Big“I” Weekly Health Care Reform Update Report

WEEK OF DECEMBER 14-18, 2009

Let it snow. With snowfall just beginning to accumulate on Friday (12/18) evening, Senator Ben Nelson (D-NE), the lone holdout in the Democratic Caucus, told Senator Majority Leader Harry Reid (D-NV) that he would support the health care reform bill with a few trade-offs for his home state. With Nelson’s vote in hand, the Democratic Caucus was now armed with a super majority of 60 votes – enough to invoke cloture and end debate on health care reform.

Rain, Snow or Shine. With Washington blanketed with nearly two feet of snow on Saturday, the city was completely shut down for the weekend – except for the Senate of course. Shortly after 1:00 a.m. this morning (12/21), the Senate, on a party line vote of 60-40, invoked cloture to end debate on the Manager’s Amendment (a 383 page smorgasbord of amendments to the bill). This morning’s vote was the first of three cloture (60 vote) hurdles the Senate must eclipse over the next three days in order to pass health care reform. However, with the Democratic Caucus now unified in support of the bill, it is just a matter of time before the Senate passes their health care reform bill.

So what’s in the Manager’s Amendment for me? The Big “I” scored a few big victories in the Manager’s Amendment:

Role of Agents and Brokers – The Manager’s Amendment requires the Secretary of HHS to establish procedures for agents or brokers to enroll employers in qualified health plans. The original Senate bill said the Secretary of HHS “may” establish such procedures. This slight tweak in the language clarifies the role of agents and brokers in the health insurance exchanges.

Agent and Broker Commissions – The Manager’s Amendment strikes (“deletes”) a provision that would have granted the Secretary of HHS the authority to establish national rate schedules for broker commissions paid by qualified health plans. The Senate bill does not clarify who will regulate commissions, but we believe the intent is to give the states such regulatory authority. The Big “I” government affairs staff will work to have this language clarified.

Public Option – The Manager’s Amendment removes the public option and instead permits private insurers to offer national not-for-profit insurance policies that would be negotiated by the Office of Personnel Management (OPM). At least two national plans would be available in each state exchange.

Medical Loss Ratio (MLR) – The Manager’s Amendment establishes a medical loss ratio of 85% for large group plans (100-plus lives) and 80% for small group (2-99 lives) and individual plans. This MLR is much more favorable than the 90% being floated over the past two weeks.

I hope you didn’t have Christmas plans. If the cloture votes proceed as scheduled over the next few days, the Senate will vote on final passage of their health care reform bill on Christmas Eve, between 7:00-9:00 p.m.

The Senate Schedule:
Tuesday (12/22)

• Vote on Manager’s Amendment (51 vote threshold); and
• Vote to invoke cloture on the Reid Substitute (underlying health care reform bill – 60 vote threshold)

Wednesday (12/23)

• Vote on Reid Substitute (51 vote threshold)

A couple more good articles to read:

• The Patient Protection and Affordable Care Act: Section-by-Section Analysis
• Trusted Choice: Side-by-Side Comparison

 

Big“I” Weekly Health Care Reform Update Report

WEEK OF DECEMBER 7-11, 2009

Deal or No Deal? That is the question that has perplexed Washington since last Wednesday’s (12/9) announcement of the Gang of 10’s public option compromise. Shortly after the compromise was announced, a few moderate members of the gang explicitly stated that they had by no means signed-off. And by the end of the weekend, the compromise appeared to be on life support when Sen. Lieberman (I-CT) announced he would not support the measure as currently drafted, and Sen. Ben Nelson (D-NE) described the Medicare expansion as “the forerunner of single-payer” (see photo above of Senators Nelson and Lieberman from their Face the Nation appearance on Sunday). With all Republicans currently in opposition to the compromise, the Senate Democratic Leadership is likely at least two votes short of the necessary 60 to end debate on a filibuster and proceed with final passage on their health care reform bill.

What’s the Gang of 10 Compromise?

National Insurance Plans – Several national insurance policies would be created and administered by private not-for-profit companies with rates negotiated by the Office of Personnel Management. This system is intended to resemble the Federal Employees Health Benefits (FEHB) plan that is available to all federal employees, including members of Congress. The national insurance plans would be available in state health insurance exchanges along with private plans.

Insurance Industry Regulations – Insurers would be required to spend at least 90% of premium money on medical care. This requirement would leave insurers with 10% to spend on salaries, administrative costs, commissions, etc. This 90% medical loss ratio (MLR) would have a severe impact on health insurers operating budgets and lead to dramatic cuts – likely to include agent commissions.

Public Option Trigger – There would be a public option trigger. The benchmarks for the trigger have yet to be defined. In theory, the trigger would be pulled if a particular state failed to meet the prescribed benchmarks after a certain number of years.

Medicare expansion – 55-64 year olds would be allowed to buy into Medicare. No details have been released on the estimated benefit costs or scope of coverage.

The truth spoken about the Medicare expansion: “Expanding Medicare is an unvarnished, complete victory for people like me. It’s the mother of all public options. We’ve taken something people know and expanded it. …Never mind the camel’s nose, we’ve got his head and neck under the tent.” – Rep. Anthony Weiner (D-NY); Chicago Tribune; December 10, 2009.

The countdown begins. The Senate Democratic Leadership has until Thursday or Friday to strike a deal that attracts 60 votes in order to set in motion the votes on cloture (60 vote hurdles) to end debate on the health care reform bill and proceed with a vote on final passage prior to Christmas. Otherwise, Senate Majority Leader Reid (D-NV) will miss his deadline, and the Senate will be faced with the prospect of returning to Washington on December 28th to resume consideration of the bill.