums. Despite that provision, opponents still consider it federal funding since money can’t be directly separated. Their belief is that if a woman receives a discount on a health insurance plan through a federal subsidy, she may then use the money she saved on that procedure. Technically, you could also make the argument that food stamps promote illegal drug use because they free up funds that would otherwise be used to feed people, and can instead be used to buy drugs. Stupak is planning to block the healthcare reform bill from moving out of committee unless House leaders like Henry Waxman allow him to offer a separate amendment that further prevents any of the new health care funds from being used for abortion services.

Abortion is a very controversial subject. It is the only legal health procedure with special regulations in the House’s reform. Activist groups like NARAL grudgingly accepted the compromise presented by House leaders, realizing that it was probably the best they could get, but see Stupak’s new proposals as a path to banning abortion coverage in the private health insurance market altogether. The 1976 Hyde Amendment already forbids the federal government from funding abortion through Medicaid, its existing public health insurance plan for low-income Americans. However, it doesn’t apply to newly provided funds. Rep. Stupak’s amendment would expand the Hyde restrictions to the new subsidies, offering even stronger assurance that no federal money will pay for abortion except under certain circumstances (when the life of the mother is in danger, or when rape or incest are involved). House leadership will probably try their best to block the amendment. In that case, Stupak threatens to create a coalition of representatives that will vote no on a procedural vote. That would serve to prevent debate on the House’s healthcare reform bill in its entirety. States will be allowed to cover abortion services on a state-by-state basis, but using solely their own money. Some states would be more likely to provide abortions to their residents than others. Whatever your views on abortion (and I realize it’s an extremely sensitive topic), that type of law is, in effect, creating unequal access. A wealthier woman’s health insurance plan will cover an abortion, while poorer women will see heavier restrictions on the insurance they can buy. Granted, in the case of the subsidies taxpayers could be, however indirectly, funding a procedure they oppose; just like those who are anti-war have to pay for Iraq and Afghanistan.

Stupak’s amendment would ban people from using the subsidies to buy private health insurance plans that cover abortions, as opposed to preventing only those specific funds from being used for that purpose. Why not let Stupak propose it? For one thing, it will probably result in division of the Democratic party at a time when unity is essential to reach their goal. There are quite a few pro-life Democrats that would vote for such an amendment; Stupak claims that he can get 40 Democrats on his side, which would eat up most of the party’s majority in the House. Despite that, a large percentage of supporters would most likely be Republicans–who wouldn’t vote for the final bill anyway, regardless of how stringent its limits on abortion funding are. In exchange, it would alienate some liberal Democrats. These representatives are relatively reliable votes, but they are already skeptical of the bill because they feel the public option doesn’t go far enough. Either way, Democrats need virtually all of their caucus to vote with them on healthcare reform, and this issue will certainly be a factor in how they vote. House Majority Leader Steny Hoyer claims that progress is being made on the issue, but both sides seem to be standing firm. The future of the House’s healthcare reform largely rests on this issue, so it’ll be interesting to see how it plays out.

(Image: number of abortions per 1,000 women each year; Guttmacher Institute)

Barack Obama’s quest for historic health-care legislation has turned into a parody of leadership. We usually associate presidential leadership with the pursuit of goals that, though initially unpopular, serve America’s long-term interests. Obama has reversed this. He’s championing increasingly unpopular legislation that threatens the country’s long-term interests. “This isn’t about me,” he likes to say, “I have great health insurance.” But of course, it is about him: about the legacy he covets as the president who achieved “universal” health insurance. He’ll be disappointed. Even if Congress passes legislation — a good bet — the finished product will fall far short of Obama’s extravagant promises. It will not cover everyone. It will not control costs. It will worsen the budget outlook. It will lead to higher taxes. It will disrupt how, or whether, companies provide insurance for their workers. As the real-life (as opposed to rhetorical) consequences unfold, they will rebut Obama’s claim that he has “solved” the health-care problem. His reputation will suffer.

