The House tries yet again to delay or gut Obama-Care mandates; And who is behind all these attempts

by LAS

The GOP-dominated House has yet again passed a bill to delay or gut key provisions of the PPACA (aka Obama-Care) law. This week they passed bills to delay implementation of two key provisions, the individual mandate and the employer mandate (for businesses with 50 or more workers).

First of all, even though the House has made several attempts to delay or gut provisions of the reform law, it is very unlikely that the Senate will even discuss comparable bills on the floor. In fact, the House has voted 37 times already to “repeal or defund at least part of the health-care law, including three times to annul the entire measure” since 2010.

The Obama administration said in a statement that the measure to delay the employer mandate is “unnecessary,” and legislation postponing the individual requirement “would raise health insurance premiums and increase the number of uninsured Americans.”

However, House members of the GOP ran on promises to delay or defund PPACA in 2010 or 2012, and so they wish to make a little political hay during the summer months by keeping the issue on the House floor.

But my question is more about who is behind all these attempts to gut the bill. The key is the the employer mandate applies to companies with 50 or more employees. Specifically, companies that may have thousands of employees.

What many Americans may not know is that the PPACA law includes something called the non-discrimination clause. This has nothing to do with the color of a policy-holder's skin or what religion he or she believes in.

As it is now, companies can design deluxe healthcare plans for executive employees,as long as the plan was fully insured. But the non-discrimination clause in Obama-Care applies to ALL group healthcare plans, in terms of eligibility or benefits. The fact is that current healthcare plans treat different groups of employees differently. Most people are aware that the top brass gets the best perks package in the company. But most people may not be aware that even their healthcare plans are different, and that the PPACA specifically bars this and penalizes this practice.

First let us define the term “highly compensated” employees. This group includes the five highest-paid officers of the company, the shareholders who own 10 percent or more of the company, and all employees among the top 25 percent of all the company's employees.

Violators of the non-discrimination rules will be subject to stiff fines. This starts at $100 per day, per “failure penalty” – which will likely apply to each NON-highly-compensated employee who is left out of the cushy coverage plans. The company is also vulnerable to a civil lawsuit to compel it to provide the same upscale coverage plan to the non-covered employees.

Multiply that $100 per day per non-covered employee for a large multinational corporation, and you are talking about a significant hit to the corporate pocketbook. For a company with say, 500 employees, this easily adds up to a fine of $37,500 PER DAY. This is where I believe the pressure is coming from on House members to keep trying to negate provisions of the PPACA law.

Corporate America really believes that the executive class has to be lured to work for a given company with the most extraordinary gold-plated perks of every kind. Not being able to offer a healthcare plan that has no deductibles and no copays seems like a small loss when they are offering a company car, country club and health club and golf club memberships, the proverbial key to the executive washroom, stock options, and much more.

The employer mandate is being delayed for one year with White House permission. And the government has stated that there will be a phasing-in period where employers will be given time to make adjustments before the government begins sanctioning those that do not comply. But still I would not be surprised if corporate America tries to get all current healthcare plans to be grandfathered under the law, thereby escaping all sanctions and fines entirely. 

We Will Have to Watch Congress like Hawks to Keep Them from Repealing ObamaCare

by LAS

While the current political situation (i.e. – factional infighting) keeps any one party from being able to repeal the Affordable Care Act outright – that will not stop them from attempting the “death by a thousand cuts.” In other words, according to the National Association of Underwriters (an arm of the insurance industry), lobbyists will attempt to get individual provisions of the act repealed by inserting lines into other bills.

The insurance industry will be working with friendly members of Congress to insert language repealing just one given provision of the Affordable Care Act into bills that may about entirely unrelated matters. And they will do this for each provision of ObamaCare until it looks like Swiss cheese and totally useless for providing healthcare to those who need it. 

Even Congressional Reps Have Had to Sacrifice Their Gold-Plated Healthcare Plan

by LAS

The official language from Section 1312 of the Senate plan (HR 3590 ):
(D) MEMBERS OF CONGRESS IN THE EXCHANGE-
(i) REQUIREMENT- Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are--
(I) created under this Act (or an amendment made by this Act); or
(II) offered through an Exchange established under this Act (or an amendment made by this Act).

Some of us may be quite familiar with the fact that current members of Congress are covered under the Federal Employees Health Benefits Program. The program, which covers over 8 million employees of the federal government, is a private plan which is the envy of most non-governmental employees.

Congressional members may also choose to be treated at a military hospital or at the office of the Attending Physician of the U.S. Capitol for a fee.

Now when the provisions of the new law roll into effect, the Cadillac plan will be phased out and replaced with the same coverage given to the rest of America. You may read the notice posted at Congress dot org at http://www.congress.org/news/2010/03/25/how_will_lawmakers_insurance_change

Your Health Insurance Industry Spent $38 Million NOT on Health Care, but on LOBBYING Congress; and, Pre-existing Conditions Covered Only for Minors?

by L.A.S.

