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Healthcare Reform Update - March 4-10, 2010


Email Alert

March 10, 2010

Compiled by Nicole DiMaria*

Obama Attacks Insurers, Rallies Public to Press Congress to Approve Health Reform
March 9, 2010

"The White House is mounting a stinging, sustained broadside against health insurance rate increases," The Washington Post reports, adding that President Obama "and his health secretary staged a two-pronged attack Monday in a stern letter to health insurance chief executives and a speech in which the president castigated insurance companies 22 times. 'How much higher do premiums have to rise,' he demanded, 'before we do something about it?'"

The president gave an impassioned speech in Philadelphia Monday. "'Part of the motivating factor here is letting members of Congress know there's a price to pay for failure,' White House Chief of Staff Rahm Emanuel said Monday in an interview." In the meantime "America's Health Insurance Plans, the industry's main lobby, plans to spend more than $1 million on a nationwide advertising campaign this week to, as one official with the group said, 'set the record straight about rising health-care costs'" (Goldstein and Wilson, 3/9).

Kaiser Health News has additional coverage of news stories regarding the health insurance industry in today's Morning Edition.

The New York Times: "In a high-octane appearance that harked back to his 'yes we can' campaign days, Mr. Obama jettisoned the professorial demeanor that has cloaked many of his public pronouncements on the issue, instead making an emotional pitch for public support as he tries to push the legislation through a final series of votes in Congress in the next several weeks" (Cooper and Herszenhorn, 3/8).

CNN has video excerpts of the speech.

Los Angeles Times : "Obama said that Washington pundits obsessed with analyzing the political repercussions of a yes or no vote on healthcare are distracting lawmakers from what's fundamentally at stake: If Congress fails to act, the president said, premiums will rise, insurers will deny coverage based on preexisting conditions and more people will be without insurance. 'They need to hear your voices because right now the Washington echo chamber is in full throttle,' Obama (said) . . . 'It is as deafening as it's ever been. And as we come to that final vote, that echo chamber is telling members of Congress, wait, think about the politics--instead of thinking about doing the right thing.'" A Democratic aide told the Times Obama's speeches "create political space for members to cast a vote in support of the bill" (Nicholas, 3/9).

USA Today: "None of the House members from Pennsylvania whose votes are in doubt attended Obama's speech. Only his firm backers were present, including Sen. Arlen Specter whose switch from Republican to Democrat last year gave Democrats the 60-vote supermajority they needed to pass a first version of the health care bill in December."

The president declared that "'The issue here is not the politics of it.' It was a reference to Republicans' threats to work against any vulnerable Democrats who support the bill, which has put passage in doubt" (Wolf, 3/8).

The Philadelphia Inquirer: "Obama slammed Republicans for their opposition to the Democrats' proposals, saying they had failed to act when they controlled Congress. 'I got all my Republican colleagues out there saying, "Well, no, no, no, we want to focus on things like cost,"' the president said. 'You had 10 years. What happened? What were you doing?'" (Fitzgerald, 3/9).

CongressDaily : "Time is running out for Obama to win votes for his overhaul proposal, since he and Democratic congressional leaders are pushing for a vote by March 18." CongressDaily notes: "Only four days after promising progressive Democrats that sometime in the future he could once again support a public option, he made it clear that that time had not yet come. It is not 'practical or realistic' to support a 'government-run' system at this point, he said" (Condon, 3/8).

The Washington Times: "[Obama's] national disapproval rating on health care hovers at 52 percent compared with an approval rating of 39 percent, according to National Journal's average of national polls. Though Democrats still claim that the American public is on their side, Mr. Obama has retooled his argument in recent weeks to stress that health care reform is the right thing to do, regardless of political implications" (Rowland, 3/9).

Stupak Indicates Abortion Compromise Possible for Health Bill
March 9, 2010

Rep. Bart Stupak, D-Mich., who is leading a coalition of anti-abortion Democrats standing in the way of party leadership efforts to pass a health bill, signaled Monday that the impasse may be close to resolution.

The Associated Press : Stupak "said he expects to resume talks with House leaders this week in a quest for wording that would impose no new limits on abortion rights but also would not allow use of federal money for the procedure. 'I'm more optimistic than I was a week ago,' Stupak told The Associated Press between meetings with constituents in his northern Michigan district. . . . 'The president says he doesn't want to expand or restrict current law (on abortion). Neither do I,' Stupak said. 'That's never been our position. So is there some language that we can agree on that hits both points--we don't restrict, we don't expand abortion rights? I think we can get there'" (Flesher, 3/8).

