FirstNews

House Releases Merged Health Reform Bill

2009-11-06T08:33:00.000-08:00

On October 29th , leadership in the House of Representatives released a bill entitled the “Affordable Health Care for America Act” that merges legislation passed in July by the three House committees (Education and Labor, Energy and Commerce, and Ways and Means) with jurisdiction over health reform. The CBO estimates that this bill will cost $894 billion over ten years and cover 36 million of the 54 million uninsured. To pay for the cost of the bill, the Committee places a 5.4% surcharge on adjusted gross income above $1 million for married couples and $500,000 for singles, reduces provider payment rates under Medicare, reduces spending for the Medicare Advantage program, obtains prescription drug rebates and discounts for Medicaid and Medicare Part D from pharmaceutical companies, places a 2.5% sales tax on medical devices, and makes changes to HSA and FSA rules. House leadership has stated that floor debate on the bill will likely start later this week or early next week. Details of the House bill include:

· Insurance Market Rules Effective in 2010: Several insurance market rules take effect in 2010, including government review of health plan premiums and a requirement that 85% of premiums be spent on medical care, prohibition of lifetime benefit limits for individual and group plans, a requirement that health plans cover children as dependents through the age of 26, and prohibition of coverage cancellation or rescission except in cases of fraud. Prior to the implementation of new market rules and the Exchange in 2013, the House bill also establishes interim provisions between 2010 and 2013 that extend COBRA eligibility, shorten the pre-existing condition “look back” period to one month and the benefit exclusion period to three months, and establish high risk pool provisions for individuals who can not obtain coverage due to health status or a pre-existing condition.

· Insurance Market Rules Effective in 2013: Beginning in 2013, the House bill makes additional insurance market changes that require guarantee issue and renewal of coverage, prohibit pre-existing condition exclusions and premium variation based on health status, and allow premium variation only for age, family size, and geographic area. The new market rules apply to all health plans inside and outside the Exchange. Starting in 2015, states could pass legislation to form “Health Care Choice Compacts” to allow the purchase of individual insurance across state lines.

· Public Plan and CO-OPs: The House bill establishes a national public plan in 2013 to compete with private insurers in the Exchange. Provider rates for the public plan would be negotiated and providers are presumed to participate unless they opt-out. The House bill also provides start-up funding to states to establish not-for-profit member-governed cooperative health plans (CO-OPs) to compete with private insurers and the public plan in the Exchange. CO-OPs and the public plan must comply with the same rules as other plans in the Exchange. States are not required to establish CO-OPs.

· Exchange: A national health insurance “Exchange” is established in 2013 and would be operated by a new federal agency, the “Health Choices Administration (HCA).” The Exchange is designed to serve as a facilitator of comparison shopping, enrollment, and subsidy administration, a regulator of plan standards and rules, and a negotiator of premiums and contracts with health plans. All individuals who purchase coverage outside the group market or whose premiums are more than 12% of income (and are not eligible for Medicare or Medicaid) are eligible to purchase coverage through the Exchange. Participation in the Exchange is voluntary, but no individual market exists outside the Exchange except for “grandfathered plans.” Employers can purchase coverage through the Exchange if they have up to 25 employees in 2013, up to 50 employees in 2014, and up to 100 employees in 2015 (with the potential to open participation to all groups starting in 2015).

· Benefit Plans: In 2013, individuals have a choice of four plan types including “Basic” (70% actuarial value), “Standard” (85% actuarial value), “Premium” (95% actuarial value), and “Premium Plus” (value over 95%). A new independent “Benefits Advisory Committee” is created to define and update the requirements for the minimum benefit plan or “Basic Plan.” Plans are prohibited from having annual or lifetime benefit limits or establishing cost sharing above $5,000 individual/$10,000 family. Plans are required to cover a list of specified mandated benefits, but states may establish additional benefit rules. Individuals may keep their current coverage (“grandfathered plans”) instead of enrolling in one of the four new plans, as long as no change is made in cost-sharing, contract terms, or benefit levels. Employers are required to at least meet the requirements of the “Basic Plan” by 2018.

· Coverage Mandates, Penalties, and Subsidies: Beginning in 2013, individuals are required to have health insurance coverage that is either a “grandfathered plan,” a government plan (Medicaid, Medicare, and the like), an employer-based plan (until 2018), or an individual or group plan that meets or exceeds the qualifications of the federally-defined minimum benefit plan (“Basic Plan”), or pay a 2.5% of income tax penalty. Waivers are allowed for Native Americans, those with religious objections, dependents, and individuals with a financial hardship defined as premiums over 12% of income. Individuals up to 400% of the federal poverty level ($88,000 for a family of four) are eligible for sliding scale premium and cost-sharing subsidies. In 2013, employers with an annual payroll over $500,000 are required to offer health insurance coverage to their employees or pay an 8% of payroll tax penalty. Employers must pay 72.5% for single and 65% for family coverage of the lowest cost qualified plan to avoid the penalty. Employers are also subject to the penalty for employees in the Exchange obtaining subsidies if the cost of employer-based coverage is higher than 12% of the employee’s income. Employers with an average wage below $40,000 and 25 or fewer employees are eligible for up to a 50% premium credit for two years.

· Medicaid and the Children’s Health Insurance Program (CHIP): Medicaid eligibility is expanded to 150% of the federal poverty level for all individuals in 2013 with full federal funding of the expansion in 2013 and 2014 and 91% federal funding to states starting in 2015. States are required to maintain existing Medicaid eligibility; states are also required to maintain CHIP eligibility, but only until 2013 when CHIP beneficiaries will get coverage through the Exchange. The bill also extends enhanced federal Medicaid funding from the stimulus bill (ARRA) to states until June 2011.