It already has. Despite Obama’s eloquence and command of the airwaves, public suspicions are rising. In April, 57 percent of Americans approved of his “handling of health care” and 29 percent disapproved, reports the Post-ABC News poll; in the latest survey, 44 percent approved and 53 percent disapproved. About half worried that their care would deteriorate and that health costs would rise.

These fears are well-grounded. The various health-care proposals represent atrocious legislation. To be sure, they would provide insurance to 30 million or more Americans by 2019. People would enjoy more security. But even these gains must be qualified. Some of the newly insured will get healthier, but how many and by how much is unclear. The uninsured now receive 50 to 70 percent as much care as the insured. The administration argues that today’s system has massive waste. If so, greater participation in the waste by the newly insured may not make them much better off.

The remaining uninsured may also exceed estimates. Under the Senate bill, they would total 24 million in 2019, reckons Richard Foster, chief actuary of the Centers for Medicare & Medicaid Services. But a wild card is immigration. From 1999 to 2008, about 60 percent of the increase in the uninsured occurred among Hispanics. That was related to immigrants and their children (many American-born). Most illegal immigrants aren’t covered by Obama’s proposal. If we don’t curb immigration of the poor and unskilled — people who can’t afford insurance — Obama’s program will be less effective and more expensive than estimated. Hardly anyone mentions immigrants’ impact, because it seems insensitive.

Meanwhile, the health-care proposals would impose substantial costs. Remember: The country already faces huge increases in federal spending and taxes or deficits because an aging population will receive more Social Security and Medicare. Projections the Congressional Budget Office made in 2007 suggested that federal spending might rise almost 50 percent by 2030 as a share of the economy (gross domestic product). Since that estimate, the recession and massive deficits have further bloated the national debt.

Obama’s plan might add almost an additional $1 trillion in spending over a decade — and more later. Even if this is fully covered, as Obama contends, by higher taxes and cuts in Medicare reimbursements, this revenue could have been used to cut the existing deficits. But the odds are that the new spending isn’t fully covered, because Congress might reverse some Medicare reductions before they take effect. Projected savings seem “unrealistic,” says Foster. Similarly, the legislation creates a voluntary long-term care insurance program that’s supposedly paid by private premiums. Foster suspects it’s “unsustainable,” suggesting a need for big federal subsidies.

Obama’s overhaul would also change how private firms insure workers. Perhaps 18 million workers could lose coverage and 16 million gain it, as companies adapt to new regulations and subsidies, estimates the Lewin Group, a consulting firm. Private insurers argue that premiums in the individual and small-group markets, where many workers would end up, might rise an extra 25 to 50 percent over a decade. The administration and the CBO disagree. The dispute underlines the bills’ immense uncertainties. As for cost control, even generous estimates have health spending growing faster than the economy. Changing that is the first imperative of sensible policy.

So Obama’s plan amounts to this: partial coverage of the uninsured; modest improvements (possibly) in their health; sizable budgetary costs worsening a bleak outlook; significant, unpredictable changes in insurance markets; weak spending control. This is a bad bargain. Health benefits are overstated, long-term economic costs understated. The country would be the worse for this legislation’s passage. What it’s become is an exercise in political symbolism: Obama’s self-indulgent crusade to seize the liberal holy grail of “universal coverage.” What it’s not is leadership.

States Work To Implement Healthcare Reform While Trying To Repeal It

21 states are currently parties to lawsuits that seek to undercut the Obama administration’s healthcare reform legislation. The major suit consists of 20 states and other interest groups. Virginia filed its own suit hours after the bill was signed.

Why didn’t the state join its fellow brethren in their class-action suit? It has unique legal standing, due to a previous amendment to its constitution that states that its residents will be free from any requirements to purchase a health insurance plan. The reform bill, which includes an individual mandate to either buy a policy or pay a penalty, conflicts with that constitutional amendment.