In an explainer on the issue, The Associated Press reports that President Obama's health proposal "would change federal policy on abortion, but not open the spigot of taxpayer dollars that some abortion opponents fear" (Alonso-Zaldivar, 3/9).

The Hill: "The Stupak abortion language is unlikely to be included in the final measure, leading some House committee chairmen to hold back their votes" (Cusack and Young, 3/8).

CongressDaily : "Rep. Dan Lipinski, D-Ill., became the second Democrat Monday to publicly join Stupak against any bill that does not include the House's abortion language, appropriately dubbed the Stupak amendment. Rep. James Oberstar, D-Minn., previously did so. Stupak says he has 11 members with him who do not believe the Senate language goes far enough." Stupak is trying to reach an agreement on the abortion language with House Energy and Commerce Chairman Henry Waxman (Edney, 3/9).

Senate Test Vote Today On Bill to Extend COBRA Subsidy, Doc Fix, and State Medicaid Funding
March 9, 2010

The Senate is poised to consider a measure today that would include extending subsidies for COBRA benefits and unemployment insurance, prevent the Medicare payment cut for doctors and provide additional funding to state Medicaid programs.

The legislation "faces a key test vote in the Senate, its momentum helped by about 60 popular tax breaks for individuals and businesses that expired at the end of last year," The Associated Press reports. "All told, the measure would add $107 billion to the deficit over the coming decade. Democrats have labeled most of the bill an emergency measure, exempting it from stricter budget rules enacted just last month." In order to pass the measure, "Democrats need to muster at least one Republican vote Tuesday to reach the 60-vote threshold needed to limit debate and guarantee an up-or-down vote. But Sen. Susan Collins, R-Maine, provided crucial help last week to keep the measure out of another procedural tangle, and Democrats sound confident they will prevail" (Taylor, 3/9).

CQ Politics : The COBRA subsidy "was meant to be temporary, but it appears that it could outlast the Obama administration's proposal to remake the nation's health care system for future decades. In other words, if the Obama plan collapses, COBRA subsidies are likely to remain among the flotsam and jetsam of 'incremental' solutions left behind. . . . Current law provides subsidies for nine months to people who were laid off between Sep. 1, 2008 and Dec. 31, 2009. The 65 percent subsidy leaves them to pay only 35 percent of the monthly premium costs. Congress has expanded the program and extended it twice. And lawmakers are ready to extend it again" (3/8).

Modern Physician : "A bold pledge from [Health and Human Services Secretary Kathleen Sebelius] to resolve Medicare's physician payment problem has yet to convince all doctors that a permanent fix will ever be realized." The 21.2% cut, which went into effect on March 1, was "lifted by an emergency measure signed by President Barack Obama the following day." But "physicians were nevertheless angered by the fact that the measure--which provided a series of short-term extensions to various Medicare programs, including a 30-day stopgap on the SGR cut--fell woefully short of providing a long-term solution to this issue. . . . Federal actuaries and others have estimated it would cost $210 billion to $230 billion over 10 years to permanently repeal the SGR" (Lubell, 3/8).

Reconciliation Update: Some Dems, GOP, and Industry Groups Wary of Health Bill Strategy
March 8, 2010

The Los Angeles Times : "Obama's signature ability to inspire fellow Democrats and Pelosi's well-honed ability to read their parochial needs will be tested as they tackle the job of finding the last stubborn votes for the healthcare bill. . . . Under the Democrats' strategy, the House would pass the Senate's version of the bill. Then both chambers would approve changes under the budget reconciliation process, which could pass the Senate with a simple 51-vote majority. Democrats hope to finish by the end of the month" (Hook and Levey, 3/8).

"The President said health care deserves a simple up and down vote," according to NPR 's Liane Hansen. "This means he's endorsing a reconciliation vote which requires a simple majority in the Senate rather than a filibuster-proof 60 vote majority. By the end of [last] week, the Democrats still didn't have the votes they need to pass it." NPR correspondent Mara Liasson adds, that one reason is departing lawmakers: "We've had seven Democratic retirements in districts that John McCain won in 2008 . . . Retirements are the key to their political fortunes" (Liasson and Hansen, 3/7).