· Medicare: The House bill reduces payments for Medicare Advantage to 100% of Medicare fee-for-service spending by 2013 and establishes quality bonuses for plans with high quality scores in markets with low Medicare fee-for-service spending and high Medicare Advantage enrollment. By 2019, the “donut hole” or coverage gap under Part D is eliminated. Pharmaceutical manufacturers are to provide a 50% discount for brand name drugs purchased in the “donut hole” and HHS is required to negotiate directly with manufacturers for Part D drug pricing. The income subsidy exclusion for employers who maintain prescription drug plans for Part D eligible retirees is eliminated. The House bill also creates pilot programs for coordinated care delivery models, establishes a new “Center for Medicare and Medicaid Innovation” to test and implement new provider payment methods, and changes payment incentives to reduce hospital readmissions. Annual provider payment updates are reduced for Medicare Part A and Part B and the Institute of Medicine is instructed to study geographic variation in payment rates and recommend changes.

Tax on Wealthy Not Tied to Inflation

2009-10-30T04:47:00.000-07:00

CQ Today (10/30, Rubin) reports that since the income levels at which more wealthy earners would be taxed to pay for healthcare reform is not indexed for inflation in the House bill, "more and more people each year would face a tax that is being sold as a levy on millionaires".

"It's a significant change in approach that will help align revenues and costs in the latest version of the bill, but it will invite criticism and comparisons to the alternative minimum tax, which has affected far more people than it was supposed to."

Employer-based Insurance under Health Reform will mean Higher Costs in Short Term

2009-10-27T05:44:00.000-07:00

Time (10/27, Pickert) reports that the employer-based system has become equally or more unsustainable than the overall "US healthcare system." Employee contributions to those premiums "went up 128 percent" from 1999 to 2009; and surveys indicate about "40 percent of employers will shift" even more costs onto employees in 2010.

Health reform proposals will do "little to change" that, although an "excise tax" on "Cadillac" policies will help in the long-term, as will several things more employers are now doing. These include replacing co-pays with "co-insurance" in which patients a percent "of the actual cost"; offering "wellness programs," which focus on getting high health-cost "workers to lose weight or quit smoking"; and conducting "dependent audits."

Still, it will take a long time before these programs begin "slowing costs" meaning that "under the reform proposals," employees face increasingly "higher costs" coupled with "fewer benefits" and choices.

Senator Reid: Senate Bill will include Public Option with State Opt-out

2009-10-27T05:37:00.000-07:00

The CBS Evening News (10/26, Cordes) reported, "For months, the public option was declared dead in the Senate," but on Monday, Senate Majority Leader Harry Reid (D-NV) "announced that the contentious government plan would be the cornerstone of the new Senate healthcare reform bill." Sen. Reid said, "The public option can achieve the goal of bringing meaningful reform to our broken system."

NBC Nightly News (10/26, O'Donnell) reported, "Leaders of both parties had predicted that a public option was dead. But tonight it is back, and Senate Majority Leader Harry Reid is taking a risk." But "for more liberal Democrats, this kind of public option or any kind of public option is considered a victory."

On ABC World News (10/26, Gibson), George Stephanopoulos said Reid "still may not have the votes to get this to the Senate floor. But what the Senate leader saw is that he would have a lot more trouble with the majority of Democrats if he didn't include the public option in the bill than if he did."

USA Today (10/27, Fritze) reports the "latest iteration of the public option would give millions of Americans who are not covered through their employer the option to buy insurance run by the government. States would have until 2014 to decide whether to withdraw from the public program, which Reid says would drive down rates."

According to Bloomberg News (10/27, Litvan, Rowley), Reid "said the so-called public option with the opt-out provision is the 'fairest way to go' to ensure competition for private insurers."

The New York Times (10/27, A1, Pear, Herszenhorn) reports in a front page story that Reid "sided with his party's liberals," but the announcement "set the stage for a test of Democratic party unity. With Republicans united for now in opposition to any bill including a public option, Mr. Reid needs support from all members of his caucus -- 58 Democrats and two independents -- to take up the legislation. Aides said Monday that he appeared to be short of that goal, lacking firm commitments from several members of the caucus."

The Los Angeles Times (10/27, Levey) reports the "'opt-out' compromise is still two votes shy of the 60 Reid needs to overcome a Republican filibuster, according to a senior Democratic aide on Capitol Hill who requested anonymity when discussing the plan."

The Washington Times (10/27, Haberkorn) reports that Sen. Olympia Snowe (R-ME) "said she was 'deeply disappointed' with Mr. Reid's decision and would not support the bill."

The Hill (10/27, Young) likewise reports Reid's decision "could cost him the support of" Sen. Snowe, "the only Republican to support a healthcare bill in Congress this year." With or "without Snowe, Reid said he's going ahead with the opt-out public option, though he voiced hope that Snowe could still be convinced."

October 16: This Week in Health Care Reform

2009-10-16T12:14:00.000-07:00

This week, Senate Finance Committee members voted on the committee's health care reform bill, and the conversation shifted to how to reconcile the bill with pending legislation from the House.

Senate Negotiations

Senate Finance Committee Passes Bill: On Tuesday, after months of negotiations, the Senate Finance Committee passed its $829 billion health care reform package with a 14-9 vote. One Republican, Sen. Olympia Snowe (R-ME) voted with Democrats on the committee. The proposal would expand coverage to 29 million uninsured Americans while reducing deficits by $81 billion over 10 years. The bill includes insurance market reforms, an individual mandate to purchase coverage that appears reduced when compared with prior versions, an expansion of Medicaid, a cut in future Medicare spending, new fees and taxes on employers, and billions in new fees on health insurance and other sectors of the health care industry. The bill also includes seed funding for state cooperative plans and subsidies for other state coverage programs.

