Weekly update on Health Care Reform

This Week in Health Reform




Federal Legislative Overview

House and Senate

Republican Scott Brown’s victory over Massachusetts Attorney General Martha Coakley (D) in the Jan. 19 special election to fill the seat of the late Senator Edward Kennedy (D) is proving to be a game-changer for the health care reform debate. It is now unclear what Democrats can do to pass President Obama’s most important legislative agenda item. Even though the Democrats held a majority in the House and Senate this year, they failed to coalesce around a strategy to pass this legislation.



Initially after Brown’s win, there were two options under discussion for moving the current legislation forward.



Have the House take up the Senate-passed bill and use the “reconciliation” bill process to “fix” several of the provisions the House finds unacceptable (e.g., the “Cadillac” tax). If the House passes the Senate bill, it will go directly to the President for his signature, with no further action needed in the Senate. A “reconciliation” bill, which would need only 51 votes in the Senate, could be passed either in tandem with the Senate bill or follow soon after.

.

Scale back the health care reform bill. A scaled-back bill could include health insurance reforms and exchanges, as well as several other provisions, and could possibly attract bipartisan support. While many Democrats are likely to view this approach as a major lost opportunity, leadership may determine this is the most viable approach.

However, Speaker of the House Nancy Pelosi (D-CA) publicly stated on Jan. 21 that the House does not have the 218 votes needed to pass the Senate version of the health care reform bill. This takes the first option off the table.



While numerous private discussions are reportedly being held on the matter, it seems that the Democrats’ only option for keeping the current legislation alive is to reach across the aisle to their Republican counterparts, most notably, moderate Senator Olympia Snow (R-ME). That would mean a more conservative bill, which could anger rank and file Democrats, who are supportive of the legislation.



Although no plans have emerged for how to move forward, it now looks like Democrats will have to modify their plans. On the night of Scott Brown’s win in Massachusetts, Representative Anthony Weiner (D-NY) – one of the biggest proponents for a single-payer health care system – said, “The only way to go forward is to take a step back. If there isn't any recognition that we got the message and we are trying to recalibrate and do things differently, we are not only going to risk looking ignorant but arrogant. I don't think it would be the worst thing to take a step back and say we are going to pivot to do a jobs thing,” and include elements of health care reform in it, he said.



Representative David Camp (R-MI), Ranking Member on the House Ways and Means Committee, declared Democrats’ health care overhaul legislation “dead.” He said that instead of full-scale change, Congress should take a “first step toward comprehensive reform” of the nation’s health care system.



Issue Overview: Nebraska Medicaid Deal

While key elements of the health care reform legislation remain in flux, the Congressional Budget Office (CBO) released its cost estimate of the expansion of the State of Nebraska’s Medicaid Deal. The expansion was negotiated by Senator Ben Nelson (D-NE), who then voted for the Senate’s Patient Protection and Affordable Care Act, HR 3590.



The letter responds to a request from Representative Paul Ryan (R-WI), Ranking Member, House Committee on the Budget, asking if the cost estimate of the Senate health reform bill would change if all states received the same level of federal assistance for Medicaid as Nebraska receives under the bill.



The CBO stated on Jan. 21 that the net spending for the Senate legislation would increase by $35 billion over ten years if all states received the same level of assistance as Nebraska.



Under the Senate’s provisions, non-elderly individuals with incomes below 133 percent of the federal poverty level would be eligible for Medicaid beginning in 2014. The federal government would pay the cost of covering newly eligible enrollees through 2016; and federal spending would be about 90 percent by 2019. The Senate legislation states that it would pay all Medicaid expansion costs to Nebraska beginning in 2014.



Read the complete CBO report at:

http://www.cbo.gov/ftpdocs/109xx/doc10992/hr3590_RyanLtr.pdf.