It is presently unclear whether a vote to adopt the Senate heath care restructuring bill will occur before Christmas or not.
According to InsideHealthPolicy.com, at a meeting with "key stakeholders" late last week, senior staff from the majority leadership sketched out a scenario for a vote on Tuesday, December 22 or Wednesday, December 23. The end game would be triggered by the filing of cloture motions -- to cut off debate and proceed to a vote-- on 3 items. One would be the so-called "manager's amendment" which is expected to contain all the compromises necessary to get 60 votes. A second would be on the Reid Substitute, as amended by adoption of the manager's amendment. The third would be on the adoption of the bill itself, a House-passed revenue measure,as replaced by the amended Reid Substitute. Once cloture is voted on each of these, there would still be 30 hours of debate permitted under the Senate rules before it could come to a vote. During that period any "germane", that is to say, related, amendments could be offered, but each could be subject to an undebatable motion to "lay on the table," which has the effect of killing it. (This, for example, is the mechanism that was used to defeat the Nelson-Hatch amendment against abortion funding in the bill.)
This scenario would require that the cloture motions be filed no later than Tuesday or Wednesday of this week. In order for that to occur, Majority Leader Reid would presumably have to be sure of his 60 votes by then, meaning that the Congressional Budget Office score on the "public option" compromise would have be delivered soon, and that it would have to satisfy the relevant Senators or else lead to quick "tweaks" that do.
It has been observed that while this schedule is technically possible, any complication, such as an inability to reach quick agreement yielding 60 votes, would scuttle it. In that case, the vote would have to be deferred until after Christmas. There have been different predictions concerning what the schedule would be in that case. One possibility is that the Senate could take only what has been called a "long lunch break," recessing, for example, only for Christmas Eve through the following weekend, and returning for the week between Christmas and New Year's Day. Others have speculated that there would be so much resistance to such a schedule that if the Senate cannot get to a final vote by Christmas, it might recess until after New Year's Day.
If there is a final Senate vote on the pending health care legislation, the differences between the Senate and House versions would still have to be resolved before a bill could be sent to President Obama for signature. One option that has been discussed would be to send the Senate-passed version directly to the House for a vote, but according to InsideHealthPolicy.com, at the stakeholders' meeting last week the senior Congressional staff suggested that would be impossible -- that there would need to be negotiations among the leaders of the two houses, even if a formal conference committee were not convened.
The White House and its allies have long sought to avoid the health care debate going over into next year, both because they want to get the public's attention focused on planned efforts to address the high unemployment rate and other effects of a poor economy and because it is widely believed that votes to adopt the measure will become more and more difficult to achieve the farther they are pushed into a Congressional election year. December polls have consistently shown majority opposition to the health care bill: by 51 to 41 percent in a December 4/5 Rasmussen poll, by 52 to 38 percent in a December 1/6 Quinnipiac poll, by 61 to 36 percent in a December 2/3 CNN/Opinion Research poll, and by 57 to 34 percent in a December 8/9 Fox News poll.
Nevertheless, the White House and key Democratic leaders remain convinced that failure to pass a health care bill in some form will be more disadvantageous politically than passing even an unpopular one -- in addition to their strong conviction that such legislation is a critically important public policy objective.
Sunday, December 13, 2009
Wednesday, December 9, 2009
“PUBLIC OPTION” COMPROMISE – WILL IT REALLY BREAK THE DEADLOCK?
Multiple sources this morning are reporting that Senate Democrats, behind closed doors, have reached agreement on several key matters associated with the “public option” debate – getting them closer to the necessary 60 votes. It will be sent for a Congressional Budget Office score today, which is expected to take two days, and the details will not be released until after the score is completed, so the compromise can be “tweaked” if deemed desirable at that time.
One reported agreement has come on a proposal to expand eligibility for Medicare to those 55 or older (currently one must normally be 65).
The American Medical Association (AMA), American Hospital Association, and Federation of American Hospitals (FAH) quickly charged that the proposal would harm the availability of treatment because Medicare reimbursement rates to health care providers are significantly below the cost to them of treating Medicare beneficiaries, something that is possible only because providers “cost shift” by charging privately insured individuals more than it costs to treat them and using the resulting surplus to make up for what they lose when treating Medicare patients.