Still, health insurance reform is the law right now, while the legal challenges may take a long while to navigate the judicial system. Even supporters of the lawsuit, such as Virginia Secretary of Health and Human Services Don Hazel, acknowledge that it may be two or three years before the case is settled.

Meanwhile, the earliest effective reforms must be implemented. They are still legally required to comply with the law regardless of how they feel about its merits, just like supporters of marijuana legalization are still subject to arrest if they are caught using it.

To that end, Hazel has called for the state to create a Health Care Reform Initiative. The most pressing issue is the expected influx of Medicaid patients, since the national law loosens eligibility standards. In Virginia, the government-run affordable health insurance program for the poor is predicted to add 155,000 by 2022.

The state must also prepare for the creation of health insurance exchanges due by 2014, as well as strengthening their regulatory apparatus against the insurance industry in order to comply. Hazel expects initial recommendations on September 30th, with follow-up reports at the beginning of the next four years.

Joonho Kim (Korean American) recently became entitled to Medicare. He and his family discuss the Medicare program while referring to the medicare.com website for information. This 27-minute Korean language video drama provides easy-to-understand information about the basics of the Medicare program.

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I’m a fan of the notion that the health care industry has gotten out of hand.  The system, including the pharmaceutical industry, needs some kind of reform to become more available, more cost-friendly, more efficient, and as silly as it sounds, healthier.  However, it’s for these reasons that I’m uneasy, as all Americans should be, with the current health care bill being muscled through the senate.

The senate health committee has already voted to pass the bill.  However, not only conservative but also many moderate members of senate committees are demanding changes, and this includes some Democrats.  This is a good indication that there could be some serious fundamental flaws.  It is also pushing wider the divide that causes a functional impasse between political parties.  It is irresponsible and reckless to deepen this divide, especially concerning such major issues.  Progress cannot be made, improvements cannot be added, and flaws cannot be corrected while some childish power struggle plays itself out.  The process is being rushed, almost as if to prove a point; everyone should stop what they’re doing, stop looking at the majority figures, and sit down together like adults and leaders to work something out.  It’s common sense.

The president was quoted as urging congress to “step up and meet our responsibilites” and saying the need “should provide urgency for both the House and the Senate to finish their critical work on health reform before the August recess”.  Why the rush?  It is not responsible to act so hastily.  This is a monumental issue of change in policies regarding one of the largest industries, in terms of size, money and necessity, in America.  Such an issue cannot be resolved overnight, a relatively close enough time frame to the one in which the President is expecting it to be done.  Mr. Obama, with all respect, this is not a national emergency; it needs to be done, but the necessity does not call for passing rash bills; instead, it calls for thoroughly thought through decisions, well made plans, and a lasting solution that won’t need to be fixed in the coming years or cause a scramble of new taxes to provide its funding.

This is going to affect every American, and it will do so for at least the next decade, potentially longer, into generations to come.  Punctuating the need for a slow down, New Hampshire Senator Judd Gregg called for “serious action by Republicans and Democrats” and “a pledge to put politics aside”.  Let’s face it, the politics of Washington’s residents does not have a rightful role to play, because it is, by all reason, the peoples’ decision.

Obama has also been pushing Senate Finance Committee chairman Max Baucus to have a bill ready by Friday.  But Baucus wants a bipartisan bill, and while he praised the efforts of the health committee, he stated, “That’s a partisan bill”.

Aside from this ridiculous attempt at a power show, the costs of the program are astronomical, and at the very least unreasonable.  Obama supports not “universal” health care, but a government run program to operate along side of, and compete with, private insurers, in theory reducing the costs full circle.  New concerns of overturning the current employer-based system of benefits has prompted the notion of government provided financial assistance for premiums to middle and lower class families.  Obama was quoted: “The American people need to recognize that there’s no such thing as a free lunch, right?  So we can’t just provide care to everybody at no cost whatsoever”.  Well, someone needs to recognize that there is already a similar and so-called unsustainable system in place: some people buy insurance; some people can’t afford private insurance and have government sponsored plans; the rest are left in limbo, many of whom work and actually pay taxed into the system, yet are unable to afford private insurance and do not qualify for the low income eligibility standards of Medicaid.

