December 9, 2009This Week in Health Reform —Legislative OverviewSenateLess than two weeks after the debut of official legislative language, the Senate began official debate on its $848 billion health care reform bill “The Patient Protection and Affordable Care Act” (H.R. 3590) on November 30. The bill, which is estimated to cover 94 percent of Americans, passed its first hurdle before the Thanksgiving holiday when Senate Democrats received the needed 60 votes on the “motion to proceed” to debate. Quoting & Saving just got easier…EasyToInsureME Health Insurance Quotes… Quote all carriers in secondsHealth insuranceHealth insurance quotes More than 60 amendments have been filed to the Senate health care reform legislation in its first week of debate. Some of the notable amendments include one by Senator Barbara Mikulski (D-MD), which was adopted by a vote of 61-39. The amendment would eliminate co-payments for many preventive services for women – and would require that insurers provide full coverage for breast and cervical cancer screenings. Senator David Vitter (R-LA) also included a stipulation to the amendment that would preclude the most recent controversial recommendations on breast cancer screenings by the U.S. Preventive Services Task Force from being used for insurance coverage determinations. Additionally, Senator Ben Nelson (D-NE) and Senator Orrin Hatch (R-UT) are crafting an abortion-related amendment that will mirror the one passed in the House version of the bill last month. The amendment would prohibit the use of federal funds for abortions.Senator Thomas Carper (D-DE) is leading efforts in the Democratic caucus on the creation of a public health insurance option that is built around a state-by-state “trigger” option. Carper has spent weeks working with members of the Democratic caucus, as well as some moderate Republicans on the amendment that he is hoping will appease a broad range of individuals concerned about the government-run health insurance plan, also known as the “public option”.Majority Leader Harry Reid (D-NV) still has significant work to do in uniting his divided Democratic caucus. Reid has stated that he will keep Senators in Washington on weekends throughout December to ensure that key legislative issues are worked out before a final bill can be brought to the Senate floor. As detailed above, Reid will have to balance trying to appease the progressive members of his party with a robust government-run health insurance plan with corralling the moderate and conservative Democrats who have been vocal on issues such as abortion and cost-containment measures. HouseThe House of Representatives remains quiet on health care reform legislation after passing its portion of the bill in November. Its main focus during the next few weeks before the holiday recess will be on a financial regulation package to be brought up by the House Committee on Ways and Means.

