State covering children with health insurance. Remedy in action at one
agency, others lag
Jacqueline Rabe Thomas, CT MIRROR
January 12, 2012
Connecticut's child welfare agency spends $16.4 million a year on
mental and behavioral health services, a sum that translates to about
$30,000 for each child.
The problem, says the Department of Children and Families, is that one
of every five children has private health insurance that is not
covering what their doctors say is needed, leaving the state to pick up
the tab.
That's about to change, and other agencies, including the state's
largest health care provider, are being pushed to follow suit.
In an attempt to save money and force insurance companies to cover
their clients, DCF is hiring an expert to appeal insurance company
denials. Right now, the agency depends on families to be savvy enough
to navigate their way through the complicated insurance appeals process.
"Dealing with insurance companies can be pretty challenging for
someone," said Elizabeth K. Graham, a deputy DCF commissioner.
"A lot of time insurance companies are denying claims and are banking
on the fact that families won't fight back against the red tape," said
Joan Alker, a leader of Georgetown University's Center for Children and
Families, which studies national health care trends.
On any given day, 650 children are receiving mental and behavioral
services through DCF. This administration and previous DCF leadership
have eyed reducing the costs of this program.
"Insurance companies are denying care knowing [the client] can get the
state to pay the expenses they should be paying," said Victoria Veltri,
the state's health care watchdog at the Office of the Healthcare
Advocate. Veltri's office is hiring the insurance appeals expert. "We
know how to shepherd the appeal through the process. It makes sense to
send these cases over to us and let us do the work."
Last year, she said, her 11-person office got almost 4,000 denied
claims reversed for families, a 75 percent success rate.
Before this year, DCF didn't investigate why a child's health insurance
denied coverage for these mental and behavioral services, and didn't
take the steps to appeal the decisions.
"We were not fully taking advantage of their health insurance... We
need to make certain we connect the dots," Graham said.
Veltri and other child advocates say this appeals process also needs to
take place at the state Department of Social Services, the lead health
care agency in the state.
"The step they don't do is appeal. I suspect there's a lot of money for
the state to recover from third party insurance," said Veltri about
DSS, which provides health care to more than 500,000 children and
adults through Medicaid.
DSS reports that 11 percent of those receiving benefits have private
health insurance.
"The practices and procedures are really all over the place," said
Mickey Kramer, the state's associate child advocate. "We throw money at
something, and we don't know if we've looked everywhere else first."
David Dearborn, a DSS spokesman, wrote in an email that the agency does
not appeal. He said the contractor that DSS uses to handle claims "will
re-bill the private insurance company" when someone is applying for DSS
services but does not go through the whole appeals process if they
again deny coverage.
The re-billing recoups approximately $24 million a year of the more
than $4.6 billion DSS spends on Medicaid.
The Department of Developmental Services does not appeal insurance
denials either. DDS provides services for 15,600 adults with mental and
behavioral illness.
"DDS has no roll in their private insurance," said Joan Barnish, a
spokeswoman for DDS. "We would not appeal the insurance decision. Our
agency does not handle that."
Graham said DCF officials will not need legislative approval to move
this initiative forward, and it already has the blessing of the Malloy
administration to spend the money for this new position.
"It's going to be worth our while," she said, noting this new position
will more than pay for itself.
The state's largest health insurers -- Anthem, Aetna and ConnectiCare
-- declined to comment.
The attorney general's office is investigating whether insurance
companies are denying services that should be covered.
Dearborn said Thursday that DSS is waiting for the results of the
attorney general office's investigation for guidance on how to tackle
the issue.
Alker said she is unaware of any other state taking similar steps to
appeal insurance denials, a statement echoed by leading national
advocacy groups Families USA and Community Catalyst.
Veltri and Graham said shifting how these services are paid for will
not delay or interrupt any services for the children.
Not the final word...
Administration gives states leeway on health rules
The Washington Times
By Paige Winfield Cunningham
Friday, December 16, 2011
Announcing a preliminary guideline on the benefits insurers must offer
under the new health care law, the Obama administration surprised some
health care advocates on Friday by remaining vague on details, choosing
instead to let states largely set their own benchmarks.
Expectations had been that the Department of Health and Human Services
(HHS) would release a list of specific benefits insurers must cover,
but the agency said it’s leaving that up to states, allowing them to
select an existing plan on which to base the essential benefits.
“The proposal reflects our commitment to giving states the flexibility
they need as they set up their state-based exchanges,” said HHS
Secretary Kathleen Sebelius. “Coverage that works in Florida may not
work in Nebraska.”
Insurance plans must offer minimum coverage beginning in 2014, when
health exchanges are supposed to be up and running in each state under
the Affordable Care Act. Industry stakeholders have been anxiously
awaiting a determination by HHS of which benefits will be deemed
essential, but officials told reporters on Friday that states can
expect to play a significant role in the process.
Outlining a basic structure for how states should go about determining
essential benefits in the individual and small-group markets, they said
states can choose a benchmark plan from among the three largest small
group, state employee or federal employee plans, or use the largest HMO
plan offered in the state’s commercial market.
The benefits and services covered by the benchmark plan would become
the essential benefits package.
While plans in all states must cover 10 different categories of care
mandated in the Affordable Care Act—like prescription drugs, maternity
care and preventative services—they could modify coverage within a
benefit category as long as they don’t reduce the value.
The Friday announcement came in advance of a final regulation HHS
officials say they will release in the near future.
Patent advocacy groups were skeptical of the approach, expressing fear
that it could undermine patient protection by leaving too much up to
the states. Carl Schmid, deputy executive director for the AIDS
Institute, called the announcement “clever,” but said it leaves a lot
to be defined.
“It’s not what we expected,” Mr. Schmid said. “We were looking for more
federal determination, a statement of benefits, and that’s kind of what
we thought the law required them to do.”
HHS officials also refrained from discussing how the essential benefits
would impact what patients pay for deductibles, co-pays and
co-insurance, or the actuarial value of plans, saying they’ll weigh in
on cost-sharing in the near future.
An independent panel advising HHS on essential benefits highlighted the
issue of cost in October, telling the agency it should take cost into
consideration when determining essential benefits. The recommendation
ventured into potentially explosive territory by raising the question
of whether the government should base health coverage for millions of
patients on how much services cost.
Where HHS lands on that question is the key concern for a group of
major trade organizations advocating for affordable and flexible
essential benefits. Neil Trautwein, chairman of the Essential Health
Benefits Coalition and vice president at the National Retail
Federation, said “the devil is in the details.”
“HHS should continue to work to develop a rule that balances
state-selected and reasonably comprehensive benefits with affordability
for employers and individuals,” Mr. Troutwein said. “A final rule that
does otherwise will make health coverage more expensive for employers
and individuals to purchase and make jobs more difficult for employers
to create.”
AP Newsbreak: Conn. budget chief
wants health care pooling plan delayed; questions about cost
THE REPUBLIC.COM (Columbus, Indiana)
SUSAN HAIGH Associated Press
First Posted: December 12, 2011 - 5:55 pm
Last Updated: December 12, 2011 - 8:02 pm
HARTFORD, Conn. — Gov. Dannel P. Malloy's budget director on Monday
said he has serious concerns about opening up the state of
Connecticut's health insurance plan next month to municipal workers and
wants the initiative delayed until the state's risks can be examined
further.
In a letter obtained by The Associated Press, Benjamin Barnes said he's
worried the state could face financial exposure if only small groups of
city and town workers are pooled into the self-insured, state employee
and retiree health insurance system.
"In particular, I am concerned that the plan will not be able to
accommodate most municipal employees because of collective bargaining
agreements in place," said Barnes, the secretary of the Office of
Policy of Management, in the letter to Comptroller Kevin Lembo. He said
if union contracts prevent many municipal workers from immediately
switching over to the state's plan, the groups that do agree to
participate could have older, sicker employees with high utilization
rates, possibly driving up the state's costs.
Barnes told the AP that while he sees health care pooling "as a very
viable way to cut costs," he wants the state's health care actuary to
analyze the program further to determine how many municipal employees
can be expected to participate, what their health insurance utilization
rates would be and how much risk the state's insurance plan could
expect. He said it could take years to get a large enrollment.
Earlier this year, the General Assembly passed legislation requiring
Lembo to offer coverage to municipalities. At the time, state officials
estimated that nearly 578,000 municipal employees, retirees and their
dependents could join the state plan, which currently covers about more
than 202,000 state employees, retirees and dependents. The legislation,
a key issue for House Speaker Chris Donovan, D-Meriden, currently a
candidate in the 5th congressional district race, also called for
allowing more than 174,342 employees of nonprofit agencies to join the
state plan beginning 2013.
Barnes says he still supports the concept.
Donovan and other advocates maintain that by grouping more people
together, the state can help drive down health care costs and make sure
more people are insured.
The legislation required Lembo to open up the plan to municipalities in
January. However, Barnes said OPM and the State Employees Bargaining
Agent Coalition, which represents unionized state employee on health
and benefits matters, have to first sign off on the proposal before any
municipal workers could join. Barnes said in his letter OPM "will not
be able to support it absent significant changes and more rigorous
evaluation."
Barnes said he understands that additional analysis will delay the
opening of the program beyond January. But he said, "I am sure we can
all agree that protection of the state's resources is critical. This is
especially true now given the fiscal challenges that we all face."
A message was left seeking comment with Lembo.
During the legislative debate in June, some Republican lawmakers voiced
concern about opening up the state's health insurance plan to other
groups. State Sen. Leonard Suzio, R-Meriden, said he worried the move
could drive up claims and eventually drive up premiums paid by state
employees and costs for taxpayers.
Barnes said expects the additional review could delay opening the
program until late winter or early spring, unless the actuary
determines the state will be facing large financial risks.
If that happens, Barnes said, "we'll just have to go back to the
drawing board and figure out how to adjust that."
Health Law Puts
Focus on Limits of Federal Power
NYTIMES
By ADAM LIPTAK
November 13, 2011
WASHINGTON — If the federal government can require people to purchase
health insurance, what else can it force them to do? More to the point,
what can’t the government compel citizens to do?
Those questions have been the toughest ones for the Obama
administration’s lawyers to answer in court appearances around the
country over the past six months. And they are likely to emerge again
if, as expected, the Supreme Court, as early as Monday, agrees to be
the final arbiter of the challenge to President Obama’s signature
health care initiative.
The case focuses on whether Congress overstepped its constitutional
authority in enacting parts of the law. Lower courts have reached
divergent conclusions. Even judges in lower courts who ultimately
voted to uphold the law have homed in on the question of the limits of
government power, at times flummoxing Justice Department lawyers.
“Let’s go right to what is your most difficult problem,” Judge Laurence
H. Silberman, who later voted to uphold the law, told a lawyer at an
argument in September before the United States Court of Appeals for the
District of Columbia Circuit. “What limiting principle do you
articulate?” If Congress may require people to purchase health
insurance, he asked, what else can it force them to buy? Where do you
draw the line?
Would it be unconstitutional, he asked, to require people to buy
broccoli?
“No,” said the lawyer, Beth S. Brinkmann. “It depends.”
Could people making more than $500,000 be required to buy cars from
General Motors to keep it in business?
“I would have to know much more about the empirical findings,” she
replied.
Judge Brett M. Kavanaugh, who ended up in dissent, then jumped in. “How
about mandatory retirement accounts replacing Social Security?” he
asked.
“It would depend,” Ms. Brinkmann replied.
Ms. Brinkmann was cut off before she could elaborate on her answers. In
other settings, she and other administration lawyers have described
what they see as the constitutional limits to government power, though
not typically using concrete examples. They have said, for
instance,
that laws authorized by the Constitution’s commerce clause must be
economic in nature, must concern interstate commerce and must address
national problems.
They have also said that the health care market is unique. And they
have suggested that questions about constitutional limits can miss the
point. The only question actually before the courts, they said, is
whether the particular law under review was within Congress’s
authority. Other cases, they said, can be decided as they arise. But
there is reason to think that at least some Supreme Court justices will
want to hear what a ruling in favor of the health care law implies and
what precedent it sets.
In 1995, when the court struck down a federal law that prohibited
people from carrying firearms in school zones, Chief Justice William H.
Rehnquist wrote that “we pause to consider the implications of the
government’s arguments” in defending the law — that stopping activities
that could lead to violent crime relates to interstate commerce because
it affects “national productivity.”
Under that reasoning, Chief Justice Rehnquist wrote, “It is difficult
to perceive any limitation on federal power,” adding that “if we were
to accept the government’s arguments, we are hard pressed to posit any
activity by an individual that Congress is without power to regulate.”
Chief Justice Rehnquist died in 2005, but three of the justices who
joined his majority opinion — Justices Antonin Scalia, Anthony M.
Kennedy and Clarence Thomas — are still on the court. The
concerns
expressed by Chief Justice Rehnquist amount to what lawyers call the
slippery slope. Many judges are reluctant to issue rulings without some
sense of what their consequences will be in other cases. But
defenders
of the health care law say that such concerns are not a reason to doubt
its validity.
“Slippery slope arguments are themselves often slippery,” Walter
Dellinger, who was acting solicitor general in the administration of
President Bill Clinton, told the Senate Judiciary Committee in
February. He gave an example. “If it is within the scope of regulating
commerce to set a minimum wage,” he said, “one might argue, then
Congress could set the minimum wage at $5,000 an hour.” But that would
never happen, he said, for practical, political and legal reasons.
When a divided three-judge panel of the United States Court of Appeals
for the 11th Circuit, based in Atlanta, struck down in August the
mandate that individuals purchase and maintain health insurance from
private companies, slippery slopes were very much on the minds of the
judges in the majority.
“The government’s position amounts to an argument that the mere fact of
an individual’s existence substantially affects interstate commerce,
and therefore Congress may regulate them at every point of their life,”
Chief Judge Joel F. Dubina and Judge Frank M. Hull wrote.
On Tuesday, on the other hand, a three-judge panel of the District of
Columbia Circuit upheld the law. Judge Silberman, who had grilled Ms.
Brinkmann so aggressively, wrote the majority opinion, and his
discussion of the limits of Congressional power may have handed the
administration a bigger victory than it wanted, because it presumably
did not want to win on the grounds that Congress could do anything at
all. Judge Silberman said he remained troubled by what he called
“the
government’s failure to advance any clear doctrinal principles limiting
Congressional mandates that any American purchase any product or
service in interstate commerce.”
Then he adopted a version of Mr. Dellinger’s argument.
“That a direct requirement for most Americans to purchase any product
or services seems an intrusive exercise of legislative power,” Judge
Silberman wrote, “surely explains why Congress has not used this
authority before — but that seems to us a political judgment rather
than a recognition of constitutional limitations.”
Judge Silberman said there were Supreme Court decisions on issues like
regulating the use of medical marijuana that had endorsed broad
Congressional power to legislate in the name of commerce.
“It certainly is an encroachment on individual liberty,” he wrote of
the health care law, “but it is no more so than a command that
restaurants or hotels are obliged to serve all customers regardless of
race, that gravely ill individuals cannot use a substance their doctors
described as the only effective palliative for excruciating pain, or
that a farmer cannot grow enough wheat to support his own family.”
In dissent, Judge Kavanaugh praised the majority for its honesty in
describing what followed from its ruling.
“The majority opinion here is quite candid — and accurate,” he wrote,
adding: “The majority opinion’s holding means, for example, that a law
replacing Social Security with a system of mandatory private retirement
accounts would be constitutional. So would a law mandating that parents
purchase private college savings accounts.”
Within hours of the decision on Tuesday, opponents of the health care
law were issuing statements, and their theme was predictable. “Like the
government,” said Randy E. Barnett, a law professor at Georgetown, “the
majority could identify no limit to an unprecedented power of Congress.”
Slashing doc pay
NYPOST
By SCOTT GOTTLIEB
Last Updated: 12:18 AM, October 25, 2011
Posted: 11:04 PM, October 24, 2011
A key government panel voted this month to whack what Medicare pays
most doctors to treat patients. It’s an important step on the path to
ObamaCare -- because the only way to make European-style health
entitlements work in America is to pay US doctors lower European wages.
This is going to hurt doctors -- and hit patients even harder, as
American physicians scale down their medical practices to adapt to the
lower pay rates.
The vote by the Medicare Payment Advisory Commission involves slashing
what the program for older Americans pays medical specialists -- then
freezing these lower rates for years.
Everyone except primary-care docs would see payments for their services
cut by 5.9 percent a year for three years (totalling a 16.7 percent cut
in income), followed by a seven-year freeze at the reduced levels.
Primary-care providers would have their reimbursement rates frozen at
today’s pay levels for the whole decade. All this is part of a larger
effort to save Medicare upward of $300 billion over 10 years.
This is no hollow threat: ObamaCare set up an agency called the
Independent Payment Advisory Committee to fast-track these kinds of
proposals into law by sidestepping Congress.
We doctors have mostly ourselves to blame for this mess. Hoping to
preserve some organized power for MDs, groups like the American Medical
Association made two Faustian bargains with Washington on behalf of
physician members.
The first evolved in the late 1990s. In a deal to cut the deficit, the
Clinton administration joined with a Republican Congress to cap total
payments to doctors and implemented a system of price controls for
their services. The AMA signed on to the scheme in part because
Washington agreed to leave it to an AMA-run process to decide how the
shrinking pie of money Washington spent would be carved up between
different medical specialties.
The second Faustian deal was ObamaCare. Doctors’ Washington lobbyists
overlooked the fact that ObamaCare would inevitably pay something close
to (far below market) Medicaid rates for medical services. Nor did they
fathom how much would need to be cut from physicians to pay for the
plan’s costly mandates.
American doctors do earn much more than their European counterparts --
if US salaries aren’t adjusted for the different wealth of nations.
Some of the best data on these pay differences appear in the September
issue of the journal Health Affairs, in a study done by one of the
administration’s assistant health secretaries before she took her
government job.
Annual pre-tax income (net of practice expenses) for primary-care
doctors was $95,000 in France in 2008, compared to $186,000 in the
United States. For specialists, the disparities were wider -- with
orthopedic surgeons averaging $154,000 in France and $208,000 in Canada
compared to $442,000 in America.
The differences reflect lower rates for individual services. In France,
for one, private insurance pays doctors about a third of what US
physicians earn for office visits -- $34 in France vs. $133 in America
for a primary-care doctor. Even public programs like Medicare pay twice
what similar French programs offer.
In a view echoed around the Obama administration, the analysis
concludes that these bigger salaries “were the main drivers of higher
US spending” on health care.
To bring European healthcare to America, these price differences always
had to be sanded away. The only way ObamaCare is going to bring our
health benefits and spending to European levels is to also adapt
European payment rates.
As a result, US doctors will adjust their business models in ways that
won’t be good for patients. Some with busy practices in big cities will
opt out of the government insurance systems entirely, and go cash-only.
Others will retire early.
But most doctors won’t have these opportunities available to them. So
they’ll need to make up in volume what they lose in margin for their
individual medical services.
This will mostly mean hiring more nonphysician providers such as nurse
practitioners to see most patients. Doctors will become managers of
large clinical staffs, leaving more direct care to less-expensive
providers.
Patients will lose access to physicians -- and spend more time waiting
in busier offices.
As for doctors, there’s still some good news. With baby boomers aging,
physicians will have plenty of business coming through their office
doors. Of course, under ObamaCare, they aren’t going to get paid much
for seeing most of these patients.
Scott Gottlieb, a physician and
American Enterprise Institute resident fellow, was a senior official at
the Centers from Medicare and Medicaid Services.
OP-ED | Exchange CEO Must Be Independent And Credible
CT NEWSJUNKIE
by Ellen Andrews | Jan 16, 2012 8:41pm
Wanted: Chief Operating Officer for the Connecticut Insurance Exchange
Board, with responsibility for executing the strategic mission of the
board established under federal health care reform and charged with
creating a fair, competitive marketplace for consumers who will be
required to buy health insurance by 2014.
The question for stakeholders, as we find our way in what is new health
care policy territory, what kind of experience should this CEO have?
With a board already dominated by insurance industry interests, it only
makes sense that this executive should understand the needs of
consumers.
For months, since the makeup of the Exchange Board was announced, the
governor and legislative leaders who made the appointments have been
under criticism for including three members whose sole work experience
was in the health insurance industry, and not one consumer advocate.
The membership is particularly troubling given the strong conflict of
interest language that was included in the state law establishing the
exchange last spring.
Connecticut’s insurance industry has long had a powerful influence over
public policy to benefit their bottom line, leaving consumers
unprotected. Created under national health reform, state insurance
exchanges are meant to counter this advantage. It is estimated that one
in ten state residents will purchase their coverage through the
exchange – a lucrative new business opportunity for insurance companies.
The CEO will have a critically important position, that will include
setting the standards health plans will have to meet to participate in
the exchange, how much they can charge, what benefits they will have to
offer, and holding them accountable to the consumers and small
businesses who pay the bills.
This is a new concept for our state government, which is not used to
holding insurers accountable. Unfortunately, the Board members’ biases
show in the CEO job description. First in the list of qualifying
experience is 5 years or more experience in health insurance. That’s
not what we need.
Some argue it is important to know the insurance industry to
effectively hold it accountable. But input from the insurance industry
in setting public policy has never been lacking in Connecticut. If the
insurance industry had succeeded in providing decent, affordable
coverage, we wouldn’t need reform.
Indeed, the very notion of putting an insurance industry person in
charge of implementing a health care reform panel seems to guarantee
that consumers won’t be heard. Would we have put the former CEO
of CL&P in charge of the panel that evaluated response to the
hurricane and snow storm that battered Connecticut last year?
There are plenty of smart, talented people in our state, with a deep
understanding of the challenges facing consumers and small businesses,
eminently qualified to run the exchange, who have never worked in the
insurance industry.
The Insurance Exchange Board needs a CEO with consumer experience, a
leader they will trust. As a consumer advocate, I talk with uninsured
and underinsured people every day. One uninsured woman I spoke with
recently who works out at my gym highlighted the most important
challenge facing the exchange – building public trust.
The health insurance she’s had “never covered anything I needed” and
“wasn’t worth it.” She listened politely when I described the promise
of the new insurance exchange, skeptical that it would be useful to
her. But when told the exchange Board is run by former insurance
executives, she said “Of course it is.”
To be successful the exchange CEO doesn’t need to understand insurance.
He or she needs to understand the woman at my gym.
Ellen Andrews is the executive
director of the CT Health Policy Project
Health insurance exchange board searching
for CEO, quickly
CT MIRROR
Arielle Levin Becker
Oct. 11, 2011
Wanted: Educated, experienced senior-level manager to develop and run a
key piece of health care reform. Must pass muster with the governor
and, preferably, be willing to start work early next year.
Those are the basic qualifications to become the first chief executive
officer of the state's health insurance exchange, a marketplace for
individuals and small businesses to buy health insurance that will
launch by 2014. Legislation this year established the exchange as a
quasi-public agency.
The job is expected to be posted in the next couple days, seeking
candidates with advanced degrees and at least five years of
senior-level management experience. The board that oversees the
exchange will be charged with narrowing down the candidates, first
through a smaller committee of board members that will conduct two
rounds of interviews, and then the full board, which will hold the
final interviews and recommend three candidates to Gov. Dannel P.
Malloy. Malloy will then select the CEO.
The schedule for picking the CEO is expected to be tight. A timeline
for the search process calls for having the interviews in December and
a CEO in place in February.
During a special meeting of the exchange board Tuesday, state
Healthcare Advocate Victoria Veltri, who co-chairs the search
committee, praised the work done so far to identify the qualities
needed in a CEO. "The fact is, and I think it's really important to
stress this, that I believe this description will get us to somebody
who's not only extremely well qualified from an insurance standpoint in
understanding insurance processes, but it also is consumer-driven," she
said.
Office of Policy and Management Secretary Benjamin Barnes, the search
committee co-chair, said he shared Veltri's optimism about the process,
but warned that recruiting someone as critical as the exchange CEO is
an uncertain process that might not produce options the board likes in
the time allotted. If the search doesn't attract what members considers
to be the right kind of applicants, Barnes said, he and other search
committee members might come before the full board and ask for a change
in direction.
Wyman Says: SustiNet is dead… Dead I tell
you… DEAD!
What Wait
Jonathan Pelto
September 14, 2011
Think Charles Dickens’ The Christmas Carol;
“Marley was dead: to begin with. There is no doubt whatever about that.
The register of his burial was signed by the clergyman, the clerk, the
undertaker, and the chief mourner…You will therefore permit me to
repeat, emphatically, that Marley was as dead as a door-nail…This must
be distinctly understood…”
When Governor Malloy’s new Health Care Cabinet met earlier this week,
Lt. Gov. Nancy Wyman, who had helped to lead the SustiNet effort and
was once one of its greatest champions, took great pains to ensure that
no one – no one – thought that SustiNet was anything but dead.
Wyman proclaimed that “SustiNets not around anymore, there is no
SustiNet.”
In fact, Wyman and State Comptroller Kevin Lembo, who served as
Connecticut’s Health Care Advocate at the time, were the co-chairs of
the SustiNet Health Partnership Board of Directors that created
SustiNet.
Their board worked for more than a year and a half developing what was
recognized as a profound step forward in the battle to provide greater
access to affordable, high quality health care in Connecticut.
When the SustiNet Plan was finalized last December, Lembo said that
“this report provides the General Assembly with a roadmap for reform –
and propels Connecticut to the forefront in addressing a nationwide
health care and financial crisis.”
This extraordinary victory did not come easily. The legislation
creating the SustiNet Board of Directors and laying out the process for
developing Connecticut’s healthcare reform plan was vetoed by Gov. M.
Jodi Rell in 2009. The Democratic Legislature took the
unprecedented action of overriding that veto and setting in to motion
the steps that would eventual lead to the SustiNet plan. Last
December, on the day the SustiNet Board was adopting its final report,
a rally was held in Hartford.
Dan Malloy, then the Governor-Elect, spoke at the rally. As he
did during his campaign for Governor he credited his mother for his
lasting commitment to universal health care. Speaking to the
crowd, Malloy said that “it was through her eyes and her advocacy that
I think much of my commitment to making sure that all of our neighbors
have access to quality health care really arouse.”
Surrounded by health care reform proponents and religious leaders,
Malloy pointed out that SustiNet represented Connecticut’s move toward
universal health care. The Governor to be added “I’m not sure
we’re at the top of the mountain, where we see the promise land but we
know the promise land exists or at least a substantial portion of that
which is necessary to provide the promise land is just around the
corner,”
Speaker of the House Chris Donovan, another leading voice in the battle
for SustiNet also spoke at the rally calling it “an impressive sight”
and pointing out how much had changed over the last few years.
Pointing to the next governor, the next lieutenant governor and all the
clergy and said “I remember a couple years ago when the clergy wanted
to meet with the governor and the governor then refused,”
Now, 10 months later, SustiNet is dead….
Dead as a doornail.
At this week’s Health Care Cabinet Meeting, Dan Malloy’s special
advisor on health reform, Jeannette DeJesús worked to put all
that in the past saying “There’s a lot of new things happening that we
need to consider, there are lots of new opportunities, and there are
lots of people who want to play that have not participated in the past.
Our goal is to really be inclusive at every turn.”
New things, new opportunities, lots of people who want to play a role?
But despite the thousands of hours spent developing the SustiNet plan,
there was no discussion about what elements of the old plan were so
terrible that the SustiNet plan needed to be trashed. Was it the
effort to leverage Connecticut’s tremendous buying power to lower
healthcare premiums for people whose healthcare is funded by
taxpayers? Was it the effort to create a system in which
municipalities, non-profit organizations and small businesses could buy
healthcare at a lower cost? Was it the focus on lowering costs
for everyone by making greater use of electronic medical records,
preventative treatment initiatives or promoting cutting edge care in
patient homes?
Or was it the creation of a “public option”, which was scheduled to
begin in 2014 and would have provided health care insurance for the
tens of thousands of Connecticut’s uninsured residents- an option that
would have be financed by premium payments and federal tax credits and
would not have required significant state subsidies.
Everyone in the room knew, but few would say, that part of the problem
was that the SustiNet plan had gotten caught up in the recent
Malloy/SEBAC agreement when, as a result of poor communication by both
the state unions and the Malloy Administration, opponents of the
concession deal interpreted the proposed health care changes as part of
a secret plan to use SustiNet to undermine the state employee’s
health care plan.
But of course, that problem could have easily been resolved.
What could not be easily resolved was the strong opposition from
Connecticut’s health care industry. And since that opposition was
very real and politically significant, the Governor’s new Health Care
Cabinet did what it had to do and simply skipped over the true reason
SustiNet was killed. In the end the real problem was that here,
in what was once the “Insurance Capital of the World”, if the SustiNet
System worked as it was designed to do then health care premiums would
drop and if health care premiums dropped, insurance company profits
might drop as well.
In a year when Dan Malloy gave Cigna Insurance company almost $50
million in public funds to “move” its corporate headquarters back to
Connecticut and create at least 250 jobs, whacking the insurance
industry’s bottom line was hardly the message some wanted to
send. And equally important was the fact that SustiNet would
allow a variety of entities to buy their health insurance through one
of the state’s pools or plans. Many chambers of commerce,
especially the Connecticut Business and Industry Association, make
their money by selling insurance to their members.
Giving small businesses another option for getting insurance, even if
it mean cheaper insurance for businesses and their employees would have
had a devastating impact on the ability of business groups to fund
their activities. So yes, SustiNet is Dead. It was killed
by some of the very people who helped create it in the first place.
Timeline
from the NYTIMES on how the Health Care Law is faring in the courts...
Health Law Is Dealt Blow by a Court on Mandate
NYTIMES
By MICHAEL COOPER
August 12, 2011
The provision in President Obama’s health care law requiring Americans
to buy health insurance or face tax penalties was ruled
unconstitutional on Friday by the United States Court of Appeals for
the 11th Circuit, in Atlanta.
It was the first appellate review to find the provision
unconstitutional — a previous federal appeals court upheld the law —
and some lawyers said that the decision made it more likely that the
fate of the health care law would ultimately be decided by the Supreme
Court.
The court found that Congress exceeded its powers to regulate commerce
when it decided to require people to buy health insurance, a provision
of the health care law known as the “individual mandate.” But the court
held that while that provision was unconstitutional, the rest of the
wide-ranging law could stand.
A 2-to-1 majority ruled that the mandate was beyond Congress’s power
under the Commerce Clause of the Constitution, writing that “what
Congress cannot do under the Commerce Clause is mandate that
individuals enter into contracts with private insurance companies for
the purchase of an expensive product from the time they are born until
the time they die.”
The 11th Circuit case may have been the most closely watched of the
health law cases wending their ways through the courts, in part because
its plaintiffs included Republican governors and attorneys general from
26 states. But it was just the second of at least three appellate
reviews. The Obama administration prevailed in the first round in June,
when the individual mandate was found to be constitutional by the
United States Court of Appeals for the Sixth Circuit, in Cincinnati.
The next opinion is expected shortly from the Fourth Circuit in
Richmond, Va.
Supporters and opponents of the law, known as the Affordable Care Act,
expect that the Supreme Court will eventually decide the issue. Some
lawyers said the fact that the Atlanta court created a conflict among
courts of appeals made it more likely that the Supreme Court would hear
the case as early as its next term, which starts in October.
The health care law — passed in 2010 after more than a year of
wrangling, and frequently criticized by Republican presidential
candidates and members of Congress — is intended to insure 32 million
Americans by mandating that most people obtain health insurance,
subsidizing policies for the poor and requiring insurers to accept
people with pre-existing health problems.
Supporters of those provisions, which take effect in 2014, argue that
without the insurance mandate, which brings more people into the
insurance pool, it is unreasonable to require insurers to cover all
applicants regardless of their health status.
The Cincinnati court ruled that the mandate was constitutional. The
Atlanta court disagreed, in a majority opinion written by Chief Judge
Joel F. Dubina, who was appointed by the first President George Bush,
and Judge Frank M. Hull, who was named by President Bill Clinton. Judge
Stanley Marcus, another Clinton appointee, wrote a dissent.
The majority opinion said, “This economic mandate represents a wholly
novel and potentially unbounded assertion of Congressional authority:
the ability to compel Americans to purchase an expensive health
insurance product they have elected not to buy, and to make them
re-purchase that insurance product every month for their entire lives.”
Their opinion overturned the part of a lower court ruling that would
have thrown out the entire health care law: they ruled that while the
individual mandate was unconstitutional, the rest of the law could
stand.
The White House and the Department of Justice said they were confident
that the law was constitutional.
Kevin Sack contributed reporting.
Greenwich (above):
A good place to spend time if you have to be in a hospital.
Hospitals facing a double hit
from Hartford, Washington
Deirdre Shesgreen and Arielle Levin Becker, CT MIRROR
April 25, 2011
WASHINGTON--Frank A. Corvino, the CEO of Greenwich Hospital, is still
reeling from the fiscal punch from Hartford, in the form of a proposed
new tax on hospitals across Connecticut. Now, he's girding for a second
hit from Washington, where federal Medicare officials are fine-tuning a
cut to hospital reimbursement rates.
The two blows, Corvino and other hospital executives say, would ripple
across the health care system and take a toll on the quality of care.
"The combination of these two... is going to have a devastating effect
on patient care in the state," Corvino said. "It's going to pierce the
safety net that hospitals provide for their patients."
Even before Gov. Dannel P. Malloy unveiled a budget plan that included
a new levy on hospitals, Connecticut institutions were focused on a
federal proposal to pare back Medicare payments. The Connecticut
Hospital Association and others have lobbyied against the measure,
drafted by the federal Centers for Medicare and Medicaid (CMS).
But they appear to have lost that battle, at least the first round.
Last week, CMS released a proposal to slice nearly $500 million from
its Medicare payments to hospitals across the country. The Connecticut
Hospital Association said it will file a formal protest against the
rule in June. And it's still subject to public comment, and possibly
revision. But hospitals failed in their efforts to soften a similar cut
imposed at the start of this fiscal year.
CMS officials have said the reduced reimbursements are an effort to
make up for overpayments to hospitals, in Connecticut and around the
country, in previous years. Prior to 2008, hospitals were paid the same
amount for treating an otherwise healthy patient with pneumonia, for
example, as they were for a pneumonia patient who had other
complications.
Since then, CMS has instituted a more sophisticated system, allowing
for more varied levels of diagnosis-and more nuanced payment rates. But
before that went into effect, CMS officials say, some hospitals "bumped
up" patients' diagnoses to a more severe category than was necessary,
resulting in overpayments. Hospitals have adamantly denied that charge
and pressed CMS to abandon the cuts, or at least temper them.
But starting last fall, CMS began recouping half of the alleged
overpayments through an initial Medicare payment cut. And this week,
CMS issued a fresh proposal to gain back the second half, through $498
million in additional Medicare cuts to 3,400 acute care hospitals
around the country.
Kim Hostetler, vice president for administration and communication at
the Connecticut Hospital Association, said CHA is still examining the
proposal to see how it will impact Connecticut's 30 acute care
facilities. She said they're seeking clarification from CMS on some
elements of the cut.
"But it's safe to say that Connecticut will be harder hit than the
national average," she said, adding that Connecticut hospitals are
already only reimbursed 93 cents for every dollar spent caring for
Medicare patients.
The reduction, combined with a lower-than-usual boost for inflation
from CMS, will result in an "unprecedented" cut, she said. "This really
is a double whammy for Connecticut hospitals."
For Greenwich Hospital, Medicare patients make up about 30 to 40
percent of the patient population, so any reduction in reimbursements
will be hard felt, Corvino said. But he knew they were coming and was
prepared to absorb the trim one way or another.
Not so for the budget proposal approved by the Appropriations and
Finance, Revenue and Bonding committees in Hartford this week. That
budget deal would eliminate $83.3 million in state aid that helps
hospitals cover the cost of caring for people who are uninsured or
underinsured; it also levies a new tax on hospitals.
"If it was just the Medicare cuts, we could probably live... with a
couple of million dollars [in lower revenue] here or there," Corvino
said. "But when you up that on top of this devastating budget, the
hospitals are really going to be hard pressed to provide the same level
of service that their currently providing."
By taxing hospitals, the state can capture federal matching funds for
its own coffers-and then redistribute the tax revenue back to the
hospitals. But to get the federal money, the state can't simply give
each hospital back what it paid. Instead, some hospitals have to get
more back than they paid, and some have to get less. The amount
returned is based on each hospital's volume of Medicaid patients and
uncompensated care.
Malloy's original proposal called for raising $266.6 million from
hospitals and returning the same amount to them, with the state keeping
the $133.3 million in federal funds it brings in. The final plan,
agreed to by two legislative committees last week, would raise $349
million from hospitals and give them $399 million. It includes
additional funding for five hospitals in higher-cost areas - Stamford,
Greenwich, New Milford, Danbury and Norwalk hospitals.
Overall, the plan gives hospitals $50 million more than they pay. But
hospital officials say they end up worse off, once the $83.3 million
cut is factored in. Between the tax and the cut, 20 hospitals would
lose money, while eight would make money, according to calculations by
the Connecticut Hospital Association.
"From our perspective, this is still pretty painful," the CHA's
Hostetler said.
The biggest blow would be dealt to Greenwich Hospital, which would lose
$9.6 million from the tax and the cut.
"It will take a small operating gain that we had last year and plunge
that into a significant deficit in the coming year," Corvino said,
adding that it could put the hospital $7 million to $8 million in the
red.
Other hospitals will see a benefit-or no effect at all--from the
proposed tax. St. Vincent's Medical Center in Bridgeport would gain the
most - $3.6 million. Two hospitals--UConn's John Dempsey Hospital and
Connecticut Children's Medical Center--would not be subject to the tax.
Hostetler said hospitals losing money from the budget will "be back to
doing the kinds of things they've had to do in the past." That could
mean curbing services, she said, "but more often, it's delayed
investments in equipment, or in technology, in staff."
That could be particularly difficult for hospitals that need to make
significant capital investments, such as in electronic medical records.
"It's a scary thing when you're not quite sure what your revenue stream
is going to be, particularly when Medicare reimbursement numbers are up
in the air too," Hostetler said.
With the tax and cut going forward, the hospital association has been
trying to get legislators and the Malloy administration to make other
changes that could help hospitals. They include:
Creating a $35 million fund to help hospitals losing
the most from the budget
Writing the tax law to raise a set amount from
hospitals, rather
than taxing them at a rate that could translate to more money if
hospital revenues - the basis for the tax - increase
Making the tax temporary
Revising the hospital payment system by 2014
But Ben Barnes, secretary of the Office of Policy and Management, the
governor's budget office, said he wasn't impressed by the proposals.
"I did not find that to be a compelling package," he said.
Barnes noted that the tax was restructured to leave the hospitals with
more money overall. The tax on health care providers--including nursing
homes and intermediate care facilities for the mentally
retarded--provides an "enormous" net benefit to the state in addressing
the budget deficit, he said, and the sacrifices hospitals will make are
reasonable.
"I think they've overplayed their hand," he said. "I think the tax
proposal that we have is pretty moderate."
Long-Term
Budgeting, Obama-Style
The health-care law’s hidden features
James C. Capretta, National
Review
March 7, 2011 4:00 A.M.
President Obama’s 2012 budget has rightly been lambasted as completely
detached from fiscal and economic reality. Even under the budget’s own
rosy assumptions, the country would accumulate $7.2 trillion in
deficits over the coming decade. Under more realistic assumptions, it’s
a plan for trillion-dollar deficits every year, with no end in sight.
By 2021, government debt would likely approach $21 trillion under this
budget, up from $5.8 trillion at the end of 2008.
This might lead one to think there is no Democratic plan for closing
the fiscal gap. But actually, the president and his allies do have a
plan of sorts. They just don’t want voters to know what it is. Indeed,
it is their hope that they can get their plan adopted by stealth — and
that voters never fully realize that the government has adopted it.
To Democrats, the solution to our budget problem has two components.
First, massive and steady tax hikes, not just over the next few years
but every year for the next quarter century to match the explosion in
entitlement costs. Second, they want stiff government cost controls on
the entire health sector, not just on public insurance programs.
For years, the only thing that stood in the way of Democrats’ securing
these changes were unenlightened and intransigent Republicans. But when
Democrats secured once-in-a-generation majorities in the 111th
Congress, Republicans were no longer in a position to stand in their
way. So Democrats took the opportunity not only to pass Obamacare — the
largest entitlement expansion in two generations — but also to try to
reshape the long-term budget picture according to their big-government
vision.
On taxes, the Democrats were more aggressive than most realize. The
Congressional Budget Office (CBO) says the total tax hike over the next
ten years will exceed $800 billion — a significant sum. But that’s
really just the beginning of it. The authors of Obamacare were looking
for a “game-changer” that went beyond a near-term tax hike. What they
really wanted was a perpetual cash machine for the government,
something that would generate ever-increasing amounts of revenue over
the coming decades without forcing Democratic politicians to cast any
further votes in support of higher taxation.
Their solution: Go back to 1970s-style bracket creep. One of the key
economic reforms of the Reagan years was to put an end to the automatic
tax hikes that used to occur every year as inflation pushed households
into higher tax brackets. The Reagan tax cut permanently indexed those
brackets to inflation, thus forcing politicians to get their tax hikes
the old-fashioned way — by voting for them.
But the Obamacare tax hikes associated with Medicare — 0.9 percent on
wages and 3.8 percent on non-wage income — were sold as hitting only
individuals with incomes exceeding $200,000 and couples with incomes
above $250,000 annually. But those income thresholds are fixed. They
will be the same in 2030 as they are in 2013, when they kick in.
Consequently, as the years go by, more and more Americans will find
themselves paying much higher federal taxes for Medicare — even though
they are decidedly not the “rich” people the president said he was
targeting.
Similarly, the so-called “Cadillac” tax on insurance plans — sold as a
way to hold down costs in the most expensive arrangements — will
quickly become a tax that nearly everyone in America pays. In 2018,
when the tax goes into effect (conveniently after President Obama has
exited the scene), insurers and employers offering plans with premiums
exceeding $27,500 for family coverage will pay the tax. But in 2019 and
beyond, that threshold will not grow with medical inflation. Instead,
it will increase only with economy-wide consumer prices, generally a
few percentage points below the inflation trend in the health sector.
As the years go by, therefore, virtually all health-insurance plans
will start bumping up against the “high-cost” tax threshold. Last year,
the average cost of family coverage was about $13,700. If premiums rise
6 percent per year and consumers inflation just 3 percent, the average
plan will exceed the “high cost” threshold by 2026.
By 2020, the total tax hike associated with Obamacare will already be
bad enough — about 0.5 percent of GDP. But by 2035, because of bracket
creep, it will have more than doubled — to 1.2 percent of GDP,
according to CBO. And it won’t stop there. It will keep going up every
year, in perpetuity.
The second part of the Democrats’ long-term budget plan is the
imposition of a global budget on the U.S. health sector. For years,
Democrats have wanted to give the government the power to set prices in
the health sector, and not just for public insurance programs, but for
private-sector health care, too. In 1994, President Clinton explicitly
sought such authority as part of his health-care push, which was one
key reason his effort failed.
President Obama wants to achieve the same objective, but once again has
chosen to pursue it in a way that is less perceptible to voters.
Obamacare established what’s known as the Independent Payment Advisory
Board, or IPAB, supposedly to find cost “efficiencies” in Medicare. In
truth, the IPAB’s mandate is to enforce what amounts to a cap on
overall Medicare spending. The only tool at its disposal to do so is
price setting for suppliers of services and products to Medicare
patients. It will impose arbitrary, across-the-board payment-rate
reductions to hit budget targets, which will have the predictable
result of driving willing suppliers of services out of the marketplace.
As the years go by, if Obamacare is allowed to stand, tens of millions
of American will become enrolled in publicly subsidized coverage. The
costs to the Treasury will be steep — and will lead to calls for
greater cost control. That’s when Democrats will push for the next step
— to extend the IPAB’s authority beyond Medicare to the insurance plans
subsidized by Obamacare. We will nearly be at the bottom of the
slippery slope to a Canadian-style health system.
The Democratic plan for closing the budget gap has always centered on
raising taxes and rationing care. What most people don’t yet realize is
just how far Obamacare has already taken us down that road.
GOP senators force vote on health law repeal
Democrats call measure doomed
The Washington Times
By Sean Lengell
8:17 p.m., Tuesday, February 1, 2011
Senate Republicans have forced a vote on repealing the health
care reform law, an action Democrats say is a waste of time that will
end in defeat. Minority Leader Mitch McConnell, Kentucky
Republican, on Tuesday offered the repeal measure as an amendment to an
aviation safety bill under debate. He said he has the support of all 47
Senate Republicans.
"It's no secret the American people don't like the health bill that
passed last year," Mr. McConnell said. "It's not every day that you can
get a second chance on a big decision after you know all the facts."