Theoretically, the new bill would eliminate that limbo crowd, making insurance more affordable and available to them.  however, the bill requires government to provide financial assistance to people and families who make up to four times the poverty level (approximately $88,000 a year for a family of four), encompassing most of the middle class.  In reality, this is the unsustainable system, and it is just asking for abuse.  People who truly do not need the assistance would certainly apply for and accept it, costing billions and causing families like mine to foot the tax bill for their health care.  That’s absurd.  My family of five has an annual income of around $29,000, and while it’s nowhere near a life of luxury, we buy our own insurance and pay our premiums with no government assistance.  So I’m positive that a family with one less member and almost three times the income could afford it.  It’s called personal responsibility, and people need to step up to it.  The government needs to expect people to step up to it.  I’m not saying there should be no assistance at all, but that income bracket needs to be lowered by about thirty grand.

On the other hand, Obama suggests excluding “hardship cases” from a coverage mandate.  That’s hardly fair.  Nothing against people on welfare or other assistance who use it correctly (at one time I had my children on Medicaid, so I’m not judging anyone or putting anyone down), but these institutions are so widely abused.  While there are many who really need it and use it in its intended form–assistance–there are also many who use it as a means  of living.  For example, the purpose of food stamps is to supplement a family’s monthly food budget, but many of the parents nationwide who use food stamps, use them as the family’s SOLE monthly food budget.   This goes back to the “personal responsibility” concept, and a lack of it should not be considered “hardship”.  People who work and raise their kids, trying their best to give them a clean, safe, and comfortable living environment, yet struggle to pay their bills, is a hardship case, so exempt them.  But do not exempt those who consider waiting on a welfare “cash allowance” check to be a full time occupation and use that as their sole income; they should be able to use some of their cash allowance to help cover their premiums.

The finance committee is currently looking at options that could possibly raise $100  billion over the next ten years as partial funding of the bill, by imposing fees on health insurance companies.  Unspecific as to what kind of fees, two things are clear.  One, this would cover only a tiny fraction of the proposed $1 trillion worth of funding the bill requires.  Two, one of the main goals of the program is to reduce costs to Americans.  An explanation is needed as to how imposing fees would achieve this goal.  Logic tells us this will increase the industry’s costs, which will translate into higher costs for providers and buyers.  While I’d much rather see fees for them instead of taxes for us, it doesn’t quite fit that fees would help lower costs.

Under the bill, employers will face fines for not offering benefits.  Seems reasonable. However, this will punch small businesses, who do not qualify for much lower group rates that the larger companies get. This should only be included if insurance companies are willing to offer lower cost plans or there is a max limit named that the employers would have to pay into it.  While I’m in favor if this measure, it needs serious revisions to ensure the safety of small businesses.

Also, there is a proposed individual mandate, forcing Americans to buy coverage or face fines.  Fundamentally, this makes a lot of sense.  If more people are buying to it, this should lower everyone’s costs, and it avoides the costs associated with the uninsured going to emergency rooms and not paying the bill, which falls back on the insured.  However, I’m not comfortable with the government forcing me to buy anything.  Many accidents requiring ER visits are covered in other ways: work injuries are usually covered by workman’s comp, car accident injuries are usually covered by the car insurance’s bodily injury benefit.  As far as visits not covered in other ways, this is another issue entirely, having less to do with insurance and more to do with soaring costs of care.  An uninsured person could expect to see a bill of easily a couple thousand dollars.  If these unwarrented prices were lower, we could expect to charge patients at least half the cost at the time they are seen.  Some say this would prevent many people from going to an ER to have necessary or even life saving treatment.  Well I’m sorry.  Life isn’t free, neither are your injuries, get insurance or pay your bills.  Either way, that’s an individual’s choice to make.  The government has no place trying to force us to buy something.  If you pay your taxes, you can’t have someone claiming authority to tell you how to spend the rest of your money.

