October 26, 2009

This weekly installment of Hall Render's Health Law Broadcast series on health reform is designed to provide you with a brief update on significant developments from the previous week.

HOW PUBLIC WILL THE OPTION BE?

Just as expected, health reform negotiations would be difficult in the days following the Senate Finance Committee's significant progress a week ago.  The issue of a public option has taken center stage as both the Senate and House debate what exactly a public option means.  And the definition (or presence) of a public option will change as Senator Reid and Congresswoman Pelosi tally necessary votes.

Senator Reid and Congresswoman Pelosi, What Say You?

Following the Senate Finance Committee's passing of its America's Healthy Future Act of 2009 (S.1796), Senate Majority Leader Harry Reid (D - NV) has been busy working with other Senate leaders and White House officials to prepare a piece of legislation for the Senate floor.  Senator Reid's efforts require a merger of S.1796 with the Senate HELP Committee's Affordable Health Choices Act (S. 1679), which is no small task as there are significant differences between the bills.  These include the presence or scope of a public option, individual mandate penalties, and insurance premium subsidies.  Senator Reid has indicated that a merged bill may be ready for consideration on the Senate floor as early as next week with floor debates expected to last two to four weeks. 

In the House, despite appearing inflexible on the presence of a so-called "robust" public option in the House's final version of health reform legislation, House Speaker Nancy Pelosi (D - CA) gave indications this week that she may see acceptable variations of a public option.  From the "robust" version based on paying providers Medicare rates plus 5%, the House leadership is indicating an openness to the opt-in/opt-out variants along with a "robust" trigger, to be included as part of a "government-run insurance plan."  House leadership has indicated that it expects to hold a vote on the House floor either the first or third week of November. 

A copy of the Senate Finance Committee's (S.1796) released on October 19, 2009 can be found here:
http://finance.senate.gov/sitepages/leg/LEG%202009/101909%20America's%20Healthy%20Future%20Act%20Legislative%20Language.pdf

A detailed summary of the Senate HELP Committee's Affordable Health Choices Act (S. 1679) can be found here:
http://www.help.senate.gov/101609%20-%20Affordable%20Health%20Choices%20Act%20Detailed%20Summary.pdf

A Section-by-Section analysis of the House Tri-Committee's America's Affordable Health Choices Act (H.R. 3200) can be found here: http://edlabor.house.gov/documents/111/pdf/publications/AAHCA-SectionBySection-071409.pdf

Not Dead Yet

The public insurance option received a shot in the arm last week as Senator Reid began a renewed push to include a public option in the Senate's health reform bill.  Senator Reid considers giving states the chance to opt out of a public option very important for winning senators' support on the issue.  On the same front, Congresswoman Pelosi reiterated her staunch support for some version of a public option and that the House's reform bill will include such an option.  Almost immediately, many members of Congress responded to this new fire burning under the public insurance option -- if nothing else, illustrating how divisive this issue has become within the broader health reform debate.

Hopes remain high that the Senate will be able to find a way to get the public option passed with 60 votes as part of a health reform bill.  As the Senate leadership surveys whether the 60 votes exist, and whether Olympia Snowe (R – ME) will come along, it's still not clear what form of a public option will actually make it to a vote.  A newer version of the public option that appears to be under serious consideration is the "opt-out" plan.  The opt-out version has been led behind the scenes by Senator Chuck Schumer (D - NY) who stated yesterday on "Meet the Press" he believes the Senate has 60 votes to include the public option. 

Under the opt-out version, the government would provide a public option that would operate on a level playing field with private insurers by having the same negotiated rates.  Each state would be able to decide whether they want to participate in a nationwide government plan.  However, moderates, such as Senator Ben Nelson (D - NE), have mentioned a preference of an "opt-in" public option.  Under an opt-in plan, states would have the option to set up a state-run public option or band together with other states to have a regional public plan.  The opt-in plan, however, would mean no guaranteed national government-run option.  And finally, there is the "trigger option" still being kicked around but with less favor.  Under the triggered plan, the public option would be available under a government-run initiative if private insurers failed to provide certain efficiencies and affordable health insurance options.

Seniors and Medicare

Seniors and other Medicare beneficiaries have expressed significant concern about possible changes to the federal health care program that could come as part of the reform package.  Over the past few months, rationing of care and "forced" end-of-life decision-making have been touted as two of the most pernicious health reform proposals.  AARP and other advocacy groups have worked to reassure seniors and to debunk these myths.  But fears remain.  This week, details about cuts to the Medicare program, as part of the reform packages, have started to emerge.  Specifically, part of the price tag for comprehensive reform legislation would be offset by approximately $500 billion in cuts and savings to the Medicare program.    Most of those savings are expected to be generated by reductions in waste and fraud, while additional savings will come from reduced annual payment increases to hospitals and home health care agencies.  Reform legislation could also strengthen Medicare drug coverage and increase benefits for preventive care.

Visit our Health Law Broadcast at hallrender.com/reform for a comprehensive listing of health care reform resources.  Also sign up for health care reform alerts and periodic updates as we continue to monitor this important issue.