The Senate debated the measure late Tuesday and was expected to vote
Wednesday. The repeal effort was made a day after a judge in
Florida ruled that Congress breached the Constitution when it enacted
the measure last year. U.S. District Judge Roger Vinson was the second
jurist to say that Congress exceeded its powers by requiring Americans
to buy insurance, known as the "individual mandate."
But the Florida judge went further, saying that if the individual
mandate is unconstitutional, so is the entire law.
Mr. McConnell said that while the court decision was significant, "we
would have moved ahead in any event."
The Republican-controlled House voted last month to repeal the measure.
Every Republican in the chamber voted in favor of repeal. Senate
Democratic leaders condemned the repeal effort, saying it was
undermining work on passing a vital Federal Aviation Authority (FAA)
bill that would update the nation's antiquated aircraft navigation
system.
"It's not going to go anyplace," Majority Leader Harry Reid, Nevada
Democrat, said of the repeal proposal.
Senate Majority Whip Richard J. Durbin, Illinois Democrat, also
predicted the amendment would lose.
"Eighty percent of the American people oppose repeal of health care
reform," he said, "and yet the Republicans in the House, and now the
Republicans in the Senate, think that this is the single most
important, highest priority thing for them to do.
"What they're doing is bowing to the tea party."
It's unlikely the repeal effort will be successful, but Senate
Republicans also have introduced legislation that would allow states to
opt out of the law's major provisions, including the individual mandate
and the "employer mandate" that penalizes businesses that don't provide
workers with government-approved health insurance.
"Instead of requiring states to follow Obamacare's one-size-fits-all
health care policy, our bill lets states decide what works best for
them," said Sen. John Barrasso, a Wyoming Republican and a medical
doctor who was a sponsor of the effort.
Meanwhile, there was bipartisan support in the Senate for an effort to
eliminate an unpopular part of the health care law; the so called "1099
provision" that calls for businesses to report to the Internal Revenue
Service purchases of $600 or more. After the axing of the entire
health care law, Republicans have made repealing the 1099 provision
among their highest priorities. Democrats agreed that the provision
should be fixed and said they would vote for its repeal.
But Democrats complained that Republicans were playing politics with
the FAA bill, which has been in the works for years, that would convert
the nation's decades-old radar air traffic control system to a modern
satellite-based system already is use throughout Europe and
elsewhere. Revamping the nation's airport navigation system would
significantly improve safety and reduce airline delays, supporters of
the measure say. The measure also calls for an $8 billion investment
for airport planning, improvements and construction.
Senate Democrats have touted the FAA legislation as the year's first
"jobs bill," saying it would create or save almost 300,000
airline-related, construction and other jobs.
"On the Senate floor this week, we're going to pick up where the
president left off in his State of the Union address," said Sen.
Charles E. Schumer, New York Democrat. "The FAA bill is exactly the
type of investment in our future that will propel our country forward,
spur growth, create jobs."
A similar FAA bill passed the Senate last year by a vote of 93-0. That
legislation stalled after the House included union measures in its bill
and the two chambers couldn't reconcile the versions.
© Copyright 2011 The Washington
Times, LLC. Click here for reprint permission.
WOLF: Tawdry details of Obamacare
White House quietly exempts pampered
politicos
By Dr. Milton R. Wolf, The Washington Times
7:21 p.m., Friday, January 28, 2011
If you would like to know what the White House really thinks of
Obamacare, there's an easy way. Look past its press releases. Ignore
its promises. Forget its talking points. Instead, simply witness for
yourself the outrageous way the White House protects its best friends
from Obamacare.
Last year, we learned that the Department of Health and Human Services
(HHS) had granted 111 waivers to protect a lucky few from the onerous
regulations of the new national health care overhaul. That number
quickly and quietly climbed to 222, and last week we learned that the
number of Obamacare privileged escapes has skyrocketed to 733.
Among the fortunate is a who's who list of unions, businesses and even
several cities and four states (Massachusetts, New Jersey, Ohio and
Tennessee) but none of the friends of Barack feature as prominently as
the Service Employees International Union (SEIU).
How can you get your own free pass from Obamacare? Maybe you can just
donate $27 million to President Obama's campaign efforts. That's what
Andy Stern did as president of SEIU in 2008. He has been the most
frequent guest at Mr. Obama's White House.
Backroom deals have become par for the course for proponents of
Obamacare. Senators were greased with special favors, like Nebraska
Democratic Sen. Ben Nelson and his Cornhusker Kickback and Louisiana
Democrat Sen. Mary L. Landrieu and her Louisiana Purchase. Even the
American Medical Association was brought in line under threat of losing
its exclusive and lucrative medical coding contracts with the
government.
Not only are the payoffs an affront to our democracy and an outright
assault on our taxpayers, the timing itself of the latest release makes
a mockery of this administration's transparency promises. More than 500
of the 733 waivers, we now know, were granted in December but kept
conveniently under wraps until the day after the president's State of
the Union address. HHS is no stranger to covering up bad news; in fact,
this is becoming a disturbing pattern. Last year, Secretary Kathleen
Sebelius hid from Congress until after the Obamacare vote a damning
report from the Medicare and Medicaid Office of the Actuary showing
Obamacare would cost $311 billion more than promised and would displace
14 million Americans from their current insurance.
For this administration, transparency promises last only until the
teleprompter is unplugged.
Backroom deals and cover-ups may be business as usual for Washington,
but understanding why the Obama administration protects its friends
from Obamacare offers special insight into what the purveyors of the
mandate themselves think about their own law. This is key: The waivers
aren't meant to protect victims from unintended consequences of
Obamacare; they are meant to exempt them from the very intentional
increased costs of health insurance that the law causes. Under Section
2711 of the Public Health Service Act, Obamacare increases the annual
cap of insurance benefits, which sounds great - as does everything else
in big government - until the bill comes due, in this case, in the form
of higher insurance premiums.
In short, the administration has decided that you will face increased
health insurance premiums, but special friends in the unions will not.
Look closely, and you'll see not only the White House's duplicity but
also what the Obama administration really thinks of its crown jewel,
Obamacare. White House words say that the annual insurance benefit cap
is a feature of the program, but its actions say that it's a bug.
The question remains: If Obamacare is such a great law, why does the
White House keep protecting its best friends from it?
Our democracy cannot allow a president to exercise the unholy power of
picking and choosing winners and losers, of choosing who must follow
his flawed laws and who gets a free pass. If any American deserves a
waiver from Obamacare, then all Americans do.
It was Mr. Obama himself who infamously said, "We're gonna punish our
enemies and we're gonna reward our friends." This president speaks
anything but softly, and Obamacare is his big stick.
It's time to give every American his own waiver: Repeal Obamacare.
Dr. Milton R. Wolf is a board-certified diagnostic radiologist, medical
director and cousin of President Obama. He blogs daily at
miltonwolf.com.
© Copyright 2011 The Washington Times, LLC. Click here for reprint
permission.
Not an ad always - sometimes
on online newspaper?
Insurance industry says
no to repeal of health care reform, but reticent on details
Deirdre Shesgreen, CT MIRROR
January 10, 2011
WASHINGTON--As House Republicans make their first run at the health
care reform law, Democrats say the GOP is doing the bidding of big
insurance.
"Why are they engaged in this effort?" asked Rep. Rosa DeLauro, D-3rd
District. "Because, quite frankly, I believe it's what the insurance
companies want."
It just ain't so, comes the response from Hartford, where insurance
giants such as CIGNA, Aetna, and UnitedHealthcare all have major
corporate offices.
"Our focus remains on implementing the law and the various provisions
that just recently took effect, from extended dependent coverage to
enhance preventive care and tax credits for small businesses," said
Daryl Richard, a spokesman for UnitedHealthcare.
The true role of Connecticut's big insurance firms, and other industry
players across the country, remains to be seen. But there's little
question they have much at stake as this new twist in the debate over
health reform gets underway.
The House proposal to repeal the health care law is almost certain to
pass, but it will likely die in the Senate. (The House vote was
originally set for this week, but it has been delayed in light of the
Arizona shootings that targeted, among others, a Democratic
congresswoman from that state.)
If full repeal fails, Republican opponents have promised a fresh
offensive, going after the law in bits and pieces.
Health insurance interests spent millions of dollars on lobbying in
2009 to help shape the original overhaul. And they've spent millions
more in 2010 trying to influence federal bureaucrats charged with
writing regulations to implement the law.
It's unlikely they will sit on the sidelines now as this new skirmish
gets underway. At least two insurance company CEOs--at Aetna and
CIGNA--have said they don't support overturning the health care law,
even if they're not thrilled with all its particulars.
"I don't think it's in our society's best interest to expend energy in
repealing the law," Cigna CEO David Cordani said at a health care
conference in November, shortly after the elections that swept the GOP
to power in the House and trimmed Democrats' majority in the Senate.
"Our country expended over a year of sweat equity around the formation
of it."
Aetna President Mark Bertolini told that same audience: "We can't go
back. We need to keep moving forward."
Consumer groups say it's no wonder the industry is taking this stance.
"There's a very good reason for that," said Carmen Balber, director of
the Washington office for Consumer Watchdog, a liberal advocacy group
that has been closely tracking health reform.
"They spent over $80 million lobbying on the bill and they got their
two main goals--they killed the possibility of a public option and they
got a mandate included that requires every American to buy their
product," Balber said. "That mandate is a money-maker for the industry."
The requirement that nearly all individuals purchase insurance, which
goes into effect in 2014, could bring some 30 million new customers to
the doors of Aetna and other firms.
"That was something that they adamantly insisted was necessary to make
insurance market reforms actually work," said Rep. Joe Courtney, D-2nd
District.
To be sure, the mandate and the market reforms went hand-in-hand. The
latter include new consumer protections that prevent insurance
companies from denying coverage to patients with pre-existing
conditions, that allow young adults to stay on their parents' policies
until age 26, and that end lifetime caps on insurance coverage.
Among the American electorate, those are among the most popular
elements of the law. The mandate is among the least popular.
"If the public had its way, the most unpopular piece of reform would be
repealed and that's the mandate," said Balber. "But I certainly believe
the industry would pull out all the stops to preserve that provision."
Aetna, United, and CIGNA all declined to answer specific questions
related to heath reform repeal, such as what provisions they might like
to see undone and what they'd like to see saved.
"We will remain compliant with the new health care law, and we will
continue to advocate for a stronger focus on improving quality and
affordability in the health care system," said Aetna spokesman Mohit M.
Ghose.
A CIGNA spokeswoman provided some "talking points" from a recent
presentation by the company's top health reform implementation
executive, Tom Richards The reform teams at Cigna "are busy at
work
and these efforts will only intensify as we ring in the New Year,"
Richards' talking points say.
The insurance industry's lobby group in Washington, America's Health
Insurance Plans, was only a little bit more forthcoming.
Robert Zirkelbach, AHIP's spokesman, said the industry wants to see
changes in the law "in order to minimize coverage disruptions and cost
increases."
"While the new law will bring more people into the system, major
provisions will raise costs and disrupt the coverage people have
today," he said. "We will continue to work with members of Congress
from both parties to address these issues."
The provisions AHIP sees as problematic include, for example, limits on
how much more insurers can charge older patients versus younger
patients and scheduled cuts to Medicare Advantage subsidies, which uses
private insurers to deliver Medicare services.
AHIP and other insurance interests have also opposed strict regulations
allowing review of "unreasonable" rate increases and new rules
requiring insurance companies to spend at least 80 percent of their
customers' premium payments on medical care, as opposed to
administrative expenses or CEO salaries.
Critics say the industry would probably like to see those provisions
undermined, if not nixed entirely.
"The industry won't be publicly for full repeal, but they may be
working behind-the-scenes as hard as they can to weaken enforcement of
some of their least favorite requirements," Balber said, citing the 80
percent requirement as one juicy target for big insurance firms.
Once the full repeal vote is over, House Republicans have vowed to go
after narrow provisions in the law. They've also called for trying to
block funding to enforcement and implementation of the law.
It's unclear just how the insurers will react to these more targeted
strikes. Some industry critics predict they will support any effort to
weaken the measure.
But industry officials say that blocking funding or implementation
could cause chaos and uncertainty.
Bertolini, of Aetna, said such efforts could lead the healthcare
industry to "a bad place." A stalemate with a total funding shutdown
"would be problematic," he said at the November conference.
Ghose declined to elaborate on his boss's remarks.
But another industry source said that defunding implementation of
health reform, while leaving the law in place, is far from ideal. For
starters, health insurers have spent millions of dollars trying to
shape key regulations and then complying with them.
"If we still have to abide by it, but there's no ability for federal
agencies to give us clarity on how to do that, I can't imagine that
being very good for us," said the source, who asked for anonymity to be
more candid. "Either have the law, or get rid of it. Having a big in
between" would not be good.
DeLauro acknowledged the industry's perspective might be more
"complicated" that a full-throated push for repeal. But she said she
still believes the GOP is driven in large part by the industry's
wishes. And she said she thinks that means overturning major
protections for consumers.
Insurance companies "want to make it as difficult as possible to move
forward" with the law, said DeLauro.
Spending Taxpayers' Money to Promote
Obama's Agenda
Buying ads to promote Obamacare on
Google, Yahoo!, and Bing.
Weekly Standard
Jeffrey H. Anderson
January 6, 2011 8:00 AM
As I reported on Monday, the Obama administration is paying taxpayer
money to Google, Yahoo!, and Bing so that, when Americans search for
"Obamacare" (and a whole host of other entries, the first listing that
comes up (or the first listing after "Stories" on Yahoo!) is the
administration's own health care web site, www.healthcare.gov -- which
gushes about the "merits" of the highly unpopular health care "reform."
On Tuesday, I reported that the ad appeared to have been pulled off of
Google, but it turns out, according to an HHS official -- via
Politico's Ben Smith -- that the ad's maximum daily allotment of (your)
money had merely been hit. The paid listing is back up today, and now
appears again on all three search engines (although it doesn't always
come up on all computers, at least for Google), and the administration
apparently has no plans to stop using taxpayer money to promote
Obamacare in this manner any time soon.
This is both shocking (in a general sense) and par for the course (for
this administration). After all, the Obama administration is
brazen enough to use taxpayers' money to run TV commercials to try to
convince seniors that looting money from Medicare and spending it on
Obamacare deserves their support because it will "strengthen" Medicare.
Actually, the ads aren't even as genuine as that; rather, they try to
make it sound like Obamacare is funneling more money into Medicare
instead of siphoning it out.
In truth, according to the Congressional Budget Office, to help finance
more than $2 trillion in new federal spending in its real first decade
(2014 to 2023), Obamacare would cut Medicare spending by almost $1
trillion. About a quarter of those cuts would be to the popular
Medicare Advantage program, and most of the other three-quarters would
be cuts in payments to Medicare providers -- which would plainly
jeopardize Medicare beneficiaries' access to care.
There is a simple principle here that the Obama administration seems
unable to grasp: Don’t spend taxpayers’ money to promote your own
political agenda. Of course, members of this administration generally
prefer not to think in terms of a stark separation between your money
and their money, or between public information ("Medicare enrollment
begins on November 15th") and politicized speech ("Look at these great
new benefits you'll get under the health-reform law!"). A basic
tenet of this administration is that such distinctions are bygones of
another age -- of an age of limited, constitutional government.
Both the TV and search-engine ads might not be legal and are certainly
not justifiable. But, then, this is an administration that empowers
"czars" to skirt the Senate confirmation process; that relies on recess
appointments to further skirt that process; that vests truly massive
amounts of de facto lawmaking power in the hands of unelected
officials; and that picks judges who it believes will also act as de
facto lawmakers. Firm and unquestionable adherence to legal
forms, the separation of powers, and the distinction between public and
private, is not this administration's forte.
House Republicans eye quick repeal of healthcare law
YAHOO
3 January 2011
WASHINGTON (Reuters) – Republicans in the House of Representatives plan
to hold a vote in January to repeal President Barack Obama's healthcare
overhaul and say they have nearly enough support to override a
presidential veto of the repeal, a top lawmaker said on Sunday.
"Unpopularity numbers are as high as 60 percent across the country,"
Fred Upton, the incoming chairman of the House Energy and Commerce
Committee, said of the healthcare law.
"I don't think we're going to be that far off from having the votes to
actually override a veto," Upton said on "Fox News Sunday."
Democrats contend Republicans are wasting Congress' time by staging a
healthcare repeal vote, saying it will die in the Democratic-controlled
Senate.
But Upton said a big House vote for repeal could sway votes in the
Senate "to perhaps do the same thing. But then, after that, we're going
to go after this bill piece by piece," he said, by trying to block
various parts of the law including an individual mandate for insurance
coverage.
"We will look at these individual pieces to see if we can't have the
thing crumble," Upton said.
But Representative Debbie Wasserman Schultz, a Democrat, said on CBS'
"Face the Nation" people are learning more about benefits of the
healthcare law, diminishing chances it will be defeated.
"A constituent in my district came up to me a few weeks ago and thanked
me for saving her $3,000 a year because she could put her two adult
children back on her insurance. That's what the Republicans are going
to be proposing to repeal this week. It's not going to happen," she
said.
"I think you're going to see the fight on Obamacare across the board in
the House and the Senate to try to defund the Obamacare bill and to
start over," Republican Senator Lindsey Graham said on NBC's "Meet the
Press."
Graham said he would work "to allow states to opt out of the individual
mandate, employer mandate and expansion of Medicaid."
Cuomo: Time to play Dr. No
NYPOST
By MICHAEL F. CANNON
Last Updated: 4:21 AM, January 2, 2011
Posted: 10:45 PM, January 1, 2011
Gov. Cuomo enters office this week with the state’s budget in shambles
— thanks in large part to Medicaid.
The economy, the feds and Cuomo’s predecessor have left him an
unexpected current-year deficit of $315 million. The state Division of
the Budget projects that gap will increase to $9 billion next fiscal
year and $17 billion two years hence. Yet the real driving force
behind this fiscal mess is the state’s $48 billion Medicaid program —
the most expensive in the nation.
Medicaid is now “the single largest portion of total state spending,”
accounting for 22% of state budgets, according to the National
Association of State Budget Officers. But the math is particularly
frightening for New York. Medicaid consumes a whopping 28% of Albany’s
budget. Medicaid spending is growing at 14% a year in New York,
compared to 8% nationwide.
When measured on a per-enrollee basis, New York’s Medicaid program is
the second-most expensive in the nation behind Rhode Island, according
to the Kaiser Family Foundation. Medicaid spending even defies
projections. An unanticipated bump in Medicaid spending this year is
what threw the state budget out of balance, and it will continue to add
more than $800 million to future years’ deficits. When you
consider what taxpayers are getting in return for their $48 billion,
things get even uglier.
Medicaid reeks of waste, fraud and abuse. In 2003, one New York dentist
fraudulently billed Medicaid for as many as 991 procedures in a single
day. A former New York City fraud investigator has estimated that fraud
and abuse account for as much as 40% of Medicaid spending in New York —
an amount that dwarfs all future budget gaps combined. ObamaCare
makes this unmanageable program even worse. The health-care bill’s
Medicaid mandate forces states to expand eligibility, to enroll more
people who were already eligible, and gives states less flexibility to
eliminate abuse.
Should Gov. Cuomo fail to comply, New York will lose more than $26
billion in federal funds.
Medicaid’s soaring costs are leading more states than ever to ration
care to patients. Arizona’s GOP governor and legislature voted to nix
organ transplants for certain enrollees. Call it a Republican death
panel. ObamaCare will spur even more government rationing.
Medicaid is bleeding taxpayers and wrecking New York’s health-care
sector. But Gov. Cuomo can’t fix Medicaid by himself. He needs the help
of Congress.
There is a solution: block grants, where Congress gives each state a
lump sum of money and the flexibility to run their Medicaid programs
according to their state’s unique needs. The federal government
currently funds Medicaid by matching each dollar a state spends. So New
York can double its money by spending an additional dollar on Medicaid.
It sounds like a bargain. It’s actually a scam. When every state
uses Medicaid to raid the federal treasury — or more accurately,
taxpayers in other states — you get . . . well, you get the fiscal mess
we’re in nationwide.
Medicaid’s “matching grants” mean that when states eliminate waste,
fraud and abuse, they only get to keep (at most) half the savings. So
they don’t try even half as hard as they should. Matching grants
have turned Albany into a giant health-insurance company with side
interests in education, police and roads.
Block grants will be unpopular with all the usual suspects: state
officials who make their careers on robbing out-of-state taxpayers;
health-care providers who make their careers on an open-ended federal
entitlement; federal bureaucrats; the innumerable Medicaid fraudsters
who bilk taxpayers out of billions every year; and ideologues who see
government-run health care as the highest form of compassion.
Congress should do it anyway.
Block grants are how President Bill Clinton and a Republican Congress
reformed welfare back in 1996, to spectacular success. Welfare reform
forced New York to be smarter about welfare spending, just as a block
grant would force New York to rededicate Medicaid to its original
mission — providing necessary medical care to the truly needy.
There’s one place Gov. Cuomo can start on his own: Close the loopholes
that allow well-to-do New Yorkers to feign poverty on paper so that
Medicaid underwrites their long-term care. Medicaid exists for the
poor, not to help well-off baby boomers protect their
inheritance. Steve Moses of the non-partisan Center for Long-Term
Care Reform recommends that Cuomo take steps to ensure that New Yorkers
with means pay for their own long-term care. These include reducing New
York’s home-equity exemption from $750,000 to $500,000 (and seeking a
federal waiver to reduce it to $0), expanding the use of liens and
estate recovery and ending the abusive practice of “spousal refusal.”
Reducing Medicaid abuse won’t be easy. But Cuomo doesn’t have much
choice. In fact, what he has is an opportunity to become the
leading national spokesperson for block grants, the quickest and
easiest course to relief for states toiling under the unsustainable
yoke of Medicaid spending.
Michael F. Cannon is director of
health policy studies at the Cato Institute and co-author of “Healthy
Competition: What’s Holding Back Health Care and How to Free It.”
The smallest victims of ObamaCare
NYPOST
By MICHELLE MALKIN
Last Updated: 12:21 AM, December 1, 2010
Posted: 11:16 PM, November 30, 2010
For the last two years, President Obama has promised our children
universal health care for all. But the White House entitlement mandates
are a predictable bust. Take it from ObamaCare's own biggest
cheerleaders.
Late last month, the Service Employees International Union informed
dues-paying members of its behemoth 1199 affiliate in New York that it
was dropping its health-care coverage for children. That's right. A
radical leftist union, not an evil Republican corporation, is
abandoning the young 'uns to cut costs. More than 30,000 low-wage
families will be affected, according to The Wall Street Journal.
Who's to blame? SEIU 1199 benefits manager Mitra Behroozi singled out
oppressive new state and federal regulations, including the
much-ballyhooed ObamaCare rule forcing insurers to cover dependents
well into their 20s:
"New federal health-care reform legislation requires plans with
dependent coverage to expand that coverage up to age 26," Behroozi
explained in an Oct. 22 letter to members. "Our limited resources are
already stretched as far as possible, and meeting this new requirement
would be financially impossible."
In a related development, over the last several months several insurers
across California, Colorado, Ohio and Missouri have dropped child-only
plans because of ObamaCare-induced premium increases. Untold tens of
thousands of families will be affected.
This was a wholly man-caused disaster. To manufacture support for
ObamaCare, desperate Democrats pandered to the college set and their
parents. Former SEIU chief Andy Stern touted the kiddie-insurance
mandate, telling The Washington Post early this year that the lobbying
campaign would be "helped by which parts of the bill go into effect
immediately. It's hard to talk about things that'll happen in 2019. But
if you can say to people that if your kid is 26 years old, you can keep
him on your insurance plan? . . . They get that."
Some 20 states had already passed legislation requiring insurers to
cover adult children before the federal rule was imposed. Citing
results in New Jersey, Wisconsin and elsewhere, many critics pointed to
how such top-down benefits mandates were driving up the cost of
insurance and limiting access instead of expanding it. In response, top
SEIU thug Dennis Rivera accused ObamaCare foes of "terrorist tactics."
Now, confronted with the thorny allocation of scarce resources, money
managers at the SEIU are dropping thousands of kids' health coverage
because they, too, can't afford to foot the bill.
The SEIU pumped tens of millions of dollars in union funds directly
into the campaign for ObamaCare. Workers regurgitated White House
talking points hyping increased access, lower premiums and peace of
mind for the working class. SEIU 1199 was at the forefront of those
DC-directed "reform" rallies.
Yes, the union road to hell is paved with workers' own hard-earned dues
money.
How far we've come from President Obama's speech to college students at
George Mason University in March. To wild applause, he pledged: "If you
buy a new plan, there won't be lifetime or restrictive annual limits on
the amount of care you receive from your insurance companies. And by
the way, to all the young people here today, starting this year if you
don't have insurance, all new plans will allow you to stay on your
parents' plan until you are 26 years old."
More than 111 unions (including two SEIU affiliates), companies and
insurers have now secured federal waivers to escape the first provision
Obama mentioned to the George Mason University students. And more
financially strapped union affiliates will undoubtedly be canceling
children's coverage to escape the costs tied to Obama's second vow.
For the kiddie human shields who helped the Democrats dig their own
ditch, reality bites. Live and learn.
Advocate
DCF commissioner
appointment a 'high priority'
Jacqueline Rabe, CT MIRROR
November 22, 2010
For two decades, the state has failed to meet the mandates of a federal
court order to improve the way it cares for children in its custody,
making Gov.-elect Dan Malloy's choice to head the Department of
Children and Families a closely-watched decision.
"He has to get this right," said Martha Stone, one of the lawyers
behind the class-action lawsuit that led to federal oversight of DCF.
"Enough is enough. Let's finally fix this."
"This appointment is a very high-priority,' said Malloy's chief of
staff and transition team leader, Timothy F. Bannon. "Now that the
focus is no longer on filling the [budget director] job, we have
shifted to this."
The latest quarterly report by the court-appointed monitor overseeing
DCF cites both the state's continued lack of foster homes and the lack
of medical and mental health treatment for too many of the 4,000
children in DCF care. Overall, DCF adequately met the needs of children
in just over half the cases reviewed, the report said
"You can't change things overnight, but it shouldn't take 20 years to
fix things... Many children still aren't getting the care they
deserve," said Stone, who still represents plaintiffs in the lawsuit.
Among the problems resulting from the lack of foster homes, she said,
are the 300 children living in out-of-state facilities at any given
time and infants living in large group settings.
"When Malloy chooses who will run DCF, hopefully they will be able to
make progress pretty quickly," she said.
Malloy has said the problems at DCF stem from the lack of leadership
and the state's inability to recruit and retain enough foster care
parents.
"We just about need to change everything we've been doing... We have to
change directions," Malloy said during the campaign after a federal
judge rejected Gov. M. Jodi Rell's request to relieve DCF of federal
supervision. Malloy said he agreed with U.S. District Court Judge
Christopher F. Droney's ruling.
Three Connecticut governors have failed so far to reform the state's
child welfare agency enough to end federal supervision. Now it's up to
Malloy and whomever he appoints as the next commissioner to reshape the
$865 million bureaucracy.
Bannon said they have begun reaching out to potential candidates to
replace current-commissioner Susan Hamilton, who announced the day
before Malloy was elected she would resign at the beginning of the year.
"We have been focused on top-tier appointees who just haven't come out
of the process in the past. They have been unsuccessful," Bannon said.
"We are going to solve the problems at the root of that consent decree."
Stone said the constant turnover of leadership in DCF has been part of
the problem.
"It's a revolving door," Stone said, noting that no DCF commissioner
has lasted more than 3 years since federal oversight began. "We need
real leadership."
The state's child advocate, Jeanne Milstein, is confident Malloy
understands what needs to be done.
"He clearly understand the need for a new leadership team at DCF," she
said.
Malloy faces first test of his relationship with labor
Keith M. Phaneuf, CT MIRROR
November 19, 2010
Gov.-elect Dan Malloy's relationship with the labor unions who helped
him win on Election Day is facing its first test this week as
Connecticut's largest health care workers union called on him to halt a
controversial privatization policy.
New England Health Care Employees Union, District 1199, which has been
balling with Gov. M. Jodi Rell for several years over ongoing
efforts to privatize group homes and other services for clients with
developmental disabilities, rallied in Meriden on Thursday to oppose
planned closures of four more homes.
The Department of Developmental Services, formerly known as the
Department of Mental Retardation, converted 17 group homes to private
control and closed another five over the past two years, according to
union records. The majority of clients in state-run homes that are
closed are transferred to private facilities.
But the latest closures planned by DDS, involving homes in Hamden,
Meriden, Mansfield and Windsor would be phased in between December and
March 1, giving Malloy - who takes office on Jan. 5 - an opportunity to
block the process.
"It's a bottom-line driven decision, and one that hurts the clients and
the workers," District 1199 spokeswoman Deborah Chernoff said Friday.
The closures of these state-run homes disrupt close relationships that
developmentally disabled clients share, both with each and with the
workers who care for them, Chernoff said. "Consistency of routine is
extremely important to allow people to function at their best. ... They
are breaking up their relationships with their caregivers and with each
other."
Both Rell and her predecessor, John G. Rowland, relied increasingly on
the private sector to deliver social services at a greatly reduced
price. This fiscal year's $19.01 billion budget includes about $1.3
billion to fund contracts with private, nonprofit agencies that not
only provide support services for the developmentally disabled, but
also counseling for abused children and the mentally ill, substance
abuse treatment for drug addicts, and job training and other programs
for prison inmates.
DDS released a written statement Friday that said "Throughout the
planning process, careful and thoughtful consideration was given in an
effort to maintain quality of services for our consumers and their
families. Consumers will have the opportunity to move to
alternate residential programs that will meet their identified level of
need. Guardians will be involved in the selection of new
residential services and all phases of transition."
But for nearly a decade the private, nonprofit social service sector
has complained that little or no growth in state funding has left
hundreds of community-based agencies in tough financial straits.
According to both the Connecticut Association of Nonprofits and the
Connecticut Community Providers Association, the state's two largest
parent groups for nonprofits, average social worker pay in the private
sector is roughly half that of comparable state employees, and many
community-based agencies struggle with annual turnover rates of close
to 25 percent.
More than 2,400 developmentally disabled residents are on a state
waiting list for residential placement, including 863 on a "Priority 1"
list. Most clients in that group are disabled adults living at home
whose parents are getting to old to care for them.
Chernoff said District 1199, which represents 20,000 health care
workers statewide - including 8,500 state employees - would reach out
to Malloy's transition team this month.
"We all know what it means when we have fewer state homes," she said.
"There are going to be more people who end up having to go to the
private sector.
House Speaker Christopher G. Donovan, D-Meriden, who attended
Thursday's rally, said he also hopes to speak with Malloy in the next
week or two to discuss ending the trend toward privatization.
The governor-elect, who had criticized some DDS privatization measures
this past spring, said Friday that his transition staff would listen to
concerns raised by unions or legislators, and that "I would not be
doing this (latest closure plan) based on the information I currently
have here."
But Malloy was quick to add that the budget deficit he faces, which was
daunting before the election, hasn't gotten any better since then.
In fact, both the Rell administration and the legislature's Office of
Fiscal Analysis recently worsened their deficit forecasts for the
fiscal year that begins July 1.
The administration estimated the deficit this week at $3.37 billion,
with no shortfall in the current budget.
Legislative analysts see things slightly worse, projecting a $3.67
billion hole next fiscal year and an $83 million deficit for the
current year.
Malloy added that his assessment of privatization proposals would look
at much more than just the dollars involved, noting that many of the
clients served in state-run facilities have the most severe medical
challenges--in some cases, challenges that the private sector doesn't
want to tackle.
"Sometimes these aren't apples-to-apples" comparisons, he said.
Malloy spent much of the final weeks of the campaign rebutting attacks
from his Republican opponent, Tom Foley, that he had made a secret pact
to accommodate labor from spending cuts in exchange for their support.
But Farmington lawyer John F. Droney, a former Democratic state
chairman, said that while he wouldn't predict how Malloy would resolve
this particular privatization dispute, he was confident the
governor-elect would call upon public-sector unions to make fiscal
sacrifices to help close the deficit.
"I think Dan is a problem-solver," Droney said. "I think he is going to
be saying 'no'--a lot."
State deficit an obstacle to health care overhaul
Victoria Colliver, San Fransisco Chronicle Staff Writer
Saturday, November 13, 2010
While California remains committed to moving forward with the federal
health law, Sacramento may prove to be a bigger obstacle to the
overhaul effort than the politics of Washington.
In last week's midterm elections, California voters picked mostly
Democratic leaders supportive of President Obama's health care
overhaul, bucking the anti-health-change trend that helped score gains
for the GOP elsewhere in the country. But the state's budget problems
could prove challenging for the new law.
"For California, the problem is not going to be the United States
Congress. The problem is going to be the California budget," said Peter
Harbage, a Democratic health policy consultant. "A lot of the changes
(in the federal health law) help improve California, but they don't
necessarily help improve the state budget."
California's nonpartisan budget analyst on Wednesday estimated the
state's budget deficit had grown to $25.4 billion, or more than a fifth
of the general fund.
The state's health programs for the poor have been and will continue to
be targeted for cuts. More resources will be needed in the future to
meet the requirements of the new health law.
"The state budget is an issue that affects everything - when you're
working four-day weeks and you're down staff because you have a hiring
freeze, it's hard to work your way through something new," said Alan
Weil, executive director of the nonpartisan National Academy for State
Health Policy. He said the costs may be small in the short run, but
will increase over time.
California has already been at the forefront in implementing the new
law. It became the first state to pass laws to set up a health care
exchange, the centerpiece of the federal legislation. These are the
marketplaces where, beginning in 2014, consumers can go to buy coverage.
The federal government last week granted California a $10 billion
Medicaid waiver, which will allow the state to expand Medi-Cal to cover
people who make too much money or don't meet the other qualifications
for the federal-state program. Expanding Medicaid and funneling
additional funds to safety-net health services is a key element of the
federal health law.
Repeal unlikely
Considering Democrats remain in control of the Senate and the president
has veto authority, Democrats and other observers believe the chances
of Republicans overturning the law to be slim to none.
But if momentum slows in Washington, that could reverberate in
California. And even with the promised influx of federal funds to pay
for the expanded Medicaid health insurance program for the poor and
other elements of the reforms, states still need to have the staff,
programs and resources to make the changes happen.
Daniel Zingale, former health policy adviser to Gov. Arnold
Schwarzenegger and now a senior vice president for the California
Endowment, said California could influence the debate in Washington by
showing the country the law can be implemented successfully.
"I'm a big believer in California not waiting for Washington," Zingale
said. "They're going to continue arguing back there, but we know
California has a history of standing outside Washington infighting and
moving forward. I think this is one of those moments."
States have leeway
States have a fair amount of leeway when it comes to the new law.
Governors and legislatures will influence how and how quickly the
federal law is implemented.
"California certainly is the first to pass enabling legislation to get
started in setting up the exchanges, but a lot of other states will be
dragging their feet," said Grace-Marie Turner, president of the
conservative Galen Institute.
Turner supports giving states more flexibility in how they set up
exchanges and backing away from some of the more unpopular provisions
of the law, such as IRS reporting requirements that small businesses
find onerous.
"There's a big effort right now at damage control," she said. "Let's
just not let any more bad things happen as a result of this
legislation."
Analysts: SustiNet would
cost the state hundreds of millions per year
Arielle Levin Becker, CT MIRROR
April 4, 2011
The proposed
state-run SustiNet health insurance plan could cost the state hundreds
of millions of dollars a year, according to the legislature's
nonpartisan Office of Fiscal Analysis.
The analysis,
released Monday night, offers the first nonpartisan projection of how
SustiNet could affect the state's finances. Although it does not
provide a total dollar figure, the analysis cites a variety of
potential added costs from the proposal, which calls for reorganizing
existing state-funded health plans and selling state-run insurance to
municipalities, small businesses, nonprofits and, eventually, anyone in
the state who wants it.
Previous
assertions about what SustiNet would cost have offered competing
pictures. Supporters have cited estimates that the state could save
more than $224 million a year with SustiNet, although most of the
projected savings were the result of funding from the federal health
reform law and could be achieved with or without SustiNet. Opponents
have argued that SustiNet would likely increase state spending.
According to
the analysis released Monday, the largest new cost to the
state--between $222.8 million and $478.6 million a year--would come
from offering coverage to low-income adults who earn slightly too much
money to qualify for Medicaid.
Consultants to
the board that developed the SustiNet plan projected that covering
those adults would save the state millions of dollars, because the
state would receive federal funding for it. The Office of Fiscal
Analysis, or OFA, projected that the cost of offering coverage would
exceed the federal funds the state would likely receive.
The SustiNet
proposal has passed three legislative committees but must still receive
approval from at least three more. It has drawn passionate support from
many people who want a public insurance option for the state and say
SustiNet will make health coverage more affordable, and passionate
opposition from business groups and insurers who say it is too costly
and sends a bad message to the state's health insurance industry. Gov.
Dannel P. Malloy has said he shares many of the goals of the proposal,
but has expressed concern about several parts of it, including the
potential cost.
"I believe in
the goals of SustiNet," he said Monday at a town-hall meeting in
Norwalk. "I don't believe in the vehicle as it's currently designed."
SustiNet backers late Monday issued statements questioning the OFA
analysis...full
story here.
Malloy administration moving HUSKY out of
managed care
Arielle Levin Becker and Keith M. Phaneuf, CT MIRROR
February 8, 2011
The Malloy administration announced plans Tuesday to move the HUSKY and
Charter Oak health programs out of managed care and increase care
coordination in the state's other Medicaid programs, an effort
officials said would save money while giving the state more control
over health programs that serve more than 500,000 people.
The administration also plans to expand the Money Follows the Person
program, which is aimed at getting seniors and adults with disabilities
out of institutions and enabling them to live at home or in
community-based housing. Under the plan, the program could serve as
many as 5,200 people by 2016--nearly a quarter of the people currently
receiving Medicaid coverage for nursing home care.
Lieutenant Governor Nancy Wyman and budget director Benjamin Barnes
said the changes could save "tens of millions" of dollars a year in the
$4 billion Medicaid program and would best position the state for the
implementation of federal health care reform.
"We will be able to get more funding from the federal government and
deliver a better service and save money for the people in the state,"
Wyman said during a press conference.
The plans delighted patient advocates who have long been critical of
using managed care to administer the HUSKY program, which serves more
than 400,000 mostly low-income children and their parents.
"This is huge, and we could save a lot of money," said Ellen Andrews,
executive director of the Connecticut Health Policy Project and a
member of the Medicaid oversight council. "This has all been tried in
other states. It's working in other states."
In the current system, the state pays three managed care companies set
fees for each HUSKY and Charter Oak member every month, and the
companies use the money to pay medical claims. Critics say it gives the
managed care companies an incentive to deny care since they get to keep
the money not spent on medical costs.
Under the plan announced Tuesday, HUSKY and Charter Oak will be moved
into a self-insured system in which the state, rather than the managed
care companies, pays medical claims. The state would pay one or more
companies, known as administrative service organizations, a smaller fee
to administer the programs.
Barnes noted that the state currently pays managed care companies to
assume the financial risk for medical claims, even though the risk is
not significant because of how large the insurance pool is.
"We're no longer going to pay somebody to take on risk which we think
we can absorb ourselves at no cost," he said.
Coordinating Care
Although the company administering the programs in the new model would
not have a direct financial incentive to contain costs, Barnes said the
state's request for proposals--expected to be issued next month--will
call for significant care management, which would likely save money.
The administration is also looking into providing incentive payments if
the administrative service organization hits savings and patient
wellness targets.
Barnes said the new model will also make the state better able
implement delivery system changes such as medical homes, which are
aimed at better coordinating patient care. The state expects to
aggressively expand the use of medical homes, he said, including
through the primary care case management program.
Care coordination will also apply to two Medicaid-covered groups that
have not had it in the past. More than 60,000 people are covered by a
program for aged, blind and disabled residents, and close to 59,000
people are covered by a new Medicaid program for low-income adults.
Both are now paid for on a fee-for-service basis, and that will not
change. But Barnes said they will gain access to care coordination,
which could include call centers for people to get information on
medical care issues.
This is not the first call to change the way state Medicaid programs
are administered. Former Gov. M. Jodi Rell proposed moving HUSKY out of
managed care in her last budget, and legislators passed a law
authorizing, but not requiring, the state Department of Social Services
to do so. The department has not, and department leaders have raised
concerns about the proposed model.
The Malloy administration does not need legislative approval to move
forward with the changes, Barnes said. The new system is expected to
begin Jan. 1, 2012.
Aetna, one of the three HUSKY managed care companies, issued a
statement expressing interest in the details of the request for
proposals. "Until we see those details, it is difficult to say for
sure, but we would anticipate responding to it. In the meantime, we
remain dedicated to serving the needs of the 105,000 people served by
Aetna Better Health in the HUSKY A & B and Charter Oak programs,"
the statement said.
A second managed care organization, United Healthcare's AmeriChoice,
issued a written statement indicating the company and the state "share
the common goal of ensuring that members continue to have access to
quality health care services and benefits. We are eager to discuss with
the state their proposed changes to the administration of health care
services for the Connecticut Medicaid programs."
Under another change announced Tuesday, children would be presumed
eligible for the HUSKY B program--which covers children whose family
incomes are too high for Medicaid--based on the family's declaration of
income, allowing children to be covered sooner. The federal government
has been promoting the concept, and the state is expected to receive
between $1 million and $4 million in federal bonus funds, which Barnes
said would exceed any potential cost of the change.
More Home Care
The plan to expand alternatives to nursing home care could garner
strong support in the legislature, where increasing numbers of
lawmakers from both parties, as well as Connecticut's business
community, have called for tighter controls on an expense that is
expected to grow dramatically in the coming decades.
A coalition of business and economic development groups issued a report
last March projecting that the state will face nearly $3.4 billion in
increased annual costs for long-term care between now and 2025. But if
the state could have 75 percent of Medicaid long-term care delivered in
non-institutional settings--a dramatic shift--it could knock more than
$900 million of the costs each year, the report projected.
Roughly 40,000 patients received long-term care coverage through
Medicaid last year. Less than half--about 18,700--received care in
nursing homes, but the cost of their care accounted for $1.2 billion,
or 30 percent of the state's overall Medicaid budget.
And the over-65 population of the state is set to jump by 40 percent
over the next decade-and-a-half.
The Malloy administration's goal of moving 5,200 people out of nursing
homes by 2016 likely would push Connecticut's share of long-term care
patients outside of nursing homes beyond the 60 percent mark.
The Connecticut Association of Health Care Facilities, the state's
largest nursing home coalition, pledged to work with the Malloy
administration, but warned against undervaluing the role they play.
"Aggressive rebalancing under these circumstances if not done correctly
may jeopardize quality health care for seniors," said Matthew V.
Barrett, the association's executive vice president. "Certainly a
strong and vibrant nursing home options will remain critically
important in the continuum of long term in the future. We are very much
talking about different level of care needs--home care is intermittent
care, whereas nursing homes provide 24/7 personal and nursing care."
Connecticut should also be fully exploring new federal options to
assist nursing homes, Barrett added, including the so-called "bed
buy-back" programs that provide financial incentives for homes to limit
the supply of beds.
Connecticut's nursing home industry is suing state government, charging
that it has under-funded long-term care in violation of federal
Medicaid standards.
State government hasn't increased general rates for nursing homes since
2007, and the current budget made to changes that cost homes $166
million this fiscal year: the cancellation of a scheduled rate
adjustment and an accounting maneuver designed to push a portion of the
June monthly rate payment into 2011-12.
Barnes said the state is working with the federal government to ease
the transition for the nursing home industry. Wyman spoke of helping
nursing homes become rehabilitation centers, which could help people
move from hospitals to their homes.
AARP State Director Brenda Kelley praised Malloy for expanding Money
Follows the Person, and said the state has lagged behind the rest of
the country on shifting long-term care dollars to non-institutional
care.
"The Governor's announcement today begins to change that," Kelley, a
member of the state's Long-Term Care Advisory Council and the Money
Follows the Person Steering Committee, said in a statement. "His
proposal not only recognizes and reinforces the success of the Money
Follows the Person, but lays out a bold vision that over time will save
the state money, while providing thousands of older residents with what
they want - the ability to live independently in their homes and
communities as they age."
Federal health reform adds a new wrinkle to
mandate debate
Arielle Levin Becker, CT MIRROR
February 7, 2011
Opponents of state mandates on what health insurance plans must
cover have a new argument, and it comes from federal health reform.
Under the law, the federal government will define a set of "essential
benefits" that must be included in health plans sold in the exchange,
the marketplace for private insurance that will open by 2014. States
that mandate benefits beyond what the federal government deems
"essential" will have to pay the cost of covering those benefits if
they are required for plans sold in the exchange.