AMA President Dr. J. James Rohack, noting that “the AMA has longstanding policy opposing the expansion of Medicare given the financial projections for the future. Currently, . . . 28% of Medicare patients looking for a new primary care physician are having trouble finding one.”
The American Hospital Association noted, “Medicare pays hospitals just 91 cents for each dollar of care provided, yet the proposal being considered would allow people 55-65 to enroll in Medicare instead of the insurance exchange . . . “
According to InsideHealthPolicy.com, FAH says that “[t]he buy-in policy would „crowd-out‟ private insurance, would be controlled by CMS [the federal government‟s Centers for Medicare and Medicaid Services] and would only pay Medicare rates. The FAH also suggested that members point to MedPAC, which has “„documented negative and declining Medicare hospital margins for seven years.’”
The agreement also reportedly incorporates a provision from Sen. Jay Rockefeller (D-W.V.) which would require insurers to spend at least 90 percent of premium money on medical care, rather than on administrative costs or profits. This is known as a medical loss ratio.
Although no language from Sen. Rockefeller‟s proposal has emerged, generally speaking, a medical loss ratio is the ratio between what the company actually pays out in claims or medical services and what it has left over to cover sales, marketing, underwriting, taxes, and other administrative expenses and profits.
This would occur at the same time as other provisions in the health care bill impose significant additional administrative expenses on insurers involving reporting on quality and efficiency as well as “managing” care to achieve greater “value” for the funds expended. With a narrower margin for administrative expenses, this restriction could lead to is the inability of insurers to operate in the black and have the effect of driving many of them out of the market.
Despite press reports describing a “breakthrough,” these consequences and the opposition they stir may mean that the end of the Senate‟s battle over health care restructuring may not be as imminent as Majority Leader Senator Harry Reid (D-Nev.) would hope.
One reported agreement has come on a proposal to expand eligibility for Medicare to those 55 or older (currently one must normally be 65).
The American Medical Association (AMA), American Hospital Association, and Federation of American Hospitals (FAH) quickly charged that the proposal would harm the availability of treatment because Medicare reimbursement rates to health care providers are significantly below the cost to them of treating Medicare beneficiaries, something that is possible only because providers “cost shift” by charging privately insured individuals more than it costs to treat them and using the resulting surplus to make up for what they lose when treating Medicare patients.
AMA President Dr. J. James Rohack, noting that “the AMA has longstanding policy opposing the expansion of Medicare given the financial projections for the future. Currently, . . . 28% of Medicare patients looking for a new primary care physician are having trouble finding one.”
The American Hospital Association noted, “Medicare pays hospitals just 91 cents for each dollar of care provided, yet the proposal being considered would allow people 55-65 to enroll in Medicare instead of the insurance exchange . . . “
According to InsideHealthPolicy.com, FAH says that “[t]he buy-in policy would „crowd-out‟ private insurance, would be controlled by CMS [the federal government‟s Centers for Medicare and Medicaid Services] and would only pay Medicare rates. The FAH also suggested that members point to MedPAC, which has “„documented negative and declining Medicare hospital margins for seven years.’”
The agreement also reportedly incorporates a provision from Sen. Jay Rockefeller (D-W.V.) which would require insurers to spend at least 90 percent of premium money on medical care, rather than on administrative costs or profits. This is known as a medical loss ratio.
Although no language from Sen. Rockefeller‟s proposal has emerged, generally speaking, a medical loss ratio is the ratio between what the company actually pays out in claims or medical services and what it has left over to cover sales, marketing, underwriting, taxes, and other administrative expenses and profits.
This would occur at the same time as other provisions in the health care bill impose significant additional administrative expenses on insurers involving reporting on quality and efficiency as well as “managing” care to achieve greater “value” for the funds expended. With a narrower margin for administrative expenses, this restriction could lead to is the inability of insurers to operate in the black and have the effect of driving many of them out of the market.
Despite press reports describing a “breakthrough,” these consequences and the opposition they stir may mean that the end of the Senate‟s battle over health care restructuring may not be as imminent as Majority Leader Senator Harry Reid (D-Nev.) would hope.
