[NYAPRS Enews] MM, USPRA: Details on Obama's Revised Health Care Reform Proposal

[Harvey Rosenthal]

NYAPRS Note: The following is compiled from reports shared with us
courtesy of USPRA and Medicaid Matters. President Obama has released a
blueprint of his health reform proposal that can be found at
http://www.whitehouse.gov/health-care-meeting/proposal.  One analysis
yielded the following observations: 

The proposal seems to heavily borrow from the Senate bill H.R. 3590. As
regards Medicaid, it sets the expanded Medicaid floor at 133% of the
federal poverty level and provides the sought after extension of the
current enhanced federal match (FMAP) at 100% FMAP for FY 2014, FY 2015;
and FY 2016,  95% FMAP for FY 2017 and FY 2018 and  90% FMAP for FY 2019
and thereafter. It eliminates the Nebraska 100% federal match provision
and extends the CHIP authorization through FY 2019, providing funding
for CHIP through FY 2016.

-------------

>From the Coalition for Whole Health

The President's proposal is not meant to be stand-alone bill, rather it
is a series of fixes, modifications, and small additions intended to
bridge the differences between the House and Senate bills and
incorporate some Republican ideas.    It does not go into a level of
detail that would include many of the specific mental health and
substance use disorder provisions included in the Congressional bills.


The proposal is built off the Senate-passed bill and includes some key
changes that were agreed to during January House/Senate negotiations,
such as additional Medicaid federal financing for all states (the
proposal eliminates the Nebraska Medicaid deal) and closing the Medicare
"donut hole" for prescription drug coverage.   

As you will see below, one new provision that was not in either the
Senate or House bill is the new "Health Insurance Rate Authority" to
provide oversight of insurance market behavior.  

While the proposal is not a legislative bill and does not go into a lot
of detail, some of the key provisions in the proposal related to MH/SUD
consumers and providers include:

*       It supports education and training grants to meet the critical
needs of Americans who require mental and behavioral health care. 

*       Both the House and Senate bills include significant reforms to
make insurance fair, accessible, and affordable to all people,
regardless of pre-existing conditions.  One essential policy is "rate
review" meaning that health insurers must submit their proposed premium
increases to the State authority or Secretary for review.  The
President's Proposal strengthens this policy by ensuring that, if a rate
increase is unreasonable and unjustified, health insurers must lower
premiums, provide rebates, or take other actions to make premiums
affordable.  A new Health Insurance Rate Authority will be created to
provide oversight at the Federal level and help States determine how
rate review will be enforced and monitor insurance market behavior.

*       Remove lifetime and yearly limits on coverage so people would
know that all of the care they need will be paid for.

*       New conditions of participation in Medicare will be imposed on
community mental health centers to ensure they are providing necessary
and high quality care; (Source:  H.R. 3970, "Medical Rights & Reform
Act" (Kirk bill))

*       It creates a loan repayment program for pediatric, mental and
behavioral health specialists who provide services to children and
adolescents in underserved areas or with underserved populations.

The proposal does not include a public plan, but rather endorses the
Senate proposal to offer insurance plans administered by the Office of
Personnel Management (OPM) to anyone buying coverage though the
exchange. 

As you know, this proposal was released in advance of the bipartisan
White House Summit that is scheduled for Thursday and the White House
said the proposal is intended to serve as a starting point for those
discussions.

While the White House said they have not endorsed any one path for
moving health care reform forward on Capitol Hill, they said the
proposal was drafted with reconciliation in mind. 

---------------------

 

Obama Unveils Health Reform Plan

By: Carrie Budoff Brown Politico February 22, 2010 

 

President Barack Obama released a health care reform proposal Monday
aimed at pleasing the warring wings of his own party and bring along
skeptical voters, in part by including a provision to put off an
unpopular tax on high-cost health insurance plans until 2018. 

One notable absence in Obama's plan - any provision for a public health
insurance option, a favorite of liberals, but a provision that became
the most controversial part of the congressional debate on reform. Obama
has long said he would sign a bill without it, and his own legislation
confirms that.

Obama released his bill just days before Thursday's bipartisan health
care summit, and by doing so, he tried to set the agenda for the meeting
- making his own bill the starting point for any discussions, and
putting Republicans in the potentially uncomfortable position of having
to respond to the president's own legislation. 

The plan appears designed to allay liberals in the House while not going
too far in a way that would alienate Senate moderates. For example, it
vastly scales back the tax on "Cadillac" insurance plans, which will
please liberal Democrats, but by leaving out the public option, hopes to
win over moderates. 

At the same time, the president makes a run at Republicans by boosting
measures to crack down on waste, fraud and abuse in Medicare - a
constant in the GOP talking points. It would also delay implementation
of the taxes on various health care industry players, and changes the
fee on medical device manufacturers to an excise tax. 

The proposal eliminates some of the most maligned elements of the Senate
bill and enhances popular provisions, such as fully closing the "donut
hole" for Medicare prescription drug beneficiaries. 

