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Healthcare Reform Update - December 10-16, 2009


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Compiled by Brian Betner*

December 16, 2009

After Tense Meeting, Dems Likely To Ditch Medicare Buy-In Plan In Health Bill
December 15, 2009

Top Senate Democrats were prepared Monday night to sacrifice proposals to expand Medicare in a bid to win over moderates and amass the 60 votes needed to pass their health legislation, according to news reports.

The Washington Post : "Democratic negotiators had already disappointed liberal lawmakers by jettisoning a full-fledged public insurance plan a week earlier. Last night, party leaders conceded that a key portion of the compromise they crafted to replace the public option--a proposal allowing people as young as 55 to buy into Medicare--also did not have sufficient support from Democratic moderates to overcome a likely Republican filibuster (Murray and Montgomery, 12/15).

The New York Times : "After a tense 90-minute meeting on Monday evening, Senator Max Baucus, Democrat of Montana and chairman of the Finance Committee, was asked if Democrats were likely to jettison the Medicare proposal. 'It's looking like that's the case,' Baucus said, indicating that the provision might be dropped as a way of 'getting support from 60 senators.' The view of lawmakers--all 58 Senate Democrats and 2 independents who caucus with the party--in the meeting was that "they should forge ahead with some legislation even if it was not all that they wanted" (Hulse and Pear, 12/14).

The Wall Street Journal: "The idea of letting people ages 55 to 64 buy into Medicare, announced just last week, had threatened to explode the Democrats' hopes of getting a bill through the Senate when Sen. Joseph Lieberman [I-Conn.] came out against it." Sen. Evan Bayh, D-Ind., said lawmakers agreed that they should move to head off that dispute before it stalled the legislation (Hitt, 12/15).

USA Today: "Talk of dropping the Medicare idea . . . underscores the lengths Democratic leaders are going in their quest to hold their 60-member caucus together to pass some form of legislation by the end of the year." But, Lieberman's reaction to Monday night's talk remained noncommittal. "Put me down . . . as encouraged about the direction," he said (Fritze, 12/15).

Politico: Sen. Russ Feingold, D-Wis., "a big supporter of the public option and the Medicare idea," said after the meeting, "Things are not moving in the right direction." Some liberals "can't believe a senator who no longer considers himself a Democrat"--Lieberman--"is in the position of effectively vetoing a key part of the health reform bill."

Some Democrats and progressive activists are already calling to punish Lieberman, though party leaders have so far deflected those protests, though Politico quotes a "perplexed" Sen. Mary Landrieu, D-La., as saying: "Sen. Lieberman, it's my understanding, proposed a similar measure [a] few years ago . . . So I'm not sure why he's having a hard time with it today" (Brown and Allen, 12/15).

Los Angeles Times : "Several leading liberal lawmakers on Monday appeared resigned to the collapse of their dream of including either a new government insurance plan to compete with private plans or the proposal to expand Medicare. 'There's enough good in this bill that even without those two, we've got to move it,' said Sen. Tom Harkin (D-Iowa), who succeeded the late Sen. Edward M. Kennedy as chairman of the Senate Health Committee" (Levey and Hook, 12/15).

The Boston Globe : The Medicare plan "negotiated by a set of senators last week, appeared to be foundering before it even received a detailed public vetting, and more questions than answers swirled around Senate deliberations yesterday." Senators said Monday they still awaited a report expected Tuesday or Wednesday from the Congressional Budget Office, which would also review both the Medicare idea and a plan--"far less objectionable to moderates"--to allow the federal government to negotiate with private insurers to offer national, nonprofit plans (Wangsness, 12/15).

Senate Holdouts Threatening '09 Health Care Reform Bill Passage
December 14, 2009

The Washington Post : "The next 48 hours will be critical to the fate of health-care reform in the Senate, as Democratic leaders struggle to settle disputes that stand in the way of holding a final vote this year on the massive package reports on the distance among senators that has to be bridged before a bill can pass." By mid-week, Senate Majority Leader Harry Reid, D-Nev., must "begin the process of ending debate on the $848 billion bill or risk missing his deadline of final passage by Christmas, pushing the contentious health-care debate into early 2010." To do this, he must maintain the backing of 60 Senators, which includes convincing "Democrats who are on the fence to come to his side" (Murray, 12/14).

Politico: "Most insiders agree that Democrats have until Thursday to work out their differences if they want to pass a bill by Dec. 23. It will take at least five or six days after Democrats move to end debate before they can vote on the bill." Democrats are also split on a proposal to allow cheaper drugs to be imported from countries with similar safety procedures to the United States, like Canada (Frates, 12/14).

Roll Call : "As Senate Democrats show tentative signs of coalescing around a compromise health care bill that eliminates the controversial public insurance option, some of their allies are wasting no time in trying to sink the new proposal. While lawmakers await a Congressional Budget Office cost analysis of the proposed substitute, doctor and hospital groups are already trying to scuttle part of the plan that would allow people ages 55 to 64 to enroll in Medicare. . . . Liberal groups, including and union-backed Health Care for America Now, have also railed against the compromise proposal because they view the public option as central to any health care reform effort." Also, doctor and hospital groups are opposing the proposed Medicare expansion because they say the system already "shortchanges" doctors and other providers and that an expansion would further burden an overburdened system (Roth, 12/14).

Bloomberg: "After hailing a potential breakthrough for U.S. health-care legislation, Democrats this week will learn whether the new deal passes muster with budget analysts and the senators they are courting. . . . A positive appraisal from the nonpartisan CBO would go a long way to help Reid meet his Christmas deadline for Senate passage of the plan" (Jensen and Rowley, 12/14).