Tuesday, December 8, 2009
“COST CONTAINMENT” AMENDMENT WOULD AUTHORIZE HHS SECRETARY TO REQUIRE HEALTH CARE PROVIDERS TO ABIDE BY “EFFICIENCY” STANDARDS
A cost-containment amendment drafted by freshman Democratic Senators Mark Udall, Tom Udall, Jeanne Shaheen, Mark Warner, Kay Hagan , Jeff Merkley, Mark Begich, Roland Burris, Ted Kaufman, Michael Bennet, Al Franken, and Paul Kirk (see prior blog posting) would expand the authority the health care restructuring bill would give to require doctors, hospitals, and other health care providers to abide by "quality measures" so that the Secretary could also impose "efficiency" measures.
This seemingly small provision, in section 10007 on page 13 of the amendment, would have dramatic consequences. It would give authority to the federal government to regulate the "efficiency" of health care providers throughout the country. It takes little imagination to recognize that denial of treatment whose cost is deemed – by federal bureaucrats – to exceed its benefit could thus be imposed by administrative ruling on all patients– in short, government-imposed rationing.
This seemingly small provision, in section 10007 on page 13 of the amendment, would have dramatic consequences. It would give authority to the federal government to regulate the "efficiency" of health care providers throughout the country. It takes little imagination to recognize that denial of treatment whose cost is deemed – by federal bureaucrats – to exceed its benefit could thus be imposed by administrative ruling on all patients– in short, government-imposed rationing.
Friday, December 4, 2009
NEW DETAILS ON MEDICARE COMMISSION AMENDMENT
Our Wednesday (December 2) blog post titled “Senate Amendment With More Extreme Rationing Coming?” warned about a potential “cost containment” amendment that might apply the Medicare Commission reimbursement limitations beyond Medicare into the private sector.
More details of this amendment have become available. An internal memo circulated yesterday, although not including amendment language, provides a more specific outline.
It appears that the proposed amendment is intended to authorize the Medicare Commission to make “cost containment” recommendations for private insurance, but (unlike the panel’s recommendations for Medicare, which become law unless Congress acts to override them) these recommendations would require further legislation or administrative regulation to be implemented.
The proposal (being worked on by Senators Mark Udall (CO), Tom Udall (NM), Jeanne Shaheen (NH), Mark Warner (VA), Kay Hagan (NC), Jeff Merkley (OR), Mark Begich (AK), Roland Burris (IL), Ted Kaufman (DE), Michael Bennet (CO), Al Franken (MN), and Paul Kirk (MA)) is described as follows:
Another aspect of the proposal would increase the authority of the Secretary of Health and Human Services:
More details of this amendment have become available. An internal memo circulated yesterday, although not including amendment language, provides a more specific outline.
It appears that the proposed amendment is intended to authorize the Medicare Commission to make “cost containment” recommendations for private insurance, but (unlike the panel’s recommendations for Medicare, which become law unless Congress acts to override them) these recommendations would require further legislation or administrative regulation to be implemented.
The proposal (being worked on by Senators Mark Udall (CO), Tom Udall (NM), Jeanne Shaheen (NH), Mark Warner (VA), Kay Hagan (NC), Jeff Merkley (OR), Mark Begich (AK), Roland Burris (IL), Ted Kaufman (DE), Michael Bennet (CO), Al Franken (MN), and Paul Kirk (MA)) is described as follows:
“We broaden the scope of the new Independent Medicare Advisory Board to look at total health system spending and make system wide recommendations to assure that we are lowering costs not shifting them. Recommendations for the non Medicare sector would be advisory and non binding.” [emphasis added]
Another aspect of the proposal would increase the authority of the Secretary of Health and Human Services:
“Under this bill, Medicare will reward high quality care, rather than high volume care – with the belief that private payors will follow suit. Medicare will also be able to experiment with promising new models to further lower costs, improve quality and improve patient health. Our amendments would take Medicare further by replacing studies with action, recognizing success stories already underway, modernizing Medicare’s tools to evaluate and implement delivery system reforms that work, and broadening the scope of the Secretary’s authority to put effective cost containment in place.” [emphasis added]
Authorizing the Secretary to determine what is “quality care," without proper protections [1] to prevent discrimination (based on characteristics like age, disability, or terminal illness) against these could be dangerous.
