Cost, Not Universal Coverage, is Top Health Care Concern for Voters

Another survey shows that many of the survey numbers uses to show support for the proposed healthcare reform are only part of the message. It seems that very few surveyed top concern is quality of care or inconvenience of the current system. Overall people are concerned with the tax hikes associated with the plans. Some people say this comes down to party lines but look at the unaffiliated voters: 50% to 30% do not want the reform with tax hikes and two-to-one want to keep current coverage verses reform. So, when you hear surveys that 61% to 70% of Americans want reform, look further into the number to see what they really want!

Rasmussen Reports Saturday, July 18, 2009

Sixty-one percent (61%) of voters nationwide say that cost is the biggest health care problem facing the nation today. The latest Rasmussen Reports national telephone survey finds that just 21% believe the lack of universal health insurance coverage is a bigger problem.

Only 10% believe the quality of care is the top concern, and two percent (2%) point to the inconvenience factor of dealing with the current medical system.

Given a choice between health care reform and a tax hike or no health care reform and no tax hike, 47% would prefer to avoid the tax hike and do without reform. Forty-one percent (41%) take the opposite view.

The opposition is stronger when asked about a choice between health care reform that would require changing existing health insurance coverage or no health care reform and no change from current coverage. In that case, voters oppose reform by a 54% to 32% margin.

Surveys released at the end of this past week show that 78% believe the passage of health care reform is likely to mean middle-class tax hikes. Also, by a 50% to 35% margin, Americans oppose the creation of a government insurance company to compete with private insurers.

Polling released earlier in the week found that 46% favored the health care plan working its way through Congress while 49% were opposed. However, there have been many developments on Capitol Hill since that survey was completed. Updated polling will be conducted next week.

On all questions in the new survey, there are huge partisan differences with Democrats holding one view while Republicans and voters not affiliated with either party hold another.

On the question of the biggest health care problem, Republicans and unaffiliated voters overwhelmingly say cost is number one. While Democrats lean in that direction, they are much more evenly divided. Fifty-two percent (52%) of those in President Obama’s party say cost is the top concern, but 35% think it’s the lack of universal coverage.

On the trade-off with taxes, 73% of Democrats would rather have reform and a tax hike while 79% of Republicans say the opposite. As for unaffiliateds, they side with the GOP by a 50% to 30% margin.

On the trade-off between reform and keeping your current insurance coverage, Democrats opt for reform by a two-to-one margin. Unaffiliated voters prefer keeping their existing insurance coverage by two-to-one. Republicans overwhelmingly prefer to maintain their current insurance.

Earlier surveys have shown that health care reform is the top priority for Democrats. But Republicans and unaffiliated voters view deficit reduction as more important.

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NAIC Blasts Health Czar

The Association of State Insurance Commissioners are coming out against the centralization of healthcare the House is proposing. They argue that the proposed Health Choices Adminstration "would merely add more regulation and cost without enhancing consumer protection.” Are they listening?

Posted on lifeandhealthinsurancenes.com

By ARTHUR D. POSTAL Published 7/16/2009

WASHINGTON BUREAU -- The National Association of Insurance Commissioners is asking the leaders of 3 House committees to give up the idea of creating a separate federal agency with strong powers to oversee health delivery.

The proposal is in Section 141 of the “committee print” of H.R. 3200, “America’s Affordable Health Choices Act,” the health system bill now being marked up in the House.

The provision would create the Health Choices Administration, an independent federal agency headed by a commissioner appointed by the president.

The HCA would have market conduct oversight authority as well as authority to establish standards for operation of the public health coverage plan that is part of the House bill.

The HCA also would have authority to establish standards for qualified private plans and oversee the health insurance exchange that would serve as an Internet-based clearinghouse for health insurance information and choices.

The House Ways and Means Committee is meeting today to mark up the finance-related sections of H.R. 3200.

The House Energy and Commerce and Education and Labor Committees will mark up their portions of the bill next week.