Meanwhile, CBS News' "60 Minutes" interviewed President Obama: "'I think it's going to pass out of the Senate before Christmas,' Mr. Obama said in the interview. 'I think that when we look back after I signed this bill, people are going to acknowledge that not only was this the most important piece of domestic legislation since at least social security, but it also tackled the biggest problem that we had in terms of our long-term fiscal well-being,' the president said" (Condon, 12/13).

Roll Call , in a separate story: "The White House until a few days ago was saying that the final bill could still be passed by the House and the Senate and get to Obama's desk before the end of the year. The president had earlier set a 'deadline' of Dec. 31 for final passage." Roll Call reports that Obama's insistence that the Senate will pass a bill by Christmas seemed a "recognition that the health care debate is likely to continue into 2010" (Koffler, 12/13).

CongressDaily reports that Senate Minority Leader Mitch McConnell has filed for cloture on a health reform bill amendment offered by Sen. Mike Crapo that would send the measure back to the "Senate Finance Committee to strip all taxes on individuals who earn less than $200,000 and families earning less than $250,000. . . . The cloture vote would take place Tuesday morning, unless an agreement is reached or Democrats move to table the Crapo amendment, a Republican aide said" (Sanchez and Hunt, 12/13).

Fine Print Raises Alarms Over Health Bill
December 14, 2009

News reports forecast that some provisions in the Senate health-overhaul legislation could create distractions for Democrats seeking to pass a bill by the year's end. "In a victory for people with cancer and other serious medical problems, the White House agreed Friday to help close a loophole in the Senate health care bill allowing annual dollar limits on their care . . . ," the Associated Press/San Francisco Chronicle reports. "Tucked in a clause of the Senate bill captioned 'No lifetime or annual limits' is a provision that would permit such caps." By stipulating that the limits must not be "unreasonable," the legislation opens the door for insurers to override the provision. As the bill is written, administration officials could set the bar for what constitutes a reasonable limit (Alonso-Zaldivar, 12/12).

Another issue, The Baltimore Sun reports, is that "little-noticed fine print in the legislation includes delays on many benefits of health reform. And those extended timelines will likely come as news to many who need and are expecting aid now, according to some of those monitoring the rancorous and evolving process." Other benefits are tied to delayed timelines, such as financial aid packages to help people buy insurance (Cohn, 12/14).

A gray area between purely cosmetic surgery and reconstructive surgery is heating the debate over the so-called "botax," a tax on plastic surgeries, the Houston Chronicle reports. The Senate health reform bill "would impose a 5 percent levy on cosmetic procedures not considered medically necessary--the liposuction, nose jobs and hair plugs that weren't caused by disfiguring disease, congenital abnormalities or injury." The area is already a matter of dispute between plastic surgeons and insurers, who may not pay claims that address purely aesthetic issues. The surgeons argue that the tax is discriminatory to women, who receive the vast majority of the operations and that insurers sometimes argue that medically necessary procedures are mere beautification rites to avoid paying. "Dr. Jeff Friedman of Methodist Hospital, president of the Houston Society of Plastic Surgeons, tells of one patient born without breasts, another without a vagina. None of the patients' insurance plans covered the surgeries in question" (Ackerman, 12/14).

All these, and the many other issues, leave Americans divided on the health reform plan, and presents a "fundamental question: Could any legislation that significantly overhauls the health care system win broad support? Probably not," the Milwaukee Journal Sentinel reports. The public is split by a series of contradictions in their opinions, such as the fact that people think their insurance premiums are too high, but don't recognize that they reflect underlying costs of care, or that people want to lower costs without affecting their own coverage and care. "The contradictions provide some perspective on the challenge facing Congress in the coming months--and the odds against any legislation being greeted with applause" (Boulton, 12/13).

Long-Term Care Proposal Triggers Cost, Sustainability Concerns
December 14, 2009

"Embedded in sweeping health legislation passed by the House and being debated on the Senate floor is a major new federal insurance program," called the Community Living Assistance Services and Supports Act, or Class Act, The New York Times reports. The program, which is to be financed with premiums paid through voluntary payroll deductions, would provide cash benefits to people with cognitive impairments or those who could not perform two or three of the "activities of daily living," such as eating, bathing or dressing. "Advocates for older Americans and people with disabilities see the program as a long-overdue effort to address needs that will explode as baby boomers age. It is meant for people with severe disabilities who want to live in the community, though the benefits could also be used to help pay for nursing home care or assisted living. But critics say that the program is unsustainable and that it could ultimately create serious fiscal problems for the government" (Pear, 12/13).

The National Journal reports that the program may be in jeopardy: "Senate Majority Leader Harry Reid, D-Nev., last week cleared the first--but not the last--major hurdle to creating a government-run long-term-care insurance program along the lines of what Sen. Edward Kennedy championed until his death in August. Although Reid was able to defeat a Republican attempt on December 4 to strip the proposal from the health care reform bill, the vote was close, and 11 Democrats plus Sen. Joe Lieberman, ID-Conn., who caucuses with the party, sided with Republicans. . . . "

"Many older people who require long-term care end up on Medicaid, the federal-state health care program for the poor. Medicaid pays about 40 percent of the cost of long-term care in the United States, which in 2006 totaled $178 billion. Federal and state budgets are being strained by the expenditures" (Serafini, 12/12).

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 Brian C. Betner, Esquire (Hall Render Killian Heath & Lyman, Indianapolis, IN), for selecting the articles for this week's update.

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