There is no recession in the lobbying industry. In fact, you might be cheered to note that the major insurers increased their lobbying budgets by anywhere from 7 to 80 percent. Yes, I said 80 percent. Little-big Humana upped its investment (ahem) in our Congress by 80 precent, to hit a mere $3.2 million dollars that might have paid for a life-saving surgery or two.

The increase looks large because their budget is tiny compared to America's Health Insurance Plans(AHIP), which spent a total of $8.9 million on lobbyists.

And what would YOU have done with that money? Probably spend it on worthless stuff like groceries and gas and rent -- nothing that helps the real economy grow.

But that is water under the bridge now and money gone down the tubes. It is spent, and we have to buckle down and make our voices heard above the din.

One of the things that has been quietly dropped in this season of healthcare reform is the notion of covering everyone regardless of pre-existing conditions. Now we find that only minors will be guaranteed that right. Yes, slipped in between the cracks of the newest version of reform poroposals is one that says children 19 and under will be guaranteed coverage without regard to any pre-existing conditions. According to another story on Alternet:

“The challenge for Democrats: a ban on denying coverage for those with pre-existing conditions went hand-in-hand with a requirement that all Americans carry insurance. Insurance companies conceded that they would accept all patients, regardless of health history, but only if everyone was required to have insurance, which would spread the cost of insuring the sick across a wider pool. Without an insurance mandate, a pre-existing ban would mean that premiums would almost certainly rise.”

Whoa. Wasn't that going to be UNIVERSAL, in those heady days when we thought that a major reform bill might get pushed through?
Insurers wanted that provision to be linked to mandatory purchase of insurance by everyone; that was the only way that risk could be spread out among the whole population.

Details of any reforms for this year (if any) are sketchy at best. But if this is the best that can be done for America, then I wonder if it is worth all the paper it will be printed on.

See whole stories at the AlterNet website at --
http://www.alternet.org/story/145389/are_democrats_dropping_the_ban_on_preexisting_conditions http://blogs.alternet.org/speakeasy/2010/01/25/health-insurers-spent-38-million-lobbying-congress-in-2009/

Things the Healthcare Reform Bill WON'T Fix, and a Handful of Things it WILL Fix and Quickly

by L.A.S.

The hard truth of the healthcare reform bill passed by the US Congress is that most of the provisions will not go into effect until 2014 (the House version would take effect in 2013).

The even harder truth is that even if it does become law, some things will still not be fixed. This is because the special interest groups lobbied hard and long so that their industry would not have to be the ones to pay for a national healthcare program.

As listed by economics writer Paul Zane Pilzer, these are the items that will still need reform. One wonders if the new bill is even worth all the paper and toner used to print it.

# The American Medical Association, representing doctors, was promised that nothing would be done to cut payments to physicians or tie doctor payments to performance.

# Trial lawyers were promised that no caps would be put on legal liability for medical mistakes.

#Big Pharma was promised that nothing would be done to their net revenues — even things like giving Medicaid patients generic vs. brand-name drugs were taken off the table.

# Local insurance companies were promised that they would not have to compete with larger national insurers over state lines.

# Medical network providers were promised that there would not be "transparency" — the varying charges medical providers give each patient would never be disclosed.

On the other hand, the bill does have the saving grace of offering consumers seven quick fixes that will go into effect almost immediately. My thanks to Congress dot org for posting this information.

1. Insuring high-risk citizens. Both bills would create a $5 billion fund for temporary insurance for citizens with pre-existing conditions who have not been insured for at least six months. The program would end once the insurance exchanges begin in 2013 or 2014.

2. Extending insurance for adult children. The House bill would allow parents to keep unmarried adult children on their health insurance until their 27th birthday; the Senate bill, until their 26th birthday. This would reduce the number of uninsured young adults.

3. Extending insurance for the recently unemployed. Under current law, laid-off workers are allowed to continue buying their existing insurance through the COBRA program for up to 18 months. The bills would extend that coverage until the insurance exchanges begin.

4. Ending lifetime limits on benefits. Both bills would end the lifetime caps on insurance coverage which have sometimes been used to deny payments to consumers with particularly expensive treatments. Both bills would also restrict annual limits on health-care benefits.

5. Ending rescission. Insurance companies often cancel policies for consumers who require expensive medical care because they made honest mistakes on their medical histories. Both bills would prohibit insurance plans from canceling coverage except in cases of fraud.

6. Starting to close the doughnut hole. Both bills would begin closing the so-called "doughnut hole" in Medicare Part D prescription drug coverage by providing an additional $500 in coverage starting in 2010. Over several years, the gap would be reduced until it was closed entirely.

7. Taxing plastic surgery. The Senate bill would include a new 5 percent tax on elective cosmetic surgery. The tax is estimated to raise $5.8 billion over the next 10 years. It does not apply to cosmetic surgery to fix problems caused by accidents, disease or birth defects.

So while the healthcare reform bill is far from perfect, it does have some redeeming value. Let us hope that this is only the beginning, and not the end, of healthcare reform.

