Senate Health Care Debate Stalled This Week With GOP Request to Read Aloud 767-Page Healthcare Amendment

Senator Bernie Sanders (I-VT) offered a scheduled amendment to the Senate’s health care bill Wednesday to create a single-payer health care system under Medicare. However, in a rare move, Senator Tom Coburn (R-OK) objected to a routine request to waive the reading of the amendment by the clerk—a reading which was expected to last until midnight. After three hours of the reading of the amendment, Sanders withdrew his amendment. Republicans requested the reading both on the grounds of transparency and as a means of delaying Senate action to file cloture on the Defense Appropriations bill and further action on the health care bill.

In addition, Senator Coburn has made two unanimous consent requests—(1) all amendments considered to the health care bill in the future must be available online 72 hours ahead of time and 2) be fully scored by the Congressional Budget Office (CBO). This week’s request by Coburn to read the Sander’s amendment aloud may be used again regarding Reid’s health care manager’s amendment or other Senate action to be taken up before Christmas.

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Senate Short One Vote to End Several Health Care Filibusters

Following last weekend’s unexpected announcement by Senator Joe Lieberman (I-CT) that he would not accept new provisions (i.e., opening Medicare to individuals aged 55-64 or a public option in a manager’s amendment to the Senate health care legislation), Senate Majority Leader Reid (D-NV) brokered a deal earlier this week with Lieberman that brought the total of votes needed for cloture (ending filibuster) to 59. However, Senator Ben Nelson (D-NE) appears to be the lone hold-out on the 60 Senators who caucus with Democrats needed to end the first of several cloture votes (ending filibuster) in the Senate’s adoption of health care legislation by Christmas. Among the issues over which Nelson has concerns include the abortion language, Medicaid expansion, public option, and taxes.
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Senate Health Care Bill A Moving Target, Still Evolving and Awaiting CBO Scoring on Reid Manager’s Amendment Before Continuing Action on HealthCare

Last week Senate Majority Leader Reid (D-NV) announced work he had completed on a manager’s amendment to the current Senate health care legislation that has been under debate for three weeks. He had requested the Congressional Budget Office to score changes in the manager’s amendment—expecting scores back last weekend. However, to date, the Senate is still awaiting the CBO scores and all details of the tightly-kept manager’s amendment. No one knows what is or will be in the manager’s amendment (i.e. changes to mandates on individuals rather than employers, penalties on employers, or excise tax on individuals with health care plans exceeding $8,000)—especially with individual negotiations ongoing with some Democratic Senators.

The latest word is that the manager’s amendment and CBO scores will be released Saturday with the first cloture vote to take up the amendment on Monday. With a total of three cloture votes to end filibusters needed before a final vote on a Senate bill, Reid has said the vote may occur Christmas Eve, Christmas Day, or on December 28th. Keep in mind that although 60 votes are required to close filibusters, it would take only 51 votes to pass final legislation. It is possible that either Senator Ben Nelson (D-NE) or Senator Snowe (R-ME) could agree to be the 60th vote to end cloture, but still vote against the final legislation.

After the Senate adopts its bill, differences with the House-passed bill must be ironed out or, as we usually think about the two chambers passing different versions of a bill, going through a conference committee to develop one single bill to be passed by both chambers. However, Congressional Democratic leaders are talking about a ping-pong-ping approach which would bypass the usual conference committee process. In this scenario, the Senate would send its bill to the House and request them to pass the Senate. House members would likely make some marginal changes--but would still have to garner 218 votes to pass the bill. If the House makes changes, then the bill would have to go back to the Senate for another vote. This ping-pong-ping approach would likely occur in late December or early January--in time for President Obama to claim victory on healthcare legislation before his State of the Union Address. All of this depends on some timely votes and negotiations with the Democratic party and between the two chambers.

