HHS Consumer Website Expected July 1; Will Include Data on Public, Private Plans

The Department of Health and Human Services plans to unveil the first iteration of a website designed to help individuals and small businesses find information about insurance options in their state by July 1, according to an interim final rule published in the May 5 Federal Register. The HHS Office of Consumer Information and Insurance Oversight will oversee the web portal that will provide consumers with state-based information about private insurance, high-risk pools, Medicaid, and the Children's Health Insurance Program—as required by the Patient Protection and Affordable Care Act (Pub. L. No. 111-148). To meet PPACA's July 1 deadline, HHS said it will require insurance issuers to submit needed information by May 21, such as product names and types, enrollment data, and product availability. The web portal will include information about plans' services, providers, and formularies, if available. The portal also will include information about eligibility and enrollment procedures for public programs.

Then, in October, HHS will expand the portal to include more detailed information about pricing and benefits, as well as more information about enrollment in public programs. HHS said that for plans offered in states without community rating, any information about premiums will be presented in terms of standard risks, even though insurers can vary rates based on health status. HHS also said it anticipates including medical loss ratio information through the portal, once regulations defining MLRs are promulgated. Under the reform law, insurers must spend a set percentage of premiums on health services, as opposed to administrative costs.

Comments on the interim final rule are due 30 days from its publication.
HHS also said it plans to offer training to states and health insurance issuers about the information that must be submitted for development of the portal.
The rule and further information about it are available at http://www.hhs.gov/ociio/gatheringinfo/index.html.

Read more!

HHS Sets Up Consumer Information & Insurance Oversight Office To Oversee Health Insurance Reforms

HHS is establishing an Office of Consumer Information and Insurance Oversight charged with developing and implementing major reforms affecting the private insurance market. The new office will design and administer the temporary high-risk pools, establish new rules on medical loss ratios and oversee the state-based health insurance exchanges.

As announced in the April 19th Federal Register, the new office will design and administer the temporary high-risk pools, establish new rules on medical loss ratios and oversee the state-based health insurance exchanges. A director has yet to be announced.

The director of the new office will report to the HHS secretary, according to an HHS Federal Register notice. Four deputy directors will head additional programs established under the new office, including: The Office of Oversight, Office of Insurance Programs, Office of Consumer Support and Office of Health Insurance Exchanges.

The Office of Oversight will be headed by a deputy director and will be responsible for implementing, monitoring compliance with and enforcing new rules governing the insurance market and medical loss ratios; performing rate reviews and issuing rate review grants to states.

The Office of Consumer Support, is to be led by a deputy director, will be responsible for collecting, compiling and maintaining comparative pricing data for the HHS Website; providing assistance to help consumers obtain the maximum benefits from the new health insurance system and establishing and issuing consumer assistance grants to states.

The Office of Insurance Programs will be tasked with administering the temporary high-risk pools and the early retiree reinsurance program.

And the Office of Health Insurance Exchanges will develop and implement policies and rules governing the state-based exchanges; establish and issue planning grants to states; and oversee the operation of the exchanges.

Read more!

House and Senate Pass Reconciliation Package

The Senate passed the reconciliation package 56 to 43 and sent it to the House where it was also passed.The bill will go to President Obama's desk where he is expected to sign it on Tuesday. Read more!

Arizona 1st State to Drop CHIP Program

Arizona Gov. Jan Brewer (R) has signed budget legislation that removes the statutory authorization for the state Children's Health Insurance Program (CHIP), thus making Arizona the first state to do so amid fiscal constraints. Brewer and Republicans who control the Arizona Legislature said the elimination of the program, known here as KidsCare, was necessary to help close the state's budget deficit, which is pegged at $2.7 billion in fiscal 2011 beginning on July 1. KidsCare would lose funding June 15.

Meanwhile, Arizona House Democrats, led by Minority Leader David Lujan and Assistant Leader Kyrsten Sinema, are working to head off the program's demise.
They asked House Speaker Kirk Adams (R) in a letter dated March 22 that the authorization be reinstated, and that funding be provided through repeal of a sales tax exemption on retail warranties.

The elimination, Democrats argue, may also have consequences beyond children's health, jeopardizing an estimated $7 billion in federal Medicaid matching funds to the state.
The federal health overhaul plan signed March 23 by President Obama requires states to continue “maintenance of effort,” or providing health care at the same funding level as when the legislation was signed. Elimination of KidsCare would put Arizona in violation of that new law, Democrats argue.

Other states, including California, have considered eliminating their CHIP programs, but none has done so.


Read more!