The plan is to have the bill ready for floor action by next Thursday.
In a letter sent to the chairmen and highest-ranking members of each of the House committees drafting the final bill, Sandy Praeger, the Kansas insurance commissioner and chairman of the Health Insurance and Managed Care Committee at the NAIC, Kansas City, Mo., argues that the HCA would merely add more regulation and cost “without enhancing consumer protection.”

Praeger cites what she says are the “egregious failures” created by the inability of the federal Centers for Medicare and Medicaid Services to properly oversee marketing of Medicare Advantage plans.

Reliance on federal Medicare Advantage oversight left “millions of seniors exposed to deceptive, fraudulent and abusive sales tactics that would have been prevented had the states been allowed to act,” Praeger writes.
The NAIC believes that a single federal blueprint is unlikely to be effective in every state because “health care delivery systems, demographics, rural and urban mix, economies and labor markets are distinctive and regulations that fail to take those distinctions into account will damage markets and consumers,” Praeger writes.

The House bill would give the proposed HCA director no guidance about the content of health coverage standards, “making it probable that these standards would change dramatically with each new administration,” Praeger writes.

Praeger also warns that healthy consumers may opt to pay the modest annual penalty the bill would impose on individuals without acceptable health coverage rather than pay much more to buy health insurance.
That would cause “adverse selection that increases the cost of coverage for all and defeating the purpose of the requirement that all Americans obtain coverage,’ Praeger writes.

Lawmakers reject tax to pay for health reform

It seems interesting that Washington changes their story on healthcare almost daily, here is the latest. I find interesting is that they keep pointing to the problem of the "Cadillac Plans". In most cases, where do you find these "Cadillac Plan", they are the ones offered to government employees and to union members. These group are often discussed as posssibly exempted from the new proposals. Interesting!

Sun Jul 12, 2009 3:55pm EDT By David Alexander
WASHINGTON (Reuters) - U.S. lawmakers on Sunday criticized a plan to raise taxes on the wealthy to pay for a $1 trillion healthcare overhaul and warned Congress was unlikely to meet President Barack Obama's goal of passing the measure by August.

Republican Senator Judd Gregg said finishing a healthcare bill by Congress' August recess was "highly unlikely" because the Senate Finance Committee had not yet completed a draft. Senator John Kyl, the Republican whip, said there was "no chance" it would be done before the break.
"President Obama was right about one thing. He said if it's not done quickly, it won't be done at all. Why did he say that? Because the longer it hangs out there, the more the American people are skeptical, anxious and even in opposition to it," Kyl told ABC's "This Week" program.
Obama has made healthcare reform his top legislative priority and hopes to sign the bill in October. The United States spends more than $2 trillion annually on healthcare, twice any other nation, but it ranks worse than most developed countries on measures of health like life expectancy.

Some 46 million are uninsured and have little access to routine healthcare, relying instead on costly emergency room visits.

Committee leaders in the House of Representatives plan to introduce a healthcare overhaul measure on Monday and consider amendments later in the week, even as they search for ways to fund the 10-year program.

Representative Charlie Rangel, head of the House Ways and Means Committee, said the bill would include a tax on Americans earning more than $350,000 per year that would raise $540 billion over 10 years. The tax would begin in 2011 and have higher rates at the $500,000 and $1 million income levels.

'CADILLAC' PLANS
Asked if Obama would support Rangel's tax proposal, Health Secretary Kathleen Sebelius said the U.S. leader wanted to pay for the healthcare overhaul by finding savings in the system and cutting tax deductions claimed by rich Americans, but he was open to other options.

"President Obama has outlined his preferred payment plans," Sebelius told CNN's "State of the Union" program, adding that Obama had found $660 billion in savings within the existing system and proposed to raise another $330 billion by capping the itemized tax deductions of wealthier Americans.

"I think the bottom line is, it's got to be paid for," Sebelius added. "We all need to play a role."
Pressed on whether the president could support Rangel's approach, Sebelius said, "I think everything is on the table and discussions are under way."

