House and Senate look to final health care talks

How to pay for overhaul joins abortion and public option as key concerns

   WASHINGTON - How many Americans will get subsidized medical coverage — plus who will pay for it — will be front-burner issues when Congress returns next month to complete President Barack Obama's health care remake.
   Pocketbook concerns join abortion and whether Uncle Sam should peddle insurance as the top bones of contention for negotiators who must resolve difference between the House and Senate bills.

   The negotiations are the last chance for Democrats to shape the legislation to deliver concrete benefits to Americans skeptical that it will help control skyrocketing premiums as it expands coverage to millions more.
   "People will really begin to focus on some of the core issues that have received less attention," said Rep. Chris Van Hollen, D-Md., a member of the House leadership. "These are the bread-and-butter issues that will have the most significant impact on people's pocketbooks."
   Broadly speaking, both bills would gradually expand coverage, while banning objectionable insurance industry practices such as turning down people with health problems. Eventually, all Americans would be required to carry health insurance, with government subsidies to make premiums more affordable for many of them.

Employer-insured workers won't see big changes
   Those covered by big employers wouldn't see major changes, but individuals buying their own policies and small businesses would be able to shop for competitively priced plans in an insurance supermarket called an exchange. Medicare cuts and an assortment of taxes and fees would pay for the bills.
   Democrats are under pressure to reconcile the House and Senate versions before Obama's first State of the Union speech. Not yet scheduled, it's usually delivered in late January or early February. Republicans will wage legislative guerrilla warfare to delay an agreement.
   There's not much time, and apparently not much give either.
   Senate moderates say they won't vote for a bill that changes the basic terms they agreed to with Majority Leader Harry Reid.
   Independent Sen. Joe Lieberman of Connecticut and conservative Sen. Ben Nelson, D-Neb., have drawn a line against reintroducing a government-run insurance plan to compete with the likes of Aetna and Wellpoint. The House bill includes it, but Reid, D-Nev., needs every member of his 60-vote coalition to hold off GOP opponents.
   More difficult to solve is the issue of how to restrict taxpayer funding for abortions. Abortion opponents disagree among themselves over the Senate's approach. Abortion rights supporters are completely against the more restrictive House language and are divided on how the Senate has handled it.
   Obama will probably have to step in to settle disputes and keep things moving.
   Democrats have options on how to handle the negotiations. They could agree to a limited set of changes, allowing each chamber to pass identically amended bills. Or they could set up a formal conference committee to resolve differences. Leaders have made no decision yet. Naming a conference committee would signal that the issues have proven difficult.
   Yet the longer Democrats argue, the more suspicious the public becomes about remaking the health care system. "The making of salami and legislation is not pretty for people to watch," said Harvard professor Robert Blendon, who tracks public opinion on health care. "It has left them nervous that the interests of middle-income people are not being served."
   That's one reason leading Democrats are arguing for a focus on pocketbook issues in the homestretch.
   "There will be a certain amount of replaying issues that have been hot-button issues, but I think there will also be a refocusing, especially on cost," said Senate Budget Committee Chairman Kent Conrad, D-N.D. "At the end of the day, when all of us go home, what we hear about is the ever-increasing, ever-escalating costs."


Scrutiny will center now on costs
   There are some signs of that already.
   Last week, Reid pledged on the Senate floor to close the coverage gap in Medicare prescription benefit — as the House bill already does. The message was aimed at seniors worried that Medicare cuts to hospitals and other providers will jeopardize their care.
   And Conrad said senators may go along with the House timetable for expanding coverage, which calls for starting subsidies in 2013, a year earlier than the Senate bill.
   The House bill provides coverage to 36 million, while the Senate covers 31 million. Lawmakers in the House want the Senate to move toward their number.
   Another priority will be to make sure the final bill promotes competition in the health insurance market, which in many states is dominated by one or two large carriers.
   Though it sounds arcane, a major problem for negotiators is whether the new insurance supermarket should be state-based, as in the Senate bill, or national, as the House calls for.
   Some advocates say a national approach provides stronger consumer protection.
   Finally, the issue of who to tax won't be easy.
   Unions are adamantly opposed to the Senate plan, which would impose a 40 percent tax on high-cost health insurance above $8,500 for an individual plan, $23,000 for families. Organized labor sees the tax on so-called Cadillac plans as a hit on its members, who have fought for years for better-than-average coverage. Unions are a core Democratic constituency and many House Democrats want to knock out the insurance tax.
   The Obama administration, however, supports such a tax. In a recent session with reporters, White House economic adviser Christina Romer called the tax "a very effective cost-growth containment mechanism," arguing that it will force people into more efficient plans.
   Rep. Joe Courtney, D-Conn., wasn't buying it. "The most troublesome component of the Senate bill remains the 40 percent excise tax on high-cost health care premiums," he said. More than 190 House Democrats agree. Instead, they want to tax upper-income earners.