The federal government has yet to define what essential benefits are,
but the provision has added a new wrinkle to a longstanding debate
about adding services to the list of benefits that state-regulated
health plans must cover.
The Connecticut Insurance Department has urged lawmakers to consider
the potential state cost as they contemplate creating new mandates. "In
simple terms, all mandated coverage beyond the required essential
benefits...will be at the State's expense," said the department in
testimony on a bill that would require insurers to cover breast
ultrasound screenings. The department did not otherwise take a position
on the proposal.
The Connecticut Association of Health Plans also has cited the federal
requirement in testimony opposing bills that would require coverage of
breast ultrasound screenings, breast MRIs, and breast thermography.
"What we've tried to do is tune people into the fact that the analysis
needs to be done under a new paradigm," said Keith Stover, a lobbyist
who represents the association.
But acting state Healthcare Advocate Victoria Veltri said the federal
law should not be used to stop proposed legislation that could benefit
a larger group of consumers.
"The exchange is only one portion of the insurance that's going to be
offered to people in the state of Connecticut," Veltri said. "The vast
majority of people are still going to be enrolled in commercial plans."
It's too soon to know how many people will buy coverage through the
exchange. One estimate, cited in a state application for a federal
exchange planning grant, projected that 120,000 uninsured state
residents would be eligible for federal subsidies to buy coverage in
the exchange. Individuals and small businesses that already buy their
own coverage could also buy insurance through the exchange.
Lawmakers should consider the potential future cost when contemplating
new mandates, Veltri said. But she said the issue should be "framed
accurately," with an acknowledgment that most state residents will
still be enrolled in the commercial market.
State Sen. Joseph J. Crisco, Jr., D-Woodbridge, co-chairman of the
Insurance and Real Estate Committee, said he would prefer to pass
legislation that benefits people now and, if it conflicts with federal
law later on, repeal it or make other changes then.
If legislators avoid requiring insurers to cover benefits because of
changes that will take effect in the future, Crisco said, people will
lose out on protection in the interim. "I can't consciously support
that," he said.
Health benefit mandates are a reliable source of debate each year as
lawmakers consider new services to require in state-regulated insurance
plans.
Crisco, who has proposed several of them, prefers the term "prevention"
to "mandate."
"In the long run, you not only save people's lives, but you reduce
insurance costs," he said.
But opponents say mandated benefits make insurance too costly, hurting
individuals who buy coverage and businesses that want to offer it to
their workers. The mandates apply to about 40 percent of state
residents, typically those who work for smaller businesses or purchase
coverage individually. Larger companies are generally
self-insured--meaning they pay their own medical claims--and those
plans are not subject to state regulations.
Health insurance mandates became a source of controversy during last
year's gubernatorial campaign when Republican nominee Tom Foley
proposed allowing businesses that don't cover workers or spend too much
on health insurance to offer their workers "bare bones" plans that
would be exempt from state benefit mandates. His opponent, now-Gov.
Dannel P. Malloy, criticized Foley for the proposal, and his campaign
ran an advertisement saying Foley's plan would allow insurers to deny
services.
So how much do the mandates add to insurance costs?
The benefit mandates in effect at the start of 2009 account for about
22 percent of the premium costs of group insurance coverage and about
18 percent of premiums for individual coverage, according to a report
prepared for the insurance department by researchers at the University
of Connecticut Center for Public Health and Health Policy.
But the authors noted that the figures likely overstate the cost. Some
of the costliest mandates, including coverage for cancer, diabetes and
mammography, "are considered part of the basic package of essential
benefits covered by health insurance and thus not easily removed," they
wrote.
And many of the benefits the state mandates are covered by self-insured
plans, even though they are not subject to state requirements. A survey
of insurance carriers found that 13 state mandates are covered in 90
percent of self-insured plans, and 26 of the mandates are covered by
three-quarters of self-insured plans, according to the researchers,
although they cautioned that the results were not complete.
The overall cost of mandates amounts to $78.92 per month in group plans
and $48.74 in individual plans, which are subject to fewer mandates.
The costliest mandated benefit, a broad-based requirement for coverage
of cancer, tumors and leukemia, adds an estimated $13.20 to the monthly
per-member premium in group insurance plans. The report said some minor
parts of the mandate could possibly be removed, such as a requirement
that insurers pay up to $300 for a wig after chemotherapy, although the
authors added that it represents a minimal cost within the mandate.
The next most-costly mandates include diagnosis and treatment of mental
conditions, which accounted for $10.20 in monthly premium costs, and
diabetes testing and treatment, costing $5.52. Coverage of newborn
infants added $5.95 per month, and a requirement that health plans
cover the most effective psychotropic drugs added $9, although the
authors said it was likely overstated because insurers reported the
cost of all psychotropic drugs.
The 18 lowest-cost mandates accounted for less than 0.1 percent of the
total medical cost for group plans. In many cases, that's because they
require coverage of services used by very few people, such as
neurological testing for children undergoing chemotherapy--found to add
no cost to group insurance plans--and orthodontic treatment for
children born with cranio-facial disorders, which adds 2 cents to the
monthly cost of group plans. Other mandates require coverage for
services that are more commonly used but which carry relatively little
cost, adding only a small amount to the overall cost of coverage.
A high-profile mandate that took effect in 2009, coverage for autism
spectrum disorder therapies, was projected to add 4 cents to members'
monthly premiums.
Some state mandates will almost certainly be required in all
plans--including self-insured ones--under the health reform law,
according to the study authors, including coverage for newborns ($5.95
a month for group plans). The federal law already requires health plans
not considered "grandfathered" to fully cover preventive care. The
study authors said that would appear to encompass several state
mandates, including screening for blood lead, colorectal cancer
($4.08), prostate cancer (23 cents) and breast cancer ($3.05), as well
as some parts of the state's birth-to-three program.
Stover said the effect of mandates should be taken cumulatively.
Individual mandates might only add a few cents to an insurance rate, he
said. "Then when you look across the field across dozens of mandates,
all of a sudden it's real money."
New federal insurance not luring residents
with pre-existing conditions
Temporary
bridge to health care reform has less to offer in Connecticut than
Charter Oak policy
By Judy Benson Day Staff Writer
Article published Jan 19, 2011
Few Connecticut residents with diabetes, heart disease, asthma and
other chronic conditions have signed up for the new federal insurance
program that became available in August.
This is because the state's Charter Oak Health Plan is more attractive
- less costly and less restrictive - to those seeking insurance.
"Connecticut is in a different position than many other states," said
David Dearborn, spokesman for the state Department of Social Services,
which administers the Charter Oak plan.
Republican lawmakers in Washington this week have launched an attempt
to repeal or seriously undermine the new federal health care law,
prompting the Obama administration to warn that without the new law,
millions with pre-existing medical conditions could lose health
insurance.
Nationwide, more than 8,000 have enrolled in the new program thus far -
just 39 of them in Connecticut - but federal officials expect that
number to grow. Supported by $5 billion in federal subsidies, the
program is offered as a bridge until 2014, when provisions of the
health law would take effect barring insurance companies from denying
or limiting coverage because of a pre-existing condition.
"The new law is already helping to free Americans from the fear that an
insurer will drop, limit or cap their coverage when they need it most,"
Health and Human Services Secretary Kathleen Sebelius said Tuesday.
"And Americans living with pre-existing conditions are being
freed from discrimination in order to get the health coverage they
need."
Charter Oak is for adults of all income levels with pre-existing
conditions. For most enrollees, Charter Oak offers coverage at lower
cost and fewer restrictions, so it's more attractive, Dearborn said.
Charter Oak, which began in 2008, offers coverage for monthly premiums
of $307 per person, regardless of age or income. In addition, the new
federal program is available only to those who have been without
insurance for six months or more, and Charter Oak has no such
restriction. Dearborn said that 125 people who had applied for
the federal program as of last month qualified, but only roughly
one-third elected to enroll.
On Tuesday, Sebelius released an analysis showing that nationwide, up
to 129 million Americans with conditions such as diabetes, asthma,
heart disease, high blood pressure, cancer or arthritis would be at
risk of losing insurance coverage if the new health care law is
repealed. In Connecticut, up to 1.6 million non-elderly residents are
at risk, the study said. It was released to respond to the
Republican-led effort to repeal or dilute the new law.
Yolanda Bowes, supervisor of community outreach services at United
Community & Family Services in Norwich, said staff at the clinic
who work to enroll uninsured patients in insurance programs have signed
no one up for the new federal program. Called access to care
specialists, they also enroll uninsured patients who come to The
William W. Backus Hospital. Charter Oak and other programs such
as Medicaid and Husky B for adults with children are more affordable
options, she said.
"We do tell people about it," she said of the federal plan.
But someone would choose the federal plan, she said, if they prefer its
provider network, which is accepted by more doctors and hospitals than
Charter Oak's.
Lawrence & Memorial Hospital in New London also has staff to help
uninsured patients find plans they can afford. It also has not enrolled
anyone in the new federal program, said L&M spokesman Mike
O'Farrell.
Dearborn, the state social services department spokesman, said there
are other details of the two plans that might lead someone to choose
the federal plan over Charter Oak. The federal plan has no limit on
annual benefits, while Charter Oak's limit is $100,000. It also has
more generous prescription drug coverage, he said.
For information on the pre-existing condition insurance plan in
Connecticut, visit: www.ctpreexistingconditionplan.com.
For information on the Charter Oak Health Plan, visit:
www.charteroakhealthplan.com.
Charting SustiNet's
course after federal
reform
Arielle Levin Becker, CT MIRROR
November 18, 2010
When it was introduced last year, the SustiNet health plan was
envisioned as a way to achieve universal health care coverage for the
state. That was before federal health care reform changed the landscape
for state-level reform efforts, putting Connecticut and the rest of the
country on a path toward near-universal coverage by 2014.
Now the board charged with developing SustiNet is nearing key decisions
that will shape the health plan. The board is slated to make
recommendations in the coming months to the legislature and governor,
who will ultimately determine what SustiNet becomes.
But it remains to be seen exactly what role SustiNet plays, and how
much attention it gets from a legislature and governor negotiating a
budget deficit of between $3.4 billion and $3.7 billion.
SustiNet supporters say the plan can still play a key role in the
state, serving as a public health insurance option that competes with
commercial insurance plans.
Governor-elect Dan Malloy said Thursday that he is awaiting the board's
recommendations about exactly what role SustiNet will play and how it
interacts with federal health reform. But he said SustiNet should have
a role, and noted that he was an early supporter of the original
SustiNet proposal.
"There's nothing more important to the 14 percent of Connecticut's
population currently without health care than access to health care and
access to a job," he said. "I know that it's first and foremost on
their minds and therefore needs to be a high priority for me as
governor."
Juan Figueroa, president of the Universal Health Care Foundation of
Connecticut, which created SustiNet, said Malloy's election was a
positive move for the prospects of state-level health care reform.
"Having said that, look, we're all aware that the first thing that he
has to deal with is the 3-plus-billion-dollar structural deficit, and
as it should be, that's going to be framing everything that gets done
next legislative session," Figueroa said.
But Figueroa and other SustiNet supporters say addressing health care
reform is critical to, not a distraction from, improving the economy.
"The out-of-control spiraling health care costs that small businesses
face is something that's going to have to be dealt with if we expect to
revive our economy and create jobs in those small businesses," Figueroa
said. "They're interrelated."
According to an analysis presented Thursday, nearly any option the
SustiNet board is considering could save the state between $32 million
and $427 million in one year once it is implemented, largely because
the state could capture additional federal money.
"The state budget situation would improve," said Stan Dorn, a senior
fellow at the Urban Institute and a consultant to the SustiNet board
who presented the analysis.
A key premise behind SustiNet is that having a large pool of insured
people will give the health plan leverage to negotiate lower costs and
other changes to the health care delivery system that could ultimately
save money. The board has also worked on developing practices intended
to cut health care spending, including the use of the patient-centered
medical home concept, health information technology such as electronic
medical records, and payment reform.
Dorn's presentation included six options under consideration. The
economic impact of any of them depends largely on how much SustiNet can
affect health care spending, and the analysis looked at each option
under two scenarios: a "pessimistic" version in which SustiNet produces
no change in health care costs, and an "optimistic" one in which
SustiNet slows the annual growth in health care spending by 1 percent.
According to the analysis, each option would cut the number of
uninsured residents in the state by more than half, and all but one
would save the state money.
The potential SustiNet models would likely lead some small employers to
stop offering coverage to their workers, saving the businesses money.
Dorn said most of the workers would instead be covered by SustiNet or
through the health insurance exchange, the marketplace created by
federal health reform for purchasing coverage that will begin in 2014.
Under the federal health reform law, people earning below a certain
income level will receive subsidies to purchase coverage on the
exchange.
The different options vary in how expansive SustiNet would be.
The most basic would be to use SustiNet to cover only those already
covered by state-administered health programs - state employees and
retirees and people in Medicaid, HUSKY and other public health
programs. Under federal health reform, more state residents would
become eligible for Medicaid coverage, so the number of people covered
in this scenario by 2017 would be more than are currently covered.
Three other coverage options add more groups to the SustiNet insurance
pool.
One would expand SustiNet only to low-income adults who are not
eligible for Medicaid, an estimated 56,000 people. For them, it would
be an alternative to buying insurance through the exchange.
Getting coverage through SustiNet would cost those adults less than
purchasing coverage on the exchange, even with the subsidies, Dorn
said. The federal government would pay the costs of covering that
group, saving the state between $47 million and $50 million, he said.
And it would make the SustiNet coverage pool larger, giving it more
leverage.
There are also downsides, Dorn said: Buying insurance through the
exchanges would give people access to more plan options and larger
networks of health care providers than participate in
state-administered programs.
Another option would allow small firms, municipalities and nonprofits
to buy coverage through SustiNet. And a fourth option would allow every
individual and firm in the state to buy into SustiNet. Doing so would
have little effect on savings to the state and for employers, according
to the analysis.
The analysis also looked at two changes to the state's HUSKY health
plan, which covers close to 400,000 children and parents. Health care
providers are paid less to treat HUSKY patients than those with
commercial insurance, leading many health care providers not to accept
HUSKY or to limit the number of HUSKY patients they see.
One option would be to raise the HUSKY payment rates to health
providers to equal what commercial insurers, a 34.5 percent increase.
Because the federal government reimburses the state for a portion of
its Medicaid costs - and the bulk of HUSKY recipients are covered by
Medicaid - the state would not pay the full cost of the additional
spending.
But if SustiNet does not have an impact on health care spending - the
pessimistic scenario - increasing HUSKY rates would ultimately cost the
state money. If SustiNet can slow the growth of health care costs,
raising HUSKY rates would cut into the savings SustiNet achieved, but
still save money overall.
The analysis also looked at expanding HUSKY in 2012 and 2013 to adults
who currently earn slightly too much money to qualify, allowing them to
receive state coverage before federal health reform rolls out. Doing so
would reduce the number of uninsured residents in the state by 59,000,
according to the analysis, but would cost the state between $103
million and $150 million a year. Several board members said the
state must be more aggressive in cutting the growth of health care
spending than the 1 percent projected in the analysis' "optimistic"
scenario.
"We don't have a choice no matter what happens on anything else," said
Ellen Andrews, a board member and executive director of the Connecticut
Health Policy Project. "We have got to reduce spending."
The board will meet in executive session Dec. 2 for what co-chairman
Kevin Lembo called "the embarrassing questions, break the dishes"
session. They are then scheduled to meet in public Dec. 15.
Who will lead state's health care reform?
Arielle Levin Becker, CT MIRROR
November 12, 2010
Grappling with a $3.3 billion budget deficit and a bad economy might
dominate the work of Governor-elect Dan Malloy's administration, but
his staff's to-do list will also include implementing federal health
care reform, a law that gives considerable responsibility--and work--to
the states.
Connecticut is one of many states expected have a change in leadership
in handling the health care law. Twenty-six states are changing
governors, and many, like Connecticut, have a political appointee in
charge of the implementation effort.
The Patient Protection and Affordable Care Act won't be fully rolled
out until 2014, and it could still be revised if Republicans in
Congress get their way. But some provisions require planning now,
including building the health insurance exchange, a marketplace for
purchasing coverage that must be operational by Jan. 1, 2014.
Connecticut's lead in implementing health reform, Cristine Vogel,
serves as a special adviser to Gov. M. Jodi Rell and expects to leave
the job sometime before Malloy takes office. Vogel also heads the
state's Health Care Reform Cabinet, which includes the commissioners of
11 agencies.
The Department of Social Services, which is already facing a surge of
new Medicaid enrollees because of the economy and new eligibility
rules, will need to prepare for a projected 114,000 or more new
Medicaid clients under health reform. The department is certain to get
a new leader: Commissioner Michael Starkowski is already retired and
has been leading the department on a contract basis.
The Connecticut Insurance Department, which will have more
responsibilities as insurers face more data reporting requirements,
also will get new leadership. Commissioner Thomas Sullivan, who came
under fire after approving double-digit rate hikes for some
individual-market health insurance plans, is leaving the job after this
week.
"There's just so much that the new governor will need to focus on, I'm
just hopeful that health care will pop back up on the radar screen,"
Vogel said. "But he does have a lot of work ahead of him."
Malloy's chief of staff-designee Timothy F. Bannon, who is leading the
transition team along with Lieutenant Governor-elect Nancy Wyman, said
there have not been any major decisions made about health reform
implementation efforts yet.
"Right now, it's just one of those things that we're trying to figure
out how to best address," he said.
Vogel said federal officials have acknowledged that many of state
officials working to implement the law across the country are departing.
"They acknowledge that new governors have a learning curve and they
come with their own different policy approach," she said. "The
policymakers down in Washington DC are changing a little bit too. It's
a time of great flux."
In her remaining time in the job, Vogel plans to focus on the health
insurance exchange. The state recently received a planning grant and
Vogel hopes to hire a manager for the grant to move forward with
research on the insurance market and information technology
infrastructure that will help inform the exchange-planning process,
including determining whether a state-run exchange is a viable option.
In addition to making information about health insurance plans
available to the public, the exchange will have a variety of data
collection and reporting functions. It will be responsible for
certifying and rating insurance plans, ensuring that quality and
satisfaction are being measured, reporting to the federal government
and tracking which employers do not offer insurance to their employees.
By 2015, the exchange must be financially self-sustaining. The state
will need legislation to create the exchange.
It's not clear how many people would be required to staff such a
program; a similar effort in Massachusetts, called the Health
Connector, has dozens of employees. States have the option of
outsourcing the functions, teaming with other states to create regional
exchanges, or having the federal government run their exchanges.
The Department of Social Services might also need to add jobs to handle
the influx of applications and inquiries likely as Medicaid eligibility
expands to nearly all state residents with incomes up to 133 percent of
the poverty level in 2014.
Asked what advice she had for her successor, Vogel said she had many
opinions, but that "I advise Governor Rell."
"We in state government typically know where our lines are, and so if
asked by the governor-elect, I would at least share my thoughts and
opinions with him," she said. "But during the transition, it's
important for him to create his vision and his policy and make sure his
administration knows what he believes in."
Judge:
Justice takes 'Alice-in-Wonderland' approach to health care
Challenge of
health law can continue
The Washington Times
Updated: 8:39 a.m. on Friday, October 15, 2010
A federal court judge in Florida ruled Thursday that key portions of a
lawsuit challenging the Obama administration's health care reform law
can go forward, and accused the Justice Department of taking an
'Alice-in-Wonderland' approach to its defense of the controversial
"penalty" for people who don't buy insurance.
Though it's just a preliminary ruling, Senior U.S. District Judge Roger
Vinson's decision to let the case proceed is a victory for opponents of
the law, since it means he will ultimately decide the merits of the
challenge brought by 20 states.
Judge Vinson said the states can challenge the constitutionality of
whether provisions in the law violate state sovereignty through
expansion of the Medicaid program and if Congress exceeded its
authority by forcing people to obtain health insurance or pay a penalty.
Judge Vinson questioned whether lawmakers called the provision a
"penalty" instead of a "tax" simply to avoid political blowback.
"Congress should not be permitted to secure and cast politically
difficult votes on controversial legislation by deliberately calling
something one thing, after which the defenders of that legislation take
an 'Alice-in-Wonderland' tack and argue in court that Congress really
meant something else entirely," wrote Judge Vinson, a 1983 appointee of
President Reagan.
The 20 states argue that the penalty imposed for failing to obtain
health insurance, a provision of the law that goes into effect in 2014,
exceeds Congress' power through the Constitution's Commerce Clause. The
Justice Department, in turn, argued that Congress' authority to impose
the penalty comes from its broader authority to collect taxes.
"This ruling confirms the significance of this lawsuit in protecting
against the federal health care act's intrusions on individual liberty
and limited government," said Florida Attorney General Bill McCollum, a
former congressman who filed the constitutional challenge. He applauded
the judge's decision.
During the legislative debate the Obama administration repeatedly
denied the penalty amounted to a tax, but changed its tune when the
time came to defend the law in the courts. Administration lawyers
concluded the taxing power in the Constitution is broader than the
government's ability to regulate interstate commerce, and therefore
more likely to be upheld as a valid exercise of federal powers.
Judge Vinson did agree with the Obama administration, however, in
dismissing several other challenges, such as the assertion that the law
interferes with the sovereignty of the states on the grounds that they
are large employers. In all, Judge Vinson dismissed four of the six
counts in the case, ensuring a lengthy battle that likely is headed to
the Supreme Court.
Tracy Schmaler, a spokeswoman for the Justice Department, which
represents the administration in the case, acknowledged disappointment
that Judge Vinson did not dismiss the entire case.
UK Cuts Child
Benefit Payments in Austerity Drive
NYTIMES
By THE ASSOCIATED PRESS
October 4, 2010
Filed at 10:20 a.m. ET
LONDON (AP) — Britain will cap payments to jobless families and scrap
child benefits for high earners in a sweeping overhaul of the country's
welfare system, Treasury chief George Osborne said Monday.
Osborne, who is seeking to save about 86 billion pounds ($135 billion)
in government spending over the next five years, said the cost of
welfare payments was out of control — and rewarding some people for
staying out of work.
At an annual rally of his Conservative Party, Osborne said Britain's
coalition government would introduce a new welfare cap to make sure
families in which both parents are unemployed do not receive more in
benefits than an average family earn in wages.
Osborne also announced parents who earn more than 44,000 pounds
($70,000) per year will lose child benefit payments from 2013.
Currently, all families are paid 20 pounds ($32) a week for their
eldest child and about 13 pounds ($20) for other children. The benefits
continue until the children are 19, if they stay in full-time education.
There would be welfare payments "to families who need it — but not more
money than families who go out to work," Osborne told activists at the
rally in Birmingham, central England.
"That is what the British people mean by fair — and we will be the
first Government in history to bring it about," he said.
Since the coalition took office in May, Osborne has already announced a
multibillion pound package of spending reductions and tax hikes,
including a two-year pay freeze for most public sector workers, a new
levy on banks and a rise in a tax on goods and services.
He will set out detailed plans for spending cuts over the next five
years in an address to Parliament on Oct. 20, aiming to all but clear
Britain's deficit by 2015.
Osborne said the government's austerity measures would bring prosperity
in the future. He dismissed plans from the main opposition Labour Party
to cut the deficit at a slower rate, saying that would only prolong the
period of budget restraint.
"The hard economic choices we make are but a means to an end, and that
end is prosperity for all," he said.
On Sunday, about 7,000 labor union members — including teachers and
health service workers — staged a march outside the Conservative
convention, to protest at planned spending cuts. Labor unions plan
further protests to coincide with Osborne's announcement to Parliament.
"Everyone can agree that we need a fairer economy built on higher,
better balanced growth. But the spending and benefit cuts will do the
opposite — pushing many people into poverty, hitting middle income
Britain hard and threatening growth," said Brendan Barber, general
secretary of the Trades Union Congress.
Yvette Cooper, a Labour lawmaker and the party's spokeswoman on work
and pensions, said the government should increase its levy on banks,
rather than cut child benefit payments.
Osborne said the Conservative-led government would prioritize spending
on education and improvements to Britain's infrastructure — including a
new high-speed railway network.
"Britain has no divine right to be one of the richest countries in the
world. As economic power is shifting to the east, there is nothing
automatic about our prosperity," he told the rally. "If our skill base
continues to decline, there will be no growth. If our infrastructure
remains poor, there will be no growth."
You Can’t Keep the
Plan You Have
Obamacare is
coming to a doctor’s office near you.
NATIONAL REVIEW
Marc Siegel, M.D.
October 4, 2010 4:00 A.M.
Last year, I ordered a CT scan of the chest on a 63-year-old patient
whose chest X-ray had revealed a lung nodule. I had no problem getting
the test approved by his private insurance company. The radiologist
suggested that I repeat the CT scan this year to make sure the nodule
hasn’t turned into cancer.
But this year, the same insurance company is denying the test, having
clamped down on several elective services while also raising its
premiums. This company now has to cover children with pre-existing
conditions and can place no lifetime limits on care. It is struggling
to preserve its profits as Obamacare kicks in — profits that, to begin
with, are only approximately 4 percent of its total revenue.
Next year, my patient will have Medicare. He can’t afford a secondary
insurance plan (Medicare Part B covers only 80 percent of most
charges), and he doesn’t qualify for Medicaid as his secondary, so he
was hoping to join a Medicare Advantage plan — a private insurance plan
that seniors can choose to receive, partly at government expense,
instead of Medicare. But in 2011, Medicare Advantage is due to be cut
$140 billion by the new law, and it is doubtful that the plan he wants
will still be available. Harvard Pilgrim, the second-largest insurer in
Massachusetts, has just dropped 22,000 patients from its Medicare
Advantage plan in anticipation of these cuts. Soon seniors everywhere
will have the same problem. In fact, the Medicare actuary estimates
that 7 million out of the 11 million people with Medicare Advantage
will be set adrift over the next seven years.
One of those patients will likely be my fellow with the lung nodule who
needs a follow-up scan.
President Obama clearly hasn’t visited a real doctor’s office recently.
If he sat on my office couch, he would immediately discover that real
patients are terribly worried about how dysfunctional and expensive all
health insurance, public and private, is becoming under the new law of
the land. Of course, the problem of spiraling health-care costs and
inadequate access to essential services was already happening before,
but Obamacare is making it far worse.
My medical office is changing, and not for the better. As I write this,
I have a patient waiting in the next room who has to pay cash to see me
because his employer’s contribution to his plan has dropped this year,
and his deductible has gone up. Many employers are getting ready to
dump their employees on the state exchanges in 2014. They are adopting
plans that won’t “grandfather in” under the draft regulations of the
new law, which mandate low deductibles and low co-pays. I am treating
my patient for high blood pressure, which may be due to his worrying
over his medical bills. My bill is minor compared to the hundreds of
dollars that the laboratory charges him for the routine blood tests his
insurance no longer covers.
Next door to this man is a woman complaining about her premiums, which
are up 20 percent from last year. She wants to add her 23-year-old son,
who has diabetes, to the policy under the new law — but she can’t,
because her son has a full-time job and is supposed to get it from his
employer. But the employer isn’t offering it, and is prepared to
ultimately pay the Obamacare penalty that is supposed to enforce the
“mandate” that he provide insurance.
Under the “consumer protections” that just kicked in, private insurers
are unable to charge co-pays for preventive services including
mammograms, colonoscopies, and vaccines. This sounds good until you
consider that when these services are “free,” demand for them will
increase, and we doctors are ill equipped to handle such a demand
surge. Further, it is unlikely that doctors will receive greater
reimbursements to compensate for the lost co-pays — and so they will
stop providing these services in droves. Your insurance may pay for
your colonoscopy, but you may not be able to find a doctor to perform
it.
And things are only going to get worse. Full-throttle Obamacare, which
comes into effect in 2014, will promote insurance plans that require
little payment from patients out-of-pocket — and thus are easy to
overuse. This will remove the brakes from the system. In my doctor’s
office of the near future, I expect the waiting room to be clogged with
more and more patients even as the government and private insurers
limit the tests and treatments I can offer.
Yesterday I saw a patient who just lost his job. He had no insurance,
and I saw him for a very small fee. He expects to end up on Medicaid
(it will be much easier to qualify under Obamacare), and since I don’t
accept it — and more and more doctors are doing likewise — he will
likely end up getting his care in the ER. But ERs are already
overcrowded, and are not ready to handle more patients.
The president can keep telling Americans that their health care won’t
change. But for my patients, it already has.
– Marc Siegel, M.D., is an associate
professor of medicine at NYU and the medical director of Doctor Radio
at NYU Langone Medical Center. He is a Fox News medical contributor.
The Anatomy of a Hostile
Government Takeover
Obamacare at six months.
National Review
James C. Capretta
September 28, 2010 4:00 A.M.
During the long national debate over the future of American health
care, President Obama frequently chastised his opponents for launching
exaggerated attacks on his plan for “reform.” He took particular
exception to the criticism that the changes he was pushing amounted to
a government takeover of the whole health sector. He knew full well
that this kind of criticism might derail the entire effort in Congress,
because most Americans recoil at the thought of a distant and
bureaucratic federal government running the health-care system for
everyone. So Obama vigorously denied that his program would lead to any
such thing. In his Aug. 8, 2009, radio address, he described the
“takeover” accusation as “outlandish” and characterized his approach as
a mainstream and moderate attempt simply to reform the nation’s private
health-insurance system.
It’s now been six months since Congress passed Obamacare — not a long
time given the sweeping nature of the legislation and the long phase-in
schedule for its most significant provisions. Even so, it is already
abundantly clear that Obamacare’s critics were dead right: The new
health law has set in motion a government takeover of American health
care, and a very hostile one at that. The Obama administration’s clumsy
and overbearing behavior since its passage proves the point.
First, there are the heavy-handed statements coming out of the
Department of Health and Human Services (HHS). Two weeks ago, HHS
secretary Kathleen Sebelius sent a letter to the nation’s insurers with
a plainly stated threat: Either the insurers conform to the political
agenda of the administration and describe the reasons for premium
increases in terms acceptable to the Democratic party, or they will be
shut out entirely from the government-managed insurance marketplace.
What could possibly have provoked a cabinet secretary to launch such an
indiscriminate broadside against an entire industry? Simple: A handful
of insurers had dared to utter the truth, noting that the new law has
imposed costly insurance mandates that will raise premiums for
everyone. For that offense, the federal government has essentially
threatened to put the truth-telling insurers out of business. And
what’s truly astonishing, and telling, is that the new law almost
certainly gives the HHS secretary the power to do so if she really
wants to.
Then there is the matter of Dr. Donald Berwick. Recall that President
Obama took more than a year to settle on Dr. Berwick as his nominee to
head the Centers for Medicare and Medicaid Services (CMS) — and then
moved in a matter of weeks to put him in place without Senate
confirmation. The president tried to blame Republicans for this blatant
end-run around constitutional checks and balances, even though
Democrats control the Senate and could have held a hearing and a vote
if they had wanted to. The truth is that Democrats didn’t want Dr.
Berwick to be confirmed in the Senate. They wanted him on the job, for
sure, because he is an ardent government-takeover enthusiast, and is
prepared to use all of the levers at his disposal to advance that
objective. The president and his Democratic allies just wanted to get
Dr. Berwick in place without the public’s really noticing. So they
chose to circumvent the normal process and put him in the CMS position
with a time-limited recess appointment. For the next year and a half,
Dr. Berwick is free to use CMS’s enormous new powers to force doctors
and hospitals to conform to his vision of effective health care, and he
is essentially accountable to no one but the president.
To distract the public from these power plays, the administration
decided to launch a series of “information” campaigns that are plainly
political and filled with all manner of distortions. HHS sent a letter
to the nation’s Medicare beneficiaries supposedly explaining what the
new law will mean for them. Somehow, it failed to mention that the law
will cut Medicare by half a trillion dollars over a decade, and cut the
value of Medicare Advantage by an average of 27 percent by 2017. HHS
followed this up by putting the same distortions on television, in the
form of an expensive advertising campaign featuring Andy Griffith.
In the meantime, busy beavers in various corners of the federal
bureaucracy are laying plans for new fiefdoms. Thousands of new
employees are planned for various offices in HHS, including the new
office to regulate private health insurance nationwide. The IRS is
gearing up both to enforce with tax penalties the requirement that
everyone carry government-approved insurance, and to help administer
the massive new entitlement program that will require income
verification on tens of millions of applicants. States will also be
forced to build new bureaucracies to carry out the scores of tasks the
federal government will be ordering them to perform.
Massive bureaucracy. Disinformation campaigns. Blatant power plays. The
politicization of decisions that should be made with a focus on patient
care. The use of government power to threaten citizens and their
livelihood.
This is what Obamacare has brought us. And that’s just in its first six
months.
Insurers Dropping Some Coverage
For Children
By MATTHEW STURDEVANT, msturdevant@courant.com
8:37 PM EDT, September 21, 2010
Health insurers are dropping some plans for children in advance of new
federal mandates that take effect Thursday, prompting another battle
between the industry and consumer advocates.
Insurers say they're dropping the plans, which are sold directly to
families and cover children only, because of a new rule requiring them
to sell policies to families after children become sick or injured —
thus eliminating reasons for families to buy coverage for healthy
children.
Although these "standalone" policies are rare, the debate over them
exposes the broad rift between insurers and consumer advocates just as
the sweeping federal reform takes effect. Major health insurers,
including Aetna, Anthem Blue Cross and Blue Shield in Connecticut,
CIGNA Corp. and UnitedHealth Group, have all stopped offering the
policies in Connecticut and other states throughout the country. Some
insurers pulled the plans early in the summer while others dropped them
this month.
"What's disappointing about what the insurers have done is that they've
made clear that they're not going to follow the rules under reform and
that they can't be counted on to do the right thing — in this instance,
limiting the options of consumers because they don't want to cover sick
kids," said Ethan Rome, executive director of Health Care for America
Now, a nonprofit group in Washington.
Insurers said they would end up paying a high cost if they continued
the plans — a cost that would be passed on to their current customers
in the form of higher premiums.
"There's a very strong case to be made that the insurers in this
particular case are acting in defense of the kids who are currently
getting their insurance this way to protect them from the rate shock
associated with new entrants under new rules," said Keith Stover, a
lobbyist with the Connecticut Association of Health Plans.
The reform, which waives pre-existing condition exclusions for
children, almost guarantees that the only people who will sign up for
coverage will be those who need it immediately, Stover said — such as a
person on the way to the hospital with a broken arm. Neither
regulators nor insurers were able to provide estimates of how many
children are in standalone policies in Connecticut or throughout the
U.S. The huge majority of children are covered by their parents'
group health insurance offered through an employer or some other group,
or through a family plan sold on the individual market, or through
state-subsidized programs such as HUSKY in Connecticut.
Coverage for children is the latest front in a larger clash with
insurers on one side and consumer advocates as well as the federal
government on the other. The battle is playing out over prices, as
insurers have begun seeking premium increases of 20 percent or more for
some plans, saying that the mandates will raise costs — as critics say
that the increases are not warranted. Thursday is a monumental
day for health care. In addition to waiving pre-existing conditions for
children, insurers must also eliminate limits on how much they spend
per person in a year and throughout a person's life.
"The 23rd is incredibly significant because for too many years it's
been the insurance companies against us, and they always win. And with
the new consumer protections, consumers can start winning for a
change," said Rome. "Consumers can actually get the health care that
they paid for, and that's an enormous change."
Aetna spokeswoman Susan Millerick said that the Hartford-based health
insurer stopped offering standalone policies for children because
"those seeking coverage would more often be those who need to consume
health care services immediately for high-cost, known conditions —
which would significantly increase the cost of premiums."
CIGNA spokeswoman Gloria Barone offered a similar explanation.
"We made a decision to stop offering child-only policies to ensure that
we can remain competitive in the 10 markets where we sell individual
and family plans," Barone said. "We'll continue to evaluate this policy
and could reconsider changing this position as market dynamics change."
UnitedHealthcare spokesman Daryl Richard said that children who are on
their parents' policy will remain covered. Anthem also dropped the
specialized coverage in Connecticut. Perhaps ironically, a
separate provision in federal reform — a mandate that all individuals
must be covered, which kicks in in 2014 — would make the pool less
risky and therefore might allow insurers to absorb the cost of sick
children without a major increase in the price of premiums, some
experts said.
"When you front load the 'good stuff' and back load the 'tough stuff,'
" said Stover, the health insurance lobbyist, "you have this inevitable
pressure on price."
BRAINTRUSTEES:
Michael Astrue, Social Security Commissioner, Hilda Solis, Labor Sec'y,
Tim Geithner, Treasury Sec'y, Kathleen Sebelius, HHS Sec'y
Government says health care overhaul extends life of Medicare hospital
trust fund by 12 years
Baltimore SUN
Associated Press Writers
MARTIN CRUTSINGER, RICARDO ALSONSO-ZALDIVAR
12:06 PM EDT, August 5, 2010
WASHINGTON (AP) — The annual checkup of the government's big benefit
programs for the elderly show that the Obama administration's sweeping
health care overhaul will extend the life of the Medicare hospital
insurance fund by 12 years.
But officials cautioned Thursday that the dramatic gain, reflected in
the annual trustees report for Medicare and Social Security, will
depend on achieving significant savings in health care in coming years.
The report found that the Medicare Hospital trust fund will not be
exhausted until 2029, 12 years longer than estimated last year. That
improvement was credited to the cost savings that will occur with the
passage earlier this year of health care reform.
The trustees said the recession had made the outlook for the Social
Security trust fund worse in the near term, however.
They said the Social Security program is projected to pay out more in
benefits than it collects in taxes for the first time this year and
next year. The Social Security trust fund is expected to be exhausted
in 2037, the same date as in last year's report.
The report noted that achieving the health care savings needed to
extend the life of the Medicare trust fund "may prove difficult and
will probably require that payment and health care delivery systems be
made more efficient than they are currently."
The administration delayed issuance of the trustees report, which
normally comes out in the spring, in order to recalculate projected
spending estimates based on the changes the new health care law brought
about or will bring about in the future.
Treasury Secretary Timothy Geithner, the head of the trustees panel,
said that while the new report showed "very positive developments" from
the new health care law it also underscored "that we must continue to
make progress addressing the financing challenges" facing both Medicare
and Social Security.
The trustees report said that Social Security pension and disability
payments will exceed revenues for this year and 2011, reflecting a deep
recession which has knocked millions of people off payrolls, which
means they are not paying Social Security payroll taxes.
The report said the program would return to the black in 2012 through
2014 but that benefit payments will again exceed tax collections in
2015. For every year after 2015, the report projects that Social
Security will be paying out more than it receives in tax collections
under the impact of the retirements of 78 million baby boomers.
The government will then have to turn permanently to its trust fund to
make up the difference between Social Security taxes and the benefits
being paid out. The trust fund, which exists in paper form in a filing
cabinet in Parkersburg, W.Va., are bonds backed by the government's
"full faith and credit" but not by any actual assets. That trust fund,
currently at $2.5 trillion, has been spent over the years to fund other
parts of government.
To redeem the trust fund bonds, the government will have to borrow in
public debt markets or raise taxes. At the point that the trust fund is
exhausted in 2037, the trustees said the government will still be
collecting enough in Social Security payroll taxes to meet
three-fourths of current benefit levels.
Health and Human Services Secretary Kathleen Sebelius, another trustee,
told reporters that the trustees assumed current law in making their
projections, including a cut in doctor's Medicare payments of 23
percent starting in December. Congress has for years voted to put more
money in the Medicare program to keep such sharp cuts in doctor's
payments from occurring.
The number crunching and analysis for the trustees report is done by a
group of nonpartisan professionals at the Office of the Actuary, an
obscure economic unit in the Health and Human Services Department that
has a reputation for independence. To the consternation of White House
officials, recent reports from that office have raised questions about
the heath care law's impact on Medicare.
An April 22 analysis pointed out that the projected gain of 12 years of
additional solvency for Medicare, a figure that was also used in the
health care debate, was largely an "appearance," stemming from how
Medicare cuts are handled under federal accounting rules. Under the
law, savings from those cuts will be used to finance coverage for the
uninsured.
"In practice, the improved (Medicare) financing cannot be
simultaneously used to finance other federal outlays (such as the
coverage expansions) and to extend the trust fund, despite the
appearance of this result from the respective accounting conventions,"
the report said.
A companion report concluded that some of the $575 billion in Medicare
savings over 10 years "may be unrealistic" because future Congresses
could be pressured to roll back cuts to providers in the health care
law.
The actuary's office also projected that enrollment will plummet in
popular private insurance plans offered through Medicare, as a result
of cuts in the health care law.
More than 53 million people receive Social Security. Retirement
benefits average $1,100 a month, and disabled workers get an average of
$1,065. Medicare covers more than 46 million retirees and disabled
people.
Social Security is financed by a 6.2 percent payroll tax on wages below
$106,800. The tax is paid by workers and matched by employers. Medicare
is financed by a mix of general revenues, payroll taxes and premiums
paid by beneficiaries.
President Barack Obama has formed a bipartisan fiscal commission that
is working on recommendations to improve government finances, including
those for Social Security and Medicare. Seniors' groups are lobbying
against benefit cuts, while conservatives say they will oppose tax
increases, creating a difficult political environment for compromise.
Dodd seeks explanation from Rell on delay of new insurance program
Deirdre Shesgreen, CT MIRROR
July 2, 2010
Sen. Christopher Dodd, D-Conn., has expressed serious concern about
Connecticut's decision to delay a decision on implementing a new high
risk insurance pool for people with serious health problems.
In a sharply worded letter to Gov. M. Jodi Rell, Dodd asked a series of
questions about her decision to defer signing a contract with the
federal Department of Health and Human Services. That contract would
have allowed the state to begin accepting applications from patients
locked out of the private insurance market and tap into an estimated
$50 million pot of federal money to provide them with coverage.
"The timing of these actions by the state are cause for great concern,"
Dodd wrote in a July 2 letter to Rell. "I would like to better
understand what the state's plans are to ensure that no residents of
Connecticut, who would otherwise be eligible, will be denied access to
this new federal insurance program."
Dodd asked Rell why the state waited until the day after the federal
deadline for the new program to announce that Connecticut was still
reviewing premium rates and might opt to have the federal government
run the program, instead of creating a state-operated pool.
"The state's late announcement raises several questions about its true
intentions," Dodd said.
Donna Tommelleo, a spokeswoman for Rell, defended the governor's
decision as in the best interest of state residents who need this
program.
“The Governor is asking for time to examine the rate structure because
the rates Connecticut is being charged are considerably higher than
other states, including some neighboring states," Tommelleo said. "Her
concerns are that costs may be unaffordable for the very people they
are intended to help."
She said Dodd's energy would be "better spent working for lower rates
and a fairer rate structure for his home state than sending demanding
letters. This is a national program and an issue that should be dealt
with at the federal level."
The new high-risk pools are part of the federal health care reform
overhaul, which Dodd helped craft. They are designed to provide health
insurance for people who have pre-existing health conditions and who
have been without insurance for at least six months. Congress
established a $5 billion pot of money to create the new high-risk
insurance pools and gave states the option of running their own program
or having the federal government run it for them.
Connecticut initially indicated that it would set up its own pool, as
28 other states and the District of Columbia are doing. State officials
crafted a lengthy application and submitted it to HHS on June 2.
But on Thursday, the day the federal Department of Health and Human
Services rolled out the new program, Rell expressed concerns that the
premiums calculated by the state's actuarial consultants may be "beyond
the reach" of Connecticut residents with pre-existing conditions, the
target population for these new insurance pools. She asked top state
officials at the Department of Social Services and two other state
agencies to review the premiums and consider whether it would make more
sense to have the federal government run the program.
Rell asked them to complete the review by July 15.
That lengthy period for review is of particular concern, said Dodd.
"A delay in making this determination until July 15th is cause for
great concern, as individuals in the 21 states relying on HHS to run
the PCIP are already able to apply as of July 1st," Dodd wrote.
"Individuals enrolled in this plan by July 15th will begin receiving
coverage by August 1, 2010. Therefore, in my view, it is critical
that you make a final decision prior to July 15."
Tommelleo said Rell had "every intention of ensuring that Connecticut
citizens benefit from the health care reform bill."
Rell asks feds to relax insurance rule
Arielle Levin Becker, CT MIRROR
October 4, 2010
Saying federal regulations have created a "stone wall" preventing
Connecticut residents from enrolling in a new state health insurance
plan, Gov. M. Jodi Rell has asked U.S. Health and Human Services
Secretary Kathleen Sebelius to consider relaxing the rule.
The state created the Connecticut Pre-Existing Condition Insurance Plan
to comply with a requirement in the health reform law for states to
have insurance pools for previously uninsured people with pre-existing
conditions.
