Archive for the ‘health care reform’ Category

Friday, July 9th, 2010

Health insurance reform will inevitably add to the already unsustainable federal deficit. In addition, it will prove impossible for the government to create and establish a more efficient system than the one now in place.

These are some of the arguments of more than a dozen states that have filed lawsuits. The lawsuits challenge the constitutionality of the reform. Their arguments also include that the government should not force citizens to buy health insurance.

It will be several years before the reforms take effect, and opponents are trying to ensure that they never will.

But significant improvements have already been made and insurers are also moving into compliance ahead of schedule. New rules forbid insurance companies from denying coverage to children, young adults can now stay on their guardians’ policies until age 26, and setting a lifetime limit on benefits will be banned soon.

Let’s not forget the true objective and that is to reduce costs. The Obama administration  must demonstrate that reforms will eventually bring down costs. This is the true test.

Wednesday, June 23rd, 2010

The United States House of Representatives voted 187 to 230 to defeat a Republican proposal to repeal the individual health insurance mandate in the new health reform law, the PATIENT PROTECTION AND AFFORDABLE CARE ACT OF 2010 (PPACA). Twenty-one Democrats joined 166 House Republicans in voting against the requirement that most Americans purchase health care coverage beginning in 2014.

Representative Dave Camp (R-MI) – the senior ranking Republican on the powerful House Ways and Means Committee – offered the proposal as a procedural motion to an unrelated bill. Despite the proposal’s failure, some Republican members believe they scored political points by forcing a vote on the new health reform law. However, House Ways and Means Committee Chairman Sander Levin (D-MI) stated that the vote displayed increased support among House Democrats for the health reform law, because only 21 Democrats voted in support of the Republican proposal, whereas 34 Democrats voted against the health care reform bill in March.

SENATE PASSES DOC FIX LEGISLATION
The Senate passed legislation on June 18 that would avert a 21.3 percent reduction in Medicare physician payment rates that became effective June 1. Senate Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY) took to the floor and passed a six-month delay in reimbursement cuts by unanimous consent, after extracting it from a larger tax and benefits package, H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010. The $6.5 billion bill was offset with spending reductions that appeased both Republicans and Democrats.

The House, which is not scheduled to return until the evening of June 22, still must pass the “doc fix” legislation. Earlier this week, a procedural vote to end debate on the legislation failed 52 to 45 (60 votes were necessary for passage). Eleven Democrats broke with their party leaders to vote no. Many Republicans and moderate Democrats believed that the more than $50 billion net cost of the bill should be offset by spending cuts and/or federal revenue increases. The fate of the full tax-extenders legislation, H.R. 4213, remains up in the air.

Friday, June 11th, 2010

Primary elections were held in 11 states this week as lawmakers returned to Washington, D.C., to face a growing list of unfinished legislative business including a jobs bill and environmental issues stemming from the Gulf crisis. Meanwhile, President Barack Obama launched a public relations campaign to combat skepticism around his new health insurance reform legislation and to promote the early implementation of certain provisions of the law.

Health Care Reform
Health Care Reform Debate Alive and Well: Democrats continue to sell their plan for health care reform to Americans in the face of mixed public opinion, simultaneously battling Republicans pushing for its repeal.

Congressional lawmakers address concerns about the new health care reform legislation, particularly among senior citizens , who make up a disproportionate share of voters in midterm elections. Democrats and the administration are eager to publicize certain provisions of the bill, like retaining young adults on their parents’ plans until age 26, as a way to gain support and to turn voters away from Republicans who called for its repeal.

On Tuesday, President Obama held a nationally televised town hall meeting at a senior center in Maryland to highlight the distribution of $250 rebate checks for senior citizens who hit the so-called “doughnut hole ” in Medicare’s prescription drug coverage. The first round of checks was mailed yesterday and serves as the law’s first monetary benefit.

State Battle Against Health Care Reform Law Continues: On Monday, Virginia Attorney General Ken Cuccinelli disputed the administration’s claim that the state lacks standing to challenge the new federal health care reform law. The lawsuit filed by Cuccinelli in the Eastern District Court cites a Virginia law that exempts state residents from being required to have health care coverage. Sebelius argued that states cannot simply pass a statute that would nullify a federal law. A hearing to determine next steps is set for July 1.

Public Opinion
Americans Want Repeal of Health Care Reform: A recently released Rasmussen report suggests that Americans are strongly in favor of repealing President Obama’s health care reform law. Fifty-eight percent of those polled favor repeal, while 62 percent believe the new legislation will increase the budget deficit. In addition, 57 percent predict health care costs will increase, while 51 percent feel the quality of care will decrease as a result of the new health care reform law.