Shortly after the vote, labor unions and large business organizations requested changes to the Finance Committee bill primarily because it omitted a public option . The swift feedback from interest groups underscores the difficult road ahead for Senate Majority Leader Harry Reid (D-NV), who will work to merge the Finance Committee bill with the Senate Health, Education, Labor and Pensions (HELP) bill passed last summer. Unions and lawmakers such as Sens. Chuck Schumer (D-NY) and Jay Rockefeller (D-WV) have criticized the legislation for not including a public option . At the same time, insurance companies, medical device makers and others in the health care industry are voicing strong concerns about the increased premium costs of the proposed legislation.

House Activities

Legislators Look to Reconcile Health Care Measures: House leaders indicated that negotiators have trimmed costs for its proposed health care reform bill to President Barack Obama's goal of $900 billion, down from $1.2 trillion. Aides said the final bill will include slightly lower subsidies for copayments and deductibles for people who buy coverage through the new insurance exchanges that be would established for those who can't access affordable employer coverage. A provision preventing doctors who see Medicare patients from having their fees cut was excluded, while a surcharge tax on incomes of individuals ($500,000 or more) and families ($1 million or more) was included. House members will consider including more low income families in Medicaid instead of the insurance exchange market, and adopting tax increases featured in the Senate Finance Committee bill, including a profit tax on health insurers. They have, however, rejected the tax on "Cadillac" plans.

Additional Activities

Insurance Industry Study Indicates Higher Costs: On Sunday, the insurance industry trade association, America's Health Insurance Plans, released a study indicating that the proposed Finance Committee legislation would raise the price of a typical policy. The study, completed by PricewaterhouseCoopers, projected that family premiums could be $4,000 higher and individual premiums could be $1,500 higher in 2019. The report details that a weak individual mandate, measures preventing insurers from barring people with pre-existing conditions, taxes on high-cost health care plans and new taxes on some health care industry sectors will rapidly raise costs.

Employers Uneasy About Higher Taxes in Health Care Bill

2009-10-14T12:42:00.000-07:00

Employee Benefits News
By Lydell C. Bridgeford and Elizabeth Galentine
October 14, 2009

Health care reform received a major boost yesterday when the Senate Finance Committee voted 14-9 in favor of the “America's Healthy Future Act of 2009.” Yet industry watchers of employee benefits still remain concerned over the measure, citing its costs and workability.

“As the Senate — and the full Congress — continue the legislative process, we believe the Senate Finance Committee bill provides the most promising framework for achieving much-need health reform while preserving high-quality employer-sponsored coverage on which more than 160 million Americans depend,” says James Klein, president of the American Benefits Council.

Still, “more work is needed to ensure the highest possible number of individuals obtain health coverage so that sustainable health insurance reform can be achieved. In particular, weak enforcement of the individual mandate will likely cause many healthy people to refrain from buying coverage until they are sick," adds Klein, whose organization represents private-sector employers.

The group hopes that Congress will reconsider provisions in the bill that will result in a complicated and costly excise tax on high cost plans, extensive new fees on health insurers and new taxes on prescription drug coverage for retirees. “These costs are all likely to eventually be passed along to employers and employees and would certainly make health care more costly,” explains Klein, adding that ABC has created a list of priority employer issues for lawmakers to consider during the health care debate.

Another employer group that is not too ecstatic about the 10-year, $829 billion health care proposal approved by the Senate Finance Committee is the U.S. Chamber of Commerce. “One of the primary goals of health care reform is the overriding need to reduce ever-escalating costs for both consumers and employers. The Senate Finance bill increases premiums, raises taxes, and creates a new entitlement that will add to the nation's growing debt, says Bruce Josten, executive vice president of government affairs at the U.S. Chamber of Commerce, a trade association that represents the interests of American businesses.

Debating Premiums

To complicate matters, PricewaterhouseCoopers recently issued a report stating that health insurance premiums will rise even more rapidly if “America’s Healthy Future Act of 2009” becomes law.

PwC accountants calculate that the legislation would add $600 to a single person’s premiums and $1,700 a year to the cost of family coverage by the time most provisions are in effect in 2013. While Chairman Max Baucus (D-Mont.) questioned the credibility of a report commissioned by America’s Health Insurance Plans — “It’s a heath insurance company hatchet job,” Committee spokesman Scott Mulhauser told the news organization AP.

“I don’t think it does much for health care reform other than extend health insurance coverage to most of the uninsured with no reform for the drivers of cost, namely us,” says Tom Schuetz, co-president of Iowa’s Group Services.

Coupled with restrictions in the Genetic Information Nondiscrimination Act of 2008 that prohibit adverse use of genetic information in determining health care coverage, “it’s no wonder we aren’t able to address the root causes of our out of control health care costs,” adds Schuetz. He also pointed to the difference between the original projected costs for Medicare and its actual costs today as a warning.

For reform efforts to succeed, premiums must be affordable and people must be able to keep their existing private coverage, but changes made to the Finance Committee bill during markup would interfere with these goals, says Peter Stein, vice president of congressional affairs with the National Association of Health Underwriters.

“The weakening of the individual mandate, tens of billions of dollars in new insurer fees and taxes, tight limits on age rating, and high minimum benefit levels will make private health insurance unaffordable for many Americans. By some estimates, these provisions combined could double premiums for the youngest third of our population coming into a reformed insurance marketplace,” he says.

“Without an effective and enforceable insurance mandate and an influx of younger, healthier people, the bill would essentially create a marketplace where people can wait to buy coverage until they get sick. And this will cause premiums to increase significantly for everyone.”