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February 17, 2010The Week in Health Reform–Federal Legislative OverviewHouse and SenateThings were quiet last week in Washington due to the 30 plus inches of snow the area received. On Feb. 9 House leaders announced that due to the heavy snow in the area they would suspend votes in the House for the remainder of the week. Congress will not be in session this week due to the President’s Day recess and will reconvene the week of Feb. 22.As a result of the congressional schedule, the timeframe for a floor vote on the McCarran-Ferguson antitrust legislation will be pushed back until the week of Feb. 22 at the earliest. Reports have stated that the antitrust bill is part of House Speaker Nancy Pelosi’s (D-CA) strategy of moving smaller pieces of health insurance legislation quickly to help build momentum for a comprehensive individual health insurance reform bill. The Speaker also continues to urge House Democrats to pass the Senate bill as long as it is accompanied by a separate “reconciliation” bill that would “fix” key provisions in the Senate bill (e.g., raising the threshold for the Cadillac tax and dropping the Nebraska Medicaid provisions) to satisfy some members of her caucus. The Senate remained in session last week, despite the weather, although Majority Leader Harry Reid (D-NV) stated that the Senate would not conduct any votes. On Feb. 11, Finance Committee Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) released the highly anticipated “jobs bill” – The Hiring Incentives to Restore Employment (HIRE) Act. Senators Baucus and Grassley issued a joint statement, emphasizing that this bill was drafted with bipartisan input. They further stated: “We also agree that, once properly reviewed, the package should be considered in a deliberate, but expeditious manner. Any efforts to needlessly delay Senate completion of consideration of this package through partisan means will undermine our goal of timely action in the current economic climate. Action on the expired provisions is long overdue. Timely action on incentives for economic activity and job creation also is needed.”Hours after details of the “HIRE” legislation were released, Majority Leader Reid publicly stated that he was scrapping the bill. Reid told reporters that when the Senate returns from its recess on Feb. 22, “we will move to a smaller package than has been talked about in the press.” Reid went on to state that some of the tax provisions included in the legislation – key to garnering Republican support for the deal – “confuse” the bill. Reid went on to say that, “we don’t have a jobs bill. We have a jobs agenda.”The draft “HIRE” legislation addresses a number of key health care issues: * The bill extends, by three months, the eligibility period for premium subsidies for state continuation coverage and COBRA continuation coverage to include persons who are unemployed on or before May 31, 2010. The bill also clarifies that these subsidies are available to persons who are involuntarily terminated from their jobs after previously losing their employer-sponsored coverage due to a reduction in hours. The premium subsidies originally were enacted as part of the American Recovery and Reinvestment Act of 2009, also known as the “stimulus bill.” * The bill provides for a seven-month Medicare physician payment fix (sometimes known as the “doc-fix”), maintaining physician payment rates at their current levels through Sept. 30, 2010. Under current law, in the absence of congressional action, physicians are scheduled to face a steep rate reduction on March 1. * The bill provides for a one-year extension of both Medicare Advantage Special Needs Plans (section 626) and Medicare Cost Plans (section 627). * The bill includes numerous provisions addressing Medicare fee-for-service reimbursement issues. White House Health Care Reform SummitIn a pre-Super Bowl interview on CBS, President Obama said that he would like to host a televised health care summit with Republican and Democratic congressional leaders on Feb. 25. While specific details are not yet available, the summit represents the Obama Administration’s latest strategy to jumpstart the health care reform debate and seeks bipartisan cooperation following the loss of the Democrats’ supermajority in the Senate. Republican leaders expressed interest in the summit, and House Republican Leader John Boehner (OH) issued a statement saying that, “The best way to start on real, bipartisan reform would be to scrap those bills and focus on the kind of step-by-step improvements that will lower health care costs and expand access.” In response, White House officials insisted that the President is not interested in starting from scratch on health reform.This week Democratic and Republican congressional leaders also met with President Obama at the White House to discuss the jobs bill, health reform, energy, trade and other legislative priorities. Following the meeting, the President spoke with reporters and he made the following comments about health reform: “I’m going to be starting from scratch in the sense that I will be open to any ideas that help promote these goals. What I will not do, what I don’t think makes sense and I don’t think the American people want to see, would be another year of partisan wrangling around these issues; another six months or eight months or nine months worth of hearings in every single committee in the House and the Senate in which there’s a lot of posturing. Let’s get the relevant parties together; let’s put the best ideas on the table. My hope is that we can find enough overlap that we can say this is the right way to move forward, even if I don’t get every single thing that I want.”