Looking Ahead
Democrat lawmakers are expecting to pass the jobs bill next week but will need Republican support in order to get the 60 votes needed for passage. One provision of the bill, a 21 percent cut in Medicare payments to doctors, is being delayed as the bill moves through Congress and would ultimately be blocked if the legislation passes.

Tuesday, May 25th, 2010

On Monday, May 17, 2010, the IRS released new guidance on the small-employer healthcare tax credit provided under the Patient Protection and Affordable Care Act (“PPACA”), including detailed guidance on eligibility and transition criteria. Key items in the guidance include:

  • Eligibility:  The IRS notice includes detailed guidelines on how a small business can determine whether it is eligible for the healthcare tax credit and how large a credit it will receive.  The credit is generally available to employers that have fewer than 25 full-time equivalent (“FTE”) employees paying wages averaging less than $50,000 per employee per year.  The new credits will likely provide assistance to an estimated 4 million small firms that provide health coverage to their workers.
  • No Reduction Due to State Credits:  The guidance clarifies the new tax credit will not be reduced by a state healthcare tax credit or subsidy.  Therefore, an employer that receives a state tax credit or subsidy will also receive the full federal credit based on its entire contribution – as long as the federal credit does not exceed the employer’s net contribution.
  • Dental and Vision Coverage Qualify:  The guidance clarifies that small businesses can receive the credit not only for traditional health insurance coverage but also for add-on dental, vision and other limited-scope coverage.
  • Method for Determining Hours Worked:  The new guidance allows employers to choose among three different methods of determining the number of hours worked.  Employers can choose the most favorable method of determining hours worked in order to receive the maximum tax credit for which they are eligible.
  • Transition Relief for 2010 Formalized:  Because the tax credit is effective for 2010 – but was not enacted until March 23, 2010 – some small businesses that are providing health insurance in 2010 may not meet all the requirements for a qualifying health insurance offer.  Beginning in 2010, the Administration is easing the requirement that employers pay a uniform percentage (not less than 50 percent) of the premium for each employee enrolled in health insurance coverage.  Specifically, qualifying employers must only contribute 50 percent of the premium for single coverage (even if the employee elects family coverage).
Friday, May 21st, 2010

The Arizona Legislature convened its regular session in January. With the state facing a deficit of more than $4 billion in fiscal years 2010 and 2011, the budget overshadowed all other issues again this year. Lawmakers faced difficult decisions, including the elimination of critical state programs, in their effort to balance the budget. State agencies have been cut drastically.
Among the most severe budget cuts were the elimination of KidsCare and the reduction of over 300,000 AHCCCS enrollees. Although lawmakers initially approved these budget reductions, they are likely to restore these cuts as a result of the new federal health care reform law. Because the law prohibits states from changing eligibility for CHIP and Medicaid, Arizona risks losing billions of dollars in federal matching funds if KidsCare and AHCCCS enrollment reductions are not reinstated.

In an effort to increase revenues and lessen additional cuts to key programs, legislators referred a temporary one-cent sales tax to the ballot. If approved, the measure will generate approximately $1 billion that will fund education, health care and public safety. A special election on the temporary tax is scheduled for May 18.

On another topic, the Legislature passed a bill giving the Governor authority to sue the federal government over the recently passed health care reform law. Stating that the federal government is overstepping its constitutional authority by mandating that individuals have insurance, Arizona is joining a suit with 18 other states against the implementation of the law.

While the budget dominated the session, below is a description of some other bills of interest.

Health Insurance-related Bills

  • HB 2296 (law enforcement officer; spouse; insurance payment) – Allows the surviving spouse of a law enforcement officer killed in the line of duty to receive payments for health insurance premiums from the officer’s former employer for one year after the officer’s death. Status: Passed House, awaiting final vote in the Senate.
  • HB 2308 (insurance information; transfer of business) – Adds “transfer of business” to the definition of insurance transaction in the statutes governing insurance information and privacy protection. Status: Signed by Governor.
  • HB 2579 (insurance; continuing education; continuation) – Continues education requirements for insurance agents indefinitely. Status: Signed by Governor.

Health Care-related Bills

  • SB 1189 (admissibility of expert opinion testimony) – Changes the standard used in civil and criminal trials relating to admissibility of expert testimony from the Frye standard to the Daubert standard. Establishes criteria for expert testimony to be admissible in court. Legal experts expect this change will be particularly helpful in defending medical malpractice suits. Status: Passed Senate and House; awaiting Senate action on House amendments.