The National Association of Insurance and Financial Advisors also takes issue with a number of provisions in the bill, including the individual mandate. The Baucus bill originally called for non-participation penalties between $750 and $3,800, depending on income level. That was reduced to $750 per adult in a household during committee markup. Such weak mandates “could devastate affordable insurance,” says Diane Boyle, executive vice president, AHIA-NAIFA Health & Employee Benefits. “If people can carry insurance only when they’re sick or injured, the price of insurance will skyrocket for everyone. This is a very difficult problem that Congress must resolve,” she adds.

Health Plan Members Pleased with Their HSAs

2009-10-12T08:43:00.000-07:00

John Commins
HealthLeaders Media
September 25, 2009

Most employers and account holders using health savings accounts and HSA-qualified health plans are satisfied with their coverage, spend less, and are more engaged in managing health benefits, two HSA industry-sponsored surveys indicate.

The surveys, conducted last spring, examined employer and account holder selection and use of HSAs as well as health plan participation, behaviors related to plan usage, and satisfaction with product features.

The surveys, sponsored by HSA administrators ACS and subsidiary Buck Consultants, found that:

84% of account holders say their HSA-qualified plans are affordable.

72% of account holders say they pay the same or less than a traditional type of health plan.

50% of account holders say they more closely monitor their healthcare costs

48% read their medical bills more closely than when they did not have an HSA

46% have a better understanding of where their money goes

40% more closely evaluate costs before electing medical services.

81% of account holders said the ability to personally control healthcare costs is an important factor that caused them to select an HSA.

96% of employers claimed that HSAs allow the company to continue offering group-sponsored health insurance.

Democratic Healthcare Reforms Would Take Three Years to Implement

2009-10-12T06:37:00.000-07:00

USA Today (10/12) reports that Democrats have sought "legislation that provides healthcare access for all Americans" for the last sixty years, but "they'll have to wait three more if President Obama gets a bill to sign this year."

Under Democratic bills "being considered, federal tax credits to help make health insurance affordable for millions of low- and middle-income households won't start until 2013. Medicare cuts and a sizable chunk of the tax increases to pay for the changes kick in immediately."

Obama Administration officials "and Democratic lawmakers say the reason for the three-year wait is the time it's going to take to set up insurance marketplaces, write consumer protection rules and reconfigure the bureaucracy to carry out the legislation."

Some Democrats concerned by three-year delay. The AP (10/10, Alonso-Zaldivar) reported that under Democratic healthcare reform proposals, "federal tax credits to help make health insurance affordable for millions of low- and middle-income households won't start flowing until 2013 -- after the next presidential election. But Medicare cuts and a sizable chunk of the tax increases to pay for the overhaul kick in immediately."

The "eat-your-vegetables-first approach is causing heartburn for some Democrats. Three years is a long time to wait for dessert, and opponents could capitalize on misgivings about the complex legislation to undo what would be a signature achievement for Obama."

This Week in Health Care Reform - October 9, 2009

2009-10-09T12:50:00.000-07:00

This week, legislators from the Senate Finance Committee waited for the Congressional Budget Office (CBO) to provide a cost estimate for the revised health care reform bill before bringing the legislation to a committee vote, now expected to take place next week.

Senate Negotiations

CBO Provides Revised Cost Estimate: On Wednesday, the CBO estimated that the revised Senate Finance Committee bill would cost $829 billion over the next 10 years, reducing the budget deficit by $81 billion over the same time period. The CBO also projected that the health reform legislation would expand health care coverage to 94% of Americans by 2019 . This estimate provides a significant political boost to the Finance Committee bill, as it is the only proposed health care reform legislation that meets President Barack Obama's guidelines, which include having a price tag of $900 billion or less over 10 years, vastly expanding coverage and not adding to the budget deficit. However, the CBO's estimate did not include the impact of the legislation on premiums.

Senate Finance Committee Finalizes Bill

Last Friday, the Senate Finance Committee wrapped up days of negotiations and finalized its bill to overhaul the U.S. health care system. In the last days of committee negotiations, lawmakers voted to:

1) Reduce penalties on those who do not obtain insurance;

2) Modify the proposed tax on high-cost insurance policies;

3) Prevent health insurance companies from taking tax deductions for compensation in excess of $500,000; and

4) Create a government plan to offer a state option operated by private insurers.
The committee originally planned to vote on the bill this week. However, the vote was delayed to give the CBO time to assess the cost of the revised package and to give the committee time to review the legislation before the vote.

Sen. Max Baucus (D-MT) has indicated he has the necessary votes to bring his bill across the committee finish line. Yet, it is still unclear whether or not he will achieve bipartisan support of the bill. In addition, at least two Democrats , Sens. Ron Wyden (D-OR) and John D. Rockefeller IV (D-WV) have refused to support the bill in its current form.

Joint Committee on Taxation Reports Increase in Industry Fees: On Tuesday, the Joint Committee on Taxation indicated that the revised bill coming out of the Senate Finance Committee would raise $121 billion from fees on drug companies, health insurers and medical device manufacturers, up from the original $92 billion previously reported. The increase in tax revenue stems from restrictions prohibiting companies from deducting the proposed industry fees from their corporate taxes. The new estimate has fueled increased Republican opposition to the reform legislation.

Senators Call for 72-Hour Window for Public Review: On Tuesday, a group of six moderate Democratic senators and one independent senator sent a letter to Senate Majority Leader Harry Reid (D-NV). The letter called for a 72-hour period for public review of the upcoming combined Senate health care reform legislation, along with the complete budget score from the CBO, prior to a full Senate vote.

House Activities

House Democrats Reject Taxing "Cadillac" Plans: On Wednesday, 154 House Democrats signed a letter addressed to Speaker of the House Nancy Pelosi (D-CA) denouncing a plan to pay for health care reform by taxing high-end health insurance plans, known as "Cadillac" plans. The letter urged the Speaker to reject proposals with a tax on Cadillac plans because it could potentially place a heavy burden on the middle class. This letter is in contrast with legislation moving through the Senate Finance Committee that includes a tax on insurers who offer these high-end plans. Speaker Pelosi has indicated she is considering adding a tax on health insurance to the House bill.