As for the TV ads scheduled to be airing, we as a people need to demand they be pulled.  Government, and its policies, are not products to be marketed and sold with advertisements.  Organizing for America, Obama’s campaign organization and now an offical member of the National Democratic Party, is refusing to release information concerning the funds and the cost of the ads.  TV advertising should not be allowed to be used during campaigns, and it certainly has no need to show up on my TV during a term to try and persuade me to support something and push my senators to pass it.

During an interview with Nighline (ABC) last night, the President made comments of the effect that we should pay doctors more for thinking and less for doing.  It is a common government outcry that health care is highly inefficient.  Well, take a look around.  Government isn’t doing much better of a job.  In the process of making hurried decisions and uncalculated moves, common sense is being disregarded on many levels.  Between overhauling businesses, becoming a business that cannot be competed against, and tossing hard paid tax dollars, you’ll hear a lot of government trying to tell us what we want, what we need, and sometimes just saying what we want to hear in order to push things through.  One key component is being overlooked.  I’ve long been saying that the sovereign people need to muzzle it, because it has already gotten out of control, only to snowball.  This is just one area, a perfect opportunity for everyone to do just that, right here with the health care bill.  Government needs to do something that the people want and need, instead of constantly telling just what that something is.  This bill needs to be stopped in its tracks, the process slowed down, and it needs to actually be thought through.

Thanks for reading, and don’t forget to do your job as an American.  Contact your congress people, and let’s keep this place the greatest county to live.

Oleta Fitzgerald, director of the Children’s Defense Fund’s Southern Regional Office, says she is concerned over the welfare of Mississippi children if either of the two health-care reform packages considered by the U.S. House and Senate ever make it into law.

The House passed H.R. 3962 earlier this month, and Senate Democrats managed to beat back the threat of a Republican filibuster a few weeks ago, allowing the Senate to move forward with debate on the Patient Protection and Affordable Care Act, H.R. 3590. Both bills promise big reforms in the health-care and health-insurance industries. The Association for American Medical Colleges states that nearly 15 million people will be newly eligible for Medicaid and the Children’s Health Insurance Program under H.R. 3590, at an estimated cost of $374 billion over 10 years.

Fitzgerald says both bills contain huge holes regarding CHIP coverage for Mississippi children: “Right now, the fight over health-care reform in the House and Senate is all about abortion and the public option, but the children are getting lost in this discussion,” Fitzgerald said.

The issue, she said, centers on Mississippi’s unconventional requirement for CHIP eligibility.

Many states recently expanded their Medicaid program requirements to accept people who are a little further from the federal standard for poverty. Eleven states recently extended CHIP-eligible families’ income levels up to 200 percent of the federal poverty level, or higher. ($20,800 for an individual or $35,200 for a family of three).

But instead of expanding Medicaid, Mississippi set up a new health insurance program that contracts with private insurance companies. The states that expanded Medicaid will continue to receive federal support for those programs under both the bills under discussion in the House and Senate. But in Mississippi, all children and their families over 150 percent of the federal poverty level ($16,245 a year for an individual and $27,465 a year for a family of three) would go into an insurance exchange created by the House and Senate bills. The Senate bill plans to put CHIP-eligible kids in an exchange by the year 2019, while the House bill has them transferred by 2013.

Insurance exchanges do not promise the reliability of a government health program, Fitzgerald warns.

“Going into the exchange could require co-pays and premiums, the children would get lumped in with adults, and it’s not clear what requirements the insurance companies would have for their benefit packages,” she said.

There is also the question of permanence. Exchanges like the ones proposed by the House and Senate bills have not always been long-lasting. Texas, Florida, North Carolina and California all attempted—and failed—to create enduring insurance exchanges, primarily because private insurers tampered with the market.