The New York Times provides a "handy road map for the next three weeks. . . . Confused about how many votes it will take to pass the Senate bill, and then the reconciliation bill, in the House? Even House Democratic leaders have been left guessing in recent days. The short answer is a simple majority present and voting. With a full 435 House members, that number is 218. But there will not be 435. After a death and three resignations, including that of Representative Eric Massa, Democrat of New York, on Monday, there will be 431 House members. With everyone voting, 216 wins" (Herszenhorn, 3/8).

Roll Call: "Democratic leaders appear close to an agreement on a reconciliation bill, which would act as a companion vehicle of adjustments to the $871 billion health care package that the Senate approved in December."

"Democratic leaders expect to obtain a Congressional Budget Office analysis of their reconciliation package by week's end, after which they would forward the legislation to the Senate Parliamentarian to ensure that it complies with the chamber's strict rules for 51-vote bills." Those rules are narrow and any bill would face both challenges from Republicans and suspicions from House lawmakers who may find that their requested changes do not survive the parliamentarian's review (Drucker, 3/8).

One aspect of reconciliation is that industry groups find it difficult to sway lawmakers under the rules, Roll Call adds in a separate story. "Lobbyists said that reconciliation does not lend itself well to outside pressure because rules limit the substance of the bill to issues directly tied to the budget. Furthermore, they say now that President Barack Obama has outlined what he wants to see in the measure, there is less leeway for input from industry groups" (Roth, 3/8).

Republicans are bracing for the fight. "If Senate Democrats used reconciliation to make changes to their healthcare bill, Republicans would pull out every stop to bring work in the Senate to a halt between now and the November elections, both [Sen. Lindsey Graham, R-S.C.,] and [Sen. Evan Bayh, D-Ind.,] conceded," The Christian Science Monitor reports. "To Graham, using reconciliation to pass healthcare reform circumvents the very mandate for consensus-building that makes the Senate unique." Both appeared on CBS' Face the Nation (Sappenfield, 3/7).

Under Health Reform, Medicaid Would Cover Many Childless Adults
By Rick Schmitt, KHN Staff Writer
March 8, 2010

This story was produced in collaboration with The Philadelphia Inquirer.

Marilyn Matthews has no job, no health insurance, and until now, no chance of qualifying for Medicaid.

She's unquestionably poor--her last regular paycheck was more than three years ago--and would meet the income criteria for Medicaid. The rub is that Matthews, 51, is a healthy adult with no children.

While Medicaid is the main government health insurance plan for the poor, the joint state-federal program has excluded Matthews and millions of other adults with no dependent children since the 1960s. Medicaid has been limited mainly to children in poor families, the elderly, pregnant women and the disabled. Some states have tried to fill the gap, but childless adults now comprise a majority of uninsured Americans.

The lowest-income members of the group would be among the big beneficiaries of the Democratic health insurance overhaul plans in Washington.

Senate legislation and President Obama's new health proposal would expand eligibility to all with incomes up to 133 percent of the federal poverty level, or $14,404 for a single person. The House bill would set the mark at 150 percent or $16,245 for single people.

Over 10 years, Medicaid enrollment would grow by 15 million, including not only childless adults but others whose incomes don't qualify now for the program.

Whether the Democrats can push an ambitious plan through Congress is uncertain. If one doesn't pass, the states are in no position to expand Medicaid coverage without federal help: the states face huge shortfalls from the recession.

Covering childless adults would mark a radical shift in thinking about who deserves a helping hand, not to mention a departure from what Congress intended when it created Medicaid 45 years ago.

The exclusion is rooted in the welfare system of 17th Century England, and an attitude that able-bodied men should not be on the public dole. Imported to America, the distinction was reflected in cash assistance laws enacted during the New Deal, which served as a blueprint for Medicaid years later.

Pros and Cons

Supporters of a Democratic overhaul say excluding childless adults is an anachronism at a time when they are just as apt to become ill or face crushing medical expenses as anyone else. Even for many working adults, they note, health insurance has become unaffordable in recent years.

Critics say expanding Medicaid twists the program's original intent, which was to aid the most vulnerable citizens. They also cite the budget-busting potential of expanded public health care.