President Obama Signs Underlying Health Reform Legislation into Law

The President signed shortly before noon today into law the underlying Senate-passed health reform legislation--The Patient Protection and Affordable Care Act of 2010 (H.R. 8590). The President signed the bill on behalf of his "mother that while struggling against cancer, she still fought her insurance company;" on behalf of several specific individuals present at the White House ceremony who were uninsured or whose family members struggled in face of inadequate coverage; and on behalf of Presidents since Teddy Roosevelt, countless Congressional leaders, and Senator Ted Kennedy. The Senate will immediately take up the companion "sidecar" reconciliation package passed by the House late Sunday evening. The Senate is expected to finalize the reconciliation package--The American Health Reform and Education Affordability Act of 2010 (H.R. 4872) that makes "fixes" to the underlying Senate bill--by Saturday before joining House members for a two-week recess to work in their states. See ANCOR's health care website for ANCOR's first Issue Brief explaining many parts of the new legislation; text, summaries, and costs of specific provisions; and other timely information.
Read more!

House Passes Health Reform Sending Reconciliation Package to Senate

A divided House of Representatives voted March 21, 2010 on historic health reform by way of a two-track process: voting 219 to 212 to clear the Senate bill passed December 24th by a 60-vote super-majority and voting 220 to 211 pass a reconciliation package of fixes. The Senate-passed bill was sent immediately to the President who is expected to sign the legislation into law on March 23rd. However, the Senate must also pass the same reconciliation legislation. It begins floor consideration on March 23rd, where it faces an endless number of amendments and challenges to the Senate “Byrd rule” under reconciliation rules before the bill is required to be passed by a simple majority vote (51). If passed without any changes, the reconciliation package goes immediately to the President for his signature. See ANCOR’s March 9th Issue Brief on Reconciliation for discussion of the reconciliation procedure. See ANCOR links to legislative text and impact on entities.

Read more!

Employer and Individual Mandates in Health Reform

The employer responsibility provisions have been altered so that employers who do not offer coverage and have 50 or more employees would have to pay $2,000 per FTE (up from $750), if even one full-time employee get subsidies in the exchange. However, the first 30 employees would be subtracted from the total. These provisions were in the President’s February 24th proposal.

The health reform bill bill encompasses part-time workers when determining whether an employer would be considered a “large employer” (50 or more workers) subject to the tax. Employers who do offer coverage and have a FTE in the exchange must may a penalty of $3,000 per employee.

For the purpose of calculation on whether an employer is a “large employer,” the legislation requires employers to divide the aggregate hours worked by all part-time employees in a month by 120, and that number would be a full-time equivalent. The provision now raises $52 billion over 10 years, up from $28 billion in the underlying bill.

Summary of Employer and Health Reform Benefits and Requirements

The individual mandate will now be phased in. By 2017, the fee for not purchasing coverage will be the greater of $695 or 2.5 percent of income. The provision will now raise $17 billion over 10 years, up from $15 billion.

Summary of Shared Responsibility of Health Reform

Read more!

House to Vote Sunday Afternoon on Senate Health Reform Bill and Reconciliation

The House early Thursday afternoon unveiled a 153-page reconciliation package estimated to reduce the deficit by $138 billion in the first decade and $1.2 trillion in the second decade, a feat that has helped attract some Blue Dog “no” votes before an expected health reform vote after 2 PM on Sunday. The Reconciliation Act of 2010 (H.R. 4872), which costs $940 billion in the first 10 years (see CBO score), is very similar to President Obama's February 24th proposal.

Of the $940 billion, $434 billion over 10 years is new federal Medicaid money to cover Medicaid expansion, including newly eligible beneficiaries. In addition, the overall total includes $20 billion over 10 years in new state help. These additional Medicaid dollars do not include long term services dollars or disproportionate share hospital (DSH) payments. The cost of expanding coverage is shared between Medicaid and the new insurance exchange. For most states, only 4% of this Medicaid expansion will be state dollars, the rest will be federal Medicaid dollars for the next 10 years.

House and Senate staffers told ANCOR staff that if this bill does not pass, states will not see new money like this again.

The Senate bill and the reconciliation package will be combined, so the House only has to take one vote; however, Speaker Pelosi will not proceed on a vote until the Democrats reach 216 “yeas.” The Senate will then have to vote on the reconciliation package, which is likely to occur on Tuesday.

Related Summaries:
House Democratic Summary of Reconciliation Package
Health Reform Implementation Timelines
House Energy and Commerce Committee Benefits of Health Reform, District by District Impact Read more!

Confused About All the Talk About "Reconciliation"?--Let ANCOR Help!

ANCOR has prepared a new Issue Brief on the concept of "reconciliation" as an expedited Congressional process to pass legislation that targets deficit-reduction. Read more!