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House Recesses After Adopting Four Bills on Wednesday—Including FMAP Extension—Senate Likely to Take Up All But FMAP Extention This Weekend

After passing four bills—clearing a short-term $290 billion increase in the $12.1 trillion statutory limit; a $150 billion jobs package with $23.5 billion in a six-month extension of ARRA’s FMAP increase, $75 billion for infrastructure projects, and state assistance for police, firefighters, teachers, and other government workers; a Defense spending package extending unemployment insurance and COBRA; and a five-day continuing resolution—the House began its end-of-year recess. However, depending upon Senate action on health care or consideration of other bills, the House may return next week or anytime before its scheduled return on January 12th. Senate work on the Defense package, continuing resolution and debt measures are expected to begin 1:00 a.m. on Saturday morning and run through the weekend. The Senate is not expected to take up the House jobs package—preferring to develop their own jobs package with Senate Finance Committee on any tax incentives or FMAP extension. Read more!

Recession Continues to Batter State Budgets

The Center on Budget and Policy Priorities (CBPP) updated its state fiscal report on December 18th projecting budget gaps for this year and next year combined for a total of more than $350 billion. Although the ARRA fiscal relief to states mitigated states’ fiscal problems—closing state-shortfalls by 30-40%--states are continuing to cut services like education and health care as they implement 2010 budgets. Additional cuts are likely for 2011.was enough to close 30-40% of state shortfalls. More than 30 states have raised taxes and several are considering similar measures. Visit the website for the complete updated policy brief.
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President Nominates ANCOR Member Blumenthal and SABE President as New Members of the National Council on Disability

President Barack Obama announced December 16th his intent to nominate a number of individuals to key administration posts. Among the appointments is that of Gary Blumenthal to the National Council on Disability (NCD). Gary is the Executive Director of the Association of Developmental Disabilities Providers (ADDP), located in Waltham, Massachusetts and Chester Finn, Special Assistant with the New York State Office of Mental Retardation and Developmental Disabilities and President of the Safe-Advocates Becoming Empowered (SABE). Congratulations to Gary and Chester! See White House press release on announcement of all appointees.
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FY 2010 ANCOR State Budget Survey

The purpose of this survey is to continue ANCOR's quarterly efforts to collect information from individual providers and state associations on FY 2010 state budgets and mid-year state FY budget adjustments (announced or anticipated cuts) and their effects on disability providers' capacities to support individuals with disabilities of all ages.

There are "inside beltway conversations" by economists and public-interest "think tanks" with some key Congressional leaders about a one-year extension to the American Reinvestment and Recovery Act (ARRA) federal, Medicaid temporary increase to states (FMAP). These discussions are occuring very early in the process (ANCOR is a part of these) with rumors that no real movement will take place until after the first of the new year. There is very mixed Congressional interest regarding FMAP extension and a state stabilization fund with some in leadership stating that it will be either a FMAP extension OR a broader, more flexible state stabilization fund, but not both.

The information we are asking in this survey will help ANCOR demonstrate in the coming weeks to Congress the case for FMAP extension on behalf of state need, but even more importantly, on the specific direct effects on individual providers and individuals with disabilities.

Please complete this online survey by December 31st!
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WICS Live: Around the States

Washington: Large Waiting List for State’s Basic Health Program. As of mid-November, nearly 78,500 residents were on a waiting list for the program, which provides low-cost health care coverage to eligible state residents. That’s about as many that are current enrolled in the program. Recent state budget cuts are forcing the program to trim its rolls, rather than accept new members. As of July 1st, the program was subject to a 43% budget cut—the same time as the poor economy leaves more state residents without health insurance. In addition, current enrollees will face premium increases as of January 1st, which state officials believe will result in a drop in enrollment. Read more!

WICS Live: Around the States

Tennessee: AccessTN Opened to Children with Chronic Medical Needs. Because the state has frozen enrollment in its CoverKids program as of November 30th because it reached its budgetary limit, the state December 3rd opened enrollment in AccessTN, the state’s high risk pool to children with chronic and acute conditions who would normally be eligible for the state’s expanded CHIP. Read more!

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Montana: Healthy Montana Kids Faces Backlog of Applications. Montana: Healthy Montana Kids Faces Backlog of Applications. The program, which voters approved in 2008, had the goal of covering an additional 29,000 children by expanding Medicaid and the state’s CHIP. Currently, more than 2,300 families have applied to the program as of September, but only 740 children have been added due to a problem with a computer program. Read more!