Public Opinion

Poll Shows Increased Public Support: The latest Associated Press-GfK poll has found that public support for President Obama's health care reform initiative has increased, split evenly between those who support reform (40%) and those who do not (40%). In September, 34% of the public supported Congressional proposals and 49% opposed them.

Additional Activities

President Obama Pitches Health Care Reform to Doctors: President Obama addressed approximately 150 doctors from across all 50 states on the White House lawn to win their support for health care reform. Many doctors oppose reform efforts, particularly due to potential cuts in Medicare and lack of protection from "abusive" malpractice lawsuits.

Looking Ahead

Following the Senate Finance Committee vote expected next week, Sen. Reid will work to merge the Senate Finance Committee bill with the other proposed legislation from the Senate Health, Education, Labor and Pensions Committee. He expects that the debate before the full Senate will begin after Columbus Day (October 12). House Speaker Pelosi expects to have merged the three proposed bills coming out of the House and to begin full House voting by mid-October.

JCT: Baucus Bill To Cost Insureds, Insurers Billions

2009-10-09T11:04:00.000-07:00

A proposed 40% excise tax on “Cadillac health plans” could cost employers about $46 billion per year by 2019, and health insurers could be paying $6.1 billion in federal “annual fees” in 2019.

Analysts at the Joint Committee on Taxation have included those projections in an analysis of the “revenue provisions” in the America’s Healthy Future Act bill draft.

Senate Finance Committee Chairman Max Baucus, D-Mont., sent the bill to the Congressional Budget Office and the JCT Friday, and CBO analysts published their “score” of the bill Wednesday. The CBO analysts said implementing the bill precisely as written would lead to a total of $829 billion in new spending from 2010 to 2019 but, thanks to a variety of cost-cutting and revenue-raising provisions, would cut the federal budget deficit by $81 billion over that period.

The JCT now has provided more detailed estimates of the effects of the AHFA bill draft on some types of products and tax breaks of interest to insurers.

The JCT is a nonpartisan congressional committee that advises Congress on tax legislation. All revenue provisions in the AHFA bill draft combined could raise about $11 billion in revenue in 2010 and about $13 billion in 2011, and that total would increase to about $104 billion in 2019, JCT analysts predict.

The provisions could raise about $381 billion from 2010 to 2019, the analysts report.
The AHFA bill draft would impose a 40% excise tax on individual health coverage with a value greater than $8,000 and family coverage with a value greater than $21,000 starting in 2013. The excise tax revenue would start at $9.5 billion in 2013 and total $201 billion from 2013 to 2019, the JCT analysts estimate.

The AHFA bill also would require health insurers to pay annual fees. The fee would start at $5.5 billion in 2010, increase to $6.1 billion per year in 2011, then hold steady at $6.1 billion per year. That provision could raise about $60 billion over the 10-year period analyzed, the JCT analysts say.

Other JCT analyst forecasts:

- Capping health flexible spending account contributions at $2,500 per year could raise $600 million in 2011, with revenue increasing to $1.9 billion in 2019, for a total of $15 billion in revenue raised from 2011 to 2019.

- Conforming “the definition of medical expenses for health flexible spending arrangements to the definition of the itemized deduction for medical expenses (excluding over-the-counter medicines prescribed by a physician)” would raise $5.4 billion from 2010 to 2019.

- Increasing the penalty for nonqualified health savings account distributions to 20% would raise $1.3 billion from 2013 to 2019.

- Capping the deductibility of health insurer compensation at $500,000 per year might raise about $100 million per year starting in 2013, and a total of $600 million from 2013 to 2019.

A proposed 40% excise tax on “Cadillac health plans” could cost employers about $46 billion per year by 2019, and health insurers could be paying $6.1 billion in federal “annual fees” in 2019.

Analysts at the Joint Committee on Taxation have included those projections in an analysis of the “revenue provisions” in the America’s Healthy Future Act bill draft.

Senate Finance Committee Chairman Max Baucus, D-Mont., sent the bill to the Congressional Budget Office and the JCT Friday, and CBO analysts published their “score” of the bill Wednesday. The CBO analysts said implementing the bill precisely as written would lead to a total of $829 billion in new spending from 2010 to 2019 but, thanks to a variety of cost-cutting and revenue-raising provisions, would cut the federal budget deficit by $81 billion over that period.

The JCT now has provided more detailed estimates of the effects of the AHFA bill draft on some types of products and tax breaks of interest to insurers.

The JCT is a nonpartisan congressional committee that advises Congress on tax legislation.

All revenue provisions in the AHFA bill draft combined could raise about $11 billion in revenue in 2010 and about $13 billion in 2011, and that total would increase to about $104 billion in 2019, JCT analysts predict.

The provisions could raise about $381 billion from 2010 to 2019, the analysts report.

The AHFA bill draft would impose a 40% excise tax on individual health coverage with a value greater than $8,000 and family coverage with a value greater than $21,000 starting in 2013. The excise tax revenue would start at $9.5 billion in 2013 and total $201 billion from 2013 to 2019, the JCT analysts estimate.

The AHFA bill also would require health insurers to pay annual fees. The fee would start at $5.5 billion in 2010, increase to $6.1 billion per year in 2011, then hold steady at $6.1 billion per year. That provision could raise about $60 billion over the 10-year period analyzed, the JCT analysts say.

Other JCT analyst forecasts:

- Capping health flexible spending account contributions at $2,500 per year could raise $600 million in 2011, with revenue increasing to $1.9 billion in 2019, for a total of $15 billion in revenue raised from 2011 to 2019.

