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Healthcare Reform Update October 1-6, 2009


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Compiled by Brian C. Betner*

October 7, 2009

Senate Finance Committee Vote Delayed
October 6, 2009

The Senate Finance Committee will delay its vote on health care reform--and, likely the bill's move to the Senate floor--as members await cost estimates by the Congressional Budget Office.

The Washington Post : "The Senate Finance Committee wrapped up work Friday on a reform bill, but committee Chairman Max Baucus (D-Mont.) promised his members that before voting they would have a 'reasonable' amount of time to review the bill's price tag, as assessed by the nonpartisan Congressional Budget Office. That report, committee aides said Monday, will arrive later than expected. The panel's vote is expected to be close, and passage could hinge on a handful of senators who have indicated that the CBO's report may sway them." Senate Majority Leader Harry Reid has already begun merging the Finance bill with the one from the Senate Health, Education, Labor and Pensions Committee (Murray and Wilson, 10/6).

One of those senators is Sen. Olympia Snowe, R-Maine. Roll Call reports that Reid and the Obama administration "really, really, really want her vote when the bill comes to the Senate floor. Reid has called her proposal to create a trigger for the public insurance option 'a doggone good idea,' and the White House has made no secret of its interest in exploring that plan if it assures Snowe's vote. Under the proposal, a public insurance option would be created only if private insurers could not lower costs and increase coverage on their own" (Pierce, 10/6).

Politico reports on the day's developments in reform efforts: "Turns out that for the past week, aides to President Barack Obama have been meeting with senior Democratic congressional staffers to discuss how to include a public plan in the reform bill that Majority Leader Harry Reid
(D-Nev.) will bring to the Senate floor, the Los Angeles Times reported. The development jibes with other reports that Senate moderates are starting to get in line behind a public option" (Frates, 10/6).

House Democrats Question Their Reform Role While Republicans Plan Meeting With Secretary Sebelius
October 6, 2009

In the House, members are questioning if their version of the bill even matters, Politico reports. "With the media following every turn of the Senate negotiations, some House Democrats have started to ask themselves whether all of the work crafting a House bill will even make a difference in the end, or whether they'll simply get steamrolled by a White House so eager for a compromise that the president will just use the Senate bill as the template" (O'Connor, 10/6).

Some House Republicans in the Republican Study Committee, in the meantime, will nevertheless meet with Health and Human Services Secretary Kathleen Sebelius to talk reform. According to Roll Call, "[t]he RSC includes some of the most vehement critics of the Democrats' heath care reform plans. The RSC-Sebelius meeting is scheduled to take place at 5 p.m. in the Capitol" (Kucinich, 10/5).

CongressDaily also reported on this meeting: "'I think they've grown weary of our protestations,' said Rep. Tom Price, R-Ga., the RSC's chairman and a physician. He said he was referring to Republican complaints that they have been excluded by House Democrats and the Obama administration from the negotiations developing healthcare legislation." The RSC will continue to push for a meeting with Obama, he said (House, 10/6).

Insurers Push Back Against The Finance Committee's Softened Individual Mandate Penalties
October 6, 2009

Hospitals and insurance companies are not happy with amendments to the Senate Finance Committee's health bill that softened penalties on individuals who don't comply with the mandate to purchase insurance.

The Wall Street Journal : "The Senate Finance Committee could vote late this week on a sweeping bill designed to expand health-insurance coverage. Senators refining the legislation last week narrowed the scope of a new requirement that all Americans carry health insurance out of concern it penalized people who can't afford to buy it." As a result, some interests are concerned. "The changes mean the new mandate would apply to two million fewer people, largely those with lower incomes. Hospitals say that leaves too few people covered under the bill--a shortfall that could undermine a cost-cutting pledge by the industry. In July, the hospital industry agreed to swallow $155 billion in government payment cuts over the next decade to help fund expanded coverage of the uninsured." Insurance spokespeople say the maximum penalty for not carrying insurance for a family is only about 15 percent of the average health insurance premium. The Congressional Budget Office estimated that an earlier version of the Finance measure would ensure insurance coverage for 91% of Americans. When the CBO releases its updated estimated later this week this percentage is expected to be lower (Adamy and Hitt, 10/6).