But there is ambivalence on both sides. Conservative critics have backed off some of the strident anti-welfare rhetoric that has colored such debates in the past. And some supporters of expanded public coverage for the poor question whether Medicaid is the right vehicle, because care can be uneven, and the program carries the moral stigma of welfare.

"It is great that all these people will be able to get care. I don't want to denigrate that. But it is perpetuating this two-track health care delivery system," says Penn professor Michael Katz, author of "The Undeserving Poor: From the War on Poverty to the War on Welfare."

Many doctors already refuse to accept Medicaid patients because the government payments are so low. In a survey of major cities last year by health consultants Merritt Hawkins & Associates, Philadelphia ranked near the bottom in the percentage of cardiologists and OB/GYNs who accepted Medicaid.

Administrative hassles may also limit care. A 2008 study in the journal Health Affairs found that Pennsylvania took the longest to pay doctors for Medicaid services--almost four months, on average, further discouraging participation.

Supporters say just a fraction of the uninsured would have trouble getting adequate care while millions would benefit from the expansion. Moreover, they say, at a time when many uninsured visit expensive hospital emergency rooms as their primary source of care, expanding a program like Medicaid, with its emphasis on preventive care, is more efficient.

Many Need Care

What is clear is that an expanded Medicaid would cover a wide range of people, from uninsured young adults to empty nesters to divorced spouses and widows left without insurance.

Many of these folks have un-met health needs. The number of people on Medicaid who have severe mental illness and substance abuse addictions is expected to more than double if the overhaul passes.

The legislation would also bridge a gap for unemployed and uninsured Americans who are not old enough to qualify for Medicare, federal health insurance for the elderly. Matthews fits that profile. Growing up, she had insurance through her parents, and later through her husband, who worked in a family steel business. "I always had health insurance," she says.

After her husband died from leukemia in 1995, she worked as a marketing consultant, receptionist and administrative assistant. She last worked in 2006 as a front desk agent at a corporate conference center in Bryn Mawr. But she hasn't had health insurance since 2002. Without an employer to help with the premiums, she says coverage is beyond her reach.

She went back to school in 2007 to become a certified legal assistant, just in time for the recession to hit. Today, she trolls for jobs on her laptop, and tries to stay as healthy as possible, although she has not seen a doctor in years. There's a bowl of apples on her dining room table, and a treadmill in the living room of the brick Colonial she bought with her husband in the 1980s.

Matthews says she was surprised to learn that being unemployed with "no money in your checking account" counts for little in getting public health care. "It is pretty crazy," she says of the current system.

Young Also Struggle

About half of uninsured childless adults are between the ages of 19 and 34, and would be discouraged from working if they got free health care, critics say. "Medicaid should be focusing on people that Medicaid is uniquely qualified to serve, which are people with complex medical needs, people with disabilities," says Dennis Smith, head of Medicaid under President George W. Bush.

But Heather Jenkins, 29, a personal trainer living near Baltimore, says she can't get private insurance because of injuries she suffered in an auto accident a few years ago, leaving her with chronic jaw pain and hip problems. At the same time, her injuries are not considered extensive enough to get her free health care under federal disability laws.

The Medicaid expansion could help her: she now earns less than $15,000, and might meet the income criteria in an overhaul bill.

"I am hoping to still work and pay taxes. I cannot get Social Security (disability insurance) because I am not that disabled. But I am too disabled to get health insurance," she says.

Some candidates for the new Medicaid might not be considered so sympathetic. The overhaul would reverse a practice adopted as part of welfare reform in 1996 that made it more difficult for people with drug or alcohol addictions to get Medicaid coverage.

For years, Montez Tucker, 50, wrestled with alcohol and drug problems. The Philadelphia resident says he got clean three years ago after checking into a Christian mission treatment center. But he has no health insurance.

Today, he works about 20 hours a week, earning $10 an hour, as a package handler for an express mail company, low enough to qualify him for Medicaid under the proposed new rules.

"I really want to make more than $15,000 a year," says Tucker, a former National Guard paramedic, who is returning to school to become a certified nursing aide. "But (Medicaid) helps if you can't" make more.

He thinks expanding coverage for substance abusers would be money well spent.

"People want help and have no way to get it," he says.

This information was reprinted from with permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery. © Henry J. Kaiser Family Foundation. All rights reserved.

*We would like to thank Nicole DiMaria, Esquire (Wolff & Samson, West Orange, NJ), for selecting the articles for this week's update.


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