Copyright 2009 The Associated Press. 

Health Bill to result in few changes for millions

By REED ABELSON

Updated 5:05 a.m. ET, Fri., Dec. 25, 2009

Now that the Senate has caught up with the House by passing a sweeping health care bill, lawmakers are on the verge of extending coverage to the tens of millions of Americans who have no health insurance.
But what about the roughly 160 million workers and their dependents who already have health insurance through an employer? For many people, the result of the long, angry health care debate in Washington may be little more than more of the same.

As President Obama once promised, "If you like your health plan, you can keep your health plan."

That may be true even if you don't like your health plan. And no one seems to agree on whether the legislation will do much to reduce workers' continually rising out-of-pocket costs.

True, there is an important advantage for the working insured: more peace of mind for people who are worried about being laid off or would like to change jobs.

There are still many gaps to bridge between the House and Senate bills. But even before the House-Senate negotiations begin in January, both bills offer this assurance: If you lose your job or move to one that does not provide benefits, there should be better alternatives when shopping for your own coverage.

And both the House and Senate bills share the same basic goal of placing new rules on insurers so that even someone with a pre-existing medical condition, or a few years to go before qualifying for Medicare, should have a much easier time finding a relatively affordable policy.

The legislation should give most working people "the guarantee of security if their circumstances change," said Karen Davis, the president of the Commonwealth Fund, an independent research group that has studied the House and Senate bills.

Proposed changes
Of course, with more security will come more obligation. Congress seems likely to impose an individual mandate that will require people to be insured or face a financial penalty.

The other proposed changes for employer-provided coverage seem aimed mainly at workers whose benefits are either very generous or exceedingly skimpy.

On the generous end, about a fifth of employers now offer health plans that could be affected by a new 40 percent excise tax in the Senate bill on so-called Cadillac policies, according to an estimate by Mercer, a benefits consulting firm. That tax, to be imposed on annual premiums that exceeded $23,000 for family coverage, would go into effect in 2013. For example, if an insurer, or a self-insured employer, offers a plan costing $25,000, it must pay a 40 percent tax on the $2,000 that is above the threshold, or $800.

If the excise tax survives the House-Senate negotiations, it is hard to predict how employers will respond. But almost two-thirds of the employers Mercer recently surveyed said they were likely to reduce employee benefits rather than pay the tax.

"They're going to work hard to find a way to keep the cost of their plans below the threshold," said Beth Umland, Mercer's director of health and benefits research.

She predicts that many of those companies will rely on what she described as "the tried-and-true method" — passing along more of the costs to employees, in the form of higher deductibles and co-payments, in order to reduce overall premiums.

The public policy goal of the tax, in theory, is to have everyone spend less on medical care, even if it means using it less.

"We know people will use less care under such plans," said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan group.

What is not so clear, Mr. Ginsburg said, is whether people will make — or be able to make — rational choices between treatments that are not particularly effective and treatments that may help them from becoming sicker later.

'Minimal' impact
Congress also seems intent on establishing some minimum insurance standards so people with coverage could not end up with large piles of unpaid medical bills anyway. Both the House and Senate bills contain measures meant to eliminate lifetime maximum limits on coverage, for example.

But that might end up affecting relatively few people. Many plans limit how much they will pay out over a lifetime, but the ceilings are generally so high that the vast majority of people never hit them, according to a new study that used existing coverage for workers in California to compare the House and Senate proposals.