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Hawaii: With Existing Employer Insurance Mandate, States Looks to Opt Out of National Reform. For 35 years, the state has had a law on the books with an employer health insurance mandate. As a result, the state has one of the lowest uninsured rates in the nation. The Hawaii congressional delegation has inserted language into the House and Senate bills to protect the state’s Prepaid Health Care Act of 1974, should national health reform legislation pass. Read more!

WICS Live: Around the States

Georgia: State’s Own Health Reform Efforts Result in Savings. Figures released November 12th show that the state saved between $123 million and $140 million over the past fiscal year by reforms implemented in the state’s Medicaid and PeachCare for Kids programs. Both programs utilize a concept called care-management organizations, which require a high level of interaction with beneficiaries and encourage healthful habits and increased interaction with their primary care physicians, rather than emergency rooms. Read more!

WICS Live: Around the States

New Report Shows 11 States Emerging from Recession. According to a November report from MoodysEconomy.com, Alaska, Idaho, Indiana, Iowa, Louisiana, Mississippi, Missouri, Montana, Nebraska, North Dakota, South Dakota and the District of Columbia are showing signs of economic recovery, based on several factors, including employment rates, home prices, manufacturing, and home construction. While the recession is moderating in just about every other state, the one state still in the grip of recession, according to the report, is Nevada. Read more!

WICS Live: Around the States

Nine Other States Facing Budget Crisis of Par With California. A new Pew analysis has found that nine other states are on the edge of financial disaster and urges state legislatures to act quickly. The report identifies Michigan, Arizona, Florida, Illinois, Nevada, New Jersey, Oregon, Rhode Island, and Wisconsin as states in dire fiscal situations. These states all rely heavily on one type of industry, a history of persistent budget shortfalls. Compounding the historical problems are widespread home foreclosure, rising unemployment, and poor financial management. View the report. Read more!

WICS Live: Around the States

New York: Governor Signs Bill Further Reducing State Budget. Governor David A. Paterson (D) December 4th signed a package of bills to reduce a mid-year $3 billion budget shortfall. The new law includes $107 million in reduced Medicaid and health care spending. The bills also would raise the fraud recovery target for the Office of Medicaid Inspector General by $150 million for the current fiscal year, which ends March 31. The state will save $21 million by eliminating the 2010 trend factor in Medicaid reimbursement rates in 2010 for hospitals, nursing homes, and home and personal care providers. Other savings, under the bills, include $18.5 million by reducing pharmacy reimbursement rates under Medicaid and the state's Elderly Pharmaceutical Insurance Coverage (EPIC) program. The budget cuts were far less than those proposed in November by Paterson, who called for $280 million in Medicaid and health care reductions. Read more!

WICS Live: Around the States

Nebraska: Governor Proposes Additional Spending Cuts. Facing a $334 million shortfall in the state’s biennial budget, Governor Dave Heineman (R) November 3rd proposed widespread budget cuts for lawmakers to consider. He said that he would oppose any legislative plan to increases taxes to address the budget deficit. Read more!

WICS Live: Around the States

Mississippi: More Budget Cuts as State Budget Revenue Continues to Fall. Governor Haley Barbour (R) made a second round of budget cuts in early December, totaling $54.3 million. The latest round of cuts includes a 5% reduction to most state agencies and programs, including Medicaid, which will be effective in February. Overall, the Governor has cut $226 million from the state budget this year. However, there is a $160 million budget shortfall remaining. Barbour has said that he has made all the cuts he can under existing law and it will be up to legislators when they return to session in January to address the shortfall in order to have a balanced budget. Read more!