Representative Eric Cantor, the second-ranking Republican in the House, told the "Fox News Sunday" program Rangel's bill included an "incredible half a trillion dollar tax on folks making over $200,000 a year."

"Half of those people are the ones making the decision as to whether to hire Americans or not," he said, asking why the government would make it more difficult for them to hire people now out of work due to the recession.

Senator John Kyl, the Republican Whip, also flatly rejected any such tax increase.
"We're in a recession," he told CNN. "It would be a job killer. It would be exactly the wrong thing to do any time, but especially when we're in the middle of a recession.

Senator Richard Durban agreed, telling ABC's "This Week" show, "I think we're going to have a different approach." He did not spell how he would raise new revenue for the program.
Senator Lamar Alexander said he would favor limiting tax deductions on high-priced employer-sponsored health insurance plans -- so-called "Cadillac" plans. Healthcare benefits for employees are currently tax deductible, and some argue the costliest plans encourage wasteful healthcare spending.

Alexander said he would use the revenue gained from the plan to give money to all Americans to be used toward the purchase of purchase private insurance.

"I'm willing to stop giving tax deductions to people for Cadillac health insurance plans in order to give everybody a chance to buy their own health care insurance and not add a penny to the debt. I think that would be a good way," Alexander said.

Democratic Senator Debbie Stabenow rejected that approach, telling CNN, "The one thing that is off the table is taxing employee benefits."

This Week in Health Reform

In this article, provided by Anthem Blue Cross, gives an overview of healthcare debate in Washington. It seems that the President is still trying to jam socialized medicine down our throats. Another interesting fact, is that the huge profits that the carriers are suppose be getting is only 3 cents on the dollar.

As Congress returned to Washington after the Fourth of July Recess, the aggressive timetable set to pass bipartisan legislation by the end of the summer suffered a setback on Wednesday as key senators expressed doubt as to whether they could hammer out legislation in this short amount of time. The White House continues to push Congress to stick to its timetable.

While Congress considers health care reform options and how to pay for them, it's important to keep in mind that insurer profits - typically blamed for rising health care costs - in fact have little impact on health care premiums. According to PricewaterhouseCoopers research from 2008, only three cents of every health care premium dollar is spent on health insurer profit.

Public Plan

Obama Reaffirms Support for Public Option: Backing away from earlier comments made by White House Chief of Staff Rahm Emanuel indicating the government would be open to a health reform plan that did not include a public option, President Barack Obama reaffirmed his support for a government-run plan in a statement released this week while traveling in Russia.

HELP Price Tag Drops: Sens. Ted Kennedy (D-MA) and Christopher Dodd (D-CT), who are leading the Senate Health, Education, Labor and Pensions Committee (HELP), said Thursday that they had whittled down the cost of their health reform plan to $611 billion over 10 years. Debate during Wednesday's mark-up session raised questions about the overall cost, however, and suggested that when Medicaid expansions are factored in, the cost could exceed the $1 trillion mark.

The HELP committee is relying on the Finance Committee's plan to account for the additional 34 million Americans that would not be covered under the HELP proposal, including plans to expand Medicare.

Financing the Plan

Taxing Health Benefits Loses Steam: In a move indicating a rejection of bipartisan compromise Tuesday, Sen. Harry Reid (D-NV) sent word to Sen. Max Baucus (D-MT) that he should drop the concept of taxing employer-provided health care benefits, a move that would require the Senate Finance Committee to consider additional payment cuts or tax increases to offset more than $300 billion as a result.

Hospital Industry Agreement: Vice President Joe Biden formally announced Wednesday that the hospital industry agreed to contribute $155 billion over 10 years toward the cost of insuring uninsured Americans.

House Side Activity: House Democrats continue to develop their health reform proposal and are expected to release their plan to pay for health care reform by the end of this week. Democrats are focused on an income tax increase for the highest earners and are close to ruling out a proposed "sin tax" tax on sodas and other sugary drinks.

