AHIP, www.ahipwire.com1) Senate Finance Committee Begins Health Reform Markup

The Senate Finance Committee began its health reform markup this week, considering approximately 50 amendments over a four-day period. The committee recessed shortly before noon today and is scheduled to reconvene on Tuesday morning.

The starting point for the markup was a “Chairman’s Mark” for the “America’s Healthy Future Act.” Sen. Max Baucus (D-MT), the committee chairman, released this Mark on September 16 and announced modifications on September 22.

On Saturday, September 19, the Senate Finance Committee posted information on its website on more than 560 amendments that were filed by committee members prior to the markup. These amendments address a wide range of issues, with many of them focusing on insurance market reforms, the responsibilities of individuals and employers, Medicaid and Medicare, supplemental products, a government-run plan, the health insurance exchange, and health insurer related budget offsets. Key amendments that were considered by the committee this week are reviewed in article #4 below.

When the committee reconvenes on Tuesday, Sens. Charles Schumer (D-NY) and Jay Rockefeller (D-WV) are planning to offer separate amendments proposing to add a “strong public option” to the pending health reform bill. Although committee members potentially could offer several hundred additional amendments to the pending bill, Chairman Baucus will push to complete action on the markup next week. At the next stage of the legislative process, Senate leaders will work to merge the provisions of the Senate Finance Committee bill with the Senate HELP Committee bill (S. 1679). Senate floor action on the merged bill is anticipated in October.
(2) House Approves “Medicare Premium Fairness Act”

On September 24, by a vote of 406 to 18, the House approved legislation, H.R. 3631,which would hold Medicare Part B premiums at their current level, $96.40 per month, for all Medicare beneficiaries in 2010.

Action on this bill was prompted by the expectation that, due to low inflation, seniors will not receive a Social Security cost-of-living-adjustment (COLA) next year – raising questions about whether an increase in Part B premiums would reduce their Social Security checks.

Under current law, most beneficiaries are protected by a hold harmless provision that prevents an increase in Part B premiums from reducing their Social Security checks below the previous year’s amount. However, this protection does not apply to newly eligible beneficiaries and those with incomes exceeding $85,000 for a single person and $170,000 for a couple – meaning that these beneficiaries would be subject to higher Part B premiums even if there is no Social Security COLA next year. Also not covered by the hold harmless provision are low-income beneficiaries who qualify to have their premiums paid by Medicaid.

Under H.R. 3631, all Medicare beneficiaries would be protected by the hold harmless provision next year. This temporary policy change is expected to cost $2.8 billion.
(3) Reid Pledges To Bring Drug Importation Bill to Senate Floor This Year

Senate Majority Leader Harry Reid (D-NV) addressed a letter this week to the sponsors of S. 1232, the “Pharmaceutical Market Access and Drug Safety Act,” promising to bring this bill to the Senate floor before the end of the year if prescription drug importation is not addressed during the Senate’s consideration of comprehensive health reform legislation.

S. 1232 would allow individuals to order prescription drugs from Canadian pharmacies that are approved and registered by the FDA and, additionally, allow licensed pharmacists and wholesalers to import FDA-approved prescription drugs from Canada and other industrialized nations. During the Senate HELP Committee’s health reform markup in June, an amendment based on this bill was defeated by a vote of 12 to 10.
(4) Senate Committee Plows Through Health Reform Amendments

During the first four days of the health reform markup in the Senate Finance Committee, senators offered several dozen amendments for consideration. The following is an overview of key amendments the committee debated this week, including several that were withdrawn with expectations of being revisited later in the markup.

Prescription Drug Issues

• By a vote of 13 to 10, the committee defeated an amendment by Senator Bill Nelson (D-FL) that would have required drug manufacturers to provide Medicaid rebates for full-benefit dual eligible beneficiaries. The savings from this policy change would have been used to eliminate the Medicare Part D coverage gap.

• By voice vote, the committee approved an amendment by Senator Nelson that would require the HHS Inspector General to conduct a study to determine how much Medicare and Medicaid pay for prescription drugs.