Coverage under the plan began Friday, with only five people enrolled.
Rell said enrollment could be limited because of the federal "crowd
out" rule that requires a person be uninsured for at least six months
before joining the plan. Some public insurance programs use such
policies to prevent people from dropping private coverage to join a
public program.
"Implementation of such a restrictive, no-exception crowd-out/waiting
period policy seems to contradict the stated goals of providing access
to health insurance for those individuals with pre-existing
conditions," Rell wrote to Sebelius.
Rell recommended that the department approve "reasonable and good-cause
exceptions" to the six-month waiting period. She noted that the state's
Charter Oak Health Plan also has a six-month crowd out period, but
allows exceptions for people who lost their previous coverage because
of extreme economic hardship, the expiration of coverage under COBRA,
or no longer being enrolled in the state's HUSKY program.
"I believe that these accommodations are essential if the Pre-Existing
Condition Insurance Program is expected to achieve its goals of
providing crucial health coverage to individuals who otherwise cannot
access coverage," Rell wrote.
Rell described the exceptions used in Charter Oak as cases in which
people lose coverage through no fault of their own, and cited the
example of a parent who loses HUSKY coverage when his or her child
turns 18.
"In this regard, such a newly uninsured person is no different from
other uninsured individuals who need and are able to access this
important program," Rell wrote.
In addition to the five people enrolled in the pre-existing condition
insurance plan Friday, one person is slated to receive coverage under
the plan beginning next month, according to the state Department of
Social Services. Including the six who enrolled, 165 people who applied
were eligible for the program.
Rell said in the letter that people who qualified for the pre-existing
condition plan were opting to join Charter Oak, which charges $307 per
month in premiums. The pre-existing condition plan's premiums rise with
age, and for anyone 30 and older, cost more than the Charter Oak
premiums.
Like many states, Connecticut already has high-risk insurance plans for
people with medical conditions. Their premiums cost more than the new
plan, in some cases, by hundreds of dollars a month.
Because of the crowd out rule, people enrolled in those plans would not
be eligible for the new plan unless they gave up the insurance for six
months. But officials have noted that the goal of creating a new plan
was to expand coverage to people without insurance, not to lower the
price for people who have it.
The pre-existing condition insurance plans created under the health
reform law are being funded with $5 billion in federal money and are
expected to run until 2014, when insurers will be prohibited from
excluding people with pre-existing conditions.
Move to Medicaid means better healthcare
for thousands, better bottom
line for state
CT MIRROR
Jacqueline Rabe and Deirdre Shesgreen
June 25, 2010
For much of the last legislative session, debate over extending
Medicaid coverage to childless adults focused on the bottom line for
the state: more than $50 million in federal reimbursement for
assistance the state already is providing.
But putting recipients of State Administered General Assistance under
the Medicaid umbrella, approved this week in Washington, also means
elimination of a flawed system that shortchanged both the poor and the
doctors who cared for them, advocates of the move say.
"Basically, SAGA is being put in the dustbin of history, where it
richly belongs," said U.S. Rep. Joe Courtney, D-2nd District, a vocal
proponent of the health care overhaul.
Sheldon Toubman, a lawyer for New Haven Legal Assistance who has been
outspoken in his criticism of SAGA and other state-run health programs,
was even more blunt.
"They have wiped away all this crap that was called health care and
started over," he said. "This population will now have real health
coverage."
Extending Medicaid to childless adults nationwide is a key step in
implementing the new health care reform law, making the program a more
fundamental part of providing care to low-income Americans.
There's no question that the change will mean improved coverage for
some 45,000 SAGA patients, including more physicians to choose from and
more covered services. And it won't add a burden to the Medicaid
system: Most doctors who see SAGA patients also participate in the
federal program. But some worry that the reform law isn't doing
anything now to address the problems that already exist in the system.
"It's barely functional now," Ellen Andrews, executive director of the
Connecticut Health Policy Project, said of Connecticut's Medicaid
program. She said providers and consumers alike have difficulty
navigating the system, and too few doctors participate in the program.
The problem has been exacerbated by the economy: Connecticut's Medicaid
rolls have swelled by at least 53,000 patients in the last 18 to 20
months, DSS Commissioner Michael P. Starkowski said. And he said he
expects to enroll another 7,000 to 12,000 people in Medicaid over the
next year, in addition to the 45,000 low-income childless adults who
will be rolled over from SAGA. Andrews and other advocates hark
back to a 2006 survey that found only about one in four physicians
participating in the Medicaid program actually were accepting new
patients.
"Overall, access to care was found to be deficient across all health
plans and provider groups," the report concluded.
David Dearborn, a spokesman for the Department of Social Services, said
accessibility is no longer an issue in Connecticut because doctors are
reimbursed for the services provided more appropriately now. And
Starkowski dismissed the study, saying many doctors' offices probably
did not understand what program they were being asked about.
But Andrews said there is no evidence, either from state officials or
her clients' experiences, of any improvements since that study was done.
More recently, a 2008 national survey compiled by the Center for
Studying Health System Change, a nonprofit think-tank, found 28 percent
of physicians reported they were accepting new Medicaid patients
compared with almost 90 percent accepting new privately insured
patients. As part of health care reform, Congress approved
increased Medicaid payment rates to doctors for primary care, but those
boosts don't kick in until 2013 and 2014. In the meantime, however, the
gap between needy patients and willing doctors is likely to persist.
"Concerns about provider networks are widespread, and whether there are
enough providers currently in the Medicaid program to absorb an influx
of new enrollees is a big question," said Rachel Klein, deputy direct
of health policy at Families USA, a consumer health care advocacy group
based in Washington.
The Connecticut Medical Society, which represents more than 7,000
physicians, said Medicaid's low reimbursement rates result in low
physician participation. Ken Ferrucci, vice president of public policy
for the society, said the average reimbursement rate for the society's
physicians participating in Medicaid is about 56 percent of actual
costs. But the SAGA rates were even worse, he said: about 43
percent of costs. Shifting SAGA patients to Medicaid will expand their
physician choices to 17,090 participating doctors.
The low SAGA reimbursement rate was particularly troublesome for
patients seeking specialized care, advocates say. While primary care
was available, getting to see specialists such as neurologists or
dermatologists was problematic.
"You need these services? Well, you are just out of luck. That's just
bad policy," Toubman said. "What's the point of saying you cover
something if you can't find a doctor?"
Ron Dunhill, who works to get SAGA clients at Cornell Scott Hill Health
Center in New Haven the health services they need, cited the case of a
client who had fluid on his brain. There were plenty of doctors in New
Haven capable of handling the case who accepted Medicaid, but the
nearest SAGA-enrolled physician was 90 minutes away. And while
Medicaid would have paid for transportation to medical appointments,
SAGA wouldn't, except for emergencies. Medicaid also covers such things
as nursing home care, at-home care, and durable equipment such as a
walker or wheelchair, which SAGA doesn't.
"It's not like Medicaid is perfect," said Toubman. "It is better than
SAGA though, so it's a step up."
Insurance Pools Readied in Some
States
NYTIMES
By ROBERT PEAR
June 25, 2010
WASHINGTON — The Obama administration is poised to award contracts
worth hundreds of millions of dollars to about 20 states to run new
insurance pools for people with serious medical problems. In
another 20 states, where local officials chose not to participate, the
federal government will run the pools through a private nonprofit
entity. Applications will be available to the public in many
states on Thursday, and coverage could start as early as August, said
Richard A. Popper, deputy director of the new federal Office of
Consumer Information and Insurance Oversight.
After struggling for months to fend off Republican attacks on the new
health care law, White House officials hope the high-risk insurance
pool will produce tangible benefits for people who are uninsured — and
for Democrats running in midterm elections this fall. The law has
become an issue in many races.
Colorado, Maryland and North Carolina are in the vanguard of states
planning to run high-risk pools with federal money.
“We are ready to go,” said Michael T. Keough, executive director of the
North Carolina Health Insurance Risk Pool. Mr. Keough said he was
prepared to start taking applications as soon as the federal government
approved his program.
Some states, like California and New York, are just finishing their
proposals. Several others are tinkering with their plans to get federal
approval. Congress provided $5 billion for the program, which is
expected to help 200,000 to 400,000 people, or fewer than 10 percent of
those denied health insurance because of pre-existing medical
conditions. Democrats describe the program as a bridge to 2014,
when insurers will be required to accept all applicants and consumers
can do comparison shopping in marketplaces known as insurance exchanges.
In soliciting state proposals, Kathleen Sebelius, the secretary of
health and human services, emphasized that states must not allow
spending to exceed their allotments of federal money. State
officials said they would freeze enrollment if necessary to keep within
their budgets. It is not clear who would be legally responsible for
claims that remain unpaid after a state’s allotment runs out.
The temporary program for uninsured people with pre-existing conditions
was supposed to be established within 90 days after President Obama
signed the health care law — that is, by last Monday.
Thirty states have informed the federal government that they want to
run their own high-risk pools with federal money. About 20 of them have
filed formal proposals. Federal officials said they hoped to approve
many of the proposals by Thursday.
At the White House last week, Mr. Obama said, “On July 1st, uninsured
Americans who’ve been locked out of the insurance market because of a
pre-existing condition will now be able to enroll in a new national
insurance pool, where they’ll finally be able to purchase quality,
affordable health care, some for the very first time.”
A new study by the Congressional Budget Office says the money will “not
be sufficient to cover the costs of all applicants.” If more than
200,000 people participate, the budget office said, “the available
funds will probably be exhausted prior to 2013.” Consumers or states
could then be left in the lurch, seeking other sources of coverage.
Some governors cited this concern in deciding not to apply for federal
money.
Richard S. Foster, the chief actuary at the Department of Health and
Human Services, said 375,000 people could gain coverage in high-risk
pools this year. But he predicted, “By 2011 and 2012, the initial $5
billion in federal funding would be exhausted.”
Richard W. Figueroa, an aide to Gov. Arnold Schwarzenegger of
California, said the state expected to submit its proposal this week.
The goal, he said, is to start enrolling people in August, for coverage
that would start in September, assuming the Legislature authorizes the
program. California expects to receive $761 million in federal
money, which is 50 percent more than any other state, and expects to
enroll about 25,000 people.
Thirty-five states already have high-risk pools, financed by a
combination of state money, premiums and assessments on insurance
companies. Enrollment totals about 200,000. The state pools all operate
at a loss, even though they generally charge premiums higher than what
will be allowed in the federal program.
Richard Cauchi, a health policy expert at the National Conference of
State Legislatures, said states were pursuing different approaches:
¶At least 21 states, including Alaska, California, Maryland and
North Carolina, have high-risk pools and will set up new programs with
federal money.
¶Some, including Massachusetts, Michigan, New York and
Pennsylvania, do not have high-risk pools and will create and
administer new programs with federal money.
¶Some states, like Alabama, Minnesota and Texas, have high-risk
pools but will not apply for federal money and will let the federal
government run the new pools.
¶Other states, like Arizona, Georgia, Nevada and Virginia, never
had high-risk pools and will allow federal officials to run the program
within their borders.
Travis R. Ford, a spokesman for the Missouri Insurance Department, said
the state expected to hire two Blue Cross and Blue Shield plans to
manage its new program.
Kären J. Larson, executive director of the Washington State Health
Insurance Pool, estimated that 2,300 people would qualify. But she said
premiums could be high — $800 a month for a 45-year-old buying a policy
with a $500 deductible.
Confirmation Fight on Health Chief
NYTIMES
By ROBERT PEAR
June 21, 2010
WASHINGTON — President Obama’s nominee to run Medicare and Medicaid,
Dr. Donald M. Berwick, is a man with a mission, a preacher and teacher
who has been showing hospitals how they can save lives and money by
zealously adhering to clinical protocols for the treatment of patients.
Hospital executives who have worked with Dr. Berwick describe him as a
visionary, inspiring leader.
But a battle has erupted over his nomination, suggesting that Dr.
Berwick faces a long uphill struggle to win Senate confirmation.
Republicans are using the nomination to revive their arguments against
the new health care law, which they see as a potent issue in this
fall’s elections, and Dr. Berwick has given them plenty of ammunition.
In two decades as a professor of health policy and as a prolific
writer, he has spoken of the need to ration health care and cap
spending and has confessed to a love affair with the British health
care system. He has made numerous public appearances to talk about
health care and has published a book of his speeches on the topic.
Mr. Obama nominated Dr. Berwick on April 19 to be administrator of the
Centers for Medicare and Medicaid Services, the largest purchaser of
health care in the United States. The post has been vacant since
October 2006, and the need to fill it has become more pressing with
passage of the new law. The agency must write and enforce dozens of
regulations to expand Medicaid, trim Medicare and test new ways to
deliver care.
The Senate Republican leader, Mitch McConnell of Kentucky, describes
Dr. Berwick as an “expert on rationing.” Senator Pat Roberts,
Republican of Kansas, calls him “the perfect nominee for a president
whose aim has always been to save money by rationing health care.”
Dr. Berwick, a pediatrician, is president and co-founder of the
Institute for Healthcare Improvement, a not-for-profit organization in
Cambridge, Mass.
In an introduction to Dr. Berwick’s book, Dr. Frank Davidoff, a former
editor of the Annals of Internal Medicine who works for the institute
part time, said, “Don Berwick preaches revolution.”
He is trying to overthrow “a stupid system” that serves the needs of
doctors, administrators and insurers rather than patients, Dr. Davidoff
said.
Administration officials say they are confident that Dr. Berwick will
eventually be confirmed, and they say Republicans have taken his
comments out of context. In fact, many of the comments have been
repeated, with slight variations, in Dr. Berwick’s articles and
lectures over the years.
In an interview last year in the journal Biotechnology Healthcare, Dr.
Berwick said, “The decision is not whether or not we will ration care —
the decision is whether we will ration with our eyes open.”
Asked about such statements, Reid H. Cherlin, a White House spokesman,
said: “Rationing is rampant in the system today, as insurers make
arbitrary decisions about who can get the care they need. Don Berwick
wants to see a system in which those decisions are transparent, and the
people who make them are held accountable.”
In his book, “Escape Fire: Designs for the Future of Health Care,” Dr.
Berwick assailed “the dangerous, toxic and expensive assumption that
more is better.” He insists that the nation can cut health costs
without harming patients because vast sums are misspent.
“I have said before, and I’ll stand behind it, that the waste level in
American medicine approaches 50 percent,” he said in an interview in
the journal Health Affairs in 2005.
Dr. Berwick has championed efforts to “reduce the total supply of
high-technology medical and surgical care” and to consolidate services
in regional centers.
Long before the uproar over “death panels” last year, Dr. Berwick was
urging health care providers to “reduce the use of unwanted and
ineffective medical procedures at the end of life.”
“Using unwanted procedures in terminal illness is a form of assault,”
he said at the annual conference of his institute in 1993. “In economic
terms, it is waste.”
On more than one occasion, Dr. Berwick has suggested a need for a cap
on total health spending, with limits on annual increases.
In speeches and articles celebrating the 60th anniversary of Britain’s
National Health Service in 2008, Dr. Berwick said he was “in love with
the N.H.S.” and explained why it was “such a seductress.”
“The N.H.S. is not just a national treasure,” he wrote; “it is a global
treasure.”
Among its virtues, he told a British audience, is that “you cap your
health care budget.”
Instead of trying to protect the wealthy, Dr. Berwick wrote, the
British recognized that “sick people tend to be poorer and that poor
people tend to be sicker, and that any health care funding plan that is
just must redistribute wealth.”
Dr. Berwick offered a suggestion to the British: “Please don’t put your
faith in market forces.”
“In the United States,” he wrote, “competition is a major reason for
our duplicative, supply-driven, fragmented care system.”
Senator Charles E. Grassley of Iowa, the senior Republican on the
Finance Committee, said he had no doubts about Dr. Berwick’s academic
and professional qualifications, but wanted him to explain his comments
on rationing.
“It doesn’t help him to say good things about the British health care
system,” Mr. Grassley said after meeting with Dr. Berwick on Wednesday.
Whatever doubts might exist in Washington, Dr. Berwick has fans in
hospitals around the country.
Theodore E. Townsend, president of St. Luke’s Hospital in Cedar Rapids,
Iowa, said: “Dr. Berwick has inspired me and this community. He has
used his charisma and his leadership ability to improve the quality of
care at hundreds and hundreds of hospitals. I can’t think of anyone
else who has had that kind of impact.”
Donna C. Isgett, senior vice president of McLeod Health in Florence,
S.C., said Dr. Berwick had been “instrumental in catapulting us to a
much higher level of care.”
“He rolled up his sleeves and worked with our employees to reduce
medication errors, infections, accidental falls and mortality rates,”
Ms. Isgett said. “We are not a prestigious institution in Boston. We
serve rural counties in one of the poorest regions of the country, but
Don has been here and knows us.”
You're losing your plan
NYPOST
By SCOTT GOTTLIEB
Last Updated: 4:33 AM, June 14, 2010
Posted: 1:16 AM, June 14, 2010
Late last week saw the first leaks of the administration's draft
regulations for imple menting the ObamaCare law -- and everything is
playing out just as the critics warned.
The 3,000-odd pages of legislation left most of the really important
(and controversial) policy decisions to the regulations that government
agencies were told to issue once the bill passed. Now that those regs
are starting to take shape, it's clear that the Obama team is using its
new power to exert tight control over the payment and delivery of all
formerly "private" health insurance.
The ObamaCare law references the Secretary of Health and Human Services
almost 2,200 times and uses the phrase "the secretary shall" more than
725. Each reference requires HHS to set new rules on medical care,
giving control to an existing federal office or one of 160 new agencies
that the bill created.
HHS Secretary Kathleen Sebelius (who was once the Kansas
state-insurance commissioner) has taken to these tasks with zeal. In
some circles, she's now known as the nation's "insurance regulator in
chief." She's starting off by applying new regs to health plans
offered by large employers -- even though these costly rules were
supposedly only going to apply to plans sold in the state insurance
"exchanges" that don't get created until 2014. This twist is spelled
out in an 83-page draft of a new regulation that leaked late last week.
Bottom line: Sebelius means to dictate what your insurance plan must
look like almost from day one, no matter how you get your
coverage.
Indeed, the draft regs envision more than half of all policies having
to change within three years -- an unmistakable break with President's
Obama's oft-repeated promise, "If people like their insurance, they
will be able to keep it."
Yet that may be the least of the broken promises.
Ultimately, these rules force consumers to buy one of just four health
policies -- which vary mostly only by trading off higher co-payments
for lower premiums, while offering essentially the same actual
benefits. In arguing for passage of the law, ObamaCare's defenders
claimed the rules were aimed at health plans sold in the "exchanges."
Oops: Now Sebelius is applying them to employer plans. Eventually, this
would force all but the very wealthiest Americans into a single
government-designed insurance scheme.
This is far from the only area where Secretary Sebelius is exploiting
the law's fuzzy language to tighten her control over the private
insurance market. In recent weeks, she has said that the new law gives
her authority to review and even set the rates on health policies sold
in private markets, a role previously left to state insurance
regulators.
The ObamaCare bills were written to paper over an intellectual divide
between White House economists and HHS policy wonks. Some economists
wanted genuine competition to take root in the new federally managed
insurance "exchanges." The HHS crew favored a one-sized government plan
with tight federal regulation over benefits.
The law itself didn't explicitly side with either school -- but it did
leave the writing of the implementing regs to those same HHS wonks.
Unfortunately, those more moderate White House economists are now
leaving the administration, including the rumored departure of widely
admired businessman and health-care expert Robert Kocher.
Washington insiders refer to this HHS team as "true believers" -- a
group of earnest, left-leaning activists who've long favored a single
nationalized health plan. They are massaging the law's vagueness to
give themselves the tight federal control over health care that will
bring their vision into practice.
Critics warned that the Obama bill meant a federal takeover of health
care, with Washington bureaucrats making core decisions about medical
care. With ObamaCare taking shape, that's exactly what consumers are
getting. Saying "we told you so" is no consolation to those who took
the president at his word.
Scott Gottlieb, a physician and
American Enterprise Institute fellow, was a senior official at the
Centers for Medicare and Medicaid Services. He is partner in a firm
that invests in health-care companies.
DROPPING THE OTHER SHOE
Members of the State Post Employment Benefits Commission review
a new analysis of state retiree health care costs. From left: AFSCME
Council 4 Executive Director Salvatore Luciano, Thomas Woodruff,
director of health care policy for the state comptroller, and health
care actuary William Thompson with Milliman Inc. (Keith M. Phaneuf)
State faces hefty
up-front costs to fix its retiree benefits system; full story here.
Keith M. Phaneuf, CT MIRROR
June 7, 2010
State officials recently got their first glimpse of the cost of
escaping a pay-as-you-go health insurance program for retired workers,
and it wasn't pretty.
But on a long-term basis, the state's health care consultants said,
it's far less expensive the the current practice of paying the bills
out-of-pocket.
A preliminary analysis issued last week to the Post Employment Benefits
Commission projected that annual spending, which currently approaches
$500 million, will rise on the pay-as-you-go plan so that the average
cost over the next 28 years will be $1.9 billion--a total outlay in
excess of $53 billion.
If the state adopts a longer-term plan for funding the costs, the
annual outlay would jump immediately to $1.2 billion, according to
Milliman Inc. of Windsor, which provides health care consulting and
actuarial services for the state comptroller's office--but then stay
relatively stable over 28 years, for a total outlay of roughly $34
billion.
Both scenarios could be dramatically affected if health care costs grow
in excess of projections, Milliman warned...
The commission was given a July 1 deadline to submit cost-saving
recommendations to the governor's office, but Cicchetti said the panel
still is awaiting further analysis of both health insurance and pension
costs, and may need to seek a short extension into the summer.
SustiNet board outlines 'public option' for health coverage in
Connecticut
Jacqueline Rabe, CT MIRROR
May 27, 2010
A plan for a public health care option in Connecticut - dubbed SustiNet
- was released today in response to the new federal health care law.
"It's an outline of what we are looking at," said state Comptroller
Nancy Wyman, also the co-chairwoman of the SustiNet Health Partnership
Board that released the report. "We are ahead of most states. We have a
plan that fits perfectly with the federal law. It’s amazing. We really
are in good shape to go forward with the public option.”
Final draft legislation with detailed recommendations for implementing
SustiNet will be made by the end of the year so the new General
Assembly and governor can consider the package in 2011.
Kevin Lembo, co-chair of the SustiNet board and the state healthcare
advocate, has said this plan, if adopted, would go above and beyond the
federal reform.
"They set this new federal floor. Some states will chose to do nothing
additional, but Connecticut I am confident will go above that," Lembo
said two days after the federal law was signed in March by President
Barack Obama.
The SustiNet plan would offer a public insurance option to employees at
the state's small businesses, non-profits and municipalities beginning
July 1, 2012. The federal health reform does not include a public
option.
But nothing would take effect without approval by the legislature and
governor.
Republican Gov. M. Jodi Rell is not expected to sign such legislation,
as she vetoed the bill in 2009 that created this panel responsible with
crafting a public option. It took a veto override by the Democratic
majority to launch SustiNet.
With Rell not seeking re-election, a new governor will consider any
legislation implementing a public insurance plan. If another Republican
wins the office and vetoes the plan, the Democrats' ability to override
will depend on their success in the November legislative elections. If
Republicans win one more seat in the Senate, they will have enough
votes to sustain a veto.
There are currently 305,000 people - or 10.4 percent of the state's
population- with no insurance, reports the Urban Institute, a national
healthcare non-profit think tank. Of that population, 57,000 people are
currently eligible for Medicaid but have not enrolled.
Rell has endorsed portions of the federal reform law, but only as long
as it doesn't cost the state money. The state has applied for federal
reimbursements for the state's low-income SAGA health plan - a move
expected to net $49.3 million in new revenue for the state through next
fiscal year if approved.
Rell also wrote U.S. Health and Human Services Secretary Kathleen
Sebelius last week to inform her the state would be applying soon to
create a federally subsidized high-risk pool for state residents with
preexisting conditions.
VERY
INTERESTING SERIES OF DEBATES ACROSS THE POND
Three leaders after third after second (l) and last of three debates
(c), and their surrogates on health care (r) - in a NOT
League-like
moderated debate!
Election 6 May 2010...
Parties argue over NHS
improvements amid cash squeeze
Labour have warned the NHS in England would return to "the bad old
days" under a Tory government as the parties argue over the health
service's future.
Health Secretary Andy Burnham told the Daily Politics that, if
re-elected, Labour would "protect" standards even though funding would
be much tighter. Tory counterpart Andrew Lansley said the NHS was
their top priority but change was needed to make it better. Lib
Dem
spokesman Norman Lamb said he would oppose any "slash and burn" cuts.
The three men set out their vision for the future of the NHS in England
after the election, and how it will cope in an era when public spending
is likely to be squeezed. Labour have pledged to protect
"frontline
services" from future spending cuts while the Conservatives have said
they would increase the NHS budget in real terms every year.
'Good service'
The Lib Dems have not ruled out cutting some NHS budgets, saying
"significant" savings can be made in administration costs, but that
funds will be re-invested in improved patient care.
Mr Burnham said the NHS faced perhaps its toughest challenge over the
next few years but insisted the budgets of England's primary care
trusts would rise 5% this year and be maintained in real terms in the
two years after that.
"This locks in all of the funding increase Labour has put into the NHS
over the past decade," he said.
Labour had transformed the NHS over the past year 13 years, he said,
"making a poor service a good service for the vast majority today".
If the Conservatives won the election, he said the gains of recent
years could be lost and a return to "chaos in A&E departments", an
increase in waiting lists and "postcode prescribing".
Mr Lansley said the Tories were the only party committed to real terms
funding increases across the NHS but changes were needed to give
patients more control over their care and reducing its "vast"
bureaucracy.
"We can't make the sick in this country pay for Labour's debt crisis,"
he said.
Both opposition parties attacked what they said had been the growth in
NHS administrators in recent years, claiming the NHS had taken on an
extra 5,000 managers alone in the last year.
Mr Burnham said many of these were clinical staff and the number of
nurses had increased by 90,000 since Labour first came to power.
Row over guarantees
The spokesmen also clashed over the future of Labour's two-week cancer
guarantee, with Mr Burnham pressing his counterpart over whether people
would still be able to see a specialist within two weeks of GP referral.
"It is absolutely legitimate for me to say that if these standards are
taken away from the NHS people will wait longer for getting crucial
cancer care," he said.
Mr Lansley said he would scrap "politically motivated" NHS targets but
keep those that were "clinically justified".
Asked whether this meant the cancer guarantee would remain in place, he
said "yes", adding that people in that situation "should see see a
specialist rapidly".
But he said these commitments must run alongside more focus on
improving cancer survival rates by investment in technology and
drugs.
Mr Lamb said local communities must have more say over the future of
hospital services and threatened closures.
"We all know the next few years a going to be really tough for the
NHS," he said.
"We can either go for slash and burn of services or we can re-design
the way the NHS works to make the money go further and protect patient
services."
Both Mr Lansley and Mr Lamb called for a review of the licensing laws
to address concerns about binge drinking.
Asked about care for the elderly, Mr Burnham said he would work to
build a consensus over the issue but said Tory plans for a voluntary
levy would not end the fear of people having to sell their homes to
fund care.
Mr Lansley said Labour had no idea about how it would pay for its own
plans for a national care service.
Mr Lamb said reform was "long over-due" and an agreement was possible
within a year "if we have the will".
Report: Health overhaul will increase nation's tab
YAHOO
April 22, 2010
WASHINGTON – Government economic forecasters say President Barack
Obama's health care overhaul will increase the nation's health care tab
instead of bringing costs down. The report by economic experts at the
Health and Human Services Department, released late Thursday, says the
health care remake will achieve Obama's aim of expanding coverage.
But the report says that the law falls short of the president's twin
goal of controlling runaway costs. And it warns that Medicare cuts may
be unrealistic and unsustainable.
The first comprehensive look at the health care law by neutral experts
amounts to a mixed report card for Obama's top priority during his
first year in office.
Study: Malpractice worries help drive health costs
YAHOO
By STEPHANIE NANO, Associated Press Writer
Tue Apr 13, 5:15 pm ET
NEW YORK – A substantial number of heart doctors — about one in four —
say they order medical tests that might not be needed out of fear of
getting sued, according to a new study. Nearly 600 doctors were
surveyed for the study to determine how
aggressively they treat their patients and whether non-medical issues
have influenced their decisions to order invasive heart tests.
Most said they weren't swayed by such things as financial gain or a
patient's expectations. But about 24 percent of the doctors said they
had recommended the test in the previous year because they were worried
about malpractice lawsuits. About 27 percent said they did it because
they thought their colleagues would do the test.
Doctors who treated their patients aggressively were more likely to be
influenced by malpractice worries or peer pressure than those who
weren't as aggressive, the study determined. The research was
done to see whether doctors' attitudes and practices
might be contributing to the wide differences in health care use and
spending across the country.
"We have known for a long time that where you live has an influence on
what kind of health care you get and how much health care you get,"
said Lee Lucas, lead author of the study and associate director of the
Center for Outcomes Research and Evaluation at Maine Medical Center in
Portland.
Some of the reasons are known: differences in disease rates, patient
preferences and the availability of medical services or hospital beds.
And more care isn't necessarily better care, Lucas noted. For the
study, the doctors were asked to recommend tests and treatment
for three hypothetical heart patients. Their answers were used to score
them on how aggressively they tend to treat patients.
Using Medicare records, the researchers found that doctors with higher
scores were more likely to be in the areas with higher spending overall
or higher rates for a heart test, although the differences were small.
The doctors were also asked whether other issues had led them to
recommend the heart test — called a cardiac catheterization — during
which a thin tube is threaded to the heart to check how well it is
working and to look for disease. The researchers suggest that
targeting malpractice concerns could help
reduce the regional differences.
"We need a way for docs to be less afraid of not ordering a test," said
Lucas.
Medical malpractice was part of the health care reform debate, but
didn't make it into the recently approved legislation. The new law does
include pilot programs for states to explore alternatives to
lawsuits. The study was released Tuesday by the journal
Circulation:
Cardiovascular Quality and Outcomes. The results support moving
toward more integrated health care, and away
from fee-for-service payments, and working on malpractice reforms, said
Kenneth Thorpe, a professor of health policy at Emory University in
Atlanta.
Lucas said patients can help by not pressuring their doctors to do
tests.
"If he says you don't need it, let it go," she said.
Mass. medical mess
NYPOST
By RICH LOWRY
Last Updated: 4:32 AM, April 10, 2010
Posted: 12:05 AM, April 10, 2010
President Obama has an unsettling
defense of his health-care reform -- it's merely a version of the plan
implemented by Massachusetts.
Obama wants to associate his reform
with the one championed by Mitt Romney in 2006 when he was governor of
the Bay State. If the liberal Democrat Obama and the conservative
Republican Romney passed similar plans, what can be so radical about
Obama's reform?
This is superficially clever. It not
only gives Obama's plan a centrist patina, it shines a light on a
significant obstacle to Romney's likely repeat bid for the Republican
presidential nomination. Except for the fact that the Massachusetts
reform is spiraling out of control.
If the states are the laboratories
of democracy, ObamaCare's Menlo Park is about to blow up. Unsustainably
high costs and high insurance premiums are leading inexorably toward
price controls and rationing. Obama might as well boast that he's
adopted a version of the California fiscal plan, or the Michigan
economic-recovery plan.
Obama is correct that his plan and
Romney's share essential features: a mandate that individuals buy
insurance, fines on business for not offering coverage, heavily
regulated insurance exchanges, large-scale insurance subsidies and
Medicaid expansion. They share something else -- utterly fanciful
notions of cost control.
Romney believed -- and still
maintains to this day -- that emergency-room visits by the uninsured
shifted costs onto everyone else. Never mind that in post-reform
Massachusetts there are just as many non- emergency visits to the
emergency room as previously, even though only 3 percent of people are
uninsured. Many of these patients simply have trouble finding a doctor,
a shortage the Massachusetts reform only exacerbates.
Massachusetts has created a
different cost-shift problem through its ObamaCare-style guarantee that
people can wait to get coverage until they're sick or want medical
procedures. The Boston Globe reports, "Thousands of consumers are
gaming Massachusetts' 2006 health-insurance law by buying insurance
when they need to cover pricey medical care, such as fertility
treatments and knee surgery, and then swiftly dropping coverage, a
practice that insurance executives say is driving up costs for other
people and small businesses."
Predictably, costs in Massachusetts
-- always high -- have only gone higher; the state now spends about 30
percent more per capita on health care than the rest of the nation.
Predictably, the insurance regulations have only made insurance more
expensive, as has been the case elsewhere; premiums in the individual
market have been growing at a 30 percent annual rate. Predictably, the
new health-care program has cost more than expected; spending grew by
about 40 percent from 2006 to 2009.
At first, Massachusetts plugged the
holes with more taxes and fees. Now, just as Obama is hailing the state
as his opening act, it is moving to the next inevitable phase:
unapologetic price controls.
The state's regulators have rejected
235 of 274 premium increases proposed by insurers, in an extraordinary
exercise of a power that had sat idle on the books since 1977.
As The Wall Street Journal points
out, the big insurers in Massachusetts are nonprofits like Blue Cross
Blue Shield and Harvard Pilgrim, hardly the comic-book villains of
liberal rhetoric. The state's arbitrary clamp-down on rates will force
insurers to cut access to care, or go out of business. As subtle as a
knee-capping, the state's move is rationing by proxy.
Insurers have taken to the courts,
and most of them stopped offering new coverage for individuals and
small businesses pending a ruling on their request for an injunction.
Massachusetts Gov. Deval Patrick, meanwhile, wants the power to review
the rates of hospitals and doctors and disallow those deemed too high.
And so the free lunch promised
Massachusetts in 2006 devolves toward a fiscally beleaguered government
setting prices and limiting care, exactly the downward spiral critics
fear from ObamaCare. At least Romney can say he didn't know how his
experiment would end. Obama has been warned, and still embraces
Massachusetts as our national future.
AT&T will take $1B non-cash charge for health care
By BARBARA ORTUTAY, AP Technology Writer
26 March 2010
NEW YORK – AT&T Inc. will take a $1 billion non-cash accounting
charge in the first quarter because of the health care overhaul and may
cut benefits it offers to current and retired workers.
The charge is the largest disclosed so far. Earlier this week, AK Steel
Corp., Caterpillar Inc., Deere & Co. and Valero Energy announced
similar accounting charges, saying the health care law that President
Barack Obama signed Tuesday will raise their expenses.
All four are smaller than AT&T, and their combined charges are less
than a quarter of the $1 billion that AT&T is planning. The $1
billion is a third of AT&T's most recent quarterly profit. In the
fourth quarter of 2009, the company earned $3 billion on revenue of
$30.9 billion.
AT&T said Friday that the charge reflects changes to how Medicare
subsidies are taxed. Companies say the health care overhaul will
require them to start paying taxes next year on a subsidy they receive
for retiree drug coverage.
White House spokesman Robert Gibbs said Thursday that the tax law
closed a loophole.
Under the 2003 Medicare prescription drug program, companies that
provide prescription drug benefits for retirees have been able to
receive subsidies covering 28 percent of eligible costs. But they could
deduct the entire amount they spent on these drug benefits — including
the subsidies — from their taxable income.
The new law allows companies to only deduct the 72 percent they spent.
AT&T also said Friday that it is looking into changing the health
care benefits it offers because of the new law. Analysts say retirees
could lose the prescription drug coverage provided by their former
employers as a result of the overhaul.
Changes to benefits are unlikely to take effect immediately. Rather,
the issue would most likely come up as part of contract negotiations
between the company and unions representing its employees and retirees.
AT&T is the largest private employer of union workers in the U.S.
Candice Johnson, spokeswoman for the Communications Workers of America,
which represents more than 160,000 AT&T workers, said these
employees have contracts in place until 2012. An agreement covering
retirees also runs through 2012.
AT&T rival Verizon Communications Inc. was among 10 companies that
sent a letter to congressional leaders in December warning that their
costs would increase with the health care changes. Verizon did not
immediately return a phone call seeking comment.
Shares in AT&T, which is based in Dallas, climbed 9 cents to close
Friday at $26.24.
Democrat CT Rep. John Larson with
Speaker,
carrying a big "stick." Republican view - cartoon on health care "campaign."
Barack's Bravado
Weekly Standard
BY William Kristol
March 25, 2010 4:55 PM
In Iowa City today, President Obama mocked Republicans' efforts to
repeal his new health care law. He dared them to "Go for it," and
asserted, "I welcome that fight. Because I don't believe the American
people are going to put the insurance industry back in the driver's
seat."
The insurance industry is a diverting talking point, but it’s not going
to work. Republicans simply have to say: Barack Obama’s legislation
would put the government in the driver’s seat of a giant,
poorly-constructed bus in which we’re simply helpless passengers.
Republican reforms would put American families in the driver’s seat of
cars of their choice. Which do you prefer?
Republicans should take up the president on his dare. They should say,
"Thank you Mr. President, we are going for it. And we're going to win."
13 attorneys general sue over health
care overhaul
YAHOO
By BRENDAN FARRINGTON, Associated Press Writer
23 March 2010
TALLAHASSEE, Fla. – Attorneys general from 13 states sued the federal
government Tuesday, claiming the landmark health care overhaul is
unconstitutional just seven minutes after President Barack Obama signed
it into law.
The lawsuit was filed in Pensacola after the Democratic president
signed the 10-year, $938 billion bill the House passed Sunday night.
"The Constitution nowhere authorizes the United States to mandate,
either directly or under threat of penalty, that all citizens and legal
residents have qualifying health care coverage," the lawsuit says.
Legal experts say it has little chance of succeeding because, under the
Constitution, federal laws trump state laws. Florida Attorney
General Bill McCollum is taking the lead and is joined by attorneys
general from South Carolina, Nebraska, Texas, Michigan, Utah,
Pennsylvania, Alabama, South Dakota, Idaho, Washington, Colorado and
Louisiana. All are Republicans except James "Buddy" Caldwell of
Louisiana, a Democrat.
Some states are considering separate lawsuits — Virginia filed its own
Tuesday — and still others may join the multistate suit. In Michigan,
the Thomas More Law Center of Ann Arbor, a Christian legal advocacy
group, sued on behalf of itself and four people it says don't have
private health insurance and object to being told they have to purchase
it.
McCollum, who is running for governor, argues the bill will cause
"substantial harm and financial burden" to the states.
The lawsuit claims the bill violates the 10th Amendment, which says the
federal government has no authority beyond the powers granted to it
under the Constitution, by forcing the states to carry out its
provisions but not reimbursing them for the costs. It also says
the states can't afford the new law. Using Florida as an example, the
lawsuit says the overhaul will add almost 1.3 million people to the
state's Medicaid rolls and cost the state an additional $150 million in
2014, growing to $1 billion a year by 2019.
"We simply cannot afford to do the things in this bill that we're
mandated to do," McCollum said at a press conference after filing the
suit. He said the Medicaid expansion in Florida will cost $1.6 billion.
"That's not possible or practical to do in our state," he said. "It's
not realistic, it's not right, and it's very, very wrong."
South Carolina Attorney General Henry McMaster, who is also running for
governor, said the lawsuit was necessary to protect his state's
sovereignty.
"A legal challenge by the states appears to be the only hope of
protecting the American people from this unprecedented attack on our
system of government," he said.
But Lawrence Friedman, a professor who teaches constitutional law at
the New England School of Law in Boston, said before the suit was filed
that it has little chance of success. He said he can't imagine a
scenario where a judge would stop implementation of the health care
bill. Still, McCollum said he expects the U.S. Supreme Court will
eventually decide if the overhaul is constitutional.
"This is not lawful," he said. "It may have passed Congress, but there
are three branches of government."
Some states are looking at other ways to avoid participating. Virginia
and Idaho have passed legislation aimed at blocking requirements in the
bill, and the Republican-led Legislature in Florida is trying to put a
constitutional amendment on the ballot to ask voters to exempt the
state from the federal law's requirements. At least 60 percent of
voters would have to approve. Under the bill, starting in six
months, health insurance companies would be required to keep young
adults as beneficiaries on their parents' plans until they turn 26, and
companies would no longer be allowed to deny coverage to sick children.
Other changes would not kick in until 2014. That's when most
Americans will for the first time be required to carry health insurance
— either through an employer or government program or by buying it
themselves. Those who refuse will face tax penalties.
"This is the first time in American history where American citizens
will be forced to buy a particular good or service," said Nebraska
Attorney General Jon Bruning, who is also president of the National
Association of Attorneys General, explaining why his state joined the
lawsuit.
Tax credits to help pay for premiums also will start flowing to
middle-class working families with incomes up to $88,000 a year, and
Medicaid will be expanded to cover more low-income people. No
Republicans in the U.S. House or Senate voted for the bill.
Victory doesn't finish fight for Dems
NYPOST
By KIRSTEN POWERS
Last Updated: 9:04 AM, March 22, 2010
Posted: 12:49 AM, March 22, 2010
Last night, Democrats got the votes they needed to pass the Senate
health-care bill -- put over the top by a group of pro-life Democrats
who had been threatening to scuttle it.
The bill is truly historic -- the largest change to the health-care
system in generations -- but hardly the "radical" makeover the
Republicans have made it out to be. It doesn't contain a "public
option," much to the dismay of many Democrats, but it will provide
health insurance to another 32 million Americans.
GOP pundits are predicting that Democrats will pay a pretty price in
the voting booths for going against the polls that show Americans
unenthusiastic about ObamaCare. But this is the same gang who heaped
praise when George "I-don't-read-polls" Bush pushed ahead with "the
surge" in face of public opposition to the Iraq War.
One thing is clear: President Obama and Speaker Nancy Pelosi both view
health-care reform as their legacy -- and both were willing to lay
everything on the line for it.
They should be praised for following their convictions and fighting for
reform. Obama, who had too long kept a distance, put his prestige on
the line to push through the measure -- and it paid off.
Democrats know they're taking a risk -- but a calculated one. With the
bill finally becoming law, Americans will see its immediate benefits --
and also realize how exaggerated the GOP claims of a "government
takeover" really were.
This is hardly the first time Republicans have predicted that a piece
of legislation would mean the end of America as we know -- only to
embrace it later when Americans come to love it. Take Medicare, the
massive socialized government-run medical system the GOP has made
central to its "Senior's Health Care Bill of Rights."
We've come a long way from 1961, when Ronald Reagan warned Americans
that, "If you don't [stop Medicare] and I don't do it, one of these
days you and I are going to spend our sunset years telling our children
and our children's children what it once was like in America when men
were free."
Sound familiar? Now the GOP warns against Medicare cuts and points to
elderly people who oppose "socialized medicine" (unless it is for them)
as proof that Obama's health-care plan is bad for America. But
Dems shouldn't spend too long sipping the champagne. Last night's
victory was huge, but the fight is far from over.
Next, the Senate must pass the reconciliation bill. If the Republicans
succeed with some parliamentary challenges, the House will have to vote
on the entire bill again. But the real fight begins the day after
Obama signs the bill into law.
That's when Republicans will step up their counteroffensive, and Sarah
Palin will make baseless accusations from her Facebook page. If Team
Obama is as slow-footed as it has been in the past, it'll lose the PR
battle, and Americans will hate the bill no matter how great it is.
If, on the other hand, the president stays engaged in the process and
continues to sell the reform package -- highlighting provisions that go
into immediate effect -- the bill could redound to Democrats'
benefit. Polls show that people support most or all of the bill's
components. What they hate is the "massive socialized government
health-care system" that can't be found anywhere in the bill.
Americans will have no issue in taking advantage of key provisions such
as allowing their children to stay on their insurance until age 26.
You'll be hard pressed to find anyone complaining about the ban on
preexisting conditions or lifetime caps by insurance firms. The
Obama administration's challenge now is to keep sharing stories of real
Americans who benefit from this bill and beating back false accusations
or exaggerations about what the bill does.
It has won the battle. It just needs to not forget about the war.
Dem win is built on sand
New York Post
By RICH LOWRY
Last Updated: 8:55 AM, March 22, 2010
Posted: 4:56 AM, March 22, 2010
The passage of ObamaCare last night was the high-water mark of the
Democratic ascendancy.
Democrats forced through their signature initiative in an act of
ideological heedlessness that will cost them seats and perhaps their
majorities in the fall, and will remain a source of poisonous
contention in American politics for years to come.
The vote represented a significant personal victory for House Speaker
Nancy Pelosi, who scoffed at scaling back Democratic ambitions in the
wake of the loss of Ted Kennedy's seat in Massachusetts. She
prevailed in internal Democratic deliberations and then personally
lobbied a list of 68 waverers, resorting as necessary to "scary tough"
tactics, in the words of an anonymous Democrat quoted by The New York
Times.