The "impact of this change will be minimal on most employers, but would be quite meaningful for the small number of employees who meet the limits," according to the study, conducted by policy analysts from the University of California, Berkeley, the benefits consultant Watson Wyatt Worldwide and the National Opinion Research Center at the University of Chicago.

Congress is also considering annual limits on out-of-pocket medical costs. The House seems to think $5,000 is as much as somebody should pay in medical bills, while the Senate has picked a figure closer to $6,000.

Under the Senate proposal, the new limits would not apply to self-insured employers — big companies that provide their own insurance and have enough employees to effectively spread the risk of paying any large claims.

Congress is also considering other minimum standards for insurance, like setting a baseline level of coverage for plans.

Still unclear is whether any of the new standards — the lifetime caps, the out-of-pocket maximums, the minimum coverage standards — would apply to employer-based policies.

Because most big companies already offer plans that would meet the minimum standards being set, their workers would probably be unaffected by the new rules in any case.

But it is a different story for small businesses. Much of the legislation is aimed at making it easier for them to provide affordable coverage by trying to make changes to the insurance market.

Wider choice of plans
People working for small businesses — an estimated 40 percent of the private labor force — could see their coverage affected. And if their employer decided to use one of the new insurance exchanges, workers might have a much broader choice of plans than they do now.

The premiums a small-business employee are charged could also change, especially if that company's work force is particularly young and healthy. Those people could wind up paying more, Mr. Ginsburg said, because the legislation tries to spread the risk of covering employees with expensive medical conditions by setting new rules over how insurers can determine premiums.

The real unknown, of course, is whether any final legislation will accelerate the rise in premiums or slow it. At least one impartial analysis, by the nonpartisan Congressional Budget Office, concluded that the legislation was not going to have much of an effect on the cost of premiums either way.

There are plenty of doomsayers who argue that the cost of expanding coverage to millions of people, many of whom will need help to pay their premiums, is going to be borne by everyone else. But there are others, including Mr. Obama, who argue that the legislation will make health insurance more affordable than it would be otherwise. "If we don't pass it," he recently said during a television interview, "here's the guarantee — your premiums will go up, your employers are going to load up more costs on you."

This story, "As Health Bill Advances, Few Changes Seen for Millions," first appeared in The New York Times.

Copyright © 2009 The New York Times

Health Care Reform attempts from the past

Here's a timeline at the attempts of health care reform in the past.

Senate passes historic health care legislation

Unusual Christmas Eve vote symbolic in ongoing debate

updated 9:14 a.m. ET, Thurs., Dec . 24, 2009

WASHINGTON – Senate Democrats passed a landmark health care bill in a clinic Christmas Eve vote that could define President Barack Obama's legacy and usher in near-universal medical coverage for the first time in the country's history.

The 60-39 vote on a cold winter morning capped months of arduous negotiations and 24 days of floor debate. It also followed a succession of failures by past congresses to get to this point. Vice President Joe Biden presided as 58 Democrats and two independents voted "yes." Republicans unanimously voted "no."

The tally far exceeded the simple majority required for passage. The Senate's bill must still be merged with legislation passed by the House before Obama could sign a final bill in the new year. There are significant differences between the two measures but Democrats say they've come too far now to fail.

Both bills would extend health insurance to more than 30 million Americans.

Speaking not long after the Senate passed the $871 billion bill by a 60-39 vote, Obama welcomed the vote as bringing America "toward the end of a nearly century-long struggle." He said presidents since Theodore Roosevelt in 1912 have been trying unsuccessfully to overhaul medical care.

Standing in the State Room of the White House before leaving on a holiday trip to his home state of Hawaii, Obama said the measure the Senate passed "includes the toughest measures ever taken to hold the insurance industry accountable."

'It's merely the beginning' Vicki Kennedy, the widow of the late Massachusetts Sen. Edward Kennedy, who made health reform his life's work, watched the vote from the gallery. So did Rep. John Dingell, D-Mich., the longest-serving House member and a champion of universal health care his entire career.

"This morning isn't the end of the process, it's merely the beginning. We'll continue to build on this success to improve our health system even more," Majority Leader Harry Reid, D-Nev., said before the vote. "But that process cannot begin unless we start today ... there may not be a next time."