- Conforming “the definition of medical expenses for health flexible spending arrangements to the definition of the itemized deduction for medical expenses (excluding over-the-counter medicines prescribed by a physician)” would raise $5.4 billion from 2010 to 2019.

- Increasing the penalty for nonqualified health savings account distributions to 20% would raise $1.3 billion from 2013 to 2019.

- Capping the deductibility of health insurer compensation at $500,000 per year might raise about $100 million per year starting in 2013, and a total of $600 million from 2013 to 2019.

Lowering Readmission Rates Could Lower Healthcare Costs

2009-10-09T06:22:00.000-07:00

The Indianapolis Star (10/9, Groppe) reports, "One in five Medicare patients returns to the hospital within a month of being discharged, according to the Centers for Medicare and Medicaid Services, which released hospitals' readmission rates this summer."

HHS Secretary Kathleen Sebelius said, "The President and Congress have both identified the reduction of readmissions as a target area for health reform. ... When we reduce readmissions, we improve the quality of care patients receive and cut healthcare costs."

CMS' chief of clinical standards and quality Barry Straube pointed out that "heart attack, heart failure and pneumonia patients shuttling back and forth to hospitals account for 46 percent of hospital admissions and cost Medicare roughly $17 billion a year." Current health overhaul legislation in the House and Senate hopes to lower these rates by reducing Medicare payments to hospitals with high readmission rates.

Pelosi Asks for CBO Scoring of Three Public Option Variations

2009-10-09T06:20:00.000-07:00

Roll Call (10/9, Newmyer) reports, "Speaker Nancy Pelosi (D-CA) is signaling she is flexible on the final form of a public insurance option in the healthcare overhaul and is seeking budget scores on both the preferred liberal and moderate approaches before making a final call." Speaker Pelosi said that she supports "a robust public plan tied to Medicare rates," but "many moderates prefer a plan with negotiated rates."

So, she asked the CBO "to score three variations of a public insurance option," CQ Today (10/8, Epstein) noted. The "robust" version, "which would save an estimated $110 billion over 10 years, and two variations of a public plan based on negotiated rates with healthcare providers. She said the estimate of savings for such plans is $25 billion over 10 years." Still, "those numbers are not official CBO scores yet; a formal analysis will take several days."

House Democrats Eye Windfall Profits Tax on Insurance Industry

2009-10-09T06:17:00.000-07:00

The Hill (10/9, Allen) reports that House Democrats "are floating the idea of a windfall-profits tax on the private health insurance industry as a way to finance their healthcare overhaul, and to drum up support among members of a divided caucus."

House Speaker Nancy Pelosi (D-CA) "called the windfall profits tax idea 'very preliminary,' saying she's asked House Ways and Means Chairman Charles Rangel (D-NY) to look at how much the tax could raise." The Hill adds that the "idea was brought up in a leadership meeting on Wednesday night and brought before the entire caucus on Thursday morning, according to Rep. Gerry Connolly (D-VA)."

The Washington Times (10/9, Haberkorn, Rowland) notes, "Lawmakers declined to discuss any additional details of the tax, such as how much it would raise or at what rate it would be collected." But Rep. Connolly said "the idea was popular with rank-and-file Democrats at a caucus meeting on Thursday." The Wall Street Journal (10/9, Vaughan) reports that Rep. Connolly also said the notion of a tax on expensive "Cadillac" insurance plans was a non-starter in the House.

Baucus Puts Bill In Play

2009-09-16T09:07:00.000-07:00

By ALLISON BELL
National Underwriter
September 16, 2009

Senate Finance Committee Chairman Max Baucus has released the eagerly awaited text of his version of the health reform bill.

The “chairman’s mark” – the America’s Healthy Future Act bill – would bar insurers from discriminating against people based on health status, denying coverage because of pre-existing conditions, or imposing annual caps or lifetime limits on coverage, according to Baucus, D-Mont.

Implementing the bill would cost about $856 billion over 10 years, but it would not add to the federal budget deficit, Baucus says.

In addition to promising to save money by fighting fraud and making the health care system more efficient, Baucus seeks to pay for some program costs by imposing a $2,000 annual cap on an individual's flexible spending account contributions, and, starting in 2013, levying "a non-deductible excise tax of 35% on insurance companies and plan administrators for any health insurance plan that is above the threshold of $8,000 for singles and $21,000 for family plans," according a summary provided by Baucus. "The tax would apply to the amount of the premium in excess of the threshold. The tax would apply to self-insured plans and plans sold in the group market, but not to plans sold in the individual market. The threshold would be indexed for inflation, and a transition rule would increase the threshold for the 17 highest cost states for the first 3 years."

The Finance Committee will begin voting on the bill next week, Baucus says. The committee expects to consider the bill during an open executive session Sept. 22.

“We worked to build a balanced, common-sense package that ensures quality, affordable coverage and doesn’t add a dime to the deficit,” Baucus says in a statement. “Now we can finally pass legislation that will rein in health care costs and deliver quality, affordable care to the American people.”

In addition to banning medical underwriting, the bill would create health care affordability tax credits to help low and middle income families buy private health coverage.

The bill also would create new health coverage tax credits for small businesses, and it would create Web-based coverage purchasing exchanges.

Rather than creating a government-run “public option” plan, the bill would “give consumers the choice of non-profit, consumer owned and oriented plans (CO-OP),” Baucus says.

Most individuals would have to own health coverage. Employers would not have to offer coverage, but many employers who did not offer it would have to reimburse the government for part of the cost of providing the health care affordability tax credit.

The bill would standardize Medicaid coverage for everyone earning less than 133% of the federal poverty level.

Other provisions would:

- Allow plans to vary coverage rates based on an insured's age, tobacco use and family composition.