A July report issued by the California HealthCare Foundation tried to pinpoint some of the factors that killed the California insurance exchange, which closed its doors in 2006. According to the report, the California exchange became too expensive when the clients it served became too costly. An exchange requires a certain number of healthy individuals to complement the more sickly participants of the exchange’s customer base; otherwise the cost of participation becomes too high for all participants.

But insurance companies in California lured healthy customers with lower premiums and steered the more sickly individuals into the exchange, creating a disproportionately expensive customer base.

“People involved in operations of the California exchange agreed that when there is competition for the same customers within and outside the exchange, the exchange is in ‘extreme peril’ of becoming a victim of adverse selection,” the report states. “If an exchange attracts a disproportionate share of higher risk individuals and groups as the California exchange did at various times, it cannot succeed.”

Fitzgerald said Mississippi’s eagerness to boot CHIP-eligible children from the program to keep down state costs is another factor complicating the new bills.

“Another problem is enrollment. We need enrollment in the exchanges to be simplified, because enrolling in state health programs have a history of being anything but simple in Mississippi,” Fitzgerald said, referencing a Medicaid policy championed by Republican Gov. Haley Barbour, which requires Medicaid recipients to meet Medicaid personnel “face-to-face” to be considered for program renewal.

CDF is working with its national office in trying to insert an amendment in the Senate bill though Democratic Sens. Robert Casey and Jay Rockefeller, which would keep all children up to 300 percent of the federal poverty level in the CHIP program until the new insurance exchange is thoroughly vetted.

MARCH 26, 2010

This Week in Health Care Reform     

Health care reform legislation passed the House this week on a party-line vote. Late Sunday night, House Democrats approved the Senate health care reform package, sending the legislation to President Obama for his signature. On Tuesday, President Obama signed the underlying bill into law, yet the House has yet to finalize the package of “fixes” that will alter the final implications of the legislation.

Health Care Reform Negotiations

House Democrats Pass Health Care Reform Package: The House of Representatives approved the Senate health care reform bill Sunday night by a vote of 219 to 212. The vote marks the climactic finale to a year-long debate over health care reform. In the final vote, 34 Democrats joined all House Republicans in voting against the measure. Shortly thereafter, the House also passed a package of “fixes,” by a vote of 220-211, that was sent directly to the Senate for its approval through reconciliation. On Tuesday, President Obama signed into law the Senate health care reform bill, called the “Patient Protection and Affordable Care Act.”

Republicans Force Senate to Send the Reconciliation Bill Back to the House: Shortly after the President signed the Senate bill into law, Senators began deliberations on the reconciliation bill. Reconciliation protocol restricts Senators to 20 hours of debate on the measure, but it does not limit the number of amendments that can be filed. In an expression of opposition to the bill, Republicans filed 29 amendments to the reconciliation package.

After 10 hours of continuous debate, Republicans were successful in eliminating two provisions related to college financial aid in the non-health care portion of the bill. The Senate parliamentarian ruled early Thursday morning that those two provisions violated the chamber’s rules, sending the legislation back to the House for a new vote. As a result, on Thursday afternoon, the Senate voted on the reconciliation bill without those two provisions and sent the bill  back to the House for a vote on final passage. The House vote will likely come Thursday evening.

What Does This Health Care Reform Legislation Mean: While the health care reform bill extends insurance coverage to 32 million more Americans by 2019, the legislation has other far-reaching implications that will be phased in sooner, during a multi-year implementation period.

Several features of the new health care overhaul bill that would take effect in 2010 under the measure passed Sunday include:

* New product requirements beginning 6 months after enactment, including:
o Coverage for dependents up to age 26
o No lifetime maximum benefit limits
o And no cost sharing on preventive care for certain policyholders
* Temporary federal high risk pools;
* Tax credits for small employers; and
* Prohibition on pre-existing condition exclusions for children (beginning 6 months after enactment).

Most Americans will have until 2014 to purchase insurance or pay a penalty. Other elements of the bill that will not take effect until at least 2014 include insurance marketplaces called “exchanges”; rules requiring insurers to accept all applicants regardless of pre-existing conditions, and an expansion of state Medicaid programs.