Looking Ahead

The Senate HELP committee hopes to complete its markup by late this week or early next. The Senate Finance Committee is still negotiating its bill and continues to mull options on how to pay for the overhaul. The House may begin marking up legislation in Committee next week.

For up to the moment information on Health Care Reform, please visit the Health Action Network.

Washington Healthcare Update

It is a recent Washington Update on proposed healthcare changes from National Association of Health Underwriters:

NAHU Washington Update - 07/02/2009

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Details Still to Come on Health Overhaul Plans

Senators negotiating a bipartisan health care reform plan in the Finance Committee left for the July Fourth recess without any consensus, but Finance Chairman Max Baucus said he has developed ways to pay for legislation that would cost less than $1 trillion over 10 years.

Limiting the bill’s spending to $1 trillion is a significant step for the committee, which has been seen as the main arena for those in the Senate hoping to get a bipartisan health care bill. However, Baucus, who is not in election cycle and opted to stay in Washington during recess to work on health reform, did not provide details and gave no indication of when he will be ready to mark up a bill.

While Baucus continues to work behind the scenes on the yet-to-be-introduced bipartisan bill, last week the Senate Health, Education, Labor and Pensions (HELP) Committee continued toiling through titles of a draft bill that is still missing many sections. Senator Chris Dodd adjourned the mark-up on June 25, saying the panel will reconvene July 6 with the goal of finishing by July 10.

The Finance and HELP Committees share jurisdiction over broad portions of the proposed health care overhaul, and it is not clear yet how their separate efforts will be integrated into a single legislative package. Work in the House is also in the initial stages, with three committees that have jurisdiction over parts of the legislation holding hearings last week.

HELP Committee Marks up Kennedy/Dodd Bill

Over the past two weeks, the Senate HELP Committee has worked on marking up sections of the Kennedy/Dodd bill dealing with preventive care, care quality, workforce issues, accessibility and cost control. Today, the committee issued the missing language on the core issues of creating a public plan to provide an alternative to private insurance and requiring employers to offer coverage or pay a penalty.

The new draft creates a government-run public program option to be offered through state gateways called the Community Health Insurance Option. The plan specifies that physicians will be paid based on negotiated fees rather than Medicare rates and are not compelled to participate. These entities would be non-profit and subject to state solvency rules as well as newly created federal solvency rules. These new plans would initially begin with federal money. Although they would be subject to state consumer protections and in some limited cases state benefit mandates, there is no mention of whether they would have to comply with other state rules, such as paying state premium taxes.

The employer mandate provisions specify that employers with more than 25 employees must offer coverage to both full- and part-time employees and must pay 60% of the cost (pro-rata share for part-time employees) or $750 annually for each employee ($375 for part-time employees).

The new draft also contains some positive changes to the previous minimum loss ratio provision, changing it to a reporting requirement as well as some enhancements to the grandfathering provisions that would allow changes to cost sharing and benefits as long as they were not significant. Additional positive changes were made to the risk adjustment provisions, which now appear to adjust risk over entire markets rather than just inside the gateway and specifies that risks for the individual and group markets will be pooled separately while including participants both inside and outside the gateway.

A small change was also made to the navigator provisions to specify that, for enrollment purposes, the job of the navigator is to facilitate enrollment but not assist with the enrollment process, which is a big improvement over the original draft. What this means is that the navigator would help people understand where to enroll but would not actually enroll individuals in coverage.

The change we have been seeking to allow groups over 50 to use claims experience in the rating process was not included, and the modified community rating provisions remain at two to one. We will seek additional amendments as the mark-up continues.

Dodd said his committee considered close to 216 amendments during the mark-up. Of those, the committee has accepted 87 and rejected 22 amendments presented by Republicans.

Like the Finance Committee proposal, the HELP draft has been hampered by extremely high cost estimates. Today they received a cost estimate on the provisions in the parts of the bill subject to their jurisdiction of $611 billion over 10 years, a reduction from the previous estimate due to program cuts made to the previous draft.

Meanwhile, initial cost estimates have emerged on a new voluntary long-term care insurance program included in the Senate HELP Committee draft.