The Associated Press/The Boston Globe : "That would raise premiums for everyone else, since Congress' health care overhaul would also require insurers to take all applicants. 'People will drop coverage and those who stay in would see rate shock,' Karen Ignagni, president of America's Health Insurance Plans, the insurance industry trade group, said in an interview Monday." White House budget director Peter Orzag said there's a trade-off with costs and getting more people covered (Werner, 10/5).

CongressDaily: "If CBO determines fewer people will have insurance under the modified proposal than Baucus' original mark, which stood at
94 percent of Americans, the deal could be in jeopardy. The uninsured often seek care in emergency rooms, leaving hospitals with a high uncompensated care burden" (Edney, 10/6).

Examining The Recent Winners And Losers In the Health Reform Debate
October 6, 2009

The health overhaul debate has, so far, produced winners and losers.

Bloomberg : "Pfizer Inc., the world's largest drugmaker, and hospital companies including Community Health Systems Inc. are benefiting from agreements with President Barack Obama that will limit any threat to their profits." Insurers in the meantime have lost some ground as the penalties for not carrying insurance by individuals have been scaled back and medical device makers must deal with new taxes. Bloomberg lists other winners and losers as well (Jensen and Wechsler, 10/6).

The Cleveland Plain Dealer reports that that city's University Hospitals yet-to-be-built cancer center will get the same Medicare payments as most cancer hospitals despite Congressional attempts to boost their payments. "The Congress members, from both parties, say that a specialty cancer center should get extra payments to match its expertise. Such payments from Medicare, however, require an act of Congress, and the latest attempt at that has been quietly dropped." It's unclear if the proposal will be offered on the Senate floor (Koff, 10/6).

Politico reports that biotechnology is a big winner so far in the reform debate: "The biotech industry won lucrative tax credits last week during consideration of the Senate Finance Committee bill, and it dealt Energy and Commerce Committee Chairman Henry Waxman a rare defeat over the summer by gaining much longer exclusivity for so-called biologic treatments than the powerful California Democrat sought." Much can still change in the debate, however, Politico reports, and nothing is certain until President Obama signs the legislation (O'Connor, 10/6).

Roll Call reports on lobbying and the ubiquity of health care lobbyists making it harder for other lobbyists to have their voices heard: "While influence peddlers aren't exactly twiddling their thumbs, for lobbyists who specialize in such industries as telecommunications, agriculture and high tech, Capitol Hill just doesn't have much of an appetite for their agenda" (Palmer, 10/6).

Finally, The Hill reports that White House Chief of Staff Rahm Emanuel is busy behind the scenes trying to secure the deal he made with the pharmaceutical industry that some Democrats are trying to nullify. "Some Democrats on Capitol Hill believe Emanuel and others could have gotten more from the Pharmaceutical Research and Manufacturers of America (PhRMA), adding they did not sign off on the pact and are not bound by it. It's a politically intriguing situation for Emanuel, who during his career in the House positioned himself as a leading antagonist of the pharmaceutical industry" (Bolton, 10/6).

Health Insurance Exchanges Examined As Part Of Reform Proposals
October 6, 2009

Health insurance exchanges are part of every health care overhaul proposal now in Congress as Utah becomes just the second state to try its own exchange on for size.

The New York Times : "In theory at least, the exchange would fix a fundamental flaw in the present system by giving small businesses and individuals a broad choice of insurance policies at competitive prices. Right now, such buyers typically have few affordable options." But there remains little detail on them, The Times reports, and without fair play mandated by law in them, there may be little new competition--the most basic goal of the exchanges--to create savings in the system (Abelson, 10/5).

In a second story, The New York Times looks at Utah's try at an exchange, just like Massachusetts did, but with some significant differences. "Aimed initially at small businesses, the exchange offers a way for companies to pay a fixed amount toward their employees' medical coverage, instead of buying the coverage directly for them. The workers then can select from various plans on the exchange. If they cost more than the employer's contribution, the employee pays the difference." The exchange has covered 2,300 employees from 230 small businesses and has five dozen policies from large insurers and regional ones (Abelson, 10/6).

*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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