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This week focused on the unveiling of Senate Majority Leader Harry Reid’s (D-NV) proposed health care reform legislation. House and Senate NegotiationsReid Unveils Senate Bill: Senate Majority Leader Harry Reid unveiled his version of health care reform legislation on Wednesday night after receiving cost estimates from the Congressional Budget Office (CBO). With a price tag of $849 billion over ten years, the bill will reduce the deficit by $127 billion over a decade and cut Medicare spending by $500 billion, while increasing taxes by $500 billion. In addition, the bill will:* Provide coverage for 31 million Americans who currently lack health insurance – accounting for 94 percent of eligible Americans* Offer a government-run option of which states can opt out* Expand Medicaid* Require most Americans to carry health insurance, providing subsidies for those who cannot afford it and imposing weak penalties for violations* Bar insurance companies from denying coverage based on pre-existing conditions or dropping coverage for those who become sick* Impose penalties on medium and large sized employers for not providing health insurance to employees* Increase the Medicare payroll tax on higher-income workers* Imposes fees totaling $101.9 billion on insurance companies, drug makers, and medical device manufacturers over ten years* Impose a tax on high-cost health insurance plans provided by employers to their employees.While Democrats remain committed to passing the legislation, it is not certain that Reid has the 60 votes needed to bring the measure to the floor for debate. Several moderate democrats, including Sens. Mary L. Landrieu of Louisiana, Blanche Lincoln of Arkansas and Ben Nelson of Nebraska have expressed concerns over the inclusion of a government-run plan. Sen. Sherrod Brown (D-OH), however, expressed in a meeting Monday night with Reid that liberal lawmakers had conceded enough ground on the government-run plan and that he should push forward with the bill.Members of the Senate will convene on Saturday for a rare weekend session to hold a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate.Immigration and Abortion Remain Central to the Debate: Access to care for illegal immigrants will continue to be contentious as lawmakers work to reconcile the health care legislation passed by the House and pending in the Senate. Under the bill approved by the House, illegal immigrants would not be barred from using their own money in the newly-created insurance exchanges. White House officials and members of the Senate Finance Committee, however, pledged that undocumented workers be barred not only from receiving subsidies but also from buying insurance through federally sponsored exchanges – even with their own money.As Senate Majority Leader Harry Reid works to finalize the legislation, he will also need to address the question of federal funding for abortions, an issue that has proved starkly divisive. Because of pressure from the Catholic Church and anti-abortion groups, the House-approved bill restricts the use of taxpayer funds for abortions, a decision that has sparked a heated debate among pro-choice and pro-life advocacy organizations. In contrast, the Senate’s proposed bill would allow the use of federal funds for abortion in cases of rape and incest, requiring insurers that cover elective abortions to segregate money from Americans who get government subsidies.Public OpinionPolls Continue to Show Deep Divisions: A new Washington Post-ABC News poll shows that Americans are deeply divided over the current health care proposals and that the majority believes costs will rise. Forty-eight percent say they support the proposed changes to overhaul the health care system, whereas 49 percent are opposed. In addition, 52 percent say an altered system would probably make their own care more expensive, and 56 percent see the overall cost of health care in the country going up as a result of the reform.Furthermore, a recent Associated Press (AP) poll shows that Americans are split (43 percent opposed; 41 percent support) over the health care plans being discussed in Congress. The AP poll also suggests that the public is becoming more attuned to the details of the proposals, including the cost implications and the public option. And, according to a Quinnipiac University poll released Thursday, 53 percent of voters disapprove of President Barack Obama’s handling of health care reform.However, a new CBS News poll shows that only one in four Americans prefer to have no health care legislation at all, while 51 percent support a bill with a public option.Other ActivitiesCMS Report Indicates Costs Would Rise Under House Bill: According to a report issued by Richard Foster, the chief actuary at the Centers for Medicare and Medicaid (CMS), overall spending on health care would rise as a result of the legislation approved by the House. Specifically, the measure to reduce more than $500 billion from future Medicare spending would sharply reduce benefits for some seniors and may jeopardize access to care for millions of others.Drug Makers Increase Price, Anticipating Health Reform: The media has reported that the drug industry has been raising prices at its fastest rate in years, in anticipation of the costs associated with health care reform. These costs include the $80 billion in fees over the next decade that the industry agreed to in order to help pay for coverage of the uninsured.On Wednesday, Democrats in Congress asked for two separate investigations of drug industry pricing.Economists Endorse Health Care Reform Bill: Twenty-three high profile economists from universities and think tanks sent a letter to President Obama on Tuesday to support four important elements of health reform legislation critical to its success: deficit neutrality, an excise tax on high-cost insurance plans, an independent Medicare commission, and delivery system reforms.Looking AheadThe Senate will convene on Saturday for a procedural vote, deciding whether or not to bring the legislation to the Senate floor for debate. Debate could continue throughout the weekend.