The Community Living Assistance Services and Supports (CLASS) Program―a long-time priority of Senator Edward Kennedy―would save nearly $58 billion over 10 years, including a $2.5 billion reduction in Medicaid spending, according to a cost analysis released June 26 by the Congressional Budget Office and Joint Committee on Taxation.

Under CLASS, participants would have to contribute monthly premiums for five years before qualifying for benefits that are triggered by evidence of functional limitation, including cognitive impairment.

Premiums would average $65 per month, adjusted for age, although students and those with incomes less than 100% of the federal poverty level would pay $5 per month.

While the long-term care program would be a government-run insurance plan, it is intended to complement private long-term care insurance, not compete with the products, Democratic aides claim. Benefits under the program are intended to only cover about half the average cost of long-term care, according to a summary distributed by HELP staff.

NAHU shares the HELP Committee Republicans’ concerns about the long-term costs of the Democrats’ proposal and the wide and unspecified latitude it would give to the Health and Human Services secretary to manage the program. Republicans generally would rather provide people tax deductions for private long-term care insurance premiums or tax credits to purchase services directly, an approach NAHU supports.

The program’s benefits would be at least $50 per day, according to the committee summary. Many of the program’s details would be left to the secretary, who could, for example, raise and lower premiums, set benefit levels and determine eligibility for benefits. She could also close enrollment to the program or even ask Congress to repeal it if she determines that it is on track to become insolvent. [return to top]

House Expected to Take Action on Tri-Committee Proposal

On the other side of the Capitol, after narrowly passing a controversial “cap and trade” energy bill and a week of hearings on the House Democratic leadership’s tri-committee draft proposal, Democrats came no closer to winning GOP support for their health bill, although that does not seem to be a priority.

The House Ways and Means Committee plans to mark up its portion of health care overhaul legislation starting the week of July 13, and the Energy and Commerce and Education and Labor Committees are likely to follow similar schedules. This is perfect timing to coincide with our popular Washington fly-in with other agent and broker groups.

Democrats are narrowing their options and are beginning to confront the difficult issues of how to raise hundreds of billions of dollars to fund the overhaul.

Ways and Means Committee Chairman Charlie Rangel said he is aiming for an approximately $1 trillion package, paid for about equally by cost savings and revenue increases. He said he still does not have estimates from the Congressional Budget Office on the cost of the bill, which would impose mandates on individuals to purchase coverage and require employers to provide it. The bill would give subsidies to low-income individuals and small businesses and make a variety of changes to the Medicare payment system.

Representatives are considering a variety of revenue-raising options, including a surtax on the adjusted gross income of top earners as well as taxes on sugary sodas and alcohol. [return to top]

Wal-Mart Comes Out in Favor of Employer Mandate

Wal-Mart Stores Inc., the nation’s largest private employer, announced Tuesday that it would support a mandate on businesses to help expand health care coverage, an about-face from other employer groups that have strongly opposed any such requirement.

Wal-Mart’s support adds backing to the idea of a mandate, which Democrats want to add to health care overhaul legislation. The company issued a statement in support of the mandate along with the Service Employees International Union and the Center for American Progress, two liberal-leaning groups that have been pushing for a health care overhaul.

“We are for shared responsibility. Not every business can make the same contribution, but everyone must make some contribution. We are for an employer mandate which is fair and broad in its coverage, but any alternative to an employer mandate should not create barriers to hiring entry level employees,” the groups said in a statement.

Other employer groups led by the U.S. Chamber of Commerce have been firmly opposed to any form of employer mandate or requirement that employers pay substantially to help expand health care coverage. NAHU has long aired similar concerns.

But Wal-Mart’s backing comes with some conditions, spokesman Greg Rossiter said. According to Rossiter, Wal-Mart wanted an employer mandate that would have companies pay in based not on how many employees they have but on “profit per employee.” That would favor companies such as Wal-Mart with high numbers of low-wage employees by lowering the per-employee cost of any mandate.