A number of experts question whether health care reform will really drive down insurance premiums. America’s Health Insurance Plans ( AHIP), the trade group representing health insurers, outlines a series of concerns related to the legislation including a lack of provisions that address underlying health care costs, improve quality of care or ensure a stable risk pool. In addition, AHIP expressed concerns regarding new taxes on health coverage, which will likely increase premiums.

Additional Activities

Obama’s Executive Order on Abortion Funding: On Sunday afternoon, prior to the final House vote on health care reform, President Obama agreed to issue an Executive Order that would uphold the ban on federal funding for abortion . In so doing, he secured about a half-dozen votes from anti-abortion Democrats, led by Rep. Bart Stupak (D-MI), who previously opposed the legislation. On Wednesday, President Obama signed the Executive Order banning the government from spending federal money to pay for abortions through plans offered on the insurance exchanges created under the measure.

States Filing Lawsuit to Fight Provision of Health Care Reform Bill: In response to the new health care reform legislation, states across the country have filed lawsuits asking the courts to declare the law unconstitutional and to bar its enforcement. On Monday,Attorneys General in 13 states, led by Florida, filed a joint lawsuit claiming that the new health care reforms violate state government rights in the U.S. Constitution and will force massive new spending on hard-pressed state governments. Joining Florida in the suit are Alabama, Colorado, Idaho, Louisiana, Michigan, Nebraska, Pennsylvania, South Carolina, South Dakota, Texas, Utah and Washington.

At the same time, the Attorney General in Virginia filed a separate suit contending that Congress has exceeded its power in mandating that people buy health insurance. Virginia Attorney General Ken Cuccinelli argues that the new law’s requirement clashes with Virginia law that exempts citizens from federal fines imposed for not having health insurance.

Senate Voting to Extend COBRA Until May 5:  Senate Democrats plan another short-term extension of unemployment aid this week, setting up a face-off with Republicans, who are vowing to fight the extension if the $10 billion cost isn’t offset with spending cuts. The bill, currently set to expire on April 5, would extend a series of emergency programs – including funding for unemployment insurance benefits and COBRA health coverage for the jobless  – and would hold off a deep cut in reimbursement rates for doctors who serve Medicare patients. The long-term extension has already passed in both the House and Senate, but the two measures are not expected to be reconciled and sent to the President’s desk until after the Easter recess.

President Obama Heads to Iowa to Speak on Health Care: President Obama headed to Iowa on Thursday to increase support for his health care legislation. This was President Obama’sfirst trip out ofWashington since signing health care reform legislation earlier this week. He spoke at the University of Iowa, in the city where he first announced his health care proposal during the Presidential campaign.

Public Opinion

Most Americans Want Republicans to Fight Health Care Reform Bill: In a recent CBS News poll, 62 percent of Americans said they want congressional Republicans to continue challenging the bill, while 33 percent said they should not. Disapproval of the bill has remained steady, with 46 percent saying they disapprove, including 32 percent who “strongly” disapprove. A majority of Americans continue to say that they find the bill to be confusing and do not understand what it means for them or their family.

American’s Split on Health Care Reform Passage: In a recent USA Today/Gallup poll, 42 percent of Americans said they were angry or disappointed with the recent passage of health care reform legislation. When asked to reveal party affiliation, 79 percent identified themselves as Republicans.

Polling Shows Support for State Lawsuits Against Government: National polling reveals significant opposition to the individual mandate. In a newly released Rasmussen report , 53 percent of those polled oppose the new mandate requiring every American to buy or obtain health insurance. Further, 49 percent of voters are in favor of their state suing the federal government to fight the mandate. Fifty-one percent say individual states should have the right to opt out of the health care plan entirely.

Looking Ahead

After this week’s final health care reform vote, President Obama plans to travel the country in the next few months to discuss the new law. Republicans have begun their own discussions of the law, with an eye towards the November elections.

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