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Health insurance is a kind of agreement between you and your insurance company that you need in case you get sick and need medical help. Unfortunately, usually people get interested in their health insurance only when something bad happens – only to find out that they have a 3,000 deductible or some important things you need (such as a wheelchair) are not included into the policy. Before you get a health insurance policy it’s recommended to review all of them and find the one that will give you most coverage.

Almost all health insurance policies cover emergency services and whenever you have to go to the hospital and receive the treatment the cost will be covered less the deductible specified in the policy. A basic deductible for emergency room treatment can start at $50 and it should be mentioned that insurance companies are very particular about conditions that can be considered an emergency. If you have flu it’s probably not going to be covered, unless your fever is way too high. Your health insurance is likely to cover annual check-ups, with their number specified by the policy. If you need to see your doctor more often than it’s usual you need to look for a health insurance policy that soul be more comprehensive and would provide you with more coverage. Vision services are usually covered, including one visit to the eye doctor a year, while glasses and contact lenses are not covered in most cases, especially if you have a basic health policy.

Hardware coverage is required for people wearing glasses or contact lenses. Certain diagnostic services that are considered to be reasonable by your insurance company (X-rays and other procedures intended to diagnose certain conditions). You may not qualify for coverage if the symptoms you have are not considered to be serious enough – so it’s always best to call our insurance company with this question. If you are planning to have a surgery a pre-authorization from you insurance company is required. The necessity of the surgery will be evaluated by the doctor and the request is supposed to be sent by your health care provider. This can take up to 30 days. So, in general you need to keep in mind that most insurance companies will not be paying 100% of your medical costs, and in most cases you will have to co-pay from 10 to 50% of each medical bill you get. Before you purchase a health insurance policy it’s worth thinking about how much you are ready to pay out of your pocket for the service provided, and if that amount is not too high be ready to purchase a standard or above health insurance policy with maximum coverage.

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Week of January 25, 2010The sudden halt to health care reform’s steady march forward came as a shock to many who saw an upset win by Republican Senator-elect Scott Brown in Massachusetts as all but impossible. But if many took delight in the election outcome’s impact on health reform legislation, Aetna Chairman Ronald A. Williams made it clear in a New York Times story last week that the country still needs meaningful health care reform – reform that addresses access as well as affordability. Everyone benefits by health reform that gets at the factors driving soaring health care costs and the loss of coverage for so many Americans. While Congress thinks carefully about its next steps, Aetna will continue to support meaningful health care reform and continue to offer responsible solutions to legislative leaders. Federal The election of Republican Scott Brown as the new senator from Massachusetts has derailed the Congressional health care reform train, less because Brown denies Democrats the 60th filibuster-proof vote, though that is certainly a major result, and more because it collapsed the Democratic political house of cards by highlighting the power of independent voters and the frustrated anti-incumbent mood of the electorate. Whether Democrats can regroup from this wake-up call will consume their leadership from now until the November off-year elections. How Democrats handle, and how Republicans respond to, health care reform in the short term and other key priorities – such as jobs, the economy, energy and security – over the rest of the session will underscore all Congressional decisions from now until the first Tuesday in November. In short, the 2010 elections started in earnest with Brown’s victory.Once Democrats get past the shock of losing Kennedy’s seat, they will have to grapple with health care reform, one way or the other. The early favorites, including passing the Senate bill “as is” in the House, have been dropped for now as Democrats recognize the political cost of ramming through something unpopular propelled by political muscle only. Passing a smaller, less invasive and mostly Democratic bill has only a slightly better chance, as Republicans are not too likely to “crossover” quite yet. There is a growing interest in using reconciliation (the 51-vote tactic) down the road to pass a Democratic-only bill, once the House and Senate Democratic leadership can agree to a single bill. And, there is the outside chance that Democrats will see the Massachusetts election as an imperative to craft a bipartisan bill with Republicans that can secure 70-plus votes in the Senate. Wednesday’s State of the Union speech, followed by the party issues retreats later in the week, will go a long way toward determining which path will be pursued.

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