At a news conference a few moments later, Reid said the vote "brings us one step closer to making Ted Kennedy's dream a reality."

The Nevadan said that "every step of this long process has been an enormous undertaking."

Sen. Max Baucus, D-Mont., chairman of the Finance Committee, said he "very happy to see people getting health care they could not get."

It was the Senate's first Christmas Eve vote since 1895, when the matter at hand was a military affairs bill concerning employment of former Confederate officers, according to the Senate Historical Office.

The House passed its own measure in November. The White House and Congress have now come further toward the goal of a comprehensive overhaul of the nation's health care system than any of their predecessors.

The legislation would ban the insurance industry from denying benefits or charging higher premiums on the basis of pre-existing medical conditions. The Congressional Budget Office predicts the bill will reduce deficits by $130 billion over the next 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals and others who treat Medicare patients.

For the first time, the government would require nearly every American to carry insurance, and subsidies would be provided to help low-income people to do so. Employers would be induced to cover their employees through a combination of tax credits and penalties. The legislation costs nearly $1 trillion over 10 years and is paid for by a combination of taxes, fees and cuts to Medicare.

Republicans were withering in their criticism of what they deemed a budget-busting government takeover. If the measure were worthwhile, contended Minority Leader Mitch McConnell, R-Ky., "they wouldn't be rushing it through Congress on Christmas Eve."

House Minority Leader John Boehner assailed the bill moments after passage.

"Not even Ebenezer Scrooge himself could devise a scheme as cruel and greedy as Democrats' government takeover of health care," the Ohio Republican said in a statement.

"Senator Reid's health care bill increases premiums for families and small businesses, raises taxes during a recession, cuts seniors' Medicare benefits, adds to our skyrocketing debt, and puts bureaucrats in charge of decisions that should be made by patients and doctors," he said. "The bill also authorizes taxpayer-funded abortions, violating long-standing federal policy. It's no coincidence that the more the American people learn about this monstrosity, the more they oppose it.

The occasion was moving for many who'd followed Kennedy, who died in August.

"He's having a merry Christmas in Heaven," Sen. Paul Kirk, D-Mass., appointed to fill Kennedy's seat, told reporters after the tally.

Kirk said he was "humbled to be here with the honor of casting essentially his vote."

Said Dingell: "This is for me, this is for my dad, this is for the country."

Reid nailed the last votes down in a rush of dealmaking in the last week that is now coming under attack because of special provisions obtained by a number of senators. In Nebraska, home to conservative Democrat Ben Nelson, the Democrats' crucial 60th vote, the federal government will pay 100 percent of the cost of a planned Medicaid expansion in perpetuity, the only state getting that deal.

Negotiations between the House and Senate to reconcile differences between the two bills are expected to begin as soon as next week. The House bill has stricter limits on abortion than the Senate, and unlike the House, the Senate measure omits a government-run insurance option, which liberals favored to apply pressure on private insurers but Democratic moderates opposed as an unwarranted federal intrusion. Obama has signaled he will sign a bill even if it lacks that provision.

Copyright 2009 The Associated Press. All rights reserved.

Christmas Greetings

I hope this finds my readers having a wonderful Christmas season.

Local 771's Election Results

Local 771 Officers for 2010

Helen Hanson, President

Alpha One

Joseph Berry, Vice President, Delegate

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Ted Rippy, Secretary, Delegate

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Patricia Crowell, Treasurer, Alternate

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Carol Cammack, Delegate

Home Care for Maine

Dave Levasseur, Delegate

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Janet (Dixie) Lewis, Delegate

Home Care for Maine

Sherrie Rippy, Delegate

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Juanita Burtt, Alternate

Home Care for Maine

Roxann Gargac, Alternate

Home Care for Maine

Kyle Hofman, Alternate

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Welcome to all 771's officers, delegates and alternates.

Playing Hard to Get: Maine's Senators Suddenly Back in Play on HCR?

Brian Beutler | December 2, 2009, 9:55AM

What a difference a week makes. After casting votes to kill the Senate health care bill, Sens. Olympia Snowe (R-ME) and Susan Collins (R-ME) are meeting with high-level White House officials as Democrats try to reach sixty votes.