Pelosi yesterday wielded the same sledgehammer-like gavel used during
the 1965 enactment of Medicare, an apt symbol of the Democrats'
historic commitment to the expansion of the social welfare state.
If the enactment of a program for universal coverage fulfills a
long-standing goal of the Democrats, this wasn't how it was supposed to
happen -- with public opinion firmly opposed, with protesters chanting
just steps away from the Capitol, with procedural contortions and
brazen deals, with blatantly dishonest accounting, with a wave of
popular revulsion threatening to undo their work.
Democrats sealed their majority yesterday with a characteristically
farcical deal over abortion.
The Senate bill provides federal funding for the procedure, in a
departure from the long-standing prohibition of such funding under the
Hyde Amendment. Pro-life Democrats led by Michigan's Rep. Bart Stupak
didn't want to support the Senate bill without the Hyde-like
restrictions that were in the version first passed the House. But
they folded for a legally meaningless executive order purporting to
preserve the status quo as defined by Hyde. The bill makes the
entire category of "pro-life Democrat" look dubious.
The question now is whether Democrats have built their reform on a rock
or on sand. If they had stacked the bill so the major benefits
came first, underpromised so it would exceed expectations once enacted
and designed it to be fiscally sustainable, it'd rest on a solid
foundation.
Instead, desperate to sell the unpopular reform in a center-right
country, they've done the opposite on all counts:
* They backloaded the benefits to keep the official costs in the first
10 years just under $1 trillion. This makes the bill vulnerable to
rollback or diminishment over time, especially as representations made
about it prove untrue.
* The bill won't reduce premiums and costs as Obama promises.
* As its tawdry fiscal tricks -- double-counting revenue, keeping
inconvenient new spending off the books, assuming unlikely Medicare
savings -- get exposed in the harsh light of reality, Obama's
description of the bill as an indispensable deficit-reduction measure
will look equally cynical and laughable.
For all that, the left's investment in Obama beginning in the 2008
nomination contest has been vindicated. He promised to reject
Clintonian triangulation, and he has. He talked of transforming the
country, and has taken a major step toward social democracy in America.
Despite his silky rhetoric, when push came to shove, he adopted the
partisan hardball beloved by lefty bloggers to forestall serious
compromise and work his ideological will. Obama stands exposed as
the kind of unabashed liberal Democrat who hasn't won a presidential
election since 1964. The first electoral test for this iteration of
Obama, shorn of all pretense to moderation, comes in November.
The mid-term elections will in large part be a referendum on health
care, as the exclamation point on top of a vaulting agenda of
government aggrandizement. Democrats won the battle within their
caucus to pass a large-scale bill that threatens to change the
relationship between citizen and government. But they haven't yet won
the battle for the country.
That begins today.
Final health bill omits some of Obama's promises
YAHOO
By ERICA WERNER, Associated Press Writer
Fri Mar 19, 4:18 pm ET
WASHINGTON – It was a bold response to skyrocketing health insurance
premiums. President Barack Obama would give federal authorities the
power to block unreasonable rate hikes.
Yet when Democrats unveiled the final, incarnation of their health care
bill this week, the proposal was nowhere to be found.
Ditto with several Republican ideas that Obama had said he wanted to
include after a televised bipartisan summit last month, including a
plan by Sen. Tom Coburn of Oklahoma to send investigators disguised as
patients to hospitals in search of waste, fraud and abuse.
And those "special deals" that Obama railed against and said he wanted
to eliminate? With the exception of two of the most notorious — extra
Medicaid money for Nebraska and a carve-out for Florida seniors faced
with losing certain extra Medicare benefits — they are all still there.
For the White House, these were the latest unfulfilled commitments
related to Obama's health care proposal, starting with his campaign
promise to let C-SPAN cameras film negotiations over the bill. Obama
also backed down with little apparent regret on his support for a new
government-run insurance plan as part of the legislation, a liberal
priority.
But was it all the president's doing?
In the cases of the insurance rate authority, the Republican ideas and
the special deals, it came down to Obama making promises that Congress
didn't keep. He can propose whatever he wants, but it's up to Congress
to enshrine it into law.
Arguably, the president could have foreseen that outcome, and was
making a low-risk p.r. move by floating proposals — dismissed by
critics as insubstantial anyway — whose demise he couldn't be blamed
for.
While the White House worked hard to trumpet Obama's plans for the rate
authority, his embrace of bipartisanship and his opposition to special
deals, the administration hardly advertised the lack of follow-through.
Understandable, certainly, but perhaps not the new way of doing
business that Obama promised to bring to Washington.
Removing the special deals ran into opposition from powerful lawmakers
including Sens. Chris Dodd, D-Conn., and Max Baucus, D-Mont. The
rate-limiting authority and the Republican ideas were left out of the
legislation because the bill is going to be considered under special
filibuster-proof Senate rules that prohibit provisions that don't have
a budgetary impact, and those ideas don't fit in.
"There are a number of proposals that the president wanted to
incorporate into the legislation including additional Republican
proposals, but the parliamentarian ruled against allowing those
proposals to be included," said White House spokesman Reid Cherlin. "We
would like to enact those proposals in separate legislation in the
coming months. In the meantime, some important Republican measures
remain."
Of the four main Republican ideas Obama endorsed, only one made it into
the final bill — a proposal embraced by Sen. Charles Grassley of Iowa
to bump up payments to primary care physicians under Medicaid. A
proposal to expand the use of health savings accounts was rejected out
of hand by congressional Democrats, while a plan to increase funding
for medical malpractice reform projects was also determined to be
undoable under fast-track Senate rules.
Coburn's spokesman, John Hart, complained that Democrats "found time to
buy votes with earmarks but couldn't include bipartisan ideas endorsed
by President Obama." House Minority Leader John Boehner, R-Ohio, had
dismissed the GOP ideas Obama endorsed as "bread crumbs" sprinkled atop
the health bill — and now even most of those bread crumbs are blown
away.
At the same time, Baucus got to keep a provision to give Medicare
benefits to asbestos-sickened residents of Libby, Mont., and Dodd still
has one that could result in a new hospital being built at the
University of Connecticut. Both senators argue their special deals
aren't really special deals, because the Medicare provision could apply
to other places where public health emergencies are declared, and other
sites outside of Connecticut could be eligible for the hospital.
Most of the provisions of the health care bill don't kick in until
2014, so Obama still has time to make good on everything he promised —
or try to get Congress to do so.
"To hold the president accountable for every single provision he
advocates for is simply unreasonable," said Alec Vachon, a health
policy consultant and former Republican Capitol Hill aide. "Some things
aren't in there because the members of Congress who have the votes
don't want it. Some things aren't in there because congressional rules
which Republicans will be enforcing won't allow it. But Democrats will
have three years to tinker with health reform before universal coverage
goes live."
State to use stimulus funds for health info network
DAY
Article published Mar 16, 2010
Almost $7.3 million in federal stimulus funds will be used to build an
information technology network for health care systems in Connecticut,
Gov. M. Jodi Rell announced Monday.
"These funds allow us to bring tremendous changes to the way health
care is delivered in Connecticut," Rell said in a news release. "The
result will be a more efficient system with less paperwork for patients
and providers. Ultimately, every citizen will have an electronic
record."
The new system, she said, will be "secure and cost-effective" and will
help lower costs for care, reduce medical errors and, ultimately, be
part of a nationwide health information exchange.
The state Department of Public Health will lead the effort. All
Connecticut doctors, hospitals and other health care organizations will
be eligible to participate. The state's Health Information Exchange
Advisory Committee also is involved.
Op-Ed Columnist
Health Reform Myths
NYTIMES
By PAUL KRUGMAN
March 12, 2010
Health reform is back from the dead. Many Democrats have realized that
their electoral prospects will be better if they can point to a real
accomplishment. Polling on reform — which was never as negative as
portrayed — shows signs of improving. And I’ve been really impressed by
the passion and energy of this guy Barack Obama. Where was he last year?
But reform still has to run a gantlet of misinformation and outright
lies. So let me address three big myths about the proposed reform,
myths that are believed by many people who consider themselves
well-informed, but who have actually fallen for deceptive spin.
The first of these myths, which has been all over the airwaves lately,
is the claim that President Obama is proposing a government takeover of
one-sixth of the economy, the share of G.D.P. currently spent on health.
Well, if having the government regulate and subsidize health insurance
is a “takeover,” that takeover happened long ago. Medicare, Medicaid,
and other government programs already pay for almost half of American
health care, while private insurance pays for barely more than a third
(the rest is mostly out-of-pocket expenses). And the great bulk of that
private insurance is provided via employee plans, which are both
subsidized with tax exemptions and tightly regulated.
The only part of health care in which there isn’t already a lot of
federal intervention is the market in which individuals who can’t get
employment-based coverage buy their own insurance. And that market, in
case you hadn’t noticed, is a disaster — no coverage for people with
pre-existing medical conditions, coverage dropped when you get sick,
and huge premium increases in the middle of an economic crisis. It’s
this sector, plus the plight of Americans with no insurance at all,
that reform aims to fix. What’s wrong with that?
The second myth is that the proposed reform does nothing to control
costs. To support this claim, critics point to reports by the Medicare
actuary, who predicts that total national health spending would be
slightly higher in 2019 with reform than without it.
Even if this prediction were correct, it points to a pretty good
bargain. The actuary’s assessment of the Senate bill, for example,
finds that it would raise total health care spending by less than 1
percent, while extending coverage to 34 million Americans who would
otherwise be uninsured. That’s a large expansion in coverage at an
essentially trivial cost.
And it gets better as we go further into the future: the Congressional
Budget Office has just concluded, in a new report, that the arithmetic
of reform will look better in its second decade than it did in its
first.
Furthermore, there’s good reason to believe that all such estimates are
too pessimistic. There are many cost-saving efforts in the proposed
reform, but nobody knows how well any one of these efforts will work.
And as a result, official estimates don’t give the plan much credit for
any of them. What the actuary and the budget office do is a bit like
looking at an oil company’s prospecting efforts, concluding that any
individual test hole it drills will probably come up dry, and
predicting as a consequence that the company won’t find any oil at all
— when the odds are, in fact, that some of the test holes will pan out,
and produce big payoffs. Realistically, health reform is likely to do
much better at controlling costs than any of the official projections
suggest.
Which brings me to the third myth: that health reform is fiscally
irresponsible. How can people say this given Congressional Budget
Office predictions — which, as I’ve already argued, are probably too
pessimistic — that reform would actually reduce the deficit? Critics
argue that we should ignore what’s actually in the legislation; when
cost control actually starts to bite on Medicare, they insist, Congress
will back down.
But this isn’t an argument against Obamacare, it’s a declaration that
we can’t control Medicare costs no matter what. And it also flies in
the face of history: contrary to legend, past efforts to limit Medicare
spending have in fact “stuck,” rather than being withdrawn in the face
of political pressure.
So what’s the reality of the proposed reform? Compared with the
Platonic ideal of reform, Obamacare comes up short. If the votes were
there, I would much prefer to see Medicare for all.
For a real piece of passable legislation, however, it looks very good.
It wouldn’t transform our health care system; in fact, Americans whose
jobs come with health coverage would see little effect. But it would
make a huge difference to the less fortunate among us, even as it would
do more to control costs than anything we’ve done before.
This is a reasonable, responsible plan. Don’t let anyone tell you
otherwise.
Dems
look to health vote without abortion foes
YAHOO
By ERICA WERNER, Associated Press Writer
March 11, 2010
WASHINGTON – House leaders have
concluded they cannot change a divisive abortion provision in President
Barack Obama's health care bill and will try to pass the sweeping
legislation without the support of ardent anti-abortion Democrats.
A break on abortion would remove a
major obstacle for Democratic leaders in the final throes of a yearlong
effort to change health care in the United States. But it sets up a
risky strategy of trying to round up enough Democrats to overcome, not
appease, a small but possibly decisive group of Democratic lawmakers in
the House.
Democratic leaders are working to
rally rank-and-file members around last-minute agreements on several
sticking points, health insurance taxes and prescription drug coverage
among them, and dozens of other complicated issues — all as Republicans
stand ready to oppose the overhaul en masse.
"We will finish the job," Senate
Majority Leader Harry Reid, D-Nev., wrote in a letter to his Republican
counterpart describing the path ahead.
Said Sen. Tom Harkin, D-Iowa: "The
stars are aligning for victory on comprehensive health reform. The end
is in sight."
Democratic Rep. Henry Waxman of
California, chairman of the Energy and Commerce Committee, said the
leadership will press ahead without reworking the abortion provision,
which opponents say falls short in restricting taxpayer dollars for
abortion coverage. He predicted some of the anti-abortion lawmakers in
the party will end up voting for the overhaul anyway.
One point on which Obama may not get
his way is the White House demand for a vote by March 18, a week away.
Speaking to reporters after Democrats met for a status report on the
emerging health care agreements, House Speaker Nancy Pelosi called the
deadline merely "an interesting date."
Before a vote, Pelosi, D-Calif.,
said lawmakers must first receive a cost report from the Congressional
Budget Office on changes to the bill being worked out among the White
House and Democratic congressional leaders. After that, it could be a
week or more before the legislation goes to the floor.
House Democrats were meeting behind
closed doors Thursday to hear a point-by-point briefing on the latest
health care compromise from White House health reform director Nancy
Ann DeParle. Pelosi asked the members whether they wanted to vote
sooner rather than later. They responded with a broad shout of "Yes!"
according to lawmakers coming out of the session.
It will come down to a phenomenal
effort by congressional leaders and the White House to win over
skittish lawmakers after a year of incendiary debate, even as Obama
keeps up campaign-style appearances designed to fire up public support.
At stake is the fate of the
president's call to expand health care to some 30 million people who
lack insurance and to prohibit insurance company practices such as
denial of coverage on the basis of pre-existing medical conditions.
Almost every American would be affected by the legislation, which would
change the ways many people receive and pay for health care, from the
most routine checkup to the most expensive, lifesaving treatment.
White House officials and
congressional Democratic leaders met Wednesday evening in Pelosi's
office. Aides said they agreed on scaling back a health insurance tax
that unions oppose, and on gradually closing the Medicare prescription
drug coverage gap. They were not far apart on other major issues,
including Medicaid financing for states that already provide
above-average benefits, and on improving subsidies that would be
available under the plan to help individuals and families pay their
premiums.
Several Democrats expressed
frustration, however, with the absence of cost estimates from the
Congressional Budget Office on the latest provisions. They want to
ensure the total price tag stays around $950 billion over 10 years.
Those costs would be covered through
a combination of Medicare cuts and tax increases. Among the new levies,
the Medicare payroll tax would be applied to the investment earnings of
upper-income people, including proceeds from capital gains. Until now,
the tax has solely been levied on wages.
In a bit of bookkeeping, the
Congressional Budget Office on Thursday released its final cost
estimates for the bill the Senate passed on Christmas Eve. That
10-year, $875 billion plan would reduce the federal deficit and cover
31 million people who'd otherwise be uninsured. The Senate bill is the
foundation of the proposal that Obama wants Congress to pass in the
next few weeks. But the numbers will change yet again with the new
version.
Obama invited members of the
Congressional Black Caucus and the Congressional Hispanic Caucus to
meet him Thursday at the White House to discuss the health legislation.
House and Senate Democrats are
working on a complex rescue mission for the health care legislation,
which appeared on the cusp of passage late last year before Senate
Republicans gained the strength to sustain a filibuster that could
prevent final passage. The White House is pushing for a vote by the
House before Obama leaves on a foreign trip at the end of next week.
The current plan is for the House to
approve the Senate-passed bill from late last year, despite serious
objections to numerous provisions. Both houses then would pass a second
bill immediately, making changes in the first measure before both could
take effect. The second bill would be debated under rules that bar a
filibuster, meaning it could clear by majority vote in the Senate
without Democrats needing the 60-vote supermajority now beyond their
reach.
That strategy would leave in place
the Senate language on abortion. It would allow health plans receiving
federal subsidies in a new insurance marketplace to cover abortion,
provided they pay for it only with money collected from policyholders.
The House bill would have prohibited health plans receiving subsidies
from covering abortions.
Rep. Bart Stupak, D-Mich., has been
pushing for the stricter House provisions, saying that he and a dozen
or so abortion opponents would vote against the health care bill if the
Senate language is retained. But the leadership appears to be moving to
call his bluff.
Republicans have vowed to do
everything they can to thwart the plan, and for the Democrats, some
policy questions remain unsettled.
Obama already has moved to eliminate
a couple of special deals in the Senate bill that turned off voters
when they became public, including extra Medicaid money for Nebraska —
derided by critics as the "Cornhusker kickback." Late Wednesday the
White House said the president was pushing to strip out a number of
deals that remain, possibly including a provision sought by Sen. Max
Baucus, D-Mont., providing Medicare coverage for residents of Libby,
Mont., who suffer from asbestos-related illnesses because of a
now-closed mining operation.
Nancy's nutty new rules
By GRACE-MARIE TURNER
Last Updated: 1:57 AM, March 10, 2010
Posted: 1:25 AM, March 10, 2010
The next act in the drive to pass ObamaCare is the mother-of-all
political maneuvers -- in which Democrats will use an incredibly
convoluted and possibly unconstitutional process.
Things were already arcane: President Obama, House Speaker Nancy Pelosi
and Senate Majority Leader Harry Reid have been threatening to enact
"health-care reform" through the narrow path of budget reconciliation.
It's a ploy to allow the Senate to pass "reform" with just 51 votes --
making the election of Scott Brown as the 41st senator against
ObamaCare irrelevant.
To use reconciliation, Pelosi must first get House members to vote for
the exact bill the Senate passed in December. That is, the House would
"keep the process moving" so both the House and Senate could pass a
second bill to fix things members don't like in the Senate measure.
But the speaker is having trouble rounding up the 216 votes she needs
to get the Senate bill through the House. Her members rightly fear that
the Senate might prove unwilling or unable to pass the "fixed" bill --
and, at the least, would have a huge advantage in negotiations over
just what "fixes" to make.
The problem is straight out of a 7th-grade civics class: If both houses
of Congress pass identical bills, the bill can go to the president to
be signed into law.
House members are being told that they must vote for the Senate bill as
a procedural step. But the bill would then be only a presidential
signature away from becoming law. That is, House members might end up
voting for the Senate's Cornhusker Kickback, Louisiana Purchase,
"Cadillac" tax, abortion coverage and other unpopular provisions -- and
then find it's all become law.
The risks are plain enough that Pelosi doesn't yet have the votes: Her
members fear they'll be left hanging to defend their votes for the
hated Senate bill.
So now Democratic leaders say they'll package a two-for-one vote:
Moving the original Senate bill simultaneously with a "reconciliation"
bill -- thus, if the House votes for the bill of fixes, the main Senate
bill will be deemed to also have passed. Then the reconciliation bill
will go back to the Senate, where it only needs 50 votes (plus Vice
President Joe Biden's) to pass.
Hmm. Nowhere in the US Constitution does it say that Congress can deem
a bill to have passed. Pelosi & Co. aren't just making up policy as
they go, but also procedure -- possibly unconstitutional procedure, at
that. All to enact a bill remaking a sixth of the US economy over the
3-1 opposition of the American people.
Grace-Marie Turner is president of the Galen Insti tute, a nonprofit
research organization focusing on pa tient-centered health reform.
Myths about Reconciliation
Using
reconciliation to pass Obamacare would be inappropriate and
unprecedented. Here’s why.
National Review Online
March 5, 2010 4:00 A.M.
How could you tell when the Democrats had finally settled on the
reconciliation route? It was at some point between the time Harry Reid
told Republicans at the health-care summit that “nobody has talked
about reconciliation” and the time the White House stopped uttering the
word altogether.
But though their diction has changed, the Left continues to perpetuate
a number of myths about reconciliation that should be dispelled before
Democrats in Washington use the procedure to force-feed the American
people this $2.3 trillion behemoth.
Myth: Reconciliation is simply
“majority rule.”
Democrats have referred to the maneuver that dare not speak its name as
simple “majority rule.” In his March 3 speech, President Obama called
for an “up-or-down vote” on health-care reform requiring “nothing more
than a simple majority.” White House Press Secretary Robert Gibbs told
MSNBC the next day that in most American households, “51 percent
represents a majority viewpoint. I don’t think that’s a crazy concept.”
Ezra Klein claimed that “a simple majority process” has been “key to
getting anything done” in the Senate since the 90s.
But this isn’t about lowering the thresholds for passage, as most
reconciliation measures initially pass the Senate with sizeable
majorities — sometimes even by voice vote or unanimous consent. Rather,
the process is explicitly about bypassing the Senate’s usual order of
business — an open debate and amendment process with an emphasis on
consent and consensus and robust protections for minority rights — to
ensure the speedy passage of budget-balancing legislation. As a result,
reconciliation measures are “privileged,” meaning that the Senate must
consider them when they come to the floor. Likewise, debate on their
substance is strictly limited to 20 hours and amendments are allowed
only insofar as they address the contents of the measure itself
(though, as author Foster notes here, there is nothing to stop a
determined minority from gumming up the works indefinitely by forcing
votes on the germaneness of extraneous amendments).
There is nothing wrong with the principled use of this
“front-of-the-line” treatment for measures meant to bring budgetary
outlays in line with revenues, but in a Congress that demonstrably no
longer takes its duty to balance budgets seriously, reconciliation is
once again being abused as a matter of political convenience.
The truth is that every single piece of successful legislation to
emerge from the Senate — via reconciliation or otherwise — has done so
via a final, up-or-down vote with a 50-plus-one threshold. The debate
about reconciliation is a debate about the path to that vote. It’s
about whether the Senate is and ought to be something more than a
slightly smaller, slightly crustier House of Representatives.
When Harry Reid took over the majority leadership of the Senate, he
vowed that “as our founding fathers intended, the Senate will perform
its role as the ‘cooling saucer’ where debate and amendments play a
role in forging consensus and compromise.”
Would that he lived up to those words.
Myth: Obamacare is in the main about
cutting deficits, and therefore justifiably considered under
reconciliation.
First, it’s important to understand why reconciliation might be
necessary. The Senate bill includes an excise tax on high-cost
employer-provided health-insurance plans — the kind that unions have
acquired for their members through years of collective bargaining. The
inclusion of this tax was almost an accident. Like many Democratic
ideas, it started as a way to demagogue against the rich. Only later,
after unions started voicing objections, did the Democrats realize what
they had done, but by then it was too late. Health-care economists
liked the idea of an excise tax on high-cost employer-provided plans,
because the fact that these plans are otherwise untaxed is one of the
great distortions in our health-care system that drive up the cost of
insurance. Plus, the tax provided a real source of revenue to pay for
new spending in the bill, thus improving its CBO score. The excise tax
— dubbed the “Cadillac tax” by some — proved impossible to remove from
the Senate bill without rocking the boat that was moving the bill
toward passage.
But in the House, where union-backing progressives are stronger,
objection to the tax made rubber-stamping the Senate bill impossible
for Nancy Pelosi. Democratic leaders met with President Obama to devise
a carve-out to protect the unions from the tax, and they had almost
achieved a deal when a certain truck-driving Republican from
Massachusetts won an election and upset the balance. Things fell apart
for a while. The Democrats panicked. Health-care reform looked dead.
Then Obama put forward a plan that would allow the Democrats to scrap
the Cadillac tax through reconciliation. That’s where things stand.
As we’ve said, reconciliation is a process devised to ensure an easier
process for shrinking budget deficits. Liberals have argued that
according to the CBO, Obamacare would reduce the deficit, so amending
it through the reconciliation process is appropriate. There are two
problems with this argument. First, even taking the administration’s
numbers at face value, its reconciliation plan would amend the
legislation so that it reduces the deficit by less than the original
bill. The CBO has not had time to score the president’s proposal, but
the administration says that combined with the original legislation,
the president’s plan would reduce the deficit by $100 billion. The CBO
scored the Senate bill as reducing the deficit by $131 billion. Neither
is a significant sum, but the point is that reconciliation in this case
would actually move us backwards in terms of deficit reduction.
Second, the president’s plan replaces new revenue (the Cadillac tax)
with revenue that is double-counted and, according to the CBO, cannot
be used to offset new spending. Instead of the Cadillac tax, the
president’s plan would raise revenue through a 2.9 percent Medicare
excise tax on the investment income of people making more than
$200,000. But as the CBO noted in objecting to a previous attempt to do
this, that money must go into the Medicare trust fund, and the
government must use it to pay out future Medicare benefits. It cannot
simultaneously count that money as savings to be spent on a new
health-insurance entitlement for the uninsured. So the president’s
numbers are not to be taken at face value — by replacing Cadillac-tax
revenue with double-counted revenue, his reconciliation plan would
likely increase the bill’s cost by much more than $30 billion,
increasing deficits in a manner contrary to the spirit of
reconciliation.
Myth: We already passed health care
with 60 votes in the Senate. Reconciliation is just for a few “fixes.”
In his March 3 speech, President Obama said that “reform has already
passed the House with a majority. It has already passed the Senate with
a supermajority.” Robert Gibbs has said “we got health-care done not
with 51 but with 60 votes” in the Senate. By contrast, the Democrats
argue, reconciliation will only be used to pass a small package of
“fixes” introduced by the president to resolve the House and Senate
versions of the bill. Ezra Klein and others have adopted the term
“micro-reconciliation” to describe this strategy.
But to say that both chambers have already passed “reform” is deeply
misleading, considering that reconciliation is necessary precisely
because neither body’s bill is acceptable to the other. Indeed, the
greatest impediment to the Democrats’ reconciliation strategy is not
the Republicans, but the House’s mistrust of the Senate. Since the
Senate acting first to “reconcile” a bill that has yet to become law
would create a sort of legislative paradox, the White House and Senate
Democrats have spent weeks trying to assure their colleagues in the
lower chamber that they won’t be hung out to dry if they act first and
pass the Senate bill before the reconciliation measure.
We’ve already noted the excise tax as a major source of tension between
the chambers, but the Senate’s more permissive language on the federal
funding of abortion is also a non-starter in the House, with Rep. Bart
Stupak (D., Mich.) promising that a dozen or more pro-life House
Democrats who voted yes on the House bill would balk at the Senate
language. Since it will be nearly impossible to shoehorn a compromise
into a reconciliation measure, the abortion issue could well doom
Obamacare.
In short, the House and Senate are as far away from each other on
reform as they were before Massachusetts, only now they’ve lost the
supermajority that gave them the luxury of working out their
differences in a conference report. So as it stands, there is not one
health-care reform bill but two, and neither is in any shape to make it
to the president’s desk without reconciliation.
Myth: This is just like when the GOP
used reconciliation for the Bush tax cuts.
As we have noted, reconciliation would likely worsen the bill’s impact
on the deficit, but the president’s supporters might say, “So what? The
Bush tax cuts added to the deficit, and the GOP used reconciliation for
those.” Here they have a point. But there are two reasons why health
care is different. One, perhaps semantic, is that the Bush tax cuts
were temporary — their impact on deficits was limited to the ten-year
window specified by the Byrd Rule, which states that reconciliation
bills cannot add to the deficit beyond the period covered by the budget
resolution. Obamacare is designed to be a permanent new
health-insurance entitlement. Second, and more important, is that the
Bush tax cuts in addition to being temporary were strictly limited to
fiscal policy — the kind of thing reconciliation was designed to handle
— and therefore easy to score. As mentioned above, it is hard to know
the true budgetary cost of Obamacare, because it is a tangled nest of
tax hikes, regulations, twice-counted revenues, and unknowable costs
tied to hard-to-predict factors such as health-care cost inflation.
Will Obamacare increase the deficit in a fiscal year after the ten-year
period covered by the Byrd Rule? The answer is almost certainly yes.
But unlike the Bush tax cuts, Obamacare will not sunset. Unless
Republicans are able to repeal it — a difficult task, to put it mildly
— its costs will be with us for good.
Myth: This is no different than what
the Republicans did on Medicare Part D.
Again, charges of hypocrisy leveled at Republicans who object to using
reconciliation to pass health-care measures have some force. It is true
that reconciliation has been used more often by Republicans than
Democrats since its adoption. And it is true that reconciliation has
been used to pass big-ticket health-care measures such as COBRA and
CHIP.
But most of the health-care measures passed via reconciliation did so
with broad, bipartisan support. And as mentioned above, virtually all
of the votes that were tight and/or partisan dealt with straightforward
fiscal policy, without the massive unintended consequences that attend
to a measure of the size and scope of Obamacare.
Perhaps the closest parallel to the Democrats’ current effort — and the
one most often carted out in service of the hypocrisy charge — is
Medicare Part D, which passed with 54 votes in a Republican-controlled
Senate. But in fact it isn’t much of a parallel at all. For one thing,
Medicare Part D wasn’t passed via reconciliation. Rather, Democrats
could not or would not sustain a filibuster, and cloture on the
conference report was secured 70–29 via the usual order of business.
And when then-senator Tom Daschle (D., S.D.) tried to raise a point of
order under the Congressional Budget Act — from which reconciliation
rules stem — he was overruled with 61 votes.
Moreover, though the Republicans only had 54 votes, eleven Democrats
(plus one Independent) voted with the majority, including the likes of
Max Baucus, Kent Conrad, Mary Landrieu, Blanche Lincoln, and Ben Nelson.
During the floor debate, then-senator Pete Domenici (R., N.M.) raised
the possibility of pursuing the bill under reconciliation, and rejected
it:
Let me just tell you, without trying to take much
time, that our distinguished leader had an opportunity to move this
bill under what is called a reconciliation bill. Do you know what that
would have done, Mr. President? That would have limited debate, and it
would have made the bill almost not amendable and, indeed, besides
that, there would be no points of order. He chose, as the bill
progressed through, to do otherwise.
Medicare Part D is hardly a shining example of good legislation, but it
passed under the standing rules of the Senate, under which the minority
was afforded an open and extended debate. And it passed with
significant support from that minority. Neither will be said of
Obamacare if it is pushed through via reconciliation.
— Daniel Foster is National Review
Online’s news editor. Stephen Spruiell is an NRO staff reporter.
The
role for reconciliation
Washington Post
By Kent Conrad
Saturday, March 6, 2010; A15
A lot of misinformation has been spread recently about the budget
reconciliation process. As chairman of the Senate Budget Committee, I
have the primary responsibility for budget-related matters in the
Senate. So let me set the record straight.
Reconciliation is not being considered for passing comprehensive
health-care reform. Major health-care reform legislation passed the
Senate without reconciliation on Christmas Eve. If the House now passes
that legislation, it can go immediately to President Obama's desk to be
signed into law. What the president and others have suggested is that,
after the House acts, reconciliation could then be used to pass a much
smaller "fixer" bill to allow for modifications to the comprehensive
bill that will have passed under regular order.
While some have described reconciliation -- a process that requires
only a majority vote in the Senate to pass legislation that reduces the
deficit -- as an obscure, rarely used procedure, the truth is that it
has been used 22 times since 1980, with 16 of those times occurring
when Republicans controlled the Senate. Republican efforts to block its
use now for a "fixer" bill represent little more than a politically
expedient attempt to kill health-care legislation.
Since health-care reform re-emerged on the national agenda more than a
year ago, I have consistently said that comprehensive health reform
cannot be achieved through reconciliation. The reconciliation process
was never intended for comprehensive policy changes. The Senate
parliamentarian concluded that if legislation such as health-care
reform were to go through the reconciliation process, it would come out
looking like "Swiss cheese." Some of the most significant portions of
the legislation, such as insurance market reforms and delivery system
reforms, might have to be dropped.
Even if implemented only as a "fixer" bill, reconciliation could still
be used only for changes that are truly budget-related -- meaning they
affect revenue or spending. Changes to improve the affordability of
health care or adjust the amount of federal aid going to states for
Medicaid could be good candidates for a reconciliation bill. But
changes involving strictly policy matters, which do not have a
budgetary impact, would likely have to be addressed some other way.
This "fixer" reconciliation bill would also still have to meet the
requirement that reconciliation be used only for deficit reduction. In
fact, the bill would have to include at least $2 billion in deficit
reduction over the first five years and would have to be at least
deficit-neutral in every year beyond that.
Some question how the then-Republican majority used reconciliation to
pass a $1.3 trillion tax cut in 2001 and another $350 billion tax cut
in 2003, all entirely unpaid for. These were clear abuses of the
process. The authors of the Congressional Budget Act of 1974, which
established reconciliation, never envisioned it would be used to worsen
the deficit. After Democrats took control of the Senate in 2007, we
restored fiscal discipline and added an explicit rule requiring
reconciliation be used only for deficit reduction. So it is
particularly ironic to hear many Republicans criticize Democrats' use
of reconciliation today, when it is being used properly, while they
vehemently defended their use of the process when it was being abused.
The truth is, the Senate has already passed a responsible health-care
reform bill with 60 votes that will expand coverage, lower premiums,
improve quality and control costs. And most important, the
Congressional Budget Office estimates it will reduce the deficit by
$130 billion over the first 10 years and by as much as $1.3 trillion
over the second 10 years. This represents a significant step in the
right direction. If the Senate bill can be further improved with
changes made through a small "fixer" reconciliation package, we should
do so. Those who argue against its use in this context seek only to
protect the status quo on health care.
The writer, a Democrat, is a U.S.
senator from North Dakota.
BLAIR HOUSE (not as in "Tony Blair")
Who is that masked man? Why, it's the impartial moderator of the
Health Care confab!
Pelosi
lacks the votes
NYPOST
By MICHAEL BARONE
Last Updated: 10:20 AM, March 1, 2010
Posted: 12:36 AM, March 1, 2010
'More talk, no deal" was the Wall Street Journal's headline on
Thursday's Blair House health-care summit.
"After summit flop, Democrats prepare to go it alone on ObamaCare,"
proclaimed The Washington Examiner. These were apt verdicts if you
viewed the summit as an attempt to reach bipartisan agreement or even a
limited consensus.
But that, of course, wasn't why President Obama convened this unique
colloquy. He did so as part of an attempt to pass some Democratic
health-care bill, somehow, through both houses of Congress -- and to
discredit the Republicans who opposed the bills passed by the House in
November and the Senate in December.
In that, he seems to have failed. The Atlantic's Clive Crook, who
supports the Democratic bills, concluded that "the Republicans did not
come across as the party of no. They looked well informed, pragmatic
and engaged in the discussion. It was the Democrats who leaned more
heavily on talking points and seemed evasive and unspecific."
Kevin Drum, blogging for the left-wing Mother Jones, agreed: "My take
is that the summit was basically a draw but with a slight edge to the
Republicans. They didn't have to win, after all. They just had to seem
non-insane, and, for the most part, they did."
Obama and the Democrats face problems with both public opinion -- their
bills are hugely unpopular -- and legislative procedure. The problem
with public opinion has been undeniable since Republican Sen. Scott
Brown's victory five weeks ago in Massachusetts. The problem with
legislative procedure is more complex.
Democrats could theoretically solve that problem by having the House
pass the Senate bill in toto, ready for Obama's signature. But Speaker
Nancy Pelosi, who has proved herself a fine vote counter, doesn't have
the votes. Last month, she said "unease would be the gentlest word" to
describe House Democrats' resistance. They understandably don't want to
cast votes for the Senate's Cornhusker Kickback and Louisiana Purchase.
In November, Pelosi had 220 votes for the House bill. The one
Republican is now a no, one Democrat has died, one resigned last month,
and another turned in his resignation Friday. That leaves her with 216,
one less than the 217 she needs.
There's another problem. The Senate bill lacks the amendment, sponsored
by House Democrat Bart Stupak, banning abortion coverage, and Stupak
says that he and about 10 other Democrats will accordingly vote no.
That leaves Pelosi around 205. She may have commitments from former no
voters to switch to yes, but she doesn't have more than 10 other votes
in her pocket -- or she wouldn't have accepted the Stupak amendment.
So the House wants the Senate to go first and pass changes to its bill
through the reconciliation process that requires 51 rather than 60
votes. But Senate Budget Committee Chairman Kent Conrad says that you
can't use reconciliation on a bill that hasn't already become law. And
reconciliation is probably not available on abortion issues.
All of which reminds me of Alaska Sen. Ted Stevens' 2005 attempt to
allow oil drilling in the Arctic National Wildlife Reservation. Stevens
got it in the reconciliation process in the Senate, where it had 51 but
not 60 votes.
But House Republicans couldn't get it into reconciliation, even though
a majority of House members were for it. The Senate could pass it by
reconciliation but not regular order; the House could pass it by
regular order but not reconciliation. It never passed.
There are two differences here. ANWR drilling would have little effect
on most Americans. The health-care bill would affect almost everybody
-- by raising taxes, cutting Medicare spending and abolishing current
insurance. The second difference is that ANWR drilling was reasonably
popular with the public and there were majorities in both houses for
it. Neither is true of the health-care bills.
Last month, we were told that Obama would switch his focus from health
care to jobs. But Democrats have spent February and seem about to spend
March on health care. It's hard to see how they can navigate the
legislative process successfully -- and even harder to see how they
turn around public opinion. Summit flop, indeed.
Health
summit: Heated talk, little
agreement
YAHOO
By RICARDO ALONSO-ZALDIVAR and JENNIFER LOVEN, Associated Press Writers
Feb. 25, 2010
WASHINGTON – With tempers flaring, President Barack Obama and
congressional Republicans clashed in an extraordinary live-on-TV summit
Thursday over the right prescription for the nation's broken health
care system, talking of agreement but holding to long-entrenched
positions that leave them far apart.
"We have a very difficult gap to bridge here," said Rep. Eric Cantor,
the No. 2 House Republican. "We just can't afford this. That's the
ultimate problem."
With Cantor sitting in front of a giant stack of nearly 2,400 pages
representing the Democrats' Senate-passed bill, Obama said cost is a
legitimate question, but he took Cantor and other Republicans to task
for using political shorthand and props "that prevent us from having a
conversation."
And so it went, hour after hour at Blair House, just across
Pennsylvania Avenue from the White House.
Obama and his Democratic allies argued that a sweeping health overhaul
is imperative for the nation's future economic vitality. With the
marathon policy debate available from start to finish to a divided
public, Obama cast the health care crisis as "one of the biggest drags
on our economy," tying his top domestic priority to the issue that's
even more pressing to many Americans.
"This is the last chance, as far as I'm concerned," Rep. Louise
Slaughter, D-N.Y.
Obama lamented partisan bickering that has resulted in a stalemate over
legislation to extend coverage to more than 30 million people who are
now uninsured. "Politics I think ended up trumping practical common
sense," he said.
And yet, even as he pleaded for cooperation — "actually a discussion,
and not just us trading talking points" — he insisted on a number of
Democratic points and acknowledged agreement may not be possible. "I
don't know that those gaps can be bridged," Obama said. "If not, at
least we will have better clarified for the American people what the
debate is all about."
With hardened positions well staked out before the meeting, the
president and his Democratic allies prepared to move on alone.
Politically, it would be an all-or-nothing gamble in a midterm election
year for Democrats bent on achieving a goal that has eluded lawmakers
for a half-century.
Leaving the site during a lunch break, Obama was asked by waiting
reporters if he thought the debate was engendering a lot of interest
across the country.
"I don't know if it's interesting watching it on TV," he responded. But
Obama also said, "I think we're establishing that there are actually
some areas of real agreement. And we're starting to focus on what the
disagreements are."
"If you look at the issue of how much government should be involved,"
he said, "the argument that the Republicans are making really isn't
that this is a government takeover of health care but rather that we're
ensuring the ... We're regulating the insurance market too much. And
that's a legitimate philosophical disagreement."
One option is to try to pass a comprehensive plan without GOP support,
by using controversial Senate budget reconciliation rules that would
disallow filibusters. Alexander asked Democrats to swear off a
jam-it-through approach, while Senate Majority Leader Harry Reid,
D-Nev., defended it. Obama weighed in with gentle chiding, asking both
sides to focus on substance and worry about process later — a plea he
made repeatedly throughout the day with little success.
A USA Today/Gallup survey released Thursday found Americans tilt 49-42
against Democrats forging ahead by themselves without any GOP support.
Opposition was even stronger to the idea of Senate Democrats using the
special budget rules, with 52 percent opposed and 39 percent in favor.
Obama's skepticism about reaching consensus was vindicated as soon as
the first Republican spoke — in opposition to the mammoth bills that
have passed the House and Senate and in favor of a much more modest
approach. Sen. Lamar Alexander of Tennessee said Congress and the
administration should start over and take small steps, including
medical malpractice reform, high-risk insurance pools, a way to allow
Americans to shop out of state for lower-cost plans and an expansion of
health savings accounts.
"We believe we have a better idea," Alexander said. "Our views
represent the views of a great many American people."
Disagreements were not always expressed diplomatically.
Alexander challenged Obama's claim that insurance premiums would fall
under the Democratic legislation. "You're wrong," he said. Responded
Obama: "I'm pretty certain I'm not wrong."
As with much in the complicated health care debate, both sides had a
point. The Congressional Budget Office says average premiums for people
buying insurance individually would be 10 to 13 percent higher in 2016
under the Senate legislation, as Alexander said. But the policies would
cover more medical services, and around half of people could get
government subsidies to defray the extra costs.
Obama and his 2008 GOP opponent for the presidency, Sen. John McCain of
Arizona, had a barbed exchange. McCain complained at length about what
he said was a backdoor process to produce the original bills that
resulted in favors for special interests and carve-outs for certain
states.
"We're not campaigning anymore. The election's over," responded a
clearly irritated Obama.
"I'm reminded of that every day," McCain shot back, adding that "the
American people care about what we did and how we did it."
Said Obama: "We can have a debate about process or we can have a debate
about how we're actually going to help the American people at this
point. And I think that's — the latter debate is the one that they care
about a little bit more."
Generally, polls show Americans want solutions to the problems of high
medical costs, eroding access to coverage and uneven quality. But they
are split over the Democrats' sweeping legislation, with its $1
trillion, 10-year price tag and many complex provisions, including some
that wouldn't take effect for eight years.
The Democratic bills would require most Americans to get health
insurance, while providing subsidies for many in the form of a new tax
credit. The Democrats would set up a competitive insurance market for
small businesses and people buying coverage on their own. Democrats
also would make a host of other changes, which include addressing a
coverage gap in the Medicare prescription benefit and setting up a new
long-term-care insurance program. Their plan would be paid for through
a mix of Medicare cuts and tax increases.
Another alternative if bipartisan agreement eludes Obama on Thursday is
going smaller, with a modest bill that would merely smooth some of the
rough edges from the current system. The Republican approaches, for
instance, would help people now struggling with costs and coverage but
probably not put the nation on a path toward coverage for all.
A month after the Massachusetts election that cost Democrats their
Senate supermajority and threw the health legislation in doubt, the
White House has developed its own slimmed-down health care proposal so
the president will know what the impact would be if he chooses that
route, according to a Democratic official familiar with the
discussions. That official could not provide details, but Democrats
have looked at approaches including expanding Medicaid and allowing
children to stay on their parents' health plans until around age 26.
Obama himself hinted at a Democrats-only strategy. When asked by
reporters as he walked to the summit site if he had a Plan B, he
responded: "I've always got plans."
"Not only are lawmakers polarized, the parties' constituencies are far
apart," said Robert Blendon, a Harvard University professor who follows
public opinion trends on health care. "The president is going to use it
as a launching pad for what will be the last effort to get a big bill
passed. He will say that he tried to get a bipartisan compromise and it
wasn't possible."
The summit was held at Blair House, the elegant presidential guest
quarters across the street from the White House. Leaders of both
parties spoke, with Obama steering the debate as moderator.
It wasn't a grand, or even particularly comfortable, setting. About 40
senators, representatives and administration officials were crowded
shoulder-to-shoulder around a hollow square table, perched for the
six-hour marathon on wooden chairs with thin cushions. Coffee breaks
had been ruled out, so the only pause in the action came during lunch.
C-SPAN carried complete coverage, while news operations from cable
networks to public broadcasting were making it the focus of their day.
Too
Little, Too Late, Too Cynical
What’s
behind Obama sudden embrace of statesmanship?
National Review
Victor Davis Hanson
February 25, 2010 12:00 A.M.
The United States may very well owe a crushing $20 trillion by 2020.
And thus President Obama last week named a bipartisan commission to
find ways to address our national debt.
Such a Periclean response might sound sincere and worthwhile. But it
comes 13 months into this administration — and only after Obama added
nearly $1.5 trillion in new borrowing in 2009. And by the time the new
deficit commission submits its recommendations at the end of this year,
the current 2010 budget will have put us out another $1.5 trillion.
The president not that long ago ran on the theme of fiscal sobriety.
During the 2008 campaign, he took advantage of the public anger over
the Bush deficits that had climbed to an aggregate of $2.5 trillion
over eight years. Now, though, he looks to trump Bush’s eight-year
record of red ink in his first two years.