WICS Live: Around the States

Indiana: Healthy Indiana Plan Will Enroll 5,000 More. The Indiana Family and Social Services Administration November 6th announced that 5,000 Healthy Indiana Plan (HIP) enrollment slots have been opened to childless adults. The program, which began in January, currently enrolls more than 46,000 adults. The 5,000 slots opened up largely through attrition in the program. The program is open to childless adults who earn less than 200% of the Federal Poverty Level and who have been uninsured for at least six months; participants pay 2-5% of their income for program coverage, which includes hospital and physician services, and prescription drugs. Read more!

WICS Live: Around the States

New Income Eligibility Information for Medicaid & State-Funded Coverage for Adults Available by State from Kaiser Commission on Medicaid and the Uninsured. Read it. Read more!

WICS Live: Around the States

Enhanced FMAP Rates for Second Half of FY 2009 Published. The American Recovery and Reinvestment Act of 2009 (ARRA) increased states federal Medicaid matching rates by 6.2%, with additional increases depending on unemployment. The recession adjustment period included in ARRA began October 1 and will end December 31. Rates are available from the Federal Register. Read more!

WICS Live: Around the States

Despite Budget Struggles, 26 States Expanded Medicaid/SCHIP with Help from Federal Stimulus Funds. See December 8th survey by the Kaiser Family Foundation. Read more!

WICS Live: Around the States

States Continue to Face Fiscal Difficulties in the Face of Medicaid Enrollment and Spending Increases. A November 12th report from the National Governor’s Association and National Association of State Budget Officers finds that states continue to cut expenditures, and still face $14.5 billion in budget shortfalls in FY 2010 and at least $21.9 billion in funding gaps for FY 2011. Medicaid Is projected to grow at a rate of 6.6% in FY 2010. The reports are available at http://www.nga.org/ Read more!

WICS Live: Around the States

Wisconsin: State May Need to Cut $1 Billion From State Medicaid Programs. Over the next eighteen months, the state may be forces to make cuts to BadgerCare Plus, Family Care, SeniorCare, and other programs. For months, the state has been working to find approximately $608 million over the next two years. The state has identified 66 cost-saving measures so far, hoping to avoid service cuts or reductions in provider reimbursements. One of the largest savings will come from one-time accounting changes, delaying payments until the new state budget beings in July 2011. The shortfall is coming when more state residents are seeking to enroll in the programs because of the economy. About 700,000 residents were enrolled in BadgerCare Plus as of November 30th—nearly 70,000 more than in January 2009. The sharp increase in program enrollment will force the state to find an additional $450 million in savings or make program cuts. Read more!

WICS Live: Around the States

Oklahoma: State Board Cuts $17M from Medicaid Program. On December 10th, the Oklahoma Health Care Authority board voted unanimously to make cuts in services that may affect 700,000 SoonerCare beneficiaries. The cuts, which will take effect January 1st, come after Governor Brad Henry (D) and the state Legislature ordered state agencies to reduce the remainder of the year's budget by 5%. At present, the Authority’s board did not vote to reduced provider reimbursement rates, but those reductions could be on the table if budget issues remain. Read more!

Wics: Around the States

Louisiana: State Facing $306 Million Medicaid Shortfall. To make up for a mid-year shortfall, the state plans to dip into one-time revenue sources and cut mental health, public health, and prescription drugs, the state Department of Health and Hospitals announced in mid-November. The Department attributed to the mid-year shortfall to treating the H1N1 epidemic , to community-based programs for individuals with disabilities, which are over-budget by $44 million, and the economic downturn, which has added 22,000 to the state Medicaid rolls since July 1st. Read more!

WICS Live: Around the States

California: State Seeks to Restructure Medi-Cal Waiver Through 1115 Waiver. The state announced last month that it intends to seek a waiver from the Department of Health and Human Services to overhaul the state’s Medicaid program. The waiver would replace the state’s current Section 1115 Waiver, which is set to expire August 31, 2010. In addition to slowing the growth of spending, the goals of the overhaul include creating a more accountable, streamlined system of care, reward quality, and expand coverage to uninsured residents. A core component of the plan is to reduce expenditures for “high-cost beneficiaries” and provide better coordinated care to these individuals and well as people with disabilities, children with special health care needs, and dually eligible individuals. A draft of the waiver proposal is available online at http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx Read more!