But it remains unclear whether the political will exists in either
chamber to move ahead with a comprehensive health care bill in the
current political environment. 

"This is the opening bid for the health meeting," said White House
communications director Dan Pfeiffer. "We took our best shot at bridging
the differences. We think this makes some strong steps to improving the
final product. Our hope is republicans will come together around their
plan and post it online. 

Pfeiffer said the plan is the White House's proposal. Despite statements
by the White House aides that they expected a reconciled bill from the
House and Senate ahead of the meeting, neither chamber has signed off on
the proposal. 

"The president is coming to the meeting with an open mind," Pfeiffer
said. "We hope there will be a few strong ideas from both Republicans
and Democrats throughout this conversation that can be incorporated."

Pfeiffer said the White House has not determined whether to move ahead
with health care reform through reconciliation, which would allow the
Senate to pass a bill with a simple majority rather than a 60-vote
threshold. But Pfeiffer added that the president believes the bill
should receive an up-or-down vote - a statement that suggests the White
House is nonetheless moving in that direction. 

The White House could not provide an overall pricetag for the proposal.
But Nancy-Ann DeParle, director of the White House office of health
reform, said the changes were fully offset. 

Obama would also make significant changes to an agreement reached last
month with labor unions over the excise tax on "Cadillac" health plans.
Under that agreement, the tax would be delayed for union-negotiated
health plans until 2018 while kicking in more quickly for other
Americans. 

In a tacit acknowledgement that the labor agreement could be viewed as
another backroom deal, Obama would delay the tax for all plans until
2018, and further raise the threshold at which the tax would kick in to
$27,500 for an annual family plan, up from $24,500. 

This provision would appear to allay broad concerns in the House, where
liberals reluctantly accepted the labor deal but had been pushing to
further scale back the tax. 

Other provisions would also please liberals, including a boost in tax
subsidies for low- and moderate-income individuals to purchase insurance
and bigger penalties on larger employers that do not provide health
insurance. 

However, progressive House members are likely to be disappointed that
the White House plan maintains the state-based exchange system under the
Senate bill. Pelosi had pushed hard for the national insurance
marketplaces. 

The White House proposal eliminates the special Medicaid deal for
Nebraska, which Republicans dubbed the "Cornhusker Kickback" as the most
maligned element of the Senate bill. 

Obama's plan would fully close the "donut hole" for Medicare
prescription drug beneficiaries by 2020, going further than the Senate
bill, which would have narrowed it to only 50 percent. 

The bill also gives the federal government sweeping new powers to curb
exorbitant rate hikes by the nation's health insurance companies, a
White House official said Sunday night - a proposal designed to win over
skeptical voters as Obama announces his own health insurance legislation
for the first time Monday. 

Obama is seeking to play off voter anger toward recent double-digit
increases by Anthem Blue Cross of California and show that his plan is
designed to protect vulnerable Americans, both those with insurance and
those who are seeking to obtain it.

The proposal for new federal power to rein in premium hikes wasn't
included in the versions of health reform that passed the House and
Senate last year, though the rest of Obama's bill is likely to
cherry-pick some of the most popular parts of those bills to craft a
compromise proposal that can unify his fractious party, liberals and
moderates alike. 

The proposal also has a populist appeal - Obama standing up to the big
insurance companies - that could put pressure on Republicans to go
along, even though they have decried the Democrats' health reform
efforts as a "big government takeover" of the system and generally
resisted any efforts to give the government a greater role in the
private insurance market. 

Obama's proposal would give the Health and Human Services secretary,
Kathleen Sebelius, new powers to review premium hikes by private
insurance companies - and in some cases, block those deemed excessive.
Anthem's rate hikes of up to 39 percent in recent weeks have focused
attention on the skyrocketing health insurance costs, the very costs
Obama vowed to fight when he undertook comprehensive health care reform
last year. 

Obama's plan would create a new board made up health insurance experts,
which would determine annually what are reasonable premium hikes in
various markets, and the HHS secretary also would work with state
officials, the White House said. 

By announcing his bill Monday, Obama also seems intent in putting
pressure on Republicans to show they have a comprehensive solution to
skyrocketing health care costs, heading into Thursday's summit. 

White House officials have already begun urging Republicans to post
their bills on line as well - a clever tactic by the White House,
because Republicans ideas for reform were spread across several pieces
of legislation, or fell far short of the Democrats' goal of insuring 31
million uninsured Americans. The main House Republican proposal, for
instance, would only cover 3 million more Americans. 

But in some ways, Obama's main audience is his own party, where
Democratic efforts to craft a compromise bill have faltered in the wake
of Republican Sen. Scott Brown's victory in Massachusetts. 

The White House has said Obama's bill will be designed to pass on
reconciliation - with a 51-vote Democratic majority, a move that would
infuriate Republicans who say Obama is already short-cutting his own
summit by planning to shut out Republicans if needed.

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