Obama also just invited the Republican opposition to a summit at the
White House to iron out differences over his stalled health-care
legislation. Such a “let bygones, be bygones” group discussion likewise
sounds like a good idea — given the climbing cost of health insurance
and the millions who cannot afford it.
But the problem again is that such outreach is too little and comes too
late — more than a year after Obama began his unilateral effort to have
the government assume much of the nation’s health-care system. A year
ago — with a supermajority in the Senate and basking in the swell of
the November 2008 election — Obama didn’t worry much over the lack of
Republican input.
Instead, in partisan mode, he issued a series of deadlines for his
party to ram through his own preferred reforms — first by the August
2009 vacation, then by the Thanksgiving recess, then by the Christmas
break, and so on.
A couple of fence-sitting Democratic legislators, who by themselves
could block passage, were to be bought off with awards of
multimillion-dollar earmarks. Meanwhile, the president himself
reportedly ridiculed angry tea-party protestors as “the teabag,
anti-government people.” He, it appeared, did not worry too much about
the opposition.
Recently, a petulant Obama blasted Washington partisan politics, the
media, and congressional inaction. In his January State of the Union
address, Obama deplored “the partisanship and the shouting and the
pettiness” by “politicians (who) tear each other down instead of
lifting this country up” and “TV pundits (who) reduce serious debates
into silly arguments.”
Other administration supporters lamented the Republican resort to the
filibuster.
But once again, 13 months ago, the upbeat president had little bad to
say about one-party governance, pundits, and politics. And there was no
criticism of the filibuster — which in early 2009 was considered
irrelevant anyway, given Obama’s supermajority in the Senate.
So what’s behind Obama sudden embrace of statesmanship?
A year ago, a newly elected President Obama enjoyed a 68 percent public
approval rating. There were substantial Democratic majorities in both
houses of the Congress. Presidential press conferences were little more
than media lovefests. Apparently there was no need to reach out, when a
bold, new liberal agenda for the country seemed a sure thing.
But now? Obama consistently polls below 50 percent. The Senate
supermajority was lost with the stunning win of Republican Scott Brown
in liberal Massachusetts. A grassroots conservative tea-party movement
helped put Republican governors in Virginia and New Jersey. And polls
show that the November 2010 elections might result in the largest
Democratic setback in a generation, with possible losses of both houses
of Congress.
Pundits of both parties now fault Obama’s style of governance. Public
protests express disapproval over out-of-control federal spending and
borrowing, and the idea of state-run health care.
So fairly or not, it seems like a panicked President Obama is abruptly
scrambling to do what he should have done over a year ago.
But the problem is that a now jaded public believes that Obama is
changing both course and tone not because he wants to for the country,
but because he is forced to for his own survival.
In other words, the “hope and change” of last year’s messiah has
devolved into this year’s “whatever it takes” of a cynic.
Are we listening?
Obama puts forward last-ditch
health
care plan
YAHOO
By RICARDO ALONSO-ZALDIVAR and ERICA WERNER, Associated Press Writers
Feb. 22, 2010
WASHINGTON – Making a last-ditch effort to save his health care
overhaul, President Barack Obama on Monday put forward a nearly $1
trillion, 10-year compromise that would allow the government to deny or
roll back egregious insurance premium increases that infuriate
consumers.
The White House immediately demanded an up-or-down vote in Congress on
the plan, or something close to it. But it's highly uncertain that such
sweeping legislation can pass. Republicans are virtually unanimous in
opposing it, and some Democrats who previously supported a health care
remake are having second thoughts in an election year. After a year in
pursuit, Obama may have to settle for a modest fallback version of what
once was his top domestic priority.
Release of the plan on the White House Web site comes just four days
before Obama's one-of-a-kind, televised health care summit with
Democrats and Republicans. The White House said the plan would provide
coverage to more than 31 million Americans now uninsured without adding
to the federal deficit.
On Capitol Hill, Democrats cautiously welcomed the proposal, while
Republicans gave a thumbs down...
Estimated to cost about $1 trillion over 10 years, Obama's plan would
be paid for by a mix of Medicare cuts, tax increases and new fees on
health care industries.
Oversight of insurance companies has traditionally been a state
responsibility. Obama's proposal for a new federal role calls for
setting up a seven-member Health Insurance Rate Authority to monitor
insurance industry practices and issue an annual report. States that
beef up their consumer protection programs would be eligible for a
share of $250 million in federal grants.
How's that again? Thirty-nine percent?
Op-Ed Columnist
California Death Spiral
By PAUL KRUGMAN, NYTIMES
February 19, 2010
Health insurance premiums are surging — and conservatives fear that the
spectacle will reinvigorate the push for reform. On the Fox Business
Network, a host chided a vice president of WellPoint, which has told
California customers to expect huge rate increases: “You handed the
politicians red meat at a time when health care is being discussed. You
gave it to them!”
Indeed. Sky-high rate increases make a powerful case for action. And
they show, in particular, that we need comprehensive, guaranteed
coverage — which is exactly what Democrats are trying to accomplish.
Here’s the story: About 800,000 people in California who buy insurance
on the individual market — as opposed to getting it through their
employers — are covered by Anthem Blue Cross, a WellPoint subsidiary.
These are the people who were recently told to expect dramatic rate
increases, in some cases as high as 39 percent.
Why the huge increase? It’s not profiteering, says WellPoint, which
claims instead (without using the term) that it’s facing a classic
insurance death spiral.
Bear in mind that private health insurance only works if insurers can
sell policies to both sick and healthy customers. If too many healthy
people decide that they’d rather take their chances and remain
uninsured, the risk pool deteriorates, forcing insurers to raise
premiums. This, in turn, leads more healthy people to drop coverage,
worsening the risk pool even further, and so on.
Now, what WellPoint claims is that it has been forced to raise premiums
because of “challenging economic times”: cash-strapped Californians
have been dropping their policies or shifting into less-comprehensive
plans. Those retaining coverage tend to be people with high current
medical expenses. And the result, says the company, is a drastically
worsening risk pool: in effect, a death spiral.
So the rate increases, WellPoint insists, aren’t its fault: “Other
individual market insurers are facing the same dynamics and are being
forced to take similar actions.” Indeed, a report released Thursday by
the department of Health and Human Services shows that there have been
steep actual or proposed increases in rates by a number of insurers.
But here’s the thing: suppose that we posit, provisionally, that the
insurers aren’t the main villains in this story. Even so, California’s
death spiral makes nonsense of all the main arguments against
comprehensive health reform.
For example, some claim that health costs would fall dramatically if
only insurance companies were allowed to sell policies across state
lines. But California is already a huge market, with much more
insurance competition than in other states; unfortunately, insurers
compete mainly by trying to excel in the art of denying coverage to
those who need it most. And competition hasn’t averted a death spiral.
So why would creating a national market make things better?
More broadly, conservatives would have you believe that health
insurance suffers from too much government interference. In fact, the
real point of the push to allow interstate sales is that it would set
off a race to the bottom, effectively eliminating state regulation. But
California’s individual insurance market is already notable for its
lack of regulation, certainly as compared with states like New York —
yet the market is collapsing anyway.
Finally, there have been calls for minimalist health reform that would
ban discrimination on the basis of pre-existing conditions and stop
there. It’s a popular idea, but as every health economist knows, it’s
also nonsense. For a ban on medical discrimination would lead to higher
premiums for the healthy, and would, therefore, cause more and bigger
death spirals.
So California’s woes show that conservative prescriptions for health
reform just won’t work.
What would work? By all means, let’s ban discrimination on the basis of
medical history — but we also have to keep healthy people in the risk
pool, which means requiring that people purchase insurance. This, in
turn, requires substantial aid to lower-income Americans so that they
can afford coverage.
And if you put all of that together, you end up with something very
much like the health reform bills that have already passed both the
House and the Senate.
What about claims that these bills would force Americans into the
clutches of greedy insurance companies? Well, the main answer is
stronger regulation; but it would also be a very good idea, politically
as well as substantively, for the Senate to use reconciliation to put
the public option back into its bill.
But the main point is this: California’s death spiral is a reminder
that our health care system is unraveling, and that inaction isn’t an
option. Congress and the president need to make reform happen — now.
WellPoint price hike defense fails to
satisfy feds
YAHOO
By TOM MURPHY and RICARDO ALONSO-ZALDIVAR, Associated Press Writers
Feb. 11, 2010
INDIANAPOLIS – Health insurer WellPoint is blaming the Great Recession
and rising medical costs for its planned 39 percent rate increase for
some California customers of its Anthem Blue Cross plan.
But Health and Human Services Secretary Kathleen Sebelius isn't buying
the explanation proffered in a letter delivered to her Thursday.
Sebelius said "it remains difficult to understand" how premium
increases of that size can be justified when WellPoint Inc. reported a
$4.75 billion profit in the last quarter of 2009. She also noted that
the premium increases are 10 times higher than the increase in national
health care costs.
President Barack Obama has seized on the premium hikes in California as
an ill omen of what will happen around the country if lawmakers fail to
enact health care overhaul legislation. "If we don't act, this is just
a preview of coming attractions," he said at a press conference Tuesday.
Brian Sassi, the head of WellPoint's consumer business unit, said in
the letter to Sebelius that because of the weak economy, healthy people
increasingly are dropping coverage or buying cheaper plans. That
reduces the premium revenue available to cover claims from sicker
customers who are keeping their coverage.
The result was a 2009 loss for the unit that sells individual policies
to people who don't get insurance through their employers, he said.
Higher rates for this group, which accounts for about 10 percent of
Anthem's eight million customers in California, are needed to cover the
shortfall expected from the continuation of that trend, according to
the letter.
"When the healthy leave and the sick stay, that is going to
dramatically drive up costs," Sassi said in an interview. He declined
to specify the size of the unit's loss.
Affected customers can choose plans with lower premiums but higher
out-of-pocket costs, he said.
Sassi told Sebelius that insurance costs also continue to rise because
medical prices are increasing faster than inflation, and people are
using more health care. That use increase is driven by an aging
population, new treatments and "more intensive diagnostic testing," he
wrote.
Sebelius ordered a federal inquiry earlier this week after the size of
proposed premium increases for individual policies was widely
publicized. A congressional committee also has asked for information on
the increases and requested testimony from WellPoint CEO Angela Braly
at a Feb. 24 hearing.
WellPoint is the largest publicly traded health insurer based on
membership and is a dominant player in the individual insurance market
in California. Based in Indianapolis, the company runs Blue Cross and
Blue Shield plans in 14 states and Unicare plans in several others.
WellPoint as a whole made a profit of $4.75 billion in 2009, though $2
billion of that came from the sale of a business.
Rates for individual health insurance policies tend to rise much faster
than those of employer-sponsored coverage.
The pool of customers is more stable for group health insurance. In the
individual market, healthy people are more inclined to drop coverage
when they see big price hikes because they don't have employer help
paying for it, said Robert Laszewski, a health care consultant and
former insurance executive. That leaves behind sicker customers who
stay because they still need coverage.
Sassi said as much as one-third of their individual insurance customers
leave every year. That volatility can lead to big changes in the mix of
people covered and rate swings. Administrative costs also can be higher
for individual lines because the insurer has to sell each policy
individually instead of to a larger group.
Sassi said a minority of Anthem Blue Cross's 800,000 individual policy
holders in California will see rate increases as high as 39 percent.
Most premiums will rise around 24 percent when the rates take effect
March 1.
The Democratic health care legislation now stuck in Congress is largely
aimed at addressing the problems of small businesses and people buying
insurance on their own.
The bills would set up big new insurance pools called exchanges that
would promote competition. In many states the market for individual
health insurance is currently controlled by one or two dominant
insurers.
Premiums for the new coverage wouldn't necessarily be cheaper. In order
to participate in the exchanges, insurers would have to offer more
comprehensive benefits than are often available now in the individual
market. But federal subsidies would be available to help offset the
cost for moderate income people.
Rep. Chris Van Hollen, D-Md., a member of the House leadership, said he
thinks the WellPoint case should send a powerful message to lawmakers
wavering about what to do on health care overhaul. "The results of
doing nothing will be skyrocketing increases in premiums," he said.
The price shock could help Obama make his case that Republicans need to
come to the table on health care. GOP leaders are going reluctantly to
the Feb. 25 health care summit convened by the president. It's unclear
whether they can find common ground, since Republicans want to start
over from scratch, and Obama is unwilling to give up on the goals
embodied in the Democratic bills.
Oh (no) Canada
NYPost editorial
Last Updated: 3:37 AM, February 3, 2010
Posted: 2:41 AM, February 3, 2010
You've heard the mantra, chanted by everyone on the left, from Michael
Moore to The New York Times: America's profit-centric health-care
system is dismally inferior to that of Canada's purely pristine
humanitarian-driven version.
Indeed, the central theme of Moore's 2007 "documentary" film, "Sicko,"
was that Canada -- with its universal, government-run and
taxpayer-funded "free" health care -- is a medical paradise.
And a Times editorial last August glowingly declared: "Contrary to what
one hears in political discourse, the bulk of the research comparing
the United States and Canada found a higher quality of care in our
northern neighbor."
Well, tell that to Danny Williams, premier of the Canadian province of
Newfoundland and Labrador.
The popular 59-year-old politician has discovered that nothing is for
free. He's somewhere in the US today -- prepping for heart surgery.
Seems the procedure he needs simply isn't available in Newfoundland --
at any price.
And, with his own health on the line, he prefers to put his trust in
the "second-rate, profit-driven health-care behemoth" south of the St.
Lawrence, rather than try a hospital in Canada.
"Ultimately, we have to be the gatekeepers of our own health," said
Williams' deputy premier, "and he has taken medical advice from a
number of different sources,"
Williams, he added, "is doing what's best for him."
Precisely.
Last summer, President Obama -- who still hopes to overhaul American
health-care -- defended the Canadian system as one that "works for
Canada."
Not for all Canadians, apparently.
Certainly not those well-connected pols, who -- like Danny Williams --
can afford better health care in the good ol' US of A.
Get well soon, Danny.
Obama rumbles with
House GOP
YAHOO
Patrick O'Connor, Tim Grieve
Fri Jan 29, 12:58 pm ET
BALTIMORE — President Barack Obama on Friday accused Republicans of
portraying health care reform as a "Bolshevik plot" and telling their
constituents that he’s "doing all kinds of crazy stuff that's going to
destroy America."
Speaking to House Republicans at their annual policy retreat here,
Obama said that over-the-top GOP attacks on him and his agenda have
made it virtually impossible for Republicans to address the nation’s
problems in a bipartisan way.
“What happens is that you guys don’t have a lot of room to negotiate
with me,” Obama said. "The fact of the matter is, many of you, if you
voted with the administration on something, are politically vulnerable
with your own base, with your own party because what you've been
telling your constituents is, ‘This guy's doing all kinds of crazy
stuff that's going to destroy America.' ''
Obama’s comments came in the midst of an extraordinary back-and-forth
with Republican House members – a scene straight out of the House of
Commons that played out live on cable TV. Republicans invited
Obama to appear at their annual conference; the president accepted —
and then surprised them by asking that cameras and reporters be allowed
into the room. Republicans immediately agreed to the request, but
they may be regretting it now. Again and again, Obama turned the
Republicans questions against them – accusing them of obstructing
legislation for political purposes and offering solutions that won’t
work.
"I've read your legislation. I take a look at this stuff. And the good
ideas we take," Obama said. "It can't be all or nothing, one way or the
other … If we put together a stimulus package in which a third of it is
tax cuts that normally you guys would support, and support for states
and the unemployed and helping people stay on COBRA, that certainly
your governors would support … and maybe there are some things in
there, with respect to infrastructure, that you don't like … If there's
uniform opposition because the Republican caucus doesn't get 100
percent or 80 percent of what you want, then it's going to be difficult
to get a deal done, because that's not how democracy works."
House Republican Leader John Boehner (R-Ohio), who introduced Obama to
his colleagues and gave the president a stack of Republican policy
proposals, said afterward that the event had been “a good first step in
having more of a dialogue.”
Rep. Jeff Flake (R-Ariz.) said the event had helped his party by
showing that Republicans have offered alternatives to Obama’s plans.
"The real effort here was to convince people out there that we have
offered solutions, we've offered things,” Flake said. “For him to say,
‘Yes, I've read your proposal, it's a substantive proposal,’ that's
good. That's a huge thing for Republicans."
House Republican Conference Chairman Mike Pence (R-Ind.) began Friday’s
question-and-answer session by asked Obama whether he’d embrace “across
the board” tax cuts as a way to revive the economy, and Rep. Paul Ryan
(R-Wis.) asked him to support a line-item veto to help achieve a
balanced budget.
Obama pushed back backed hard, accusing Republicans of putting party
before principle andvoting against his 2009 stimulus plan but then
attending “ribbon cuttings” for stimulus projects in their own
districts.
If Republicans believe in both across-the-board tax cuts and a balanced
budget, Obama said he’d like to see their math. The afternoon
started on a more conciliatory tone, with Obama saying in opening
remarks hat he expects Republicans to challenge his ideas – and that he
understands that there are sometimes fundamental policy differences
between the parties.
"Having differences of opinion, having a real debate about matters of
domestic policy and national security, that's something that's not only
good for our country, it's absolutely essential,” he said.
But he also criticized the Republicans for reflexively opposing his
policies – even when, he said, they were in line with GOP principles.
And the encounter got progressively more raucous from there
Obama urged Republicans to come to the table and work with him on
policy compromises, saying Americans "didn't send us to Washington to
fight each other in some political steel cage match."
What voters don’t want, he said, is "for Washington to continue being
so Washington-like."
The president asked the Republicans to support his proposal to provide
small businesses with a $5000 tax credit for each new employee they add
— an idea Republicans panned before he even made the offer. He also
asked them to support his plan to freeze non-military discretionary
spending for three years.
"Join me," Obama asked. "Nothing in this proposal that runs contrary to
the ideological predisposition of this caucus."
"We have seen some party-line votes that have been disappointing," he
said, recalling the stimulus fight. "I didn't understand then, and I
still don't understand, why we got opposition in this caucus for almost
$300 billion in badly needed tax cuts for the American people" and
other assistance and infrastructure projects.
Obama jabbed: "Let's face it, some of you have been at the
ribbon-cuttings for some of these important projects in your
communities."
Continuing on a confrontational tack, Obama defended key components of
his agenda, including the proposed fee on bailed-out banks – telling
Boehner: "If you listen to the American people, John, they’ll tell you
they want their money back."
At the end of his remarks – before taking questions – Obama told
Republicans it's time to make a choice between aiming for "success at
the polls" or "lasting success" for the country. "Just think about it
for a while," he said. "We don't have to put it up for a vote today."
Freshman Rep. Jason Chaffetz (R-Utah) went after the president harder,
accusing him of breaking promising about transparency, lobbyists and
partisanship.
“I can look you in the eye and tell you we have not been
obstructionists,” he said.
Obama acknowleged that Chaffetz had a “legitimate complaint” about not
putting health care negotiations on C-SPAN – as the president had vowed
they would be – but he also asked Obama what he was doing within his
own caucus to make sure that Republicans were working with him in
bipartisan way.
Mid-way through the questions and answers, Pence said that there would
be just a few more questions.
Obama said he wasn’t in any hurry to leave.
"I'm having fun,” Obama said. “This is great."
Rep. Tom Price (R-Ga.) seemed to enjoy the experience a little
less. Price said he’s asked to meet with Obama ever week for a
year but that his question-and-answer round --- about health care
proposals Republicans have offered -- was the first time they’ve
actually spoken.
“He didn't even address the question,” Price grumbled afterward. “He
distorted the premise and refused to even answer the question."
Price said Republicans had proven that they have ideas, that Obama has
received them, and that he wouldn’t answer their questions.
"I don't know that you could get any more out of that than we did,” he
said.
Pelosi: House lacks votes to OK Senate health bill
By ALAN FRAM, Associated Press Writer
Jan. 21, 2010
WASHINGTON – Speaker Nancy Pelosi says she lacks the votes to
push the Senate's sweeping health overhaul bill through the House, a
potentially devastating blow to President Barack Obama's signature
issue.
The California Democrat made the comment to reporters Thursday after
House Democrats held a closed-door meeting at which participants vented
frustration with the massive version of the legislation.
Pelosi said, "In its present form without any changes I don't think
it's possible to pass the Senate bill in the House. ... I don't see the
votes for it at this time." Many House Democrats, reeling from their
loss of the Massachusetts Senate seat in this week's special election,
want the party to pursue a more modest health bill.
THIS IS A BREAKING NEWS UPDATE. Check back soon for further
information. AP's earlier story is below.
WASHINGTON (AP) — Support for a White House-backed plan for salvaging
the massive health care overhaul is eroding in the House as Democrats
reeling from the loss of the Massachusetts Senate seat argue for a less
ambitious approach.
The House leadership has made no decision on whether to press ahead
with the Senate bill, but rank-and-file Democrats vented their
frustration at a closed-door meeting Thursday. Emerging from the
session, Rep. Michael Arcuri, D-N.Y., said: "The mega bills are dead.
If we didn't see what happened Tuesday night, we have blinkers on."
Rep. Dennis Cardoza, D-Calif., said there was more support for
refocusing on the health care changes with more popular appeal among
American consumers. Republican Scott Brown captured the Massachusetts
Senate seat, disrupting the Senate's power to move quickly on health
care.
Bay State 'universal care' blues
NYPOST
By HOWIE CARR
Last Updated: 4:25 AM, January 21, 2010
Posted: 12:05 AM, January 21, 2010
BOSTON
US Sen.-Elect Scott Brown bobbed and weaved a bit at his post-election
press conference yesterday when asked about Massachusetts'
universal-health-care law.
Yes, Brown acknowledged, he voted for it, which has already become a
talking point among the chattering classes: See, even this GOP
troglodyte knows there's a need for ObamaCare -- so go for it!
But, Brown quickly told the press (before moving on to less
controversial topics, like terrorism), there are a few problems with
the Massachusetts law that needed to be worked out.
Yes there are -- to put it mildly. Costs are exploding, and although
the word "rationing" is gingerly avoided, that's what the state is
talking about, just as the federal government is, even with the current
reform drive stalled and perhaps doomed.
After all, Brown campaigned as "the 41st vote" to stop ObamaCare -- and
Obama's plan is increasingly unpopular here, as elsewhere.
Even the early federal proposals have been attacked by the wife of the
most prominent Massachusetts supporter of ObamaCare, Sen. John Kerry.
Teresa Heinz Kerry, 71, was diagnosed late last year with breast cancer
-- just about the time a federal "task force" recommended that women
start receiving mammograms at age 50 rather than 40.
"I was so upset about that decision of this panel," Mrs. Kerry told the
Associated Press and, indeed, the administration quickly backed off.
She didn't say much after that one interview, but apparently Mrs. Kerry
understands the reality of what Massachusetts bureaucrats like to call
"cost containment."
Here's the lowlights of a story last July in The New York Times-owned
Boston Globe. Mind you, the Globe was predicting a 15-point Martha
Coakley win less than two weeks ago, and was calling the race a "dead
heat" as late as Monday, but it's still been unable to put a shine on
this sneaker:
"A state commission recommended . . . putting providers on a budget as
a way to control exploding health-care costs . . . [to reduce] unneeded
tests and procedures . . . Patients could find it harder to get
procedures they want . . . They might find it difficult to get care
wherever they want."
Care -- you know, like mammograms.
Here's another Globe story from last May: "An increasing number of
residents are now reporting problems paying medical bills . . .
reporting they did not get needed care because of costs, which are
rising faster than inflation."
In the campaign's closing days, Martha Coakley -- and Barack Obama --
pretty much stopped talking about universal health care. At his
campaign stop here Sunday, Obama tiptoed around health care while
mentioning Scott Brown's pickup truck six times.
No one who voted here Tuesday thinks that a federal plan will cut costs
-- it sure hasn't worked at the state level.
Last November, the state's Division of Health Care Finance and Policy
issued a dry report on the system. The executive summary admitted:
"Health care in Massachusetts is projected to cost $3,000 more per
person by 2018 than the national average."
So much for saving money. But what about the "waste, fraud and abuse"
that Obama always mentions -- or used to -- as a way to cut costs?
"It's not like the fat sits out here easily identified and you just
slice it off," said one of the state bureaucrats. "It's marbled
throughout the meat."
Massachusetts government isn't exactly user-friendly. The state
recently stopped sending motorists notices that their licenses are
about to expire -- couldn't afford the 44-cent stamps, we were told.
But it has threatened to fine workers who appear not to have health
care. Even if the employee has insurance at a second job, he must
document to the state that he is insured elsewhere.
As for the premiums, they're already the nation's highest.
"My boyfriend has his own company, and he's paying a thousand dollars a
month -- for what?" one woman told me yesterday. "The state got into
health care, and the costs went through the roof -- and Martha Coakley
said if the feds took it over the costs would go down? Come on. He
voted for Brown, and so did I."
In 2006, then-Gov. Mitt Romney signed the bill into law amid great
fanfare at Faneuil Hall. Standing behind to his left was Sen. Ted
Kennedy, whose seat is now to be filled by a Republican, and then-House
Speaker Sal DiMasi, who has since been indicted on federal corruption
charges and is facing up to 185 years in prison. It's not a photo
you'll find on any Romney Web sites.
Gov. Deval Patrick will deliver his annual State of the State Address
tonight. No one expects him to say much, if anything, about the state's
universal-health-care plan. After all, he's running for re-election.
Howie Carr is a columnist for The
Boston Herald.
HISTORIC ELECTION
Shot heard round the world, Revolutionary War beginning,
around the time of Paul Revere's ride! "One if by land, two if by
sea, and I on the opposite shore will be, ready to ride..."
Time to get to work, says Sen.-elect Brown
YAHOO
By GLEN JOHNSON and LIZ SIDOTI, Associated Press Writers
January 20, 2010
BOSTON – Republican Scott Brown says his Senate victory in
Massachusetts sends a powerful message and he hopes to get to work
right away.
Brown's stunning triumph for the seat long held by Sen. Ted Kennedy was
a devastating Democratic defeat that triggered soul-searching within
President Barack Obama's party over how to stem further losses in
November's midterm elections.
Brown told a news conference on Wednesday, "The campaign is over now,
and we have to focus on solving problems."
THIS IS A BREAKING NEWS UPDATE. Check back soon for further
information. AP's earlier story is below.
BOSTON (AP) — Republicans are rejoicing and Democrats reeling in the
wake of Scott Brown's stunning triumph in a special Massachusetts
Senate election, a devastating Democratic defeat that triggered
soul-searching within President Barack Obama's party over how to stem
further losses in November's midterm elections.
Obama himself grimly faced a need to regroup on Wednesday, the
anniversary of his inauguration, in a White House shaken by the
realization of what a difference a year made.
The most likely starting place was finding a way to save the
much-criticized health care overhaul Democrats have been trying to push
through Congress. The Democratic Party also faced a need to determine
how to assuage an angry electorate, and particularly attract
independent voters who have fled to the GOP after a year of Wall Street
bailouts, economic stimulus spending and enormous budget deficits.
In one of the country's most traditionally liberal states, Brown rode a
wave of voter anger to defeat Martha Coakley, the attorney general who
had been considered a surefire winner until just days ago. Her loss
signaled big political problems for Obama and the Democratic Party this
fall when House, Senate and gubernatorial candidates are on the ballot
nationwide.
As if in a nod to voter disgust with Washington, Obama signed a
directive Wednesday aimed at stopping government contracts from going
to tax-delinquent companies. "We need to insist on the same sense of
responsibility in Washington that so many of you strive to uphold in
your own lives, in your own families, and in your own businesses,"
Obama said.
Sen.
John McCain of Arizona, Obama's Republican presidential rival in 2008,
likened Brown's win to the Revolutionary War's "shot heard 'round the
world" in Concord, Mass., in April 1775. McCain said the message was
clear: "No more business as usual in Washington. Stop this unsavory
sausage-making process."
White House officials acknowledged that one of the lessons from
Massachusetts was the intensity of voter anger, but they said it wasn't
so much with Obama as with Washington's failures in general and with
the moribund economy.
"There are messages here. We hear those messages," senior Obama adviser
David Axelrod said in an interview with MSNBC. "There is a general
sense of discontent about the economy. And there is a general sense of
discontent about this town. That's why we were elected."
Added Press Secretary Robert Gibbs: "There's a tremendous amount of
anger and frustration about where people are economically ... I think
that's what's ultimately going to define the coming political battles."
The advisers downplayed the notion that the vote was an indictment
against health care reform. But Axelrod said that officials will "take
into account" what voters said Tuesday. He added, "It's not an option
simply to walk away from a problem that's only going to get worse."
Senate Republican leader Mitch McConnell of Kentucky said Obama has an
opportunity to strike a more bipartisan approach.
"The president ought to take this as a message to recalibrate how he
wants to govern and if he wants to govern from the middle we'll meet
him there," he said.
On Capitol Hill, Democrats were urging their House and Senate
candidates to embrace in their campaigns against Republicans the
populist appeal the president had made on Sunday as he rushed to Boston
to try to save Coakley and the Senate seat held by Democrats, and
specifically the late Edward M. Kennedy, for nearly a century.
His attempt didn't work but House and Senate Democrats insisted that
the pitch — Democrats work for the people, Republicans work for Wall
Street — was simply made too late.
Brown maintained in an interview Wednesday morning that claiming the
election was a referendum on Obama would be oversimplifying what had
happened there. Nor, he said, was it merely a matter of voters
rejecting Coakley.
Asked on NBC's "Today" show if the election was a referendum on Obama,
he replied, "No, it's bigger than that."
"I just focused on what I did, which is to talk about the issues —
terror, taxes and the health care plan," he said. "I don't think it was
anything that she did."
Brown will become the 41st Republican in the 100-member Senate, which
could allow the GOP to block the health care bill. Democrats needed
Coakley to win for a 60th vote to thwart Republican filibusters.
Brown became the first Republican elected to the U.S. Senate from
supposedly true-blue Democratic Massachusetts since 1972.
"I have no interest in sugarcoating what happened in Massachusetts,"
said Sen. Robert Menendez of New Jersey, the head of the Senate
Democrats' campaign committee. "There is a lot of anxiety in the
country right now. Americans are understandably impatient."
Brown
will finish Kennedy's unexpired term, facing re-election in 2012.
Senate Majority Leader Harry Reid pledged to seat Brown immediately, a
hasty retreat from pre-election Democratic threats to delay his
inauguration until after the health bill passed.
Brown led by 52 percent to 47 percent with 100 percent of precincts
counted. The third candidate in the race, independent Joseph L.
Kennedy, who is no relation to Edward Kennedy, had less than 1 percent.
The local election played out against a national backdrop of animosity
and resentment from voters over persistently high unemployment, Wall
Street bailouts, exploding federal budget deficits and partisan
wrangling over health care.
For weeks considered a long shot, the 50-year-old Brown seized on voter
discontent to overtake Coakley in the campaign's final stretch.
"You should never see how law or sausages
are made" department - in italics
Dems' dirty deals
NYPOST
By MICHAEL TANNER
Last Updated: 6:32 AM, January 11, 2010
Posted: 1:54 AM, January 11, 2010
So, have you been following those health-care negotiations on C-SPAN?
OK, that was below the belt. Maybe it's unfair to expect the
negotiations to be televised just because President Obama promised they
would be -- at least eight times. But at least we know that the media
will be able to cover the conference to reconcile differences between
the House and Senate bills.
Oops, I guess we won't see that either -- because the Democratic
leaders have decided to forego the traditional procedure. Instead,
they'll rely on a seldom used method known informally as "ping pong,"
because it involves passing an amended bill back and forth until the
House and Senate can agree. Doing it this way lets House Speaker Nancy
Pelosi and Senate Majority Leader Harry Reid avoid all that messy
public debate and media scrutiny.
Of course, Pelosi insists that the process is "the most transparent in
history." Sure. That's why we're still finding hidden goodies in the
bill rammed through the Senate on Christmas Eve.
Now famous is the "cornhusker kickback" -- the provision that has
taxpayers in states like New York picking up the cost of Nebraska's
Medicaid expansion forever. But most people don't realize that there
were also lesser Medicaid deals for Louisiana and Vermont as well.
What are we to make of the provision that exempts three Florida
counties from cuts in the Medicare Advantage program? Or that hospitals
in certain key states like Nevada also received increases in their
payments under traditional Medicare, even as other hospitals were
seeing their payments cut?
Nor should we forget the $100 million slipped in for a still unnamed
hospital in Connecticut; money for asbestos abatement in a Montana
town; ethanol subsidies, and an exemption from a new insurance tax for
companies in Michigan and (surprise!) Nebraska.
Most recently, it was discovered that the Senate bill contained a
special goody for the building-trade unions, lowering the threshold for
the mandate on employers to provide insurance from 50 employees to 5
for that industry.
Imagine what might've happened if this process weren't so "open" and
"transparent."
Still, it's possible to sneak a peak into the back rooms and get an
idea for the final deal that is beginning to take shape. Among the
likely outcomes:
The "public option" is dead:
Liberals are starting to face the fact that the final bill won't
contain a government-run insurance plan to compete with (and eventually
supplant) private insurance. Instead, there will be a "semi-public"
option: national private insurance plans overseen by the federal Office
of Personnel Management and resembling the Federal Employee Health
Benefit Plan.
Costs are going up: In
exchange for dropping the public option, House liberals are demanding a
rise in subsidies to help people pay for insurance. There's also a push
to speed up the date when these subsidies and other benefits kick in.
As a result, the bill's price range is rapidly rising to more than $1
trillion over its first 10 years.
So are taxes: Obama has now
thrown his support behind a Senate proposal for a 40 percent excise tax
on so-called Cadillac insurance plans. Still, House members, backed by
labor unions and liberal activists, are holding out in favor of higher
income taxes on "the wealthy." Some brand-new taxes are now being
discussed, including a new tax on investments. This one could still
derail the whole thing.
Abortion remains the ticking time
bomb: Both pro-life and pro-choice Democrats are threatening to
bring down the bill over language on government funding of abortion.
This is a moral issue for both sides that doesn't easily allow for
splitting the difference.
Democrats can't afford to lose a single vote in the Senate and have
just a three-vote margin in the House. If they're going to resolve
these and other important issues in ways that keep both liberal House
members and moderate senators on board, it won't be pretty. The final
outcome is likely to have a lot more to do with special deals than with
good public policy.
No wonder they don't want us to see it.
Report:
Slight cost increase in Senate
health bill
YAHOO
By DARLENE SUPERVILLE, Associated Press Writer
Jan. 9, 2010
WASHINGTON – The Senate's plan to expand health coverage to 34 million
more Americans would raise costs slightly, government economic experts
said in a report Saturday.
Over time, cost-cutting measures could start to reduce the annual
increases in health care spending, offering the possibility of
substantial savings in the long run. At the same time, however, some of
the Senate's Medicare savings could be unrealistic and cause lawmakers
to roll them back, according to Medicare's top number crunchers.
The study found that health spending, which accounts for about
one-sixth of the economy, would increase by less that 1 percent over
the coming decade even with so many more people receiving coverage.
Health and Human Services Secretary Kathleen Sebelius said the report
shows the Senate bill would slow the rate of health care costs,
strengthen Medicare and provide millions more people with insurance
coverage.
President Barack Obama used his weekly radio and Internet address
Saturday to play up the brighter side of the overhaul he hopes to sign
in time for his first State of the Union address to a joint session of
Congress in a matter of weeks.
He said it would ban "the worst practices of the insurance industry"
even as he acknowledged it would take several years — until 2014 in
some instances — for some of the changes to be fully in place. That has
disappointed consumers and their advocates.
"Now, it'll take a few years to fully implement these reforms in a
responsible way," the president said. "But what every American should
know is that once I sign health insurance reform into law, there are
dozens of protections and benefits that will take effect this year."
Among them, Obama said:
_People with illnesses or medical conditions will be able to buy
affordable health insurance.
_Children with such conditions will no longer be denied coverage.
_Small-business owners who can't afford to cover their employees will
get tax credits to help them do so.
_Insurance companies will be required to offer free preventive care to
their customers and will be prohibited from dropping coverage when
someone becomes ill.
"In short, once I sign health insurance reform into law, doctors and
patients will have more control over their health care decisions and
insurance company bureaucrats will have less," Obama said. "All told,
these changes represent the most sweeping reforms and toughest
restrictions on insurance companies that this country has ever known."
House and Senate versions of the overhaul would require nearly all
Americans to get coverage and provide subsidies for many who can't
afford the cost, but they differ on the details. Among the remaining
sticking points are whom to tax, how many people to cover, how to
restrict taxpayer funding for abortion and whether illegal immigrants
should be allowed to use their own money to buy coverage in new
insurance markets.
Obama had several meetings with Democratic lawmakers at the White House
this week to help resolve those differences. In one instance, he
signaled to House Democratic leaders that they must drop their
opposition to taxing high-end insurance plans to pay to extend coverage
to millions of uninsured people. The tax, which is in the Senate bill,
is largely opposed by House Democrats and organized labor.
Saturday's report cited this tax on "Cadillac" health plans, as well as
reductions in annual increases to Medicare providers, as having
potential to hold down costs. But the authors were skeptical that
Congress could stand the political fallout, noting that the Medicare
cuts "may be unrealistic."
At the same time, the proposed 40 percent excise tax on high-cost
health plans would hit more and more people over time, virtually
guaranteeing lawmakers would feel pressure to ease the tax.
Republican lawmakers, saying the bills cost too much and impose too
much government control, are near unanimous in opposing the
legislation.
Jobs first, then let's talk about health-care reform
Editorial from the Seattle Times
Thursday, January 7, 2010 - Page updated at 05:46 PM
SUPPORTERS of the health-care-reform bills seem to believe they would
raise the scope and standards of coverage and lower costs at the same
time. If only it were so. But in this case, as in most others, doing
more costs more — a lot more.
Much of American politics is driven by imperatives expressed as, "Every
American should have "X." The "X" changes: It can be health care or
something else. Often this page has agreed, and no doubt will again.
But right now we fill in the blank this way:
Every American should have the best possible opportunity to find work.
Given the shrinkage of the economy since 2007, this is not the time to
promise every American a new benefit. And that is what these bills want
to do. By their attempt at generosity, they would raise the cost of
creating a job, especially by small employers.
Some small employers now offer employees no coverage. Under the Senate
bill, if employers had one employee receiving a federal subsidy to buy
insurance — and the bill creates these subsidies — the employer would
have to pay a 2- to 8-percent tax on the entire payroll. And a payroll
tax is a tax on the creation of jobs.
Also, the Senate bill would create a minimum benefit package in the
individual and small-group markets. Because this package would be
richer than many now offered, Premera Blue Cross estimates that it
would add 21 percent to costs in the small-group market. With other new
mandates in the bills, plus the cost of inflation that's already
happening, Premera estimates that the average cost of family coverage
for a small-business employee will rise from $1,000 a month currently
to $2,600 just four years from now.
That is too heavy a load to accept right now.
This is not an argument for being mean. It is an argument for getting
people back to work, and earning cash to support their families. Do
that first, and have the discussion about new social guarantees later.
YOU DON'T EVER WANT TO SEE HOW
LAWS AND SAUSAGES ARE MADE DEPARTMENT
CT's own Congressman Larson (l): "The important
thing for us now is to close ranks behind the president and get a bill
done." If it looks like a...
Democrats begin work to finalize health care bill
YAHOO
By ERICA WERNER, Associated Press Writer
Jan. 5, 2010
WASHINGTON – President Barack Obama and congressional Democrats
embarked Tuesday on the tough work of ironing out differences between
House and Senate health care legislation with the aim of quickly
approving a bill as midterm elections near.
"Now is not the time to get stuck on any one point," Rep. John Larson,
D-Conn., said as he headed into a meeting with Speaker Nancy Pelosi and
other House leaders to discuss their priorities for the final bill.
"The important thing for us now is to close ranks behind the president
and get a bill done."
Both houses have passed legislation to remake the health care system,
extending coverage to millions who lack it while cracking down on
industry practices such as denying insurance on the basis of
pre-existing medical conditions. There are numerous differences
between the two bills, include provisions on illegal immigration and
abortion, a dispute over a government-run insurance option — the House
wants one, but the Senate bill omitted it — as well as the size and
extent of federal subsidies to help lower-income families afford
coverage.
The House bill is more generous with subsidies than the Senate measure,
and many House Democrats are concerned with ensuring that insurance
will be affordable since the legislation will require most people to
buy it. At the same time, some moderate Senate Democrats don't want the
bill's price tag to grow. At nearly $1 trillion over 10 years, the
House bill is more expensive than its Senate counterpart.
"The affordability credits is going to be a critical part of this
discussion," said Rep. Chris Van Hollen, D-Md.
The president planned to begin work with congressional leaders Tuesday
to resolve those and other thorny issues. Following the meeting of
House leaders, Obama was to meet with Pelosi and Majority Leader Steny
Hoyer in the Oval Office, with Senate Majority Leader Harry Reid and
Assistant Majority Leader Dick Durbin joining the meeting by phone.
In a posting Tuesday on the White House blog, White House
Communications Director Dan Pfeiffer wrote that there is "an
unavoidable temptation among the media to focus on the five percent of
differences between the two versions, instead of the remarkable 95
percent the bills have in common. But, even as difficult work does
remain, it is important not to lose perspective of how far we have come
and how close we are to enacting health reform."
The aim is to finish up by early next month, hopefully before Obama
delivers his State of the Union address, though the date for that has
not been set.
To that end congressional leaders plan to dispense with the formal
process of appointing a conference committee to work out the
differences in the bill. Instead top House and Senate Democrats and
White House officials will aim to reach agreement among themselves,
then have the two houses vote as quickly as possible. A 60-vote Senate
majority would be required in advance of final passage.
The format is drawing criticism from Republicans who contend Democrats
are operating in secret. "My Republican colleagues and the American
people have been largely shut out of the health care reform proceedings
thus far, as Democrat leaders packaged their health care bills behind
closed doors and layered them with billions of dollars in sweetheart
deals to woo undecided Democrats," Sen. John Cornyn, R-Texas, said
Tuesday.
As a candidate, Obama pledged during a presidential debate in January
2008 that he would be "bringing all parties together, and broadcasting
those negotiations on C-SPAN so that the American people can see what
the choices are."
That has not occurred, and even C-SPAN is taking note. The network
released a letter Tuesday from chief executive Brian Lamb to
congressional leaders asking for the talks to be opened to cameras.
"President Obama, Senate and House leaders, many of your rank-and-file
members, and the nation's editorial pages have all talked about the
value of transparent discussions on reforming the nation's health care
system," Lamb wrote in the Dec. 30 letter. "Now that the process moves
to the critical stage of reconciliation between the chambers, we
respectfully request that you allow the public full access, through
television, to legislation that will affect the lives of every single
American."
White House press secretary Robert Gibbs defended the process, saying
newspapers have been filled with details of the bills.
"I don't think there's anybody that would say that we haven't had a
thorough, robust, now-spanning-two-calendar-years debate on health
care," he told reporters.
Gibbs said Obama's top priority is "getting the differences worked out,
getting a bill to the House and the Senate."
You remember
him, don't you?
Health bills nudge US on long-term care insurance
YAHOO
By CARLA K. JOHNSON, AP Medical Writer
Dec. 28, 2009
CHICAGO – Most people don't buy long-term care insurance. They simply
don't want to think about moving into an assisted living center or
hiring a stranger to bathe them.
Seven years ago, Robert Myers of suburban Chicago did buy long-term
care insurance. Myers' wife, who died in December 2008, needed care as
she fought cancer.
"It was a godsend," Myers, 64, an Episcopal priest, says of the
insurance. "It didn't cover everything, but it broke the back of the
bills."
Unlike Myers, most people may want to plan for the future, but they
need a nudge to overcome their avoidance and laziness. At least that's
the assumption behind a program tucked into the health care overhaul
legislation emerging from Congress.
The program would create a voluntary long-term care insurance program
to be run by the government.
Voluntary, yes. But workers at participating companies would be
automatically enrolled — critics say "tricked into" enrolling — unless
they opted out. People would see a deduction for the program from their
paychecks — estimates range from $160 to $240 a month — unless they
signed a form or clicked a box saying they wanted to keep the money.
The proposed program would help shift the financial burden of an aging
population from Medicaid, now the largest funder of long-term care, to
individuals. The federal-state health insurance program for the poor is
straining state budgets.
"The caregiving burden in this country will be huge" as baby boomers
age, says Dr. Robert Butler, who heads the International Longevity
Center and favors the long-term care insurance proposal.
Governments and the private sector can and should nudge people into
doing what's best for them, some economists say. A best-selling book,
"Nudge: Improving Decisions About Health, Wealth and Happiness," made
the notion popular. President Barack Obama named "Nudge" co-author Cass
Sunstein to an Office of Management and Budget post.