- Encourage all of a patient’s doctors to coordinate care and reduce duplication and waste.

- Create incentives for health care providers to use electronic medical records and other health information technology.

- “Increase health care research so doctors know what care works best for which patients.”

- Cover the cost of annual “wellness visits” for Medicare participants and their doctors.

- Eliminate out-of-pocket costs for screening and prevention services for Medicare enrollees.

- Create incentives in Medicare and Medicaid for enrollees who participate in healthy lifestyle programs.

- Increase federal Medicaid funding for states that cover recommended preventive services and immunizations for enrollees at no extra cost.

- Provide free tobacco cessation services for pregnant women who are enrolled in Medicaid.

Obama Says Loss of Insurance Can Happen to Anyone

2009-09-14T05:47:00.000-07:00

The Los Angeles Times (9/13, Nicholas) reported, "Coming off a major speech that appeared to revive prospects for his healthcare plan, President Obama [Sunday] is making the case that even Americans who have health insurance need to worry about losing it." In his weekly address, Obama "cited a study by the Treasury Department to convince families who enjoy health insurance coverage that it's squarely in their interest to embrace the overhaul he has placed atop his domestic agenda."

CNN's Newsroom (9/12, Nguyen) reported, "The President is using new figures from the Treasury Department to bolster his case, warning America, more of your friends and neighbors are uninsured than you think. But he is also assuring the public in his weekly address that reform won't add to the deficit." President Obama said, "And as I have said over and over again, I will not sign a plan that adds one dime to our deficits, period. This plan will be paid for. The middle class will realize greater security, not higher taxes. And if we can successfully slow the growth of healthcare costs by just 0.1 percent each year, it will actually reduce the deficit by $4 trillion over the long term. Affordable quality care within the reach of tens of millions of Americans who don't have it today; stability and security for the hundreds of millions who do. That's the reform we seek."

The Hill (9/12, Romm) reports the President said "about half of all Americans under 65 will go without health insurance coverage for some period of time during the next 10 years."

In Congressional Speech, Obama Must Get Specific

2009-09-09T08:03:00.000-07:00

Employee Benefits News
September 6, 2009

In a speech before a joint session of Congress tonight, President Barack Obama will attempt to take back the wheel of the health reform debate, which veered off Democrats’ preferred course in August after heated town hall meetings and comments from key Republicans who suggested they were backing away from the negotiating table.

For months, critics have been calling for the president to put forth some firm details on his vision of health reform. Even Sen. Chris Dodd (D-Conn.), who led the Health, Education, Labor and Pensions Committee in Sen. Edward Kennedy’s absence, said he’d welcome more word from the White House. EBA asked our health reform panelists, now that the president is stepping up to the pulpit, is it too little, too late?

“I would never underestimate the ability of this administration to change peoples’ minds,” says Group Services’ Tom Schuetz, adding that “enough of the American public is now very skeptical, and that makes it a much tougher task.”

Cyndy Nayer, president of the Center for Health Value Innovation, says “it's never too late to do the right thing, which is to tell the country the kind of legislative bill he wants to sign.”

Convinced that shouting over thousands of pages of legislation and making multiple amendments isn’t going to solve anything, Nayer wants to hear the president state three things that he would like on his desk by a specific date. “The country needs a vision for better health,” she says. “Think of it this way: John Kennedy didn't say we were going to build the best technology to go to the moon, he said we were going to the moon. My vision, and my request to the president, is to simply say, ‘We will be the healthiest country on the planet, both clinically and economically, by 2015.’ Now that's a goal with defined deliverables.”

Obama must squarely address the issue of cost control, rather than just seek to reduce the number of uninsured Americans, says Thomas Parry, president of the Integrated Benefits Institute. “The untapped opportunity in the health care debate is to link better health, health care cost reduction and improved workforce productivity. This strategy not only will deal with a fundamental root cause of health care costs, but will also link health care reform to economic recovery.”

This can be done through reform provisions that encourage employers to play a greater role in preventative care. “IBI’s research shows employers know this approach is in their interest,” adds Parry, “and they can then use their leverage as payers with health insurers and providers to insist on more effective treatment and focused prevention initiatives.”

The fact that the president is making the speech shows that he knows he needs to lay out a stronger position on the issue and that things may not be heading in his desired direction, says Adam Bruckman, president and CEO of Digital Insurance. “It says that maybe there’s an acknowledgement that things are off track a little bit and maybe he’s losing the battle on health care reform,” Bruckman says. “But, he’s very good and very persuasive, and I think it’ll be interesting to see if he’s able to change the direction by addressing Congress.”

WellPoint CEO: Federal Inefficiencies, Not Insurers, Drive up Healthcare Costs

2009-09-02T05:57:00.000-07:00

The AP (9/2) reports WellPoint CEO Angela Braly said in speech at the Economic Club of Indiana that by focusing on the insurance industry, those backing health reform are missing "a much bigger target" to lower costs.

"Three cents of every health insurance premium dollar collected go toward insurer profits, while 87 cents go toward medical care," Braly said. And even if insurer's profits are "completely eliminated," the savings will only "pay for two days of healthcare in America."

Braly pointed out that Medicare spending "totaled $468 billion last year" and cited a study, which found that Medicare patients receive "evidence-based medicine, only about half the time. ... This inefficiency, she said, drives up costs and forms the 'crux of the problem.'"

Braly added that she objects to the public option because its low reimbursement rates "would shift costs to private insurers," and families covered by private insurance "already pay about $2,500 per year" to make up for such care "provided by Medicare and Medicaid."