Senate and House Take Formal Steps Toward Passage of Health Reform

In a letter Thursday afternoon to Senate Minority Leader McConnell (R-KY), Senate Majority Leader Reid (D-NV) stated formally for the first time that Democrats plan to use reconciliation. Meanwhile, House Majority Leader Pelosi (D-CA) told her Democratic rank-and-file members Thursday morning that it would have a week to review and discuss a final package of changes to the Senate-passed health care overhaul bill. Language for a health reconciliation bill could go to the House Budget Committee Monday or Tuesday. The committee is required to give 24 notice before taking up the reconciliation bill and a 48-hour wait period before the House Rules Committee takes action. Whether the House can meet the President's deadline for a vote on the Senate-passed bill by next Friday and completion of final passage by Congress by the Easter recess remains to be seen.
Read more!

New CBO Estimate for Senate Health Reform Bill Is $875 Billion

The Congressional Budget Office released a new estimate of the Senate's health care bill Thursday that showed it would save less money. The non-partisan CBO originally estimated that the Senate's health care bill would cost $871 billion over a 10 year period. The figure will play into the health reform debate as House leaders whip their members to support the Senate bill. But what lawmakers are really waiting for from CBO is its score of President Barack Obama's proposed fixes to health care legislation.
Read more!

House Begins Walk-Through of Health Reform Package While House and Senate Democrats Await CBO Cost Estimates Due Out Thursday

House Speaker Nancy Pelosi (D-CA) will start walking her rank-and-file members through major components of the final health care package in a meeting Thursday morning. The briefing comes after another long negotiating session with Senate Democrats and top White House officials in Pelosi’s Capitol office. Meanwhile, Democrats are watching out for two Congressional Budget Office (CBO) cost estimates today on health overhaul measures, an update of the Senate-passed bill and a plan incorporating changes called for by President Obama. The two chambers are trying to resolve a long list of differences, both big and small, between their two bills and discussing changes made through a "reconciliation" process. All parties stated Wednesday that tremendous progress had been made, particularly with issues sensitive to House members who are going to be asked to vote on the Senate-passed version as well as a "side car" bill of changes (reconciliation bill) to deal with issues sensitive to the House in the Senate-passed bill. The changes expected in a reconciliation bill include those the President set out in his February 22nd $905 billion proposal and changes needed to gain House votes--while not upsetting the delicate balance needed to gain 51 votes in the Senate. President Barack Obama pressed Senate Majority Leader Harry Reid Wednesday to go further than Obama had previously disclosed to strip the final reform bill of narrow deals aimed at appeasing specific senators. Read more!

Providers Should Press for State Protection of Services and Supports

CMS March 5th letter to Medicaid Directors affirms HHS announcement regarding additional Federal Relief to states due to ARRA FMAP application to state Medicaid “Clawback.” As ANCOR reported in past WIC’s Updates, HHS announced on February 18th that it would provide $4.3 billion in fiscal relief to states by applying ARRA increased FMAP to the so-called clawback payments states pay to the federal government as required by the Medicare Prescription Drug Improvement and Modernization Act of 2003 that added Medicare cost of assuming drug costs for dually eligible Medicare/Medicaid beneficiaries.The recalibrations mean decreased state contributions for the increased federal FMAP. Providers should take this opportunity to use the additional federal assistance to protect services, supports and rates for individuals with disabilities.
Read more!

President Obama Calling for Passage of Health Care Bill by March 18th

While deadlines on the overhaul of health have been set repeatedly and unmet repeatedly, the President wants the House to clear the Senate-passed bill by the 18th. Having decided on a two-step process to complete comprehensive health care reform, Democrats plan on using the Senate-passed bill as the foundation bill and passing a side-car bill with changes to the Senate bill agreed to by the administration, House and Senate. House Speaker said she could not guarantee a House vote by the 18th, but expected such a vote before the Easter recess. Obama held a meeting Thursday with a mix of House Democrats in order reverse some previous House "no votes" and potential new House "no" votes to gain the necessary 217 votes to clear the Senate bill with reconciliation changes.
Read more!

Senate will take up S. 4213 Thursday morning

The Senate adjourned Wednesday at 8:00 p.m. after considering numerous amendments to the larger $149 billion jobs bill (S. 4213)which extends many tax cuts and federal funding from programs until December 31st -- including temporary federal assistance in the form of enhanced FMAP to states. It will resume consideration of the $149 billion larger jobs bill with FMAP extension on Thursday. Once it passes, the House will take up the measure.


Read more!

Democrats Readying to Move on Comprehensive Health Care Plan

Senate Majority Whip Durbin (D-IL) said Wednesday that House and Senate were “coming to closure” on revised language for comprehensive health care legislation that most likely could muster sufficient votes to pass both chambers—most likely using expedited budget reconciliation procedures. He said that Democratic leaders expect to send legislative language by the end of the week soon to the Congressional Budget Office (CBO) for cost estimates. The process would be at least a two-step process with the House passing the Senate-passed bill and both chambers passing House fixes or Administration changes (amendments to the base Senate bill) as a “side-car” reconciliation bill that allows legislation to avoid filibusters and pass with a simple majority.
Read more!