"No
one thinks they need long-term care until two years after they need
it," says Richard Thaler, the other co-author of "Nudge." "The theme of
our book is we should try to help people make decisions without telling
them what they have to do."
Automatic enrollment in 401(k) retirement savings plans has succeeded
in increasing enrollment to more than 90 percent at some companies. But
people can more easily picture themselves retiring than becoming
incapacitated by illness, and they know they can get their savings back
— if the stock market cooperates — when they do retire and start
withdrawing from their 401(k).
Long-term care insurance may look like a gamble because any individual
may never need the benefit.
The easier it is for people to sign up the more people will sign up,
says Jeremy Pincus of Forbes Consulting Group, a private company
specializing in applying psychological theory to business problems.
"The question is," Pincus says, "is it a good thing to basically trick
people into getting something that's good for them?"
The long-term care insurance program is detailed in the CLASS Act, or
Community Living Assistance Services and Support Act, which is part of
both the House and Senate bills.
It would work like this:
Any actively working American could participate, but would have to pay
premiums for at least five years before being eligible to make a claim.
Premiums would be stable over a person's life, unless the government
had to raise them to keep the program solvent.
Benefits would be at least $50 a day once a person became seriously
cognitively impaired or unable to perform at least two or three daily
activities, such as dressing and eating, without assistance. Students
and the poor would be able to enroll for $5 a month, which would mean
other participants would subsidize them.
The program is meant to be self-supporting, without government
subsidies. But some worry too few healthy people would enroll, leaving
a group of enrollees at higher risk for needing long-term care — and
not enough money in the program to care for them.
"If premiums are $2,000 a year, some people are going to look at that
and say, 'Boy, that's pretty steep. ... I'll worry about that risk some
other time,'" says Allen Schmitz, an actuary with the independent
consulting firm Milliman Inc.
Schmitz says automatic enrollment might help increase sign-ups, but
Medicare's chief actuary has predicted enrollment as low as 2 percent.
That could require raising premiums, which would mean even fewer people
would participate.
Given that, Schmitz says he sees "significant risk" that the program
will fail. Rate increases will be more likely with the government
program than in the private market, he says.
As long as Medicaid provides a safety net, many people won't believe
they need long-term care insurance, says University of Illinois
business professor Jeffrey Brown, a former member of the Social
Security Advisory Board. The nudge of automatic enrollment could help,
he says.
"People do respond to automatic enrollment," Brown says. "They don't
unenroll."
Myers, the Chicago-area priest, says his wife's annual premium was
$1,533, and the rate remained the same over the years. All told, they
paid nearly $9,000 in premiums for her policy. Their claims for
Bonnie's care, at an assisted living center and at home, added up to
$37,162.
He says he tells people to consider buying long-term care insurance on
the private market through a broker. "My advice would be definitely do
it. It's just part of good financial planning."
UConn could get big boost from Dodd amendment
By Judy Benson Day Staff Writer
Article
published Dec 23, 2009
Late in the negotiations for the Senate version of the
health care reform bill, Democratic Sen. Chris Dodd worked to add a
provision that could help the University of Connecticut partially fund
the new hospital it has been seeking to replace the antiquated John
Dempsey Hospital in Farmington.
Dodd,
chairman of the Banking Committee and a senior member of the Senate
Committee on Health, Education, Labor and Pensions, is facing stiff
competition for re-election in November. He introduced the amendment to
the main bill, designed to increase the number of Americans covered by
health insurance and enact other reforms, that passed its second test
vote in the Senate on party lines Tuesday.
Dodd's
amendment would allocate $100 million to build a university hospital
that conducts research and has inpatient and outpatient services,
criteria met by the UConn hospital and 11 others at public universities
across the country, according to Dodd spokesman Bryan DeAngelis.
The
federal funds would be distributed as a grant that would be
administered by the federal Department of Health and Human Services,
which would also decide which of the eligible public universities would
receive all or part of the $100 million. The grant could cover no more
than 40 percent of the total cost of the new hospital.
"These
provisions will bring millions of dollars to the state so that
Connecticut's residents can receive quality, affordable health care,"
Dodd said in a statement, referring to the university hospital measure
and to others he added that would benefit community health centers and
Medicaid and SAGA recipients and increase Medicare payments to
hospitals.
DeAngelis provided a list
Tuesday of the 11 other public universities with medical schools and
hospitals that would be eligible to apply for the grant. It includes
Indiana University, the University of Colorado, the University of Iowa,
the University of Maryland, the University of Minnesota Medical Center
and the University of Mississippi.
In response to a request for comment on the amendment,
UConn issued a statement from university President Michael Hogan.
"We
very much appreciate Sen. Dodd's willingness to offer up this proposal
and we can't thank him enough for all his hard work on behalf of the
state and the University of Connecticut," Hogan said. "We are currently
looking at the language in the bill and are hopeful that this will
become law so that we can apply for the grant. Without question, UConn
has a compelling case to make for awarding this funding to our
institution.
"All of us want to
bring resources to Connecticut that improve the quality of health care
and increase access to care in our state."
UConn
has been seeking a new, $475 million hospital to replace its aging
224-bed facility in Farmington, which had a $12 million deficit in
2008. A new hospital is seen as key to UConn's and the state's ability
to attract and retain medical and dental students as well as doctors,
dentists and other health professionals.
The
current hospital also provides specialty and dental care to many of the
state's uninsured as well as those with Medicaid, HUSKY, SAGA or other
government insurance that some private hospitals and dentists don't
accept because of low reimbursement rates.
A
proposal announced a year ago to merge management of the UConn hospital
with Hartford Hospital is "not on the table anymore," UConn health
center spokeswoman Carolyn Pennington said Tuesday.
UConn's
board of trustees is developing a new proposal that it hopes to submit
to the General Assembly in the 2010 session, Pennington said.
Democrats Face Challenge in Merging Health
Bills
NYTIMES
By ROBERT PEAR and DAVID M. HERSZENHORN
December 22, 2009
WASHINGTON — Even as the Senate took a significant step toward passing
its version of a sweeping overhaul of the health insurance system
before Christmas, Democrats were grappling Monday with deep internal
divisions over abortion, the issue that most complicates their drive to
merge the Senate and House bills and send final legislation to
President Obama.
In the House, advocates and opponents of abortion rights and
conservative Democrats have made clear that they object, for different
reasons, to the Senate’s compromise language on abortion. Interest
groups on both sides of the spectrum — Planned Parenthood on the
abortion rights side, Catholic bishops for the anti-abortion rights
camp — also oppose the abortion provision in the Senate bill, leaving
Speaker Nancy Pelosi with a challenge in rounding up the votes she
needs in the House.
Ms. Pelosi’s room for maneuvering is limited because any changes to the
language in the Senate bill could unravel the deal that provided
Democrats with the 60 votes they need to get the legislation through
the Senate.
Ms. Pelosi, the Senate majority leader, Harry Reid of Nevada, and the
White House will have to find a way forward on abortion even as they
confront other big differences between the House and Senate bills,
including how to pay to expand insurance coverage to more than 30
million Americans and whether to include a government-run plan to
compete with private insurers.
The Senate bill cleared a major hurdle early Monday, when the Senate
voted 60 to 40, along party lines, to limit debate on the guts of its
measure. Two more votes are set for Tuesday. Calling it a “historic
vote,” Mr. Obama said, “The United States Senate knocked down a
filibuster aimed at blocking a final vote on health care reform, and
scored a big victory for the American people.”
Senate Democrats got another lift on Monday when the American Medical
Association endorsed their legislation, which embodies Mr. Obama’s top
domestic priority.
“Of all the organizations and individuals that have supported this
bill, I rate this one as the most important,” said Senator Christopher
J. Dodd, Democrat of Connecticut and a co-author of the bill.
Jubilant and exhausted after winning the 1 a.m. test vote, Democrats on
Monday were already thinking ahead to the next stage of the legislative
process. The Senate and the House will try to hash out their
differences, with members of the House under intense pressure to
accommodate the tenuous deals in the Senate despite their ideological
qualms. And no issue is shaping up to be more complex than abortion.
Representative Bart Stupak, Democrat of Michigan and the author of the
anti-abortion provisions in the House bill, said Monday, “It would be
extremely difficult for me to vote for a bill” taking the Senate
approach on abortion.
The House, more liberal than the Senate on many issues, would impose
more stringent restrictions, barring coverage of abortion by any health
plan bought even partly with federal subsidies.
Under the bill that is likely to be approved this week by the Senate,
health plans could cover abortion. But people who enroll in such plans
would have to write two premium checks, one for abortion coverage and
one for everything else. Insurers would have to keep separate accounts,
and state officials would police the “segregation of funds.”
Douglas D. Johnson, legislative director of the National Right to Life
Committee, said it was difficult to envision a compromise because
“people opposed to abortion see it as the taking of innocent human
life.”
Senator Barbara Boxer, Democrat of California, said Monday that the
compromise she struck last week with Senator Ben Nelson, Democrat of
Nebraska, offered a potential road map for successful negotiations on
the issue with the House.
In an interview, Mrs. Boxer said the Senate bill created “a firm wall”
that would prevent the use of federal money to pay for insurance
coverage of abortions, meeting a demand of opponents of abortion
rights, while allowing women to use their own money to buy health plans
that cover the procedure.
“When you have both extremes saying they’re unhappy, I think it’s a
fair compromise,” Mrs. Boxer said. “Because we have this compromise
that’s being attacked on either side, I think that gives us momentum
going into the final conference.”
Sixty-four House Democrats, representing one-fourth of the House
Democratic caucus, voted for stringent restrictions on insurance
coverage of abortion. And 41 of them voted for passage of the House
bill, so they constitute a crucial bloc. The bill was approved, 220 to
215, on Nov. 7.
But leading supporters of abortion rights in the House said they would
not vote for a final bill if it included those restrictions, which they
fear would curtail access to abortion for many women who already have
insurance.
The House bill would establish a tax surcharge on income over $500,000
for individuals and over $1 million for couples. The Senate bill would
tax high-cost employer-sponsored health plans and increase the Medicare
payroll tax on individuals with incomes over $200,000 and couples over
$250,000.
Lawmakers said they could envision a compromise mixing the two
approaches.
More than 190 House members have gone on record against the Senate’s
proposed excise tax on “Cadillac health plans,” which is also opposed
by organized labor. But the White House and some health economists say
the tax could help control health costs by encouraging employers to
shop for cheaper policies that would not be hit by the tax.
It is unclear whether the House and the Senate will appoint a formal
conference committee or just try to work out their differences in
negotiations with Democratic leaders and committee chairmen from the
two chambers. In any event, White House officials expect to play a huge
role.
The Senate may have the upper hand in negotiations on a government
health plan, championed by liberal Democrats.
Senate Democratic leaders dropped the public option after concluding
they could not get 60 votes for it. Their bill calls instead for two or
more nationwide health plans, to be offered by private insurers under
contracts negotiated with the federal Office of Personnel Management.
Ronald F. Pollack, executive director of Families USA, a liberal
advocacy group that works closely with the White House, said Monday: “I
think we will not have a public option in the final bill. It would be
close to impossible to pass it in the Senate.”
On this, as on several other issues, Mr. Pollack said, “the Senate has
somewhat greater leverage than the House” because Senate Democrats need
60 votes, the exact number in their caucus, to overcome Republican
opposition.
Senator Joseph I. Lieberman, independent of Connecticut, said, “There
is a natural tendency to split the difference between the Senate and
the House.” But on major issues in the health bill, Mr. Lieberman said,
“splitting the difference means you won’t have 60 votes in the Senate.”
In the eyes of consumers and voters, the success of the legislation
will hinge, to a large degree, on whether it makes insurance more
affordable. One of the most important issues for House and Senate
negotiators is how to aid low- and middle- income people.
The House would expand Medicaid to cover people with incomes less than
150 percent of the poverty level ($33,075 for a family of four). The
Senate would expand eligibility to 133 percent of the poverty level
($29,327 for a family of four). Many advocates for low-income people
prefer the House approach.
You
know the
industry has read the bill - since they wrote it!
Healthcare shares rise as reform bill progresses
YAHOO
Dec. 21, 2009
BOSTON (Reuters) – Healthcare shares rose on Monday as a bill to reform
healthcare passed the first critical test in the Senate, without many
of the provisions, such as a government-run health insurance option,
that investors most feared would hurt profits.
The S&P Healthcare Index (.GSPA) rose 1.4 percent, while the Morgan
Stanley Healthcare Payor stock index (.HMO) rose 3.6 percent. The
S&P Managed Health Care index (.GSPHMO) rose 4.6 percent.
"All in all, relative to the last version of health reform issued by
the Senate, things have turned out pretty well for the health insurance
industry," said Carl McDonald, an analyst at Oppenheimer. "In
particular, all versions of a government-run health plan have largely
been eliminated."
The original Senate bill taxed the health insurance industry a fixed
$6.7 billion a year. Under the new proposal, the industry would face a
$2 billion tax in 2011, with increases over time to $10 billion in 2017.
Analysts said the new proposal would allow insurers time to factor the
tax into pricing.
The bill would require most Americans to have insurance, expanding the
membership rolls for health insurers. At the same time, it replaces a
proposed government-run public insurance option with less onerous
exchanges to cover those who are not covered through their employment.
Matthew Borsch, an analyst at Goldman Sachs & Co., said Cigna Corp
(CI.N) remains his favorite among health insurers.
"Aside from reform, the important backdrop to our sector view is
fundamentals, which are decidedly mixed but with the key being that
downside risk to commercial margins is mitigated by firming of industry
pricing," he said in a research note.
Shares of Cigna rose 5.3 percent to $37.69. Shares of Aetna Inc (AET.N)
rose 5.84 percent to $34.41. Humana Inc (HUM.N) rose 3.79 percent to
$45.17 and United Health Group Inc (UNH.N) rose 5 percent to $33.14.
Shares of Wellpoint Inc (WLP.N) rose 3.8 percent to $60.51.
Shares of pharmacy benefit managers Medco Health Solutions Inc (MHS.N)
rose 3.84 percent to $65.51 and Express Scripts (ESRX.O) rose 5.2
percent to $88.77 as concern eased that an industry tax could be added
to the bill in the final days leading up to the vote.
"Based on discussions with our political consultant in Washington, we
believe that a PBM tax is now not part of the final Senate bill," said
Steven Valiquette, an analyst at UBS Securities.
Shares of Allergan Inc (AGN.N), maker of the anti-wrinkle treatment
Botox, rose 1.7 percent to $61.68 after it dodged a bullet that would
have placed a 5 percent tax on cosmetic surgery, wrinkle-filling
injections and similar procedures. Instead, a 10 percent tax would be
placed on indoor tanning salons.
The bill's revisions delayed a tax on medical device manufacturers
until 2011. The total tax on the industry would be unchanged at nearly
$20 billion.
Shares of St. Jude Medical Inc (STJ.N) rose 1 percent to $37.18; shares
of Stryker Corp (SYK.N) rose 0.6 percent to $50.78 while shares of
Zimmer Holdings Inc (ZMH.N) rose 0.9 percent to $58.97. Shares of
Medtronic Inc (MDT.N) slipped 3 cents to $43.19.
CT benefits, too...
Deep in Health Bill, Very Specific Beneficiaries
NYTIMES
By ROBERT PEAR
December 21, 2009
WASHINGTON — Buried in the deal-clinching health care package that
Senate Democrats unveiled over the weekend is an inconspicuous proposal
expanding Medicare to cover certain victims of “environmental health
hazards.”
The intended beneficiaries are identified in a cryptic, mysterious way:
individuals exposed to environmental health hazards recognized as a
public health emergency in a declaration issued by the federal
government on June 17.
And who might those individuals be? It turns out they are people
exposed to asbestos from a vermiculite mine in Libby, Mont.
For a decade, Senator Max Baucus, Democrat of Montana, has been trying
to get the government to help them. He is in a position to deliver now
because he is chairman of the Finance Committee and a principal author
of the health care bill.
Working for a 21st consecutive day, the Senate on Sunday pushed toward
a final vote on Christmas Eve on the bill, which would provide health
insurance for more than 30 million Americans. Democrats said on
Saturday that they had secured the 60th vote needed to pass the bill,
and a 60-to-40 procedural vote early Monday morning was the first in a
series testing their ability to maintain party unity on the issue.
David Axelrod, a senior adviser to President Obama, appeared on
television talk shows on Sunday with other White House aides in an
effort to reframe the debate and to rally Democrats around the bill.
Despite polls that show declining public support for the measure, Mr.
Axelrod said it would prove to be popular once people learned more
about it.
“People understand we’re on the doorstep of doing something really
historic that will help the American people and strengthen our country
for the long run,” he said.
Mr. Axelrod said the provisions benefiting specific states, like
Nebraska, and favored constituencies were a natural part of the
legislative process.
“Every senator uses whatever leverage they have to help their states,”
Mr. Axelrod said on the CNN program “State of the Union.” “That’s the
way it has been. That’s the way it will always be.”
Republicans said they would resist the legislation with every tool
available, and they denounced the deal struck on Saturday. “This
process is not legislation,” said Senator Tom Coburn, Republican of
Oklahoma, referring to a variety of special-interest provisions. “This
process is corruption. It’s a shame the only way we can come to a
consensus in this country is to buy votes.”
Mr. Baucus defended the assistance for those affected by the asbestos
site in his state. “The people of Libby were poisoned and have been
dying for more than a decade,” he said. “New residents continue to get
sick all the time. Public health tragedies like this could happen in
any town in America. We need this type of mechanism to help people when
they need it most.”
Items were inserted into the bill by the Senate majority leader, Harry
Reid, Democrat of Nevada, to get or keep the support of various
lawmakers. He needs support from all 60 members of his caucus to
overcome a Republican filibuster and pass the bill by his self-imposed
Christmas deadline.
Senator Ben Nelson, Democrat of Nebraska, was the critical final
Democrat to endorse the bill. He obtained tighter restrictions on
insurance coverage of abortion, and additional Medicaid money and other
benefits for his state.
Another item in the package would increase Medicare payments to
hospitals and doctors in any state where at least 50 percent of the
counties are “frontier counties,” defined as those having a population
density less than six people per square mile.
And which are the lucky states? The bill gives no clue. But the
Congressional Budget Office has determined that Montana, North Dakota,
South Dakota, Utah and Wyoming meet the criteria.
Another provision would give $100 million to an unnamed “health care
facility” affiliated with an academic health center at a public
research university in a state where there is only one public medical
and dental school.
Senators and their aides said on Sunday that they were not sure who
would qualify for this money or who had requested it.
Dr. Atul Grover, the chief lobbyist for the Association of American
Medical Colleges, said he believed that Commonwealth Medical College, a
new school in Scranton, Pa., was a likely candidate.
Reached at home on Sunday, Dr. Robert M. D’Alessandri, the president of
the medical school, said initially, “We meet the conditions” in the
Senate proposal. But then he said he was not so sure.
The Senate health bill, like one passed by the House last month, would
impose tough new restrictions on referrals of Medicare patients by
doctors to hospitals in which the doctors have financial interests. The
package assembled by Mr. Reid would provide exemptions to a small
number of such hospitals, including one in Nebraska.
Under the original Senate bill, doctor-owned hospitals could qualify
for this exemption if they were certified as Medicare providers by Feb.
1, 2010. Mr. Reid’s proposal would move the deadline to Aug. 1, 2010.
Molly Sandvig, executive director of Physician Hospitals of America,
which represents doctor-owned hospitals, said the change would benefit
Bellevue Medical Center, scheduled to open next year in Bellevue, Neb.
Under the proposal, Ms. Sandvig said, “doctor-owners can continue to
refer Medicare patients to the hospital” in eastern Nebraska.
“Senator Nelson has always been a friend to our industry,” she said.
“But doctor-owned hospitals in other states were not so fortunate. They
would not meet the Aug. 1 deadline.”
Another provision of the bill would increase Medicare payments to
certain “low-volume hospitals” treating limited numbers of Medicare
patients. Senator Tom Harkin, Democrat of Iowa and chairman of the
Senate health committee, said this “important fix” would help midsize
Iowa hospitals in Grinnell, Keokuk and Spirit Lake.
Another item in Mr. Reid’s package specifies the data that Medicare
officials should use in adjusting payments to hospitals to reflect
local wage levels. The officials can use certain new data only if it
produces a higher index and therefore higher Medicare payments for
these hospitals.
Senate Democrats said this provision would benefit hospitals in
Connecticut and Michigan.
Mr. Reid’s proposal also provides additional money to several states to
help pay for the expansion of Medicaid to cover many childless adults
and parents who did not previously qualify.
Senate Democrats said Saturday that the cost would probably be less
than $100 million over 10 years. But the Congressional Budget Office
said Sunday that the cost of this provision, benefiting Massachusetts,
Nebraska and Vermont, “is approximately $1.2 billion over the 2010-2019
period.” Massachusetts and Vermont have been leaders in providing
health insurance to their residents.
Nebraska, with help from Mr. Nelson, won a particularly generous
arrangement under which the federal government would indefinitely pay
the full cost of covering certain low-income people added to the
Medicaid rolls under the bill.
Republicans derided this provision as the “Cornhusker kickback.” And
they said it was typical of the favors Democrats had given to Mr.
Nelson and a handful of other senators.
“You’ve got to compliment Ben Nelson for playing ‘The Price is Right,’
” said Senator Richard M. Burr, Republican of North Carolina. “He
negotiated a Medicaid agreement for Nebraska that puts the federal
government on the hook forever. Not for six years, not for 10 years.
This isn’t the Louisiana Purchase; this is the Nebraska windfall.”
Page last updated at 08:32
GMT, Monday,
21 December 2009
Senators worked into the night
before the vote was called at 1am
US healthcare
reform passes a key vote in the Senate
President Barack Obama's main domestic
priority, healthcare reform, has cleared a key hurdle in the US Senate.
Senators
voted 60 to 40 along party lines to end debate on a compromise bill,
putting the legislation on course to face a final vote on Christmas
Eve.
The final Senate bill will then have to be reconciled with a
more expansive one passed by the House of Representatives.
The reform measure aims to extend health coverage to more
than 30m people who currently lack health insurance.
The
long, often acrimonious, debate culminated in a procedural vote at 0100
(0600 GMT) on Monday, when the Democratic caucus voted unanimously to
overcome delaying tactics by the Republicans.
 |
 Americans have already
issued their verdict, they don't want it 
Mitch McConnell
Senate minority leader
|
The Democrats had been confident after Democratic Senator Ben
Nelson, who had been holding out for further changes, on Saturday
agreed to a compromise and announced he would back the bill.
Sixty votes are needed to bypass a lengthy debate, or
filibuster. The Democrats control exactly 60, so every vote counts.
"We'll
get this passed before Christmas and it will be one of the best
Christmas presents this Congress has ever given the American people,"
said Democratic Senator Tom Harkin.
Republicans have argued that the legislation is flawed.
"Mark
my words, this legislation will reshape our nation. And Americans have
already issued their verdict. They don't want it," said Senate minority
leader Mitch McConnell.
Three further votes are scheduled this week on the issue.
Differences
President
Obama has set health reform as a key plank of his first term and wants
the Senate to pass the bill by the end of the year.
The legislation - designed to secure coverage for millions of
uninsured Americans - could lead to the biggest changes in US
healthcare in decades, if approved.
Under the Senate bill, most
Americans would have to have health insurance, while private insurers
would be banned from refusing to provide insurance because applicants
had pre-existing medical conditions.
Insurance would be made more affordable with subsidies
available to help those in lower income bands, the Democrats say.
People would also have access to new insurance market places.
The Senate bill must be reconciled with the legislation
passed by the House before President Obama can sign it into law.
There are, however, key differences.
The
House version still includes a government-run health insurance plan, or
public option, that was removed from the Senate version.
There are also differences over how to pay for the reform.
Five Reasons It Might Not
Pass: Obamacare tests Lincoln’s adage that without public
sentiment nothing can succeed.
National Review
By Rich Lowry & Robert Costa
December 21, 2009, 4:00 a.m.
Harry Reid got his 60. Ben Nelson resorted to the typical Washington
expedient in such situations and bought into a few window-dressing
compromises, in exchange for an enormous Medicaid benefit to his state.
The Cornhusker Kickback joins the Louisiana Purchase as the latest
evidence that there’s nothing like a hundred million or so in federal
dollars to alleviate a senator’s deeply held concerns about the
substance of Obamacare. Nelson’s sellout is a gigantic step toward the
passage of the bill, but it’s not over yet. Here are five obstacles
that still stand between Reid-Pelosi and a White House signing ceremony:
1. Public Revulsion. The bill
was already under water in every major public-opinion poll, and opposed
by a margin of almost 2 to 1 in the latest CNN poll. The latest NBC
News/Wall Street Journal poll put its support at freezing, 32 percent.
A few ticks downward and the bill will be in the 20s.
Is anything that has happened recently likely to change the trajectory?
The Reid bill just got even longer, and the new version includes more
tax increases. Even by the standards of the United States Congress, the
process has been hide-the-children ugly: massive payoffs to the
on-the-fence senators and a heedless, late-night rush to pass
something, anything. The Democrats have shown no inclination to let
public opinion hold them back, but the stiff headwind makes everything
a little harder and reduces an already-small margin for error.
One subset of public opinion will be particularly important: Nebraska.
If Nelson is perceived to have made a career-defining choice that will
end his designation as a conservative Democrat and a pro-lifer, and if
he takes an immediate dive in the polls, it will cast a pall over other
Blue Dogs inclined to play ball. In that case, the various payoffs on
offer won’t seem worth the larger cost of supporting the bill. It’s too
early to tell exactly how it’s going to play in Nebraska, but Nebraska
Right to Life has been appropriately excoriating about Nelson’s
betrayal.
Democrats have set out to disprove Lincoln’s adage that without public
sentiment nothing can succeed. They may yet succeed, but sailing into
the teeth of such a howling headwind of public opinion won’t be easy.
2. The Stupak Dozen. Nelson
cut a deal so far short of the Stupak language in the House that the
National Right to Life Committee is going to score the cloture vote on
the bill as a vote to subsidize abortion on demand. That won’t matter
to anyone in the Senate, but it could have a major effect in the House.
After her initial 220–215 victory, Pelosi can afford to lose only two
net votes. Bart Stupak has declared the Nelson language unacceptable
and vows to oppose the final bill if it doesn’t include the
restrictions contained in his amendment. As John McCormack points out,
earlier in the year Stupak was part of a bloc of Democrats who wrote a
letter to Pelosi saying they’d stand against “any health-care-reform
proposal unless it explicitly excludes abortion from the scope of any
government-defined or -subsidized health-insurance plan.” Eleven of
those signatories voted for the House bill.
Then there’s Joseph Cao, the Louisiana Republican who voted for the
bill at the last moment during the first House vote but has said he
would vote against the bill — even if doing so might cost him his seat
— if it funds abortion. Surely, not all of the Stupak Dozen have that
level of commitment. The full weight of the Democratic establishment
will come crashing down on them if they threaten the bill. Still, it
would take only two or three of them to upset the entire effort. One
option would be simply to give them what they want. But will Barbara
Boxer stand for the Stupak language in the Senate? This has been a
devilish dilemma for the Democrats from the beginning, and it hasn’t
gotten any easier as the stakes have gotten higher.
3. Who Pays? As a practical
matter, it should be relatively easy to find a compromise on revenue
sources. That doesn’t involve a hot-button cultural issue or a matter
of deep principle like abortion. But the differences in financing
between the Senate and the House bills are vast. The Senate relies on a
so-called Cadillac tax on pricey insurance plans, the House on a surtax
on the wealthy. The Senate long ago declared the surtax anathema, and
the House is just as dismissive of the Cadillac tax. The unions hate
the Cadillac tax, since they enjoy such plans themselves, the fruit of
collective bargaining. If the House gives in, it will create even more
unrest on the Left. If the Senate gives in, it could upset the fragile
deal for 60. If this disagreement over financing doesn’t represent as
dire a threat to the future of the bill as the other factors we are
cataloguing, it’s still a stumbling block.
4. Feeling Blue. “Blue Dog
Democrat” is understandably becoming a term of derision, denoting a
willingness to object only enough to be noticed before caving in to the
Democratic leadership. Yet the Blue Dogs still have to be a worry for
supporters of the bill. When Obamacare first passed the House, 28 Blue
Dog Democrats, more than half of their 52-member coalition, were on
board. This is a pool that surely includes some very nervous votes. As
Michael Barone points out, nearly 70 percent of the Blue Dogs represent
districts that voted for John McCain. A vote for this bill must look
even more like a potentially career-ending decision now than it did the
first time around.
Keep an eye especially on the Pennsylvanians. Rep. Patrick Murphy
already has four GOP opponents in his suburban Philadelphia district.
After supporting round one of Obamacare, the auto bailouts, TARP, and
the stimulus, Murphy may be looking for a way back toward the center.
Reps. Kathy Dahlkemper and Christopher Carney, both elected in the 2006
anti-Bush sweep, represent blue-collar districts in the Keystone State
in which Obama failed to reach 50 percent last year. You can bet that
trio is watching the polls. Other Blue Dogs are simply getting out. In
the past month, Reps. Bart Gordon (D., Tenn.), Dennis Moore (D., Kan.),
and John Tanner (D., Tenn.) have all announced their retirements.
Don’t count on the Blue Dogs, though, since most of them are experts at
folding under pressure.
5. The Left. Progressives are
pained, at what should be their very moment of triumph. The Senate
dashed their dreams of the public option. Without it, many on the left
are abandoning ship. “This is the real sticking point,” said Howard
Dean last Sunday. “There hasn’t been much fight from the White House on
that.” It was always unlikely, no matter how much Bernie Sanders
grumbled, that left-wing senators would block the deal. It’s easier to
imagine a firebrand or two in the House doing it. No fewer than 60
liberals in the House imprudently made a pledge to oppose a bill
without a public option. Almost all of them can be expected to eat it.
But what if one or two don’t? Public-option scold Rep. Anthony Weiner
(D., N.Y.) is continuing to pressure Obama to move further left. “What
we’re saying is now’s your moment, big guy, you’re the Mariano Rivera
of this situation,” he said to MSNBC last week. “You’re going to come
in at the end, and there’s still a chance to do it.” That’s not going
to happen, but perhaps a few of Weiner’s colleagues are ideologically
besotted enough to lash out at the president’s “betrayal” when he
doesn’t come in.
All of this means that Democrats shouldn’t be celebrating until they
have the bill on Obama’s desk. But make no mistake: The momentum for
the bill that Reid had to fake a week or so ago is now real, at least
within Congress. Early next year, the question may shift from whether
Democrats can pass the bill, to whether Republican can make the sort of
gains in 2010 and 2012 necessary to repeal it.
— Rich Lowry is the editor of National Review. Robert Costa is the
William F. Buckley Jr. Fellow at the National Review Institute.
Last holdouts back in the good graces of the Majority - Senators
Lieberman and Nelson
60-40
National
Review
Robert
Costa blog
Monday,
December 21, 2009
As expected, the Democrats won this battle. Harry Reid got his 60 votes
to end debate. Some were bought (Landrieu, Nelson, Sanders), others
nudged (Lincoln, Bennet). One was wheeled in (Byrd) and another came in
from the cold (Lieberman). Passage by Christmas is likely. For that,
the Democrats will need only 51 ayes on their side. Should it pass,
it’ll be onto the House for Obamacare, where another fight awaits.
Were there any surprises? No, not really. The only moment during the
vote when I clenched fists and bit my lower lip came when the clerk
rolled past the K-names and onto the L’s. Lieberman, I thought, is the
only one who could change his mind at the last minute. He didn’t. Jim
Webb, who I had hoped would be the quiet one to deliver a surprise
knockout blow, disappointed. Olympia Snowe, however, did not. After
making the GOP sweat following her vote to move the bill out of the
Finance Committee, she stuck to her call for more debate time and voted
against cloture. Good for her.
Conrad:
House must stick close to Senate bill
The
Washington Times
ASSOCIATED
PRESS
Originally published 10:49 a.m., December
20, 2009, updated 11:25 a.m., December 20, 2009
The chairman of the Senate Budget
Committee says the House must stick close to the Senate's version of
health care reform or risk losing the 60 votes needed to pass it in the
Senate.
Sen. Kent Conrad, North Dakota
Democrat, said on "Fox News Sunday" that the 60 votes needed to stop a
filibuster would not hold together unless the Senate bill emerged
largely intact from a House-Senate conference.
Once the Senate approves the bill,
conferees would have to work out a compromise that would be submitted
to each house. The House bill includes a government-run public option;
the Senate bill does not.
In addition, Senate Democratic
leaders made concessions to some of their members to get them on board,
most recently Sen. Ben Nelson of Nebraska.
The White House, meanwhile, is
defending President Obama's stand in support of the health care
legislation amid concern from liberals that Mr. Obama is giving up too
much to get a deal done.
Senior presidential adviser David
Axelrod said the legislation that Democrats in the Senate are poised to
pass on Christmas Eve matches the goals that Mr. Obama has set. He said
those include affordable choices for people without health insurance
and more protections for people who already have coverage.
Mr. Axelrod said no major law in the
nation's history has been passed without compromise.
He spoke Sunday on NBC's "Meet the
Press."
Lieberman ripped over health care; Senator's blocking tactics enrage Rep.
DeLauro; Courtney also ramps up his criticism
By Ted Mann Day Staff Writer
Article published Dec 16, 2009
Hartford - Even as U.S. Sen. Joe Lieberman, D-Conn., indicated he might
be ready to vote for a stripped-down version of the federal health care
reform bill Tuesday, at least one member of Connecticut's congressional
delegation was calling for his head.
U.S. Rep. Rosa DeLauro, D-3rd District, suggested Lieberman should be
recalled from office for his efforts to block major portions of the
proposed legislation now moving through the Senate.
U.S. Rep. Joe Courtney, D-2nd District, didn't go as far as his
colleague, but Courtney - a health care policy specialist in his state
legislature days and a fervent supporter of the current effort to
overhaul the health care system and cover more of the uninsured - was a
lot more vocal about his dissatisfaction with Lieberman than he had
been just weeks ago.
Lieberman's recent opposition to a public option to provide a
competitive alternative to private insurance "doesn't reflect what's
happening on the ground in Connecticut," Courtney said Monday in an
appearance on MSNBC, noting the recently approved merger of two
insurers in the state.
Asked Tuesday to respond to DeLauro's comments about Lieberman - the
veteran Democratic congresswoman from New Haven said the senator was
holding reform "hostage" and should be recalled - Courtney was more
critical than he has been throughout months of debate over how to
reform the health care system.
"Congressman Courtney believes that Senator Lieberman should keep faith
with the people of Connecticut and his previously articulated positions
to move real health care reform forward," said Brian Farber, the
congressman's communications director.
Farber also pointed to a Nov. 12 Quinnipiac University poll, one
repeatedly cited by Connecticut supporters of the health care reform
package, which showed a 56-37 percent majority in favor of the public
option.
In a statement released Tuesday, Lieberman said he could support
aspects of the underlying Democratic reform legislation provided it
does not expand Medicare coverage or include other provisions like the
public option. The senator and his staff have refused repeated requests
to discuss his views on health care and the legislation with The Day.
Obama meets with senators
In Washington, meanwhile, President Barack Obama met privately at the
White House with senators on Tuesday. Differences still remain over
details, the president said, but he spoke in highly favorable terms
about the measure that party leaders hope to pass by Christmas.
The bill includes "all the criteria that I laid out" in a speech to a
joint session of Congress earlier in the year, Obama said. "It is
deficit-neutral. It bends the cost curve. It covers 30 million
Americans who don't have health insurance, and it has extraordinary
insurance reforms in there to make sure that we're preventing abuse."
With the president urging lawmakers to look beyond disappointments they
may have about parts of the legislation, several Democrats said that in
the private session, liberals lamented the absence of a government-run
insurance option they had long sought.
"There was frustration and angst," said U.S. Sen. Jay Rockefeller,
D-W.Va. U.S. Sen. Sheldon Whitehouse, D-R.I., agreed: "There's a lot of
that going around." Rockefeller added that Obama had emphasized
the historic nature of the legislation, quoting him as saying the bill
was the "biggest thing since Social Security." Rockefeller added, "It's
hard to ignore that."
U.S. Sen. Chris Dodd, D-Conn., issued a more conciliatory statement,
saying, "I know there's a lot of frustration out there, both at Joe's
position on the public option and at the way he's conveyed it. I share
that frustration. But I also know that we have a job to do right now:
Pass health care reform that offers people more choices, brings down
costs, provides better care and, in the end, saves lives. We're on
track to deliver that bill, and I am going to keep working towards that
goal."
The meeting followed an intense two days in which Democrats struggled -
apparently successfully - to keep the legislation moving forward
despite a flare-up over a proposal to expand Medicare to uninsured men
and women as young as 55.
Lieberman announced on Sunday that he opposed the proposal, and he
threatened to join Republicans in voting against the overall measure if
it stayed in the bill.
Democrats are now ready to jettison the Medicare change, and Lieberman
told reporters that, assuming they do - and that any government plan or
Medicare expansion stays out of the bill - "then I'm going to be in a
position where I can say what I've wanted to say all along: that I'm
ready to vote for health care reform."
That left U.S. Sen. Ben Nelson, D-Neb., the only known potential
holdout among the 60 senators who are members of the party's caucus.
Nelson has been seeking changes to increase restrictions on abortion
coverage in the new insurance marketplace the bill would establish.
Democrats need 60 votes to overcome a threatened Republican filibuster.
Reformers' anger at Lieberman
DeLauro, whose district includes New Haven and some surrounding towns,
angrily broke an uneasy peace among Connecticut's all-Democratic
delegation to the Congress in an interview with POLITICO, the
Washington-based political news outlet.
"No individual should hold health care hostage, including Joe
Lieberman, and I'll say it flat out, I think he ought to be recalled,"
POLITICO quoted DeLauro as saying Tuesday.
Connecticut law has no provision for recall of state officials - though
the concept has been considered in recent years after a spate of state
and municipal corruption scandals - and rules on expulsion from
branches of Congress are controlled by the House and Senate themselves.
But DeLauro's remarks are a stark departure from the tone of the
state's delegation in recent months, as Lieberman has increasingly
frustrated reform supporters with his opposition to key facets of the
Democratic package, including several that he has supported in the
past, like a purchasing exchange for health insurance plans for the
uninsured and a proposal to let those under age 65 buy in to Medicare.
Lieberman remains a registered Democrat despite still-resonant and
bitter battles with his party's base since his near-defeat in 2006. And
despite vigorous opposition to his recent maneuverings in the health
care debate, the Connecticut delegation members have notably refrained
from directly criticizing him.
But that could be changing.
"It's very disappointing for those of us who have been out there doing
the town hall meetings and making the case, and seeing that the public
really has stayed with us on this issue, to see the position that he
announced over the weekend," Courtney said on "The Ed Show" on MSNBC
Monday night.
"Again, the Medicare buy-in, as you point out, was part of the
Democratic platform going back to the Gore/Lieberman campaign,"
Courtney said. "And certainly, it would seem that that was a reasonable
attempt to try and get his vote given the fact that he went out and
campaigned for vice president on that issue."
No flip-flop
In a written statement of his own Tuesday, released by his press staff,
Lieberman said there is "much that is needed and worthy in the core
bill that I support." And he rebutted claims that he had "flip-flopped"
on issues like the Medicare buy-in, which he supported in less dire
fiscal times.
"The process to reach agreement on a bill has often been difficult, but
I sense we are now taking significant steps forward to obtain 60 votes
on the Senate floor," Lieberman's statement said in part. "I look
forward to passing a bill that will give the American people genuine
health care reform without impeding our recovery from the current
recession or adding to our exploding national debt."
Portions of an Associated Press report were included in this story.
Lieberman Gets Ex-Party to Shift on Health
Plan
By DAVID M. HERSZENHORN and DAVID D. KIRKPATRICK
December 15, 2009
WASHINGTON — Just the thought of Joseph I. Lieberman makes some
Democrats want to spit nails these days. But Mr. Lieberman, the
Connecticut independent, is not the least troubled by his status as
Capitol Hill’s master infuriator — and on Monday he showed how powerful
that role can be at a time when Democrats cannot spare a single vote.
The day before, Mr. Lieberman threatened on national television to join
the Republicans in blocking the health care bill, President Obama’s
chief domestic initiative. Within hours, he was in a meeting at the
Capitol with top White House officials.
And on Monday night, Democratic senators emerged from a tense 90-minute
closed-door session and suggested that they were on the verge of bowing
to Mr. Lieberman’s main demands: that they scrap a plan to let people
buy into Medicare beginning at age 55, and scotch even a fallback
version of a new government-run health insurance plan, or public option.
Mr. Lieberman said he believed that the Medicare expansion was off the
table, though he did not get any guarantee. “Not an explicit assurance,
no,” he said. “But put me down tonight as encouraged at the direction
in which these discussions are going.”
Mr. Lieberman could not be happier. He is right where he wants to be —
at the center of the political aisle, the center of the Democrats’
efforts to win 60 votes for their sweeping health care legislation. For
the moment, he is at the center of everything — and he loves it.
“My wife said to me, ‘Why do you always end up being the point person
here?’ ” he said, flashing a broad grin in an interview on Monday.
Just hours after his televised threat to kill the bill, Mr. Lieberman
said, he left a meeting with Senate leaders and top White House
officials in the office of the majority leader, Harry Reid, more
certain than ever that he held all the cards.
“Harry said, ‘We will do what we can do to secure this,’ ” Mr.
Lieberman recalled. “He said, ‘I have got some work to do with other
members of the caucus.’ But he said, ‘My own feeling is we need you to
get to 60 and so I am going to do my best.’ ”
Many Democrats say they have given up trying to divine the motivations
of Mr. Lieberman. Some have suggested that he is catering to insurance
industry interests back home. Others say he realizes that he cannot win
re-election in 2012 without appealing to Republicans and independents,
especially because Democrats will be energized with Mr. Obama running
that year.
Mr. Lieberman says he favors the essential elements of the health care
legislation but fears that expanding government programs would compound
the federal debt. Mr. Lieberman, who lost a Democratic primary in 2006,
won re-election as an independent and campaigned aggressively against
Mr. Obama last year, said he felt “liberated” from party loyalty.
Perhaps no one confounds Mr. Reid and Senate Democrats more. And back
in Connecticut, the anger is often raw.
“If you think you are sick of Joe Lieberman now,” Jim Shea, a columnist
in The Hartford Courant, wrote Monday, “just wait until you get sick.”
Liberal bloggers have attacked him as “a joke” and worse.
Mr. Lieberman’s threat to block the bill blew up a proposed deal among
the Democratic caucus that Mr. Reid had hailed as a breakthrough.
After the meeting on Monday evening, Senate Democratic leaders said
they still hoped to pass the bill before Christmas, and Mr. Obama
invited the caucus to the White House on Tuesday for more talks.
Democratic leaders said they were caught off guard on Sunday morning by
Mr. Lieberman’s threat and accused him of acting in bad faith. His
comments sent White House officials, including the chief of staff, Rahm
Emanuel, scrambling to the Capitol for a meeting to pinpoint where he
stood.
Democratic leaders noted that Mr. Lieberman on numerous occasions had
voiced support for the Medicare buy-in proposal that he now wants
dropped. It was part of a health care proposal that he championed as Al
Gore’s running mate in the 2000 presidential race, and three months ago
he expressed support for the same concept.
“What I was proposing was that they have an option to buy into Medicare
early,” Mr. Lieberman says on a video distributed by Democrats on
Monday.
In the interview, he did not dispute that he once supported the idea
but said he had not recalled having done so, or the context, until Mr.
Reid’s office confronted him about it.
Campaign finance advocates have attacked Mr. Lieberman as “an insurance
industry puppet,” suggesting that he wants to protect private health
insurers from competition because he has received more than $1 million
insurance company campaign contributions since 1998.
During his 2006 re-election campaign, Mr. Lieberman ranked second in
the Senate in insurance industry contributions. Connecticut is a hub of
the insurance business, with about 22,000 jobs specifically in health
insurance, according to an industry trade group.
In the interview, Mr. Lieberman dismissed assertions that he was doing
the industry’s bidding. “It’s hogwash and it’s weak,” he said, noting
that he had often sided against the companies. He said he favored a
proposal, not included in the health care bill, that would end the
insurers’ limited exemption from federal antitrust laws.
Mr. Lieberman complained that some people had begun attacking his wife,
Hadassah, urging that she be fired from her job at a nonprofit
organization that fights breast cancer, because she previously worked
in public relations for two pharmaceutical companies.
Mr. Lieberman’s opposition to a bigger government role in health care
runs counter to public opinion in his state, according to polls. In a
Quinnipiac College survey last month, a majority of voters said they
supported a so-called public option.