If an employer mandate is constructed otherwise, “it certainly could become a disincentive” to support it, Rossiter said. He added that a mandate should also come along with “affordable options” for people to buy health care coverage as well as tax credits for small businesses to help them provide coverage for their employees.

Leslie Dach, Wal-Mart’s head of government relations, stated that a mandate should not be written in a way that makes it harder to hire low-wage workers. “We believe the mandate should cover as many businesses as possible and cover part-time as well as full-time employees,” Dach said. “Any alternative to an employer mandate should not create barriers or disincentives to hiring workers with disabilities, entry level employees or people from low-income families.”

Currently, Democrats are drafting legislation that seems certain to include some sort of employer mandate. A draft of health care overhaul legislation in the House has a “pay or play” requirement that would require employers to offer coverage or pay into a fund to help people buy insurance. The Senate HELP Committee draft contains a similar proposal, and the Senate Finance Committee is also examining some version of the policy. [return to top]

CMS Suspends Agent/Broker Compensation Policies for Further Review

On June 26, the Centers for Medicare and Medicaid Services announced that it is suspending implementation of the agent and broker compensation requirements set forth in a June 5 memorandum titled “2009 Medicare Advantage and Prescription Drug Program Agent and Broker Compensation Refinements and Compensation Rate Adjustment for 2010.”

CMS’s actions are in response to issues and concerns raised by NAHU and other stakeholders regarding the requirements, and confusion over whether an initial compensation fee should be paid for 2009 enrollments from a PDP to an MA plan.

NAHU will be weighing in with the agency in the next week before it issues a memo clarifying which enrollments in 2009 are eligible for the higher compensated initial broker commissions.

A key point of confusion has been whether or not agents will qualify for an initial commission when they enroll into Medicare Advantage plans beneficiaries who have previously had traditional Medicare or a stand-alone prescription drug plan. Otherwise, such a beneficiary would be considered a renewal and the agent would receive the lower renewal compensation level.

CMS is weighing guidance surrounding the definition of a “like plan type” in that an agent moving a beneficiary into a “like” plan receives the lower renewal compensation.

For 2010, however, CMS said agents and brokers should be paid an initial fee for enrollments from a PDP to an MA plan. [return to top]

HHS Rescinds Bush Medicaid Rules

The Health and Human Services Department rescinded three controversial Bush administration regulations governing Medicaid on Monday and said it would postpone and possibly change or rescind a fourth.

The regulations were among seven that the Bush administration tried to implement in 2007 and 2008 that sent health care providers, state governments and advocates for the poor into a lobbying frenzy. Critics charged that the administration was trying to shift the burden for about $19.6 billion in Medicaid spending over five years from the federal government to the states.

The department’s action was not unexpected. Democrats have been particularly critical of the regulations and introduced several bills in the 110th Congress to stop them. A series of congressional moratoria delayed implementation of most of the regulations until June 30.

One of the regulations the department rescinded narrowed Medicaid payments for what are called “case management services” that some states offer to Medicaid clients. Another prohibited Medicaid reimbursement for administrative costs incurred by schools and for transporting Medicaid-eligible children to school. A third narrowed the definition of “outpatient services” under Medicaid to medical treatment performed outside a hospital or clinic. The regulation that was postponed limited taxes that some states assess on health providers to help pay the state portion of Medicaid expenses.

That regulation cannot take effect before June 30, 2010, and HHS Secretary Kathleen Sebelius said that the Centers for Medicare and Medicaid Services may “give additional consideration to alternative approaches.” Sebelius also said she ordered the three regulations rescinded because they might have harmed Medicaid beneficiaries. [return to top]

Results of New CNN Poll Suggest Lack of Support for Health Reform

According to a new national poll released this week, “most people worry that their health care costs would go up if the Obama Administration’s proposals were enacted into law and only one in five thinks that his or her families would be better off under the Obama plan.”

The poll suggests that 55% of Americans think the U.S. health care system is in need of a great deal of reform, with four in 10 saying only some reform is needed. [return to top]