Proposed Bill SB 1297 Would Give Tax Break for Annuities

by L.A.S.
You would get an fifty percent tax exclusion on your annuity under a pair of proposed Congressional bills called the Retirement Security for Life Act. Senators Kent Conrad of North Dakota and Senator Pat Roberts of Kansas are co-sponsors of this bill, SB 1297.
If you do not have an employer-sponsored retirement plan, you would benefit from this law. It provides for a fifty percent tax exclusion on up to $40,000 in annual income received from a non-qualified lifetime annuity.
A companion bill was introduced in the House, sponsored by Reps. Early Pomeroy of North Dakota and Ginny Brown-Waite of Florida.

What is in the New ARRA Law that Obama signed? Some details on COBRA changes, while we wait for details on implementation.

by L.A.S. --

While the thousand-page ARRA law (American Recovery and Reinvestment Act) became law on March 1, 2009 when President Barack Obama signed it on Feb. 17, your employer was awaiting the details on the law in order to be in compliance with it. This means as a practical matter that thousands desperately waiting for help in keeping up their former employer's insurance under COBRA provisions could not be assured of a smooth transition to the emergency provisions of the law.

The law itself is written rather vaguely and so employers are scrambling for guidelines on implementation of the new rules. Granted, the ARRA law was written under pressure and so some parts are less defined than others.

THE OLD COBRA LAW: a qualified beneficiary who elected to continue health insurance coverage under his former employer's group plan had to pay the full premium, plus a small percentage (two percent) toward handling fees.

THE NEW COBRA LAW: Employees who were terminated between Sept. 1, 2008 and Dec. 31, 2009 “due to an involuntary loss of employment” will have 65 percent of the premium subsidized by the federal government for a period of UP TO nine months. Included in the group of employees covered by this new provision are those former employees who already declined COBRA coverage. Former employees will be covered for a total of 18 months: nine months of subsidized coverage and nine months of unsubsidized coverage.

The subsidy is NOT available to employees whose modified adjusted gross income exceeds $145,00 (or $290,000 for joint filers). Those with incomes between $125,000 and $145,000 will see a proportional decrease in their subsidy.

The subsidy is supposed to paid out of credits against the employer's payroll tax liability. In other words this is an immediate tax exemption for the employer and should not be a crushing burden to them financially. Anyone who claims otherwise is not understanding the ARRA provisions.

To restate it more simply: eligible individuals pay 35 percent of the total premium while the employer pays the other 65 percent, which is then reimbursed to the employer as a tax credit.
Some confusion may exist over some proposals that did not become part of the final bill. One major item that was changed was the proposal to allow those former employees over age 55 to re-enter the COBRA umbrella of coverage, at least until they became Medicare eligible or obtained coverage through another employer. Again, that proposal failed to become part of the final bill.

Other proposals that died in the talking phase includes one that would have extended coverage under COBRA ; it would have been far too costly and would have essentially rewritten the whole COBRA program. While we might discuss such issues again one day, it was deemed entirely inappropriate for emergency or stimulus legislation.

Will the sickest former employees likely rush to get covered under this new COBRA provision? It is likely that the answer will be yes, just because of the fact that people with ongoing health issues need uninterrupted checkups and medications. People do not elect COBRA unless they already have health issues that make it difficult to be accepted for other health insurance policies.

Nevertheless, one must bear in mind that for most people, even those with serious health challenges, do recover and return to the realm of the healthy.

The other significant part of the ARRA bill which impacts health care costs is the provision to speed up conversion of medical records to an electronic, computerized form. Nineteen billion dollars was earmarked for this huge effort. We already have the proven example of the VA which has converted its medical records to an electronic format, and has seen it raise levels of accuracy and speed of transmission to other providers.

A major barrier to this conversion is agreeing on a format that is compatible with the majority of providers, and observing the laws regarding privacy and security of medical records as per HIPAA requirements. While the impetus for writing the HIPAA law was to maintain security of medical records when electronically submitted to insurers, it is at times used to block or deny proper access to those medical records.

Congress Overturns President’s Veto of the Medicare Bill

The House and Senate both voted today to overturn the President’s veto of H.R. 6331, (Rah! - L.A.S.) the Medicare package that includes the bidding changes and the physicians’ pay adjustment. The key HME provisions are described on the American Association for Homecare website at www.aahomecare.org.

The House voted 383 to 41 to override the President’s veto in mid-afternoon. The Senate then took up the debate in the evening and voted to over turn the veto by a vote of 70 to 26. With the two chambers voting by two-thirds majorities to override the President’s veto, the bill becomes law.

Thank you to all of the providers, state and regional associations, manufacturers, buying groups, consumer groups, disability organizations, and other stakeholders who have worked hard to accomplish this success for homecare providers and patients.
The American Association for Homecare will be working in the weeks ahead to ensure that patients and providers have minimal disruptions. Just today, AAHomecare met with the Acting General Counsel of the Department of Health and Human Services and was advised that if the override were successful, CMS would issue an immediate fact sheet on the impact of the legislation on providers.

This is a press release from AAhomecare.org -- Check www.aahomecare.org for continued news and details when they become available.