AFL-CIO's Trumka Warns Democrats Against Abandoning a Public Option

2009-09-01T06:47:00.000-07:00

The AP (9/1, Hananel) reports Richard Trumka, the AFL-CIO's secretary-treasurer who is "expected to become the AFL-CIO's next president," said "lawmakers would pay a political price if they abandon a government-run option in any healthcare overhaul."

Speaking at the Center for American Progress, Trumka said, "We need to be a labor movement that stands by our friends, punishes its enemies and challenges those who, well, can't seem to decide which side they're on."

Trumka "singled out lawmakers 'who say they are all for healthcare reform, but refuse to stand up for a public system that puts people before profits. ... I think they need to understand you can have a bill that guarantees quality, affordable healthcare for every American, or you can have a bill the Republicans will vote for,' Trumka said. 'But you can't have both.'"

According to the New York Times (8/31, Greenhouse) "the federation has long backed universal health coverage and is eager for Mr. Obama and Congress to include a government-run health option that would compete with private insurers, as a way to press the industry to reduce costs and premiums."

This Week in Healthcare Reform: August 28, 2009

2009-08-28T13:00:00.000-07:00

This week, Sen. Ted Kennedy, longtime champion of universal health coverage, died at age 77. It remains to be seen how his death will affect the debate over health care reform as Democrats continue efforts without his guidance. Sen. Kennedy was involved in nearly every piece of health care legislation that moved through Congress during his eight-term Senate tenure. In a statement, House Speaker Nancy Pelosi (D-CA) said, "Ted Kennedy's dream of quality health care for all Americans will be made real this year because of his leadership and his inspiration."

Health Reform Activities

Obama Pledges Health Care Reform

This week, after much infighting over the fate of the public option, President Obama reaffirmed his commitment to health care reform legislation, suggesting that he would be willing to bypass the GOP. As Democrats consider a wide range of strategies for getting a health reform bill passed, other key senators called for the President to move more slowly as concerns over the growing deficit and the economic recession remain.

Republicans Launch Senior Health Care Bill of Rights

On Monday, the Republican National Committee introduced a "seniors' health care bill of rights," which outlines six principles for health care reform. Examples of the principles include protecting Medicare, prohibiting rationing of health care based on age, and making sure the government does not come between seniors and their physicians.

Democrats Launch National Grassroots Offensive

In an effort to show lawmakers that a majority of Americans still support an overhaul of the health care system amidst growing public concern, the Democratic National Committee's grassroots arm launched a national campaign effort Wednesday. The Democratic Organizing for America, in partnership with the organization Health Care for America Now, expects to hold more than 500 events across the country by early September, when lawmakers return to Washington.

New Divides Emerge in the Senate

Aides have indicated that as Senate Finance Committee negotiators work to trim costs of their bill, new divisions are emerging between Republican and Democratic Senators over proposals to reduce the size of insurance tax credits to families and scale-back insurance coverage mandates. The committees, also known as the Gang of Six, rejected imposing deadlines on their efforts to reach bipartisanship legislation and agreed to talk again September 4th.

$1.2 Billion Allocated for Electronic Medical Records

Last week, Obama Administration officials announced that $1.2 billion in federal grants will be available for electronic health record systems. This is the first in a wave of funds allocated by the American Recovery and Reinvestment Act of 2009 to create record-sharing networks. The grant is part of the $36 billion originally included within the stimulus legislation to encourage adoption of electronic medical records by hospitals and doctors.

Looking Ahead

Lawmakers are slated to return to Washington on September 8th.

Popular Insurance Fixes Could Serve as Basis for Incremental Bipartisan Reform

2009-08-28T05:43:00.000-07:00

The Los Angeles Times (8/28, Hook) notes the "surprising fact" many Congressional Democrats and Republicans "actually agree on a bundle of proposals," including "such popular ideas as barring insurance companies from denying coverage to people with preexisting injuries and illnesses, cutting insurance coverage off when a policyholder gets sick, and imposing a lifetime cap on benefits.

The 'reforms are quite possibly the least controversial of all the issues in health reform -- and among the most important,' said Drew Altman, president of the Henry J. Kaiser Family Foundation, a nonpartisan research group."

According to the Times, "Lawmakers from both parties are increasingly eyeing the areas of agreement as a possible fallback if Obama's more ambitious approach collapses. ... 'There is no reason we have to do it all now, but we do have to get it started,' Sen. Joe Lieberman (ID-CT), who is generally supportive of Obama, said in a recent television interview. 'I'm afraid we've got to think about putting a lot of that off until the economy's out of recession.'"

White House Considers Two-bill Option to Pass Health Reform

2009-08-26T06:13:00.001-07:00

Employee Benefits News
August 25, 2009

In their search for an endgame to the health reform debate, the Obama administration is examining new ways to at least get a comprehensive bill through the Senate. Media reports indicate that one strategy on the table is to split reform initiatives into two bills – one containing the least-contentious provisions that would pass the chamber with a standard 60-vote majority, and another full of hot-button issues, such as a government-run option, that would move through a filibuster-proof “reconciliation” process.

It’s a “risky political proposition,” says Groom Law Group’s Bill Sweetnam, and may not even be possible, as measures passed through reconciliation must relate to mandatory spending or revenue programs. Additionally, such an action would put moderate Democrats between a rock and a hard place.

“Since the well has been poisoned by splitting the bill, no Republicans will vote for either bill, so all Democrats will have to vote for the second bill or at least vote for cloture to allow there to be a vote on the second bill,” says Sweetnam. “These moderate Democrats will have a recorded vote for health care reform, and their Republican opponents will use that against them -- regardless of whether they voted for the bill with the hot-button issues.”

Cyndy Nayer, president of the Center for Health Value Innovation, offers another perspective. “This may be the most efficient way to get some sort of health care change moving,” she says. “Sometimes, even if the job is big, you have to start with small shovels.”

However, appearing on CBS’