While possible additional threats loom in potential amendments and must be monitored, the Reid Substitute now being debated and amended on the Senate floor already contains significant provisions that, unless corrected, will lead to rationing of lifesaving medical care.
[1] The Reid substitute contains such protection applicable to how Comparative Effectiveness Research may be used, but these protections do not in the current version apply to the already significant authority under the bill of the HHS Secretary to regulate the “quality” of American medical care. See Section 6301(c) [adding Section 1182 (c), (d) and (e)] to the Social Security Act), pp. 1685-87 of the Reid substitute.
Wednesday, December 2, 2009
Urge Senate Not to Limit Senior Citizens’ Choice to Spend Own Money to Ensure Access to Life-Saving Health Care
Senior citizens’ ability to use their own money, if they choose, to avoid involuntary denial of medical treatment under Medicare could be severely limited by a provision in the Reid health care bill.
Section 3209 of Senate Majority Leader Harry Reid’s (D-NV) proposed health care bill, which the Senate is now debating and amending, would change current law, which now prevents the federal government from limiting the right of senior citizens voluntarily to add their own money of top of the government Medicare contribution so as to be able to obtain health insurance plans under the "Medicare Advantage" program that are less likely to deny treatment.
Instead, the Reid bill provision would authorize the Secretary of Health and Human Services, in her unlimited discretion, to refuse to allow such plans to be offered to senior citizens.
The provision duplicates the little-noticed section 1175 of the bill passed by the House of Representatives. Neither provision was in bills reported by the committees of either chamber; at the last minute, both were slipped into the versions sent to the floor for action.
The fundamental question is whether seniors will be prevented from using their own money, if they wish, to gain access to insurance that will not ration medical treatment. The significant cuts that the Senate and House health care bills make in Medicare increase the importance of protecting the right of older Americans, if they choose, to use their own money to save their own lives. It is critical to change Section 3209 of the Reid bill to keep this alternative available.
PLEASE CONTACT YOUR SENATORS TODAY !!
To phone your Senators (the approach most likely to be effective) or write them, you can get contact information.
Send an email to your Senators.
Additional information on this issue, and on other provisions in the Senate bill that threaten to ration lifesaving medical treatment.
Section 3209 of Senate Majority Leader Harry Reid’s (D-NV) proposed health care bill, which the Senate is now debating and amending, would change current law, which now prevents the federal government from limiting the right of senior citizens voluntarily to add their own money of top of the government Medicare contribution so as to be able to obtain health insurance plans under the "Medicare Advantage" program that are less likely to deny treatment.
Instead, the Reid bill provision would authorize the Secretary of Health and Human Services, in her unlimited discretion, to refuse to allow such plans to be offered to senior citizens.
The provision duplicates the little-noticed section 1175 of the bill passed by the House of Representatives. Neither provision was in bills reported by the committees of either chamber; at the last minute, both were slipped into the versions sent to the floor for action.
The fundamental question is whether seniors will be prevented from using their own money, if they wish, to gain access to insurance that will not ration medical treatment. The significant cuts that the Senate and House health care bills make in Medicare increase the importance of protecting the right of older Americans, if they choose, to use their own money to save their own lives. It is critical to change Section 3209 of the Reid bill to keep this alternative available.
PLEASE CONTACT YOUR SENATORS TODAY !!
To phone your Senators (the approach most likely to be effective) or write them, you can get contact information.
Send an email to your Senators.
Additional information on this issue, and on other provisions in the Senate bill that threaten to ration lifesaving medical treatment.
SENATE AMENDMENT WITH MORE EXTREME RATIONING COMING?
The Reid Substitute now being debated and amended on the Senate floor contains significant provisions that, unless corrected, will lead to rationing of lifesaving medical care. However, it may be that a still greater danger of rationing looms.
According to both the Washington Post and InsideHealthPolicy.com (a subscription-only service) this morning (December 2, 2009), a group of "centrist" Democratic Senators are fashioning new provisions "to strengthen the bill’s existing cost-containment measures," and are doing so in private consultation with committee and Senate leaders.