When Harry Reid announced that his health care bill would include a public option, but that Washington would allow individual states to opt out, it left him basically no wiggle room. He lost the cautious support of Snowe and suddenly needed to run the table in his caucus.

In the hours and days afterward, it became clear that a clean sweep would be difficult, if not impossible. Days before Thanksgiving recess, leaders began negotiating with conservative Democratic hold outs on a possible compromise, modeled on Snowe's trigger plan. And if you wanted some evidence that, on balance, the discussions are currently favoring the centrists, Tuesday offered a pretty clear picture of that.

Snowe in particular continues to speak of health care reform as a project she's a part of. Yesterday, defying her party's own talking points, she told The Hill that a new CBO report, regarding the impact of the Senate legislation on insurance premiums, is encouraging news for reformers.

The CBO report, she says, indicates that the legislation "makes strides, without question" toward extending affordable coverage. On this score she sees room for improvement: "We have to be sure that we are providing the most affordable plans to Americans, and that's not abundantly clear at this point," she said. "That's what's of concern to me."

But it's not just her. Susan Collins, Snowe's Maine colleague, told reporters yesterday that she's been meeting with Nancy-Ann DeParle, Director of the White House Office of Health Reform, and DeParle's deputy Jeanne Lambrew.

Those negotiations are ongoing, and Collins is a tougher sell than Snowe, but for the first time in weeks Collins suggested she may be in play.

"I made very clear that I could not support the bill as it's currently drafted, and that there would have to be substantial changes, but I certainly hope that that will be possible," Collins told reporters. "I think there is unease on both sides of the aisle about specific provisions in this bill, and that it's possible that we can come up with alternatives that will garner bipartisan support."

Collins says she's "not a fan," of the latest public option compromise being discussed. Still, one Democratic aide said Collins' vote might even be more gettable than some of the recalcitrant conservative Democrats.

As always in Congress, the situation is very fluid. Momentum shifts directions very suddenly. But the very fact that so much focus is being placed on these two women should be writing on the wall to public option supporters.

from talkingpointsmemo.com

Senate Bill Maintains Direct-Care Worker Provisions

Posted on01 December 2009

Matt Ozga - PHInational.org

Following months of intense negotiations and extensive input from stakeholders, Senate Majority Leader Harry Reid (D, NV) and other Democratic leaders presented the blended Senate health insurance reform bill on November 18.

The new legislation, the Patient Protection and Affordable Care Act, would extend coverage to 94 percent of Americans.

PHI’s side-by-side chart (pdf) provides an update of the new Senate bill and compares the House and Senate provisions.

Some of the most significant provisions of the bill include a public insurance option that gives states the choice to opt out, an excise tax on high-cost insurance plans offered by employers, and a Medicare payroll tax on people with high-incomes (individuals with annual incomes above $200,000 and couples above $250,000).

There are also many provisions — some related to health coverage, others to long-term care services — that could have significant impact on direct-care workers. The major changes since the Senate Finance and HELP committees released their proposals this summer include:

• Expansion of mandatory Medicaid coverage to include all non-elderly Americans with income below 133 percent of the federal poverty level (FPL), which is $24,352 for a family of three. (While affordability premium credits for individuals between 150 and 400 percent FPL have been scaled back, out-of-pocket spending has been capped to protect individuals’ level of cost sharing at each income tier.) With median annual wages of $17,000, many direct-care workers would gain affordable comprehensive coverage through Medicaid.
• Inclusion of the CLASS Act — a new, voluntary, public long-term care insurance program to purchase community-living assistance services and support for individuals with functional limitations.
• Advancing the establishment of core training competencies for personal care attendants through three-year demonstrations in six states.

Preliminary Congressional Budget Office (CBO) estimates of the blended bill project a cost of $848 billion, a figure that would reduce the federal deficit by about $130 billion over the next 10 years.

The next step is floor consideration, where the entire Senate will debate and vote on the bill. Debate began earlier this week.

Delays in CBO analyses have led to increasing speculation that work on health reform could continue into the beginning of next year.