• By voice vote, the committee approved an amendment by Senator Maria Cantwell (D-WA) that would require PBMs to disclose specified information – including aggregate data on rebates, discounts, and price concessions – to the commissioners of the proposed Exchanges and to any plans the PBMs contract with through the Exchanges.

Medicaid Issues

• By a vote of 13 to 10, the committee defeated an amendment by Senator Mike Enzi (R-WY) that would have provided that any state experiencing a decline in state tax revenues for two consecutive quarters would be exempt from the bill’s Medicaid expansions.

• By a vote of 13 to 10, the committee defeated an amendment by Senator Mike Crapo (R-ID) that would have provided additional federal funding for the proposed Medicaid expansions to avoid an unfunded mandate on the states. The cost of this policy change would have been offset with a reduction in premium assistance.

• By a vote of 13 to 10, the committee defeated an amendment by Senator Mike Enzi (R-WY) that would have allowed individuals who are newly eligible for Medicaid under the pending bill to choose to be covered by either Medicaid or by a plan offered through their state Exchange.

Medicare Issues

• Senator Bill Nelson (D-FL) offered an amendment that would expand provisions of the pending bill that propose a partial grandfathering of current benefits for certain Medicare Advantage enrollees. Nelson’s amendment would expand this provision to cover enrollees in areas where average plan bids are below 100 percent of local fee-for-service costs. After committee members raised numerous questions about the amendment’s impact on specific states, Nelson asked that the amendment be set aside temporarily. The committee is expected to revisit this amendment, perhaps with modifications, at a later time.

• By a vote of 13 to 10, the committee defeated an amendment by Senator Jon Kyl (R-AZ) that would have clarified that health plans, pursuant to their First Amendment rights, should be allowed to communicate with their enrollees about legislative issues. This amendment was prompted by a recent CMS memo that directed Medicare Advantage plans to immediately discontinue any communications with their enrollees about legislative issues.

• By a vote of 15 to 3, the committee approved an amendment by Senator Jay Rockefeller (D-WV) that would expand Congress’ role in appointing members to and overseeing the proposed Medicare Commission.

Individual Coverage Requirement

• Senator Charles Grassley (R-IA) offered an amendment that would allow states to opt out of the individual coverage requirement and use alternative mechanisms to encourage the purchase of health insurance. Grassley withdrew this amendment, and indicated that he would work with other committee members to revise the language before bringing it back for consideration.

Employer Issues

• Senator John Kerry (D-MA) offered an amendment that proposed a direct employer mandate to replace the bill’s existing provisions regarding the responsibilities of employers. Following a brief period of debate, Kerry withdrew the amendment and indicated that he would raise this issue during the Senate floor debate.

• By a vote of 21 to 0, the committee approved an amendment by Senator Mike Enzi (R-WY) that would require the Secretary of Labor, prior to implementing the proposed assessments and fees on employers, to certify that these assessments and fees would not result in a reduction of workers’ wages or an increase in the unemployment rate.

Coverage / Market Reforms

• Senator John Kerry (D-MA) offered an amendment proposing to narrow the age rating band in the individual market from 4:1 to 2:1. Kerry withdrew this amendment following a debate during which Chairman Baucus expressed interest in possibly revisiting this issue.

• By voice vote, the committee approved an amendment by Senator Bill Nelson (D-FL) that would require state legislative action before any state could enter into a compact for the sale of individual health insurance across state lines.

• By voice vote, the committee approved an amendment by Senator Debbie Stabenow (D-MI) that would apply the federal mental health parity requirement to health insurance plans offered through the state exchanges.

• By voice vote, the committee approved an amendment by Senator Robert Menendez (D-NJ) that would make a child-only health insurance plan available through the Exchange and allow minor children to qualify as Exchange-eligible individuals.

• By voice vote, the committee approved another amendment by Senator Menendez that would require health insurance plans to provide behavioral health treatment, including for autism, as part of mental health and substance abuse services.

• By a vote of 14 to 9, the committee defeated an amendment by Senator Jon Kyl (R-AZ) that would have prohibited the federal government from limiting consumer choice by defining the benefits offered through private health insurance.

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This entry was posted by Adam V. Russo on Tuesday, September 29th, 2009 at 8:56 am and is filed under Health Care Legislation. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.