Among the most dangerous possibilities reportedly under discussion is a proposal to extend the authority of the Medicare Commission, which in the Reid Substitute has the duty to cut Medicare growth below the rate of medical inflation, to cover nongovernmental health insurance as well. If a government commission is given authority to limit what private insurance plans are able to charge and the treatment they are allowed to provide, this would track proposals to create a "Federal Health Board" first put forth by former Senate Majority Leader Tom Daschle, whose original nomination to be Obama’s Secretary of Health and Human Services was withdrawn because of concerns over back taxes and financial conflicts of interest. It has been reported that despite his lack of a formal position, Daschle has been heavily involved in strategizing with White House and Senate leadership about how to guide the Senate bill to the finish line. An analogue to such a board exists as the National Institute for Clinical Excellence (N.I.C.E.) in Great Britain.
Opponents of rationing are put into a bind by the reports. On the one hand, until an actual "cost-containment" proposal is made public, it is impossible to determine whether it will compel rationing and, if so, mobilize to oppose it. On the other hand, by the time it is made public, it may already have the support of the majority caucus negotiated behind the scenes, making it very difficult to stop.
Check back often . . . .
According to both the Washington Post and InsideHealthPolicy.com (a subscription-only service) this morning (December 2, 2009), a group of "centrist" Democratic Senators are fashioning new provisions "to strengthen the bill’s existing cost-containment measures," and are doing so in private consultation with committee and Senate leaders.
Among the most dangerous possibilities reportedly under discussion is a proposal to extend the authority of the Medicare Commission, which in the Reid Substitute has the duty to cut Medicare growth below the rate of medical inflation, to cover nongovernmental health insurance as well. If a government commission is given authority to limit what private insurance plans are able to charge and the treatment they are allowed to provide, this would track proposals to create a "Federal Health Board" first put forth by former Senate Majority Leader Tom Daschle, whose original nomination to be Obama’s Secretary of Health and Human Services was withdrawn because of concerns over back taxes and financial conflicts of interest. It has been reported that despite his lack of a formal position, Daschle has been heavily involved in strategizing with White House and Senate leadership about how to guide the Senate bill to the finish line. An analogue to such a board exists as the National Institute for Clinical Excellence (N.I.C.E.) in Great Britain.
Opponents of rationing are put into a bind by the reports. On the one hand, until an actual "cost-containment" proposal is made public, it is impossible to determine whether it will compel rationing and, if so, mobilize to oppose it. On the other hand, by the time it is made public, it may already have the support of the majority caucus negotiated behind the scenes, making it very difficult to stop.
Check back often . . . .
Tuesday, December 1, 2009
SENATE DEBATE BEGINS DEBATE ON REID RESTRUCTURING BILL
Yesterday afternoon, the Senate began debating Major Leader Harry Reid’s Health Care restructuring bill known formally as the “Patient Protection and Affordable Care Act." Two amendments were raised for debate, but not voted on.
The first, offered by Sen. Barbara Mikulski (D-Md), seeks to reinsert a "Women's Preventive Care" provision that was dropped when Senate leadership merged the health and Finance committees' health bills. The other amendment, offered by Sen. John McCain (R-Az.), was a motion to recommit the bill to the Senate Finance Committee in order to remove the massive Medicare cuts that are made in the bill in order to fund the restructuring effort.
Sen. McCain, in defense of his amendment made the following statement:
Votes on amendments are expected this afternoon as debate continues.
The first, offered by Sen. Barbara Mikulski (D-Md), seeks to reinsert a "Women's Preventive Care" provision that was dropped when Senate leadership merged the health and Finance committees' health bills. The other amendment, offered by Sen. John McCain (R-Az.), was a motion to recommit the bill to the Senate Finance Committee in order to remove the massive Medicare cuts that are made in the bill in order to fund the restructuring effort.
Sen. McCain, in defense of his amendment made the following statement:
“Slashing Medicare by nearly $500 billion, one-half a trillion dollars, to create a new Federal health care entitlement is not health care reform. These reductions include $120 billion to the Medicare Advantage program, $150 billion to providers including hospitals, hospice, and nursing homes, and $23 billion in unspecified decreases to be determined by an ‘Independent Medicare Advisory board.’ Simply put, these Medicare cuts will impact seniors' access to quality care. This is a price that Americans should not be asked to pay.
Votes on amendments are expected this afternoon as debate continues.
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