Health Summit Yields No Bipartisan Accord and Sheds Light on Divergent Party Philosophies on Health Care Reform

President Obama and congressional Democrats and Republicans debated health care reform for more than six hours February 25th, but as expected, the meeting did not bring the parties closer to a bipartisan agreement on reform legislation. While participants of the summit found some areas to which there were broad agreement, Republicans stated that they wanted the President to scrap the Senate-and House-passed legislation and White House proposal released on Monday and begin anew with an incremental approach to health care reform. Obama ended the unprecedented, day-long session by saying Democrats and Republicans likely could agree on several reform issues, and he called on Republicans to provide solutions over the next month to six weeks on how to extend coverage to more Americans than under the House GOP bill. If a bipartisan agreement cannot be reached, “then I think we have to go ahead and make some decisions,” the president said. “We cannot have another year-long debate on this.” While some expect the next step will be House and Senate Democrats agreement to the Senate bill and then passage of a "reconciliation" bill with fixes negotiated by Congressional Democrats and the Administration, others are reporting that the President has already prepared a fall-back, scaled down version of health care that would provide coverage to 15 million people rather than 31 million that he might consider should other choices fail to gain enough Congressional support.

Read more!

Health Care Summit Thursday Likely to Determine What's on the Table Friday

President Obama invited a host of Congressional leaders to take part in the six-hour meeting, released his health care proposal on Monday, and invited Republicans to do the same. The meeting centers on four health care reform topics — cost control, insurance reforms, deficit reduction and expanded coverage — with Obama, Health and Human Services Secretary Kathleen Sebelius and Vice President Joseph Biden taking turns introducing each topic. While the "bipartisan health care summit" takes place Thursday, the defining moment will come the day after, when Democrats decide once and for all whether they can "go it alone" or try for Republican support to pass a bill.

House Democratic participants include House Majority Whip Clyburn (SC), Speaker Nancy Pelosi (CA), Majority Leader Steny Hoyer (MD), and Representatives Rangel (NY), Miller (CA), Waxman (CA) and Dingell (MI). Republicans include House Minority Leader Boehner (OH), Minority Whip Cantor (VA.) and Representative Camp (MI.), Barton (TX) and Kline (MN).
Senate Democratic participants include Majority Leader Reid (NV), Majority Whip Durbin (IL) and Senators Baucus (MT), Dodd (CN) and Harkin (IA).

Republicans include Minority Leader McConnell (KY), Senate Minority Whip Kyl (AR) and Senators Grassley (IA) and Enzi (WY).

In addition, House and Senate leaders from both parties were each allowed to bring four lawmakers to represent their chamber. House representatives include Representives Becerra (D-CA), Cooper (D-TN), Slaughter (D-NY), Andrews (D-NJ), Boustany (R-LA), Ryan (R-WI, Blackburn (R-TN) and Roskam (R-IL). Senate representatives include Schumer (D-NY), Murray (D-WA), Rockefeller (D-WV), Coburn (R-OK), Alexander (R-TN), John McCain (R-AR), Conrad (D-ND) and Barrasso (R-WY).
Read more!

Senate and House Democratic Leaders Continue to Move Health Reform Process Forward

The leadership of both chambers are negotiating a pathway to resume passage of comprehensive health reform that includes significant provisions related to long-term services' issues. House Democrats remain reluctant to pass the Senate bill without assurances of changes.

In order to avoid an expected 60 vote cloture to end a filibuster Democratic leaders are still pursuing a path in which the House would agree to the Senate bill, but make changes through "the reconciliation process" that would require only 51 votes. Given the level of mistrust between the two chambers, the House wants the Senate to vote first on a reconciliation package that would modify the Senate bill's provisions including the so-called "Cadillac tax" on insurance plans costing more than $8,500 for individuals and deeper subsidies for low-income beneficiaries.

Meanwhile the Senate is pivoting to job creation bills while substance and process are worked out. Read more!

President Obama Includes FMAP Extension in Budget

President Barack Obama's FY 2011 Budget endorses and includes a $28 billion six month extension of Enhanced Medicaid (FMAP). Without this provision, states would have been expected to make dramatic budget cuts this session to make up for the sudden loss of federal revenue that had previously sustained earlier recession budgets.

The FMAP extension had earlier been passed twice (most recently in December 2009) by the U.S. House of Representatives, but was stalled in the Senate with the aftermath of the demise of the current Health Care Reform bill.
Read more!