Douglas Schwartz, director of the Quinnipiac poll, said the profile of
Mr. Lieberman’s public support suggested he was shifting into a
moderate Republican. Mr. Lieberman insisted that it was his liberal
colleagues who were holding the health care bill hostage.
“People have said to me, including some people in the caucus: ‘We know
you are for health care reform. You know how important this is to the
president. Would you yourself stop this from happening?’ ” he said.
“So I say: ‘There is a wonderful core health care reform bill on the
Senate floor. Would my liberal friends in the caucus stop that from
happening and prevent the president from getting this major goal that
he has set because they want to add more on to that? Why won’t they be
reasonable?’ ”
Maybe...
Lieberman Rules Out Voting for Health Bill
NYTIMES
By ROBERT PEAR
December 14, 2009
WASHINGTON — In a surprise setback for Democratic leaders, Senator
Joseph I. Lieberman, independent of Connecticut, said on Sunday that he
would vote against the health care legislation in its current form.
The bill’s supporters had said earlier that they thought they had
secured Mr. Lieberman’s agreement to go along with a compromise they
worked out to overcome an impasse within the party.
But on Sunday, Mr. Lieberman told the Senate majority leader, Harry
Reid, to scrap the idea of expanding Medicare and to abandon the idea
of a new government insurance plan, known as a public option.
On a separate issue, Mr. Reid tried over the weekend to concoct a
compromise on abortion that would induce Senator Ben Nelson, Democrat
of Nebraska, to vote for the bill. Mr. Nelson opposes abortion. Any
provision that satisfies him risks alienating supporters of abortion
rights.
In interviews on the CBS News program “Face the Nation,” Mr. Lieberman
and Mr. Nelson said the bill did not have the 60 votes it would need to
get through the Senate.
Senate Democratic leaders, including Mr. Reid and Senator Charles E.
Schumer of New York, said they had been mindful of Mr. Lieberman’s
concerns in the last 10 days, so they were surprised when he assailed
major provisions of the bill on television Sunday. He reiterated his
objections in a private meeting with Mr. Reid.
A Senate Democratic aide, flummoxed by Mr. Lieberman’s stance, said,
“It was a total flip-flop and leaves us in a predicament as to what to
do.”
Democrats are desperately trying to round up 60 votes and conclude
Senate debate on the health care bill before Christmas.
Mr. Reid could not immediately figure out how to achieve that goal at a
meeting he held Sunday with senior Democratic senators and White House
officials, including Mr. Obama’s chief of staff, Rahm Emanuel.
The Senate Republican leader, Mitch McConnell of Kentucky, said that
passage of the bill was looking less and less inevitable. The Democrats
“are in serious trouble on this,” he said, “and the core problem is the
American people do not want us to pass it.”
On television Sunday, Mr. Lieberman said: “We’ve got to stop adding to
the bill. We’ve got to start subtracting some controversial things. I
think the only way to get this done before Christmas is to bring in
some Republicans who are open-minded on this, like Olympia Snowe.”
Senator Snowe, of Maine, has tried to find common ground with
Democrats. But she has rejected Mr. Reid’s proposal to let uninsured
people ages 55 to 64 purchase coverage under Medicare.
Mr. Lieberman described what it would take to get his vote. “You’ve got
to take out the Medicare buy-in,” he said. “You’ve got to forget about
the public option. You probably have to take out the Class Act, which
was a whole new entitlement program that will, in future years, put us
further into deficit.”
The Class Act refers to a federal insurance program for long-term care,
known as Community Living Assistance Services and Supports.
Mr. Lieberman said he would have “a hard time” voting for bill with the
Medicare buy-in.
“It has some of the same infirmities that the public option did,” Mr.
Lieberman said. “It will add taxpayer costs. It will add to the
deficit. It’s unnecessary. The basic bill, which has a lot of good
things in it, provides a generous new system of subsidies for people
between ages 55 and 65 and choice and competition.”
Mr. Nelson said he wanted to know the cost of the Medicare buy-in. “I
am concerned that it’s the forerunner of single-payer, the ultimate
single-payer plan, maybe even more directly than the public option,”
Mr. Nelson said.
Mr. Lieberman cautioned Senate Democrats to limit their appetite for
expansive new programs.
“The bill itself does a lot to bring 30 million people into the
system,” Mr. Lieberman said. “We don’t need to keep adding onto the
back of this horse or we’re going to break the horse’s back and get
nothing done.”
Medicare buy-in plans runs into
Senate resistance
YAHOO
By CALVIN WOODWARD, Associated Press Writer
December 13, 2009
WASHINGTON – A plan to let people as young as 55 buy into Medicare,
heralded as a breakthrough in the Senate's health care debate, ran into
resistance Sunday from lawmakers who can make or break Democrats'
efforts to reshape the nation's health insurance system.
Independent Sen. Joe Lieberman of Connecticut declared the early
Medicare buy-in a bad deal for taxpayers and the deficit. He pleaded
with Democrats to start subtracting expensive proposals from the
overhaul, saying, "We don't need to keep adding onto the back of this
horse or we're going to break the horse's back and get nothing done."
Government accountants are poring over the latest compromise proposals
to see how much they would cost, and some lawmakers are reserving
judgment until that plays out this week. Democratic Sen. Claire
McCaskill of Missouri said she would "absolutely" vote against the
package if it seemed destined to increase people's out-of-pocket costs
and the national debt.
In the meantime, only a few moderates have come out against the
Medicare plan. But in a legislative struggle that is a game of inches,
Democrats need all 60 votes in their caucus, and they don't yet have
them.
The early Medicare buy-in was part of a compromise reached last week
when Senate Democrats dropped the idea of setting up a federal health
insurance plan to compete with private insurers. Many Democrats who had
favored that public option only grudgingly let it go, in return
embracing the Medicare proposal as an appealing way to help people 55
to 64 — a group often vulnerable to losing employer-based health
insurance when it's needed the most.
Under the compromise, private nonprofit plans overseen by the federal
government would be offered in the marketplace.
Sen. Jay Rockefeller, D-W.Va., said he was working with Lieberman and
others on controlling Medicare costs, and he voiced confidence fellow
Democrats can get past their divisions. Party leaders, resuming the
debate Sunday, are pushing hard to finish the Senate overhaul
legislation before Christmas and to begin negotiations with the House,
which has passed its plan.
But while saying "I want to be a friend of the process," Sen. Ben
Nelson, D-Neb., sounded distinctly down on the Medicare proposal.
"I'm concerned that it's the forerunner of single-payer — the ultimate
single-payer plan, maybe even more directly than the public option," he
said. By single-payer, he meant national health insurance run by
Washington.
Nelson already says he won't support the bill unless fellow Democrats
establish a firewall to ensure no public money goes toward abortion
coverage.
Lieberman was a firm opponent of the bill's original plan for a public
insurance option. Even with it out, he said he would find it hard to
vote for the bill if it contains the Medicare buy-in as written. "The
opposition to it has been growing as the week has gone on," he said.
Lieberman, Nelson and Rockefeller spoke on CBS' "Face the Nation."
McCaskill was on "Fox News Sunday."
How 'reform' abuses research
By ALAN REYNOLDS
Last Updated: 7:14 AM, December 12, 2009
Posted: 3:00 AM, December 12, 2009
For a sense of how re search is being misrepresented in the health care
debate, look no farther than the campaign for a government-run health
plan.
Without such a "public option," it's claimed, some states will have too
few choices among private health insurers. The popularity of some
health plans is offered as evidence of monopoly and high premiums --
rather than evidence of superior performance in keeping customers
satisfied.
Wall Street Journal columnist David Wessel writes, "There are plenty of
places where one or two insurance companies dominate the market, much
to the consternation of employers and consumers. 'Most Americans live
in markets dominated by a small number of insurers, and most markets
are becoming more concentrated over time,' Northwestern University
economist Leemore Dafny and two colleagues reported in a recent
National Bureau of Economic Research working paper. 'Increases in
concentration do raise premiums,' they said."
Actually, the authors of that paper wrote, "We do not find evidence
that premiums are rising more quickly in markets that are becoming more
concentrated." On the contrary: "Premiums are not rising more quickly
in markets experiencing the greatest increases in concentration"
[emphasis in the original].
What part of the word "not" is difficult to understand?
Wessel's selected quote ("increases in concentration do raise
premiums") refers to a single unique merger. Out of many mergers among
health-insurance companies and HMOs, the study found "only one" -- the
1999 merger of Aetna and Prudential Healthcare -- that significantly
increased the merged firms' share of a few local markets. They contend
that this briefly raised premiums, which is the basis of Wessel's quote.
Yet the authors also note that the merger had "no lingering effect on
market concentration after 2002." Enrollment in the newly combined firm
reached 21 million in 1999, but "fell rapidly thereafter [to] 13
million in 2002." If the combined Aetna-Prudential plans actually
"dominated" many markets, how could they possibly lose 8 million (38
percent) of their enrollees in just three years? Companies without
serious competition can't easily lose business to competitors.
Wessel is alluding to a new Dafny paper, with Mark Duggan and
Subramaniam Ramanarayanan, which claims, "Markets are becoming more
concentrated over time." Specifically, the trio say: "The four-firm
concentration ratio for the nation as a whole . . . increased from an
impressive 58 percent in 1998 to 79 percent in 2006."
In fact, the Census Bureau survey "Establishment and Firm Size" reports
the four-firm concentration for health and medical insurance carriers
was only 23.5 percent in 2002. Dafny & Co. inflate the figure to 79
percent by defining the market in a uniquely imaginative way.
As Dafny herself noted in another paper earlier this year, 82 percent
of large firms don't pay premiums for employee health insurance, but
instead "self-insure" by paying benefits themselves (while still
contracting with an insurance company to handle the actual claims
process), though many also offer their employees the option of joining
an HMO.
Yet Dafny excluded self-insurance, so that HMOs accounted for more than
90 percent of the plans in the study -- even though only 20 percent of
those with employer-sponsored health insurance choose an HMO, according
to the 2009 Kaiser Family Foundation survey.
It is clearly nonsensical to define competition in health insurance as
if HMOs accounted for more than 90 percent of "the market."
In any case, it's absurd for Wessel to cite these studies of
large-company health policies -- because that market is totally
different from the one for non-group customers that the "public option"
is supposed to serve.
Then, too, each of the Dafny studies "does not examine the relationship
between market structures and premium levels." In other words, she
didn't claim premiums are higher in markets in which a few major
insurers capture most of the business, nor did she offer evidence of
Wessel's alleged "consternation of employers and consumers."
Those who fulminate about "market concentration" in health insurance --
including Leemore Dafny, the American Medical Association and economist
James C. Robinson (who holds the Kaiser Permanente chair at UC
Berkeley) -- haven't demonstrated any connection between premiums and
their antiquated measures of market dominance.
Premiums are not higher in states where one or two health plans are
most popular, and (as the latest Dafny paper said) "premiums are not
rising more quickly in markets experiencing the greatest increases in
concentration." Columnists and editorial writers who suggest otherwise
are abusing bad economics to promote bad policy.
Health care loophole would allow
coverage limits
YAHOO
By RICARDO ALONSO-ZALDIVAR, Associated Press Writer
December 11, 2009
WASHINGTON – A loophole in the Senate health care bill would let
insurers place annual dollar limits on medical care for people
struggling with costly illnesses such as cancer, prompting a rebuke
from patient advocates.
The legislation that originally passed the Senate health committee last
summer would have banned such limits, but a tweak to that provision
weakened it in the bill now moving toward a Senate vote.
As currently written, the Senate Democratic health care bill would
permit insurance companies to place annual limits on the dollar value
of medical care, as long as those limits are not "unreasonable." The
bill does not define what level of limits would be allowable,
delegating that task to administration officials.
Adding to the puzzle, the new language was quietly tucked away in a
clause in the bill still captioned "No lifetime or annual limits."
The 2,074-page bill would carry out President Barack Obama's plan to
revamp the health care system, expanding coverage to millions now
uninsured and trying to slow budget-busting cost increases. A tentative
deal among Senate Democrats to back away from creating a new government
program to compete with private insurers appears to have overcome a
major obstacle to the bill's passage.
Officials of the American Cancer Society Cancer Action Network said
they were taken by surprise when the earlier ban on annual coverage
limits was undercut, adding that they have not been able to get a
satisfactory explanation.
"We don't know who put it in, or why it was put in," said Stephen
Finan, a policy expert with the cancer society's advocacy affiliate.
Democratic officials of the Senate Health, Education, Labor and
Pensions Committee would not comment publicly but said the bill
contains numerous provisions that will benefit patients with cancer and
other life-threatening illnesses, not to mention improvements in
preventive care.
Advocates for patients say they're concerned the language will stay in
the bill all the way to Obama's desk.
"The primary purpose of insurance is to protect people against
catastrophic loss," Finan said. "If you put a limit on benefits, by
definition it's going to affect people who are dealing with
catastrophic loss." The cost of cancer treatment can exceed $100,000 a
year.
Under the health care bills in Congress, the major expansion of health
insurance coverage won't take place until three to four years after
enactment. Democrats have touted a series of consumer protections as
immediate benefits Americans will secure through the legislation. Both
the Senate and House bills, for example, ban lifetime limits on the
dollar value of coverage.
But Finan said the change in the Senate bill essentially invalidates
the legislation's ban on lifetime limits.
"If you can have annual limits, saying there's no lifetime limits
becomes meaningless," he said. A patient battling aggressive disease in
its later stages could conceivably exhaust insurance benefits in the
course of a year.
It's unclear how widespread such coverage limits are in the current
insurance marketplace. Large employers have moved away from coverage
limits, but insurers have wide discretion in designing plans for small
businesses and individual customers.
In the House bill, neither annual nor lifetime limits would be
allowable under an essential benefits package intended to provide
comprehensive coverage.
A neurological
procedure? Is"finding the nerve" covered?
Economic Scene: Finding the Nerve to Cut Health Costs
NYTIMES
By DAVID LEONHARDT
December 9, 2009
WASHINGTON
Over the next several weeks, members of Congress will be confronted
with one scary story after another about what will happen if they try
to cut health care costs.
Tax the costliest health insurance plans? Workers will be denied
medical care. Reduce the growth of spending on home health care
agencies? Elderly patients living alone will be left to fend for
themselves. Set up a commission to reduce Medicare waste? Again, the
elderly will suffer. Impose a tax on plastic surgery? That’s unfair to
unemployed women looking to enhance their appearance. (Seriously, the
plastic surgeons are making that case.)
But here’s the thing: It is abundantly clear that our medical system
wastes enormous amounts of money on health care that doesn’t make
people healthier. Hospitals that practice more intensive medicine, to
take one example, get no better results than more conservative
hospitals, research shows. And while the insured receive better care
and are healthier than the uninsured, the lavishly insured — those
households with so-called Cadillac plans — are not better off than
households with merely good insurance.
Yet every time Congress comes up with an idea for cutting spending, the
cry goes out: Patients will suffer! You’re cutting bone, not fat!
How can this be? How can there be billions of dollars of general waste
and no specific waste? There can’t, of course.
The only way to cut health care costs is to cut health care costs and,
in the process, invite politically potent scare stories.
I’m as skeptical as anyone of the ability of the United States Congress
to formulate good policy, but the last few days have offered reason to
hope that its members may be summoning the political courage to endure
the scare stories.
That would be a big deal. Health costs, through Medicare, are the main
source of the huge long-term budget deficit. In recent years, they have
also caused insurance premiums to rise so quickly that employers
haven’t had the money to give workers a decent raise. David Cutler, a
Harvard health economist, estimates that the measures already in the
health bills will increase the typical family’s income $2,500 a year by
the end of the decade.
Real health reform also has the potential to save lives. Because we now
pay doctors to provide more care rather than better care, we have not
given them an incentive to reduce hospital-acquired infections and
other avoidable errors. A new amendment from three senators — Susan
Collins, a Maine Republican; Joe Lieberman, the Connecticut
independent; and Arlen Specter, the Pennsylvania Republican turned
Democrat — would increase the financial penalty for giving patients
such infections.
Even this idea, however, has its own scare story. The Washington Post
reported on Sunday that hospital groups were “quietly steaming” over it
and suggested their support for health reform could be in danger.
•
One piece of encouraging news came on Saturday, when the Senate finally
began listening to its own health care advisers.
To help it oversee Medicare, Congress set up an outside board of
doctors, economists and other experts in 1997, called the Medicare
Payment Advisory Commission. Medpac, as it’s known, tries to figure out
which services Medicare may be paying too little for, thus creating
shortages, and which ones it may be overpaying for.
Perhaps the single clearest example of overpayment is home health care.
Home health agencies, which care for Medicare patients with specific
health needs (as opposed to those receiving general long-term care),
have been proliferating in recent years. Yet, according to the most
recent data, they still had fat profit margins on Medicare, 16.6
percent. One reason, the Government Accountability Office found, was
that fraud was rife.
So Medpac has recommended cutting home health payments, and the Senate
bill would do so, by 13 percent over 10 years. On Saturday, the Senate
rejected a Republican amendment, supported by a few Democrats, too,
that would have blocked that cut.
The home health provision is actually typical of the cost-cutting
measures that have made it into the Senate bill: it’s pretty good. It
won’t be perfect, obviously. Some people somewhere may indeed have to
stop working with a home health agency they like and find a new one.
But that’s not a reason to waste billions of dollars a year subsidizing
an industry’s profits.
The real problem with the Senate bill is that it doesn’t go far enough
to cut costs and improve care. Here too, however, there are positive
signs. For months, centrist Democrats have been saying that cost
containment was one of their biggest priorities, but they had not done
much to help the cause. That has now started to change.
“Senators are now really focused on cost containment,” says Mr. Cutler,
who has been advising some of them.
The day before the Senate defeated the home health care amendment,
Senators Collins, Lieberman and Specter introduced an amendment with
some measures to push medicine away from the insidious fee-for-service
payment system. The cost-cutting momentum continued on Tuesday, when 11
of the 13 freshman Democratic senators announced their own package of
measures. Neither proposal is earth-shattering, but both would make a
difference.
Among other things, the freshmen’s proposal would do more than the
current Senate bill to push insurers to use a standardized payment
process. Right now, doctors and hospitals often have to fill out
different forms for different insurers. “There’s a lot of money there,”
Len Nichols, head of health policy at the New America Foundation, says.
Intriguingly, officials from a rainbow of special interest groups
showed up at the freshman senators’ news conference to praise the
proposal. To me, their presence highlighted both the biggest strength
and the biggest weakness of the proposal. On the one hand, it has a
real chance to make it into the final bill. On the other hand, it, like
the Collins-Lieberman-Specter amendment, also fails to fix the single
biggest flaw in the Senate bill.
Last month, Senator Harry Reid, the Democratic leader, gutted an
independent commission — a more powerful version of Medpac, meant to
shield Medicare payment decisions from political interference — that
many economists consider necessary. Mr. Reid’s bill would allow the
commission to take action only if Medicare spending was rising even
faster than total health spending. If total spending rose 8 percent one
year and Medicare spending rose 7.9 percent — a miserable situation —
the commission would have to sit on its hands. AARP, unfortunately, has
emerged as an opponent of a strong commission.
But without one, health reform will be hobbled. And the Senate may be
the only hope for changing it.
The House has shown little interest in cost control. President Obama
and his administration have pushed aggressively for it, but they have
limited leverage. Mr. Obama can’t credibly threaten to veto any of the
health reform bills that now seem likely to emerge from Congress.
So after the 11 freshmen announced their plan on Tuesday, I caught up
with Mark Warner, the Virginia Democrat who is the group’s leader,
underneath the Capitol building and asked him how he and his colleagues
would deal with the inevitable scare stories still to come: How do you
respond to a lobbyist who effectively accuses you of killing patients?
“I don’t know any other way than you take incremental steps,” Mr.
Warner said, “and you hope you get to the tipping point where fear and
misinformation don’t have an effect, because people see these things
don’t do what they are accused of doing.”
That, obviously, is the long-term strategy. In coming weeks, we’ll see
how well Mr. Warner and his colleagues deal with the immediate
pressure. The Grim Reaper is a tough opponent.
It ain't
over 'til it's over department...
News Analysis: Public Option
Keeps Toehold in Senate Deal on Health Bill
NYTIMES
By DAVID M. HERSZENHORN
December 10, 2009
WASHINGTON — The “broad
agreement” that Senator Harry Reid announced Tuesday night on the
proposed overhaul of the health care system was less a comprehensive
accord among Democrats than an effort by the party’s leaders to keep
the process moving ahead, even as Republicans attempt to prolong a
seemingly endless floor fight.
The deal did not entirely resolve the biggest dispute: whether the
legislation should include a “public option,” a government-run health
plan to compete with private insurers.
Many Democrats had not even seen the agreement on Tuesday night, much
less signed on to it. But by offering something to liberal Democrats
and centrists, the tentative deal announced by Mr. Reid created a
framework for an agreement with a chance of winning the 60 votes
necessary to pass the health care bill in the Senate. As Mr. Reid
bluntly put it, as he climbed into his black S.U.V. on Tuesday night,
“It has something that we think should satisfy everybody.”
The odds now seem to be that any legislation emerging from the Senate
will omit the kind of straightforward, immediately available public
option originally envisioned by advocates, including President Obama.
But if the deal announced by Mr. Reid holds, it is likely that a bill
will be sent to the White House that includes a broader and more direct
role for government in the health insurance market.
Supporters of the public option want it to remove the profit motive as
an obstacle to medical care, and also to menace the private insurance
companies that they generally view as greedy and mean. At times, some
lawmakers seemed to favor the public plan simply because private
insurers hate the idea.
In Congress, opponents view the public plan as a dangerous expansion of
government, creating a new entitlement program that would ultimately
drive the country further into debt. Even though the Congressional
Budget Office said the plan would have little impact on insurance
premiums, the opponents fought it as a grave threat.
The preliminary agreement hailed by Mr. Reid was hatched in a series of
meetings among 10 senators, 5 of them liberals and 5 centrists. It
seeks to address all of these concerns and, more than anything, to
vault Senate Democrats over the biggest obstacle to locking down 60
votes for their larger health care bill.
To satisfy the centrists, including Senator Joseph I. Lieberman,
independent of Connecticut, who flatly threatened to vote against the
health care bill if it included a public plan, Mr. Reid’s agreement
would remove the public option as an immediate offering for people who
gain insurance coverage.
To satisfy the liberal Democrats, including Sherrod Brown of Ohio and
John D. Rockefeller IV of West Virginia, the agreement calls for the
creation of a new menu of national insurance plans, modeled after those
offered to more than eight million federal workers, including members
of Congress, and their dependents.
The new insurance plans would be overseen by a federal agency, the
Office of Personnel Management, which now runs the Federal Employees
Health Benefits Program and directly negotiates prices and benefits
packages with private insurance companies. The private firms eagerly
participate because of the large customer base.
The deal also keeps the public option as a fallback plan, to be
“triggered” if the health care legislation, including the new national
plans, fails to meet targets for providing affordable insurance
coverage to a set number of people. Such a fallback was included in the
Republicans’ Medicare drug bill; it was never needed.
It is unclear whether Mr. Lieberman would ultimately accept a bill with
the public plan on a trigger; he reiterated on Wednesday that he
opposes the idea. But it could appeal to Olympia J. Snowe of Maine, the
only Republican senator to support any version of the health care
legislation (she backed it on the Finance Committee). Her support is
still being courted aggressively by the White House.
Designing the new national plans to resemble the insurance coverage
offered to members of Congress also holds enormous political appeal. It
would provide additional choices to consumers, and it gives the entire
program an aura of a government plan even though the policies would be
issued by private firms like Blue Cross or Aetna.
In recent days, many Senate liberals angrily warned that they were done
making concessions, saying they had already moved from a public plan
tied to Medicare rates, or 5 to 10 percent above Medicare, to a much
weaker plan that would negotiate rates with providers.
Mr. Reid’s version of the bill would also let states opt out of the
program.
“We have compromised four times on the public option,” Mr. Brown had
said. “There is no more movement on the public option.”
“Many people wanted to do Medicare for all, but that was never in the
cards here,” he added. “We have moved three or four or five times on
this, and those days are over.”
In the end, the liberals had no choice, and they moved again. But not
without winning concessions in return, including an expansion of the
ultimate public plan, Medicare. The agreement announced by Mr. Reid
calls for allowing people from age 55 to 64 to buy coverage through
Medicare beginning in 2011.
While it is not Medicare for all, it is Medicare for more than under
current law, and the liberals view it as a major improvement for people
nearing retirement, who face some of the biggest obstacles to obtaining
insurance and pay some of the highest prices if they get coverage.
At first, those who want to buy in to Medicare coverage will have to
pay full cost. But once provisions of the bill take effect that will
provide subsidies to moderate-income Americans, those subsidies could
be used to buy either private insurance or coverage through Medicare.
That liberal senators in the negotiations were bargaining from a
position of strength was largely due to the strategic efforts of
Senator Charles E. Schumer, Democrat of New York, who ranks third in
the Democratic leadership, and who pressed Mr. Reid to include a public
option in the bill.
Mr. Reid, Mr. Schumer and many others realized that further negotiation
on a public option was inevitable if they were to have any hope of
enacting the health care bill as a whole. The question that arose, as
Mr. Reid combined rival versions of the legislation that were developed
by two Senate committees, was whether a public option would be in or
out of the bill at the start.
By including the public option in his blended bill, Mr. Reid, who faces
a tough re-election campaign in Nevada next year, briefly transformed
himself into a huge champion of the party’s leftward base. He held a
big news conference to announce that he would defy centrist opponents
and include the public option in the bill.
But the force behind the scenes was Mr. Schumer, who pressed for the
public option on the more right-leaning Finance Committee, and began
working closely with liberals. As a result, northern liberals in the
Senate may have more clout at the moment that at any point since the
days of Hubert Humphrey.
Mr. Reid also continued his own strategic maneuvering. When a
compromise on the public plan did not bubble up from conversations
between a handful of lawmakers, Mr. Reid designated the Team of 10 that
ultimately negotiated the agreement.
He tapped Senator Mark Pryor, Democrat of Arkansas, as the leader of
the centrists — a move to help bolster the resolve of Mr. Pryor’s
fellow Arkansan, Blanche Lincoln, who is up for re-election next year
and had expressed deep reservations about voting for a bill that
included the public plan.
And to show liberals that he was not trying to sell them out, Mr. Reid
also invited Senator Russ Feingold, Democrat of Wisconsin, to join the
group, knowing that Mr. Feingold’s pasts willingness to be a lone voice
for the left would make clear that supporters of the public plan were
not being set up.
Still, the liberals did not get everything they wanted. There were
discussions of broadening the Medicaid expansion in the bill by raising
the income eligibility threshold to 150 percent of the federal poverty
level from 133 percent. That proposal was deemed too expensive, and
risked angering governors and was dropped.
And another demand, to finance through 2015 the Children’s Health
Insurance Program through 2015, which would otherwise expire in 2013,
now depends on further cost analysis by the Congressional Budget Office.
The preliminary deal may not hold. If any part of the cost analysis
shows that the price tag of the bill is climbing too far, the agreement
may have to be reworked.
Already some senators on the Team of 10 have refused to commit
themselves to supporting the overall bill until they see how things
shake out.
Senator Ben Nelson, Democrat of Nebraska and a centrist who has
expressed deep skepticism about the legislation, was part of the group.
He went along with the agreement reluctantly, some Democrats said, and
only because the need for cost analysis meant nothing was really
decided just yet.
And even if Senate Democrats reach consensus, the wrangling over the
public plan is not finished. The health care bill approved by the House
includes a government-run plan, and convincing the more liberal House
Democratic caucus to drop it will not be easy.
Compromise in some ways, however, seems inevitable.
The fight over the public plan has never been about its short-term
impact. Opponents fear it will lead down a slippery slope to a fully
government-run, single-payer health system like those in many European
countries.
Many of the most ardent supporters hope that it will lead down a
slippery slope to a fully government-run, single-payer health system
like those in many European countries. But that was not about to happen
anytime soon.
For now, the Senate Democratic leadership and the White House are
hailing the tentative deal as a breakthrough — even though most
Democrats in the Senate have not even been briefed on the details.
Mr. Schumer, however, expressed confidence. “The feeling is if the 10
people in the room come to an agreement,” he said before the deal was
announced, “it doesn’t guarantee everybody, but it’s a pretty broad
reach into the caucus.”
Watered-down 'public plan' emerges in Senate
Stamford ADVOCATE
By Ricardo Alonso-Zaldivar, The Associated Press
Posted: 12/08/2009 06:56:01 AM EST
Updated: 12/08/2009 07:00:45 AM EST
WASHINGTON - They may still call it a "public plan," but private
insurers - not the government - would offer coverage under a compromise
Democrats are considering to win Senate passage of President Barack
Obama's health care overhaul.
The latest idea bears little resemblance to the original vision
outlined by liberals, and embraced by Obama, during the 2008
presidential campaign. That called for the government to sell insurance
to workers and their families in competition with industry giants like
UnitedHealthcare.
But instead of Medicare-for-the-masses, it would be Blue Cross Blue
Shield or Kaiser Permanente, albeit with a government seal of approval
from the department that handles the health plan for federal employees,
including members of Congress. The Office of Personnel Management - OPM
- would become an instantly recognizable federal acronym, like FDA and
CDC.
"I think it's the right way to go because it's simple and the public
can grasp it," Sen. Mark Begich, D-Alaska, said Monday, reflecting a
general hope that a deal is close.
Lawmakers will be able to tell their constituents "you're going to get
exactly what we have, and that every federal employee has, you can buy
into it," Begich added.
Five moderates and five liberals tapped by Majority Leader Harry Reid,
D-Nev., planned to work on the compromise Tuesday as the Senate debated
the 10-year, nearly $1 trillion bill. A vote on an amendment to tightly
restrict abortion coverage by health plans receiving federal subsidies could also happen
Tuesday.
Reid imposed a Tuesday deadline to complete negotiations on
the
government-run option, according to Sen. Tom Harkin, D-Iowa, a
participant in the talks.
"It's one of those kind of things in the middle that doesn't
make
everybody very happy but that's our compromise," Harkin said. "It's
something I'm going to probably have to live with."
Said Senate Finance Committee Chairman Max Baucus, D-Mont.:
"It's
probably the closest proposal thus far that could get the support of 60
senators. It's got legs."
Word of a possible compromise on the public plan drew a wary
reaction from liberals, who support a Medicare-like approach.
"We need a public option that is a government entity, or
established by
government," said Richard Kirsch of Health Care for America Now.
Insurance industry groups had little to say publicly, but
privately
some officials said the shift away from a government-run plan sounds
promising. There was plenty of skepticism.
"This is a long, long way from the original public plan that
was going
to require providers to accept Medicare reimbursement at 20 percent
less than the commercial market," said Robert Laszewski, a health care
industry consultant. "What the heck the advantage is, I don't see."
Liberals are trying to extract a price for any compromise.
Sen. Jay
Rockefeller, D-W.Va., has proposed allowing people 55 and over to buy
into Medicare. Others would further expand the Medicaid health program
for low-income people. Finally, if private insurers don't step up to
submit bids to OPM, some liberals want to authorize the federal agency
itself to set up a plan.
The Senate bill now calls for a government-run plan, with
states
allowed to opt out. The House bill includes a government plan available
in all states. Ongoing talks among Senate Democrats are nowhere near a
conclusion; nonetheless, senators and aides outlined a framework that
could lead to compromise.
The idea is for the government to lend its seal of approval
to private
plans that would be offered across the nation. The plans would be
available through new state insurance markets, called exchanges. New
markets would create big purchasing pools for those who now have
trouble finding and keeping affordable coverage - people buying their
own insurance and small businesses. Most of the 30 million consumers in
the exchanges would have government subsidies to help pay premiums.
Under the compromise, any insurer could approach the federal
personnel
office to offer a plan in the exchanges, but the plan itself would have
to be nonprofit. Most Blue Cross plans are still nonprofit, as is
Kaiser, the giant health maintenance organization.
Offered alongside other private insurance in the exchanges,
the
OPM-approved plans would carry a special designation certifying that
they meet standards comparable to those in the federal employee plan.
Supporters of the idea say it would promote competition by
creating new
national plans that could immediately go into states in which one or
two big insurers now control the market.
Skeptics say the OPM-approved plans would be pretty much the
same as
other private plans offered in the new markets. They run the risk of
attracting sicker patients who might think the government's seal means
less chance of insurance hassles. That would mean higher premiums for
those who sign up.
Solving the impasse over a government plan would move Reid
closer to
the 60-vote majority he needs to push a final bill through the Senate.
On Monday, one moderate whose vote Reid would like to have expressed
satisfaction.
"I think the discussions are going in the right direction ...
away from a government-run plan," said Sen. Ben Nelson, D-Neb.
AP sources: Dems reach deal to drop public
option
By DAVID ESPO, AP Special Correspondent
December 8, 2009
WASHINGTON – After days of secret talks, Senate Democrats tentatively
agreed Tuesday night to drop a government-run insurance option from
sweeping health care legislation, several officials said, a concession
to party moderates whose votes are critical to passage of President
Barack Obama's top domestic priority.
Majority Leader Harry Reid refused to provide any details at a
mid-evening news conference where he told reporters a "broad agreement"
had been reached between liberals and moderates on the controversial
issue.
With it, he said, the end is in sight for passage of the legislation
that Congress has labored over for months.
In place of a government-run plan, originally designed as a way of
forcing competition on private industry, officials said the Democrats
had tentatively settled on a private insurance arrangement to be
supervised by the federal agency that oversees the system through which
lawmakers purchase coverage. Additionally, the tentative deal calls for
Medicare to be opened to uninsured Americans beginning at age 55, a
significant expansion of the large government health care program that
currently serves the 65-and-over population.
The officials who described the details did so on condition of
anonymity, saying they were not authorized to discuss them publicly.
Despite their reluctance, some senators had talked openly earlier in
the day about the progress of the negotiations.
The developments followed a vote on the Senate floor earlier in the day
in which abortion opponents failed to inject tougher restrictions into
sweeping health care bill, and Democratic leaders labored to make sure
fallout from the issue didn't hamper the drive to enact legislation.
The vote was 54-45.
Based on attending the LWVCT Health Care "Fall Conference" we
checked out "SustiNet" at Wikipedia online
SustiNet
Explained
New Haven Independent
by Melinda Tuhus | April 17, 2009 7:58 AM
The director of a small non-profit in New Haven was
worried about that a new state universal health plan might mean she’d
have a harder time covering her older, less healthy workers. She was
relieved to find out that’s not how it would work.
Barbara Tinney (pictured above) is executive director of the New Haven
Family Alliance, learned those details during a nitty-gritty discussion
of a proposal before the state legislature called SustiNet. The
discussion took place Thursday night during a live airing of “21st
Century Conversations” on CTV.
SustiNet, among other features, would expand a government health
insurance program to bring in employees of not-for-profits and many
others who are uninsured or underinsured right now. Many people would
have a choice of choosing the new plan or sticking with an older
private plan.
Tinney said she feared that her younger, healthier employees would go
on that public program while her agency woudl end up paying more money
to cover the less healthy workers. Tinney learned that under SustiNet,
all the employees of a business or nonprofit would have to join
together, or none could. That’s part of the bill that passed the
General Assembly’s Public Health Committee in late March. Ihe point is
to prevent the cherrypicking of healthy individuals by any insurance
provider.
SustiNet was proposed by the Universal Healthcare Foundation of
Connecticut. It was the culmination of more than two years of meetings
with people from all walks of life with every kind of health coverage
or lack thereof. It would create a large insurance pool to bargain for
lower rates for currently uninsured or underinsured people; cut health
costs through digitizing medical records linked to a central database;
create “medical homes” that offer patients round-the-clock central
coordination of their health care as well as guidance in managing it;
and require “periodic quality review” of providers and “evidence-based
medicine. Click here for mroe details.
SustiNet was spearheaded by the Universal Healthcare Foundation of
Connecticut after more than two years of meetings with people from all
walks of life with every kind of health coverage or lack thereof. Paul
Wessel represented the foundation on Thursday night’s CTV program.
Democratic North Haven State Rep. Steve Fontana (pictured to Wessel’s
right) was also on the “hot seats” in the studio, peppered with
questions from host N’Zinga Shani and a dozen people in the audience.
Shani mentioned that Republican State Sen. Len Fasano had also been
invited and his office confirmed his attendance, but didn’t show up.
Sue Feldman runs the Village of Power in Dixwell, which supports women
working on their recovery from addictions. Some are on SAGA, the state
health insurance plan for low income adults. “There’s a terrible
process called the ‘spend down,’” she said, in which those on SAGA
undergo redeterminations of eligibility, and those making just over the
very low income limit lose their health coverage. She said if her
clients go to jail they lose their coverage, and it’s a nightmare to
get back on when they are released. Would SustiNet improve their lives?
she wanted to know.
The answer was that SustiNet is portable. That coverage moves with an
individual through job changes, family changes (like divorce) and other
personal changes. It would also not deny coverage based on pre-existing
medical conditions.
Others on the panel expressed concern about a lack of dentists who will
see low-income children on the HUSKY plan; about young adults who have
no coverage and end up using hospital emergency departments for their
care; about would-be entrepreneurs who can’t afford to leave a steady
job to develop their brilliant ideas because they need their
employer-paid health benefits; about the emphasis on illness, not on
wellness.
Wessel explained that SustiNet would bring state employees, Husky and
SAGA users together in one large, self-insured health plan, that could
gradually expand to include the uninsured and under-insured, the
self-employed, and employees of small businesses, municipalities and
non-profits.
After the show, Fontana explained that the bill must pass through
several more committees before coming up for a vote on the floor of the
state House and Senate. When a reporter asked if it could possibly pass
this year, he responded that certain pieces are likely to pass.
Possible examples are creating a medical home for patients, digitizing
health records, and uniting state employees, Husky and SAGA users into
a bigger pool. Then supporters could keep advocating for the whole
plan. “It’s time,” he told an audience member, “to make some noise” in
favor of significant health care reform.
Hardest hit by ObamaCare
By DICK MORRIS & EILEEN MCGANN
Last Updated: 7:10 AM, November 30, 2009
Posted: 1:08 AM, November 30, 2009
The "health-care reform" bills in Congress would hit 39 states hard
with new expenses, by raising Medicaid eligibility above the cur rent
income cutoffs.
The only states that won't have to raise eligibility because of the
Senate bill are Connecticut, Illinois, Maine, Massachusetts, Minnesota,
New Jersey, New York, Rhode Island, Tennessee, Vermont and Wisconsin
(plus the District of Columbia). And the House bill would force even
Massachusetts and Vermont to pay more.
Hardest hit would be Texas ($2,750 million a year in extra state
spending under the Senate bill), Pennsylvania ($1,450 million),
California ($1,428 million) and Florida ($909 million). Who knows if
Florida could avoid imposing an income tax if it has to meet so high an
unfunded mandate?
The required increases in state spending are likely to be quite high in
some states whose senators are swing votes on ObamaCare:
* In Arkansas, home to swing Sens. Mark Pryor and Blanche Lincoln, the
annual increased state spending would come to $402 million (not
counting the federal share) -- about a 10 percent increase in the state
budget, which is now $4 billion a year.
* In Louisiana, whose Sen. Marie Landrieu sold her vote on a key
procedural motion in return for more Medicaid funding, the increase
would come to $432 million (a 5 percent hike in state spending) -- more
than wiping out the extra funds she got in return for her vote.
* In Sen. Evan Bayh's Indiana, spending would go up by $586 million a
year, a rise of 4 percent.
* In Sen. Ben Nelson's Nebraska, the added state spending would be $81
million a year, a 2 percent increase.
The Sebate ObamaCare bill would cost North Dakota, home of Sens. Kent
Conrad and Byron Dorgan, $14 million. South Dakota, represented by Sen.
Tim Johnson, would have to boost Medicaid spending by $33 million.
The Medicaid-expansion provisions of the Senate bill are complex. In
the first year of the program (2013), states must enroll anyone who
earns less than 133 percent of the poverty level in their programs. For
a family of four, the national average poverty level in 2009 is $22,000
a year. So any family that size that makes less than $29,000 would be
eligible for Medicaid.
Many states, particularly in the South, actually have Medicaid cutoffs
below the poverty level. Arkansas, for example, cuts off its Medicaid
eligibility at only 17 percent of poverty level, and in Louisiana it
goes up to only 26 percent. For these states, the spending increase
required by the new bill is huge.
For the first three years of the program (2013-15) the federal
government would pay for all of the costs of the Medicaid expansion.
But, starting in the fourth year of operation -- 2016 -- the average
state would be obliged to pay 10 percent of the extra cost.
For Democratic governors, this provision means sudden death.
Particularly in states with limited Medicaid coverage, it would require
huge tax increases.
Kill the Bills. Do Health Reform
Right. The bill is irredeemable.
National Review
By Charles Krauthammer
November 27, 2009, 0:00 a.m.
The United States has the best health care in the world — but because
of its inefficiencies, also the most expensive. The fundamental problem
with the 2,074-page Senate health-care bill (as with its 2,014-page
House counterpart) is that it wildly compounds the complexity by adding
hundreds of new provisions, regulations, mandates, committees, and
other arbitrary bureaucratic inventions.
Worse, they are packed into a monstrous package without any regard to
each other. The only thing linking these changes — such as the 118 new
boards, commissions, and programs — is political expediency. Each must
be able to garner just enough votes to pass. There is not even a
pretense of a unifying vision or conceptual harmony.
The result is an overregulated, overbureaucratized system of surpassing
arbitrariness and inefficiency. Throw a dart at the Senate tome:
You’ll find mandates with financial penalties — the amounts picked out
of a hat.
You’ll find insurance companies (who live and die by their actuarial
skills) told exactly what weight to give risk factors, such as age.
Currently, insurance premiums for 20-somethings are about one-sixth the
premiums for 60-somethings. The House bill dictates the young shall now
pay at minimum one-half; the Senate bill, one-third — numbers picked
out of a hat.
You’ll find sliding scales for health-insurance subsidies — percentages
picked out of a hat — that will radically raise marginal income tax
rates for middle-class recipients, among other crazy unintended
consequences.
The bill is irredeemable. It should not only be defeated. It should be
immolated, its ashes scattered over the Senate swimming pool.
Then do health care the right way — one reform at a time, each simple
and simplifying, aimed at reducing complexity, arbitrariness, and
inefficiency.
First, tort reform. This is money — the low-end estimate is about half
a trillion per decade — wasted in two ways. Part is simply hemorrhaged
into the legal system to benefit a few jackpot lawsuit winners and an
army of extravagantly rich malpractice lawyers such as John Edwards.
The rest is wasted within the medical system in the millions of
unnecessary tests, procedures, and referrals undertaken solely to fend
off lawsuits — resources wasted on patients who don’t need them and
which could be redirected to the uninsured who really do.
In the 4,000-plus pages of the two bills, there is no tort reform.
Indeed, the House bill actually penalizes states that dare “limit
attorneys’ fees or impose caps on damages.” Why? Because, as Howard
Dean has openly admitted, Democrats don’t want “to take on the trial
lawyers.” What he didn’t say — he didn’t need to — is that they give
millions to the Democrats for precisely this kind of protection.
Second, even more simple and simplifying, abolish the prohibition
against buying health insurance across state lines.
Some states have very few health insurers. Rates are high. So why not
allow interstate competition? After all, you can buy oranges across
state lines. If you couldn’t, oranges would be extremely expensive in
Wisconsin, especially in winter.
And the answer to the resulting high Wisconsin orange prices wouldn’t
be the establishment of a public option — a federally run
orange-growing company in Wisconsin — to introduce “competition.” It
would be to allow Wisconsin residents to buy Florida oranges.
But neither bill lifts the prohibition on interstate competition for
health insurance. Because this would obviate the need — the excuse —
for the public option, which the left wing of the Democratic party sees
(correctly) as the royal road to fully socialized medicine.
Third, tax employer-provided health insurance. This is an accrued
inefficiency of 65 years, an accident of World War II wage controls. It
creates a $250 billion annual loss of federal revenues — the largest
tax break for individuals in the entire federal budget.
This reform is the most difficult to enact, for two reasons. The unions
oppose it. And the Obama campaign savaged the idea when John McCain
proposed it during last year’s election.
Insuring the uninsured is a moral imperative. The problem is that the
Democrats have chosen the worst possible method — a $1 trillion new
entitlement of stupefying arbitrariness and inefficiency.
The better choice is targeted measures that attack the inefficiencies
of the current system one by one — tort reform, interstate purchasing.
and taxing employee benefits. It would take 20 pages to write such a
bill, not 2,000 — and provide the funds to cover the uninsured without
wrecking both U.S. health care and the U.S. Treasury.