Other Legislation

  • SB 1070 (safe neighborhoods; immigration; law enforcement) – Makes changes to laws relating to the enforcement of immigration laws, failure to carry an alien registration document, day laborers and harboring or transporting illegal aliens. Amends the employer sanctions provisions of law in the following ways:
  • Provides employers with the affirmative defense for entrapment;
  • Requires employers to keep a record of the employment verification from E-verify for the duration of an employee’s employment, or three years, whichever is longer. Status: Awaiting action by the Governor.
  • HB 2250 (Arizona’s job recovery act) – Provides income and property tax reductions and incentives. Creates a new supplemental Arizona Job Training Program, the Arizona Opportunity Fund and the Arizona Quality Jobs Program. Restructures Enterprise Zones into a statewide Arizona Enterprise Development Program. Status: Passed the House; awaiting debate in the Senate.
Thursday, May 20th, 2010

On May 11, the Congressional Budget Office (CBO) released a report with additional information about the potential effects of the new health insurance reform law, the Patient Protection and Affordable Care Act (PPACA), on discretionary spending that the CBO initially provided on March 13, prior to the legislation being passed.

The updated analysis adds a minimum of $115 billion over 10 years – more than twice the initial estimate released before President Barack Obama signed the bill into law. This new estimate brings the cost of the new law to well over $1 trillion.

CBO Director Douglas Elmendorf stated that while the CBO does not have a comprehensive estimate of all the potential discretionary costs, they provided information on the major components broken down into three general categories:

  • Costs incurred by federal agencies to implement the new policies
  • Explicit authorizations for grant and program spending for one or more years
  • Explicit authorizations for grant and program spending for which no specific funding levels are specified

Minority Leader John Boehner (R-OH) immediately released a statement admonishing the Administration, saying that the new estimate “provides ample cause for alarm,” and nearly wipes out “the purported deficit reduction in the law.”

A Senate Finance Committee Democratic aide said, “The bulk of discretionary spending referenced in the report is for programs – like the Indian Health Service, the National Health Service Corps and Federally Qualified Health Centers – that were not created under health care reform and would have been funded through the appropriations process, like they have for decades, with or without health care reform.”

Tuesday, May 18th, 2010

The new health insurance law will add at least $115 billion more to government health care spending over the next 10 years, according to the CBO. If all additional spending called for in the legislation is approved, it would push the cost of the overhaul above $1 trillion. The added spending includes administrative costs to federal agencies carrying out the law, community health centers, and Indian health care.

“If Congress were to approve all of this new discretionary funding authorized in the health care bill, almost all of the administration’s highly touted savings would be made null and void,” said Jennifer Hing.

Friday, May 7th, 2010

In the new health insurance reform law the states are permitted to create their own high risk pools, expand existing pools, or allow the federal government to create and administer the pools for them.

The following states will operate their own pools:
Alaska, Arkansas, California, Colorado, Connecticut, Illinois, Iowa, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Vermont, Washington, West Virginia, Wisconsin, and District of Columbia.

The following states will allow the federal government to create and manage the pools:
Alabama, Delaware, Georgia, Hawaii, Idaho, Indiana, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia, and Wyoming.

Tuesday, May 4th, 2010

In Nevada health insurance, an April 29 letter to HHS Secretary Kathleen Sebelius, Governor Jim Gibbons estimated that the $61 million his state would receive to implement a high-risk pool under the federal health care reform law would be grossly inadequate; serving roughly 2,900 of the 100,000 people who may be eligible. In opting out, the governor stated that he does not believe there are sufficient financial or human resources available to operate the pool.

Tuesday, May 4th, 2010

In Nebraska health insurance, an April 27 letter, Governor Dave Heineman informed Secretary of Health and Human Services Kathleen Sebelius that Nebraska has elected not to participate in the temporary federal high-risk pool created under the Patient Protection and Affordable Care Act of 2009. In his letter, Governor Heineman cited Department of Insurance Director Ann Frohman who said that “the proposed level of federal support and premiums will be inadequate to meet all expected obligations of this program. Even with enrollment caps, we are very concerned that funding will not be sufficient to assure a solvent runoff of all claims when the program expires in three years.”  While he acknowledged that the federal government would proceed with a new high-risk pool in Nebraska health insurance regardless of the state’s decision, Governor Heineman noted that the existing state high-risk pool and the proposed federal pool are sufficiently different to require running separately. He questioned the value of adding a new layer of bureaucracy at the state level to administer this program. Secretary Sebelius gave Governors an April 30 deadline for indicating whether they intend to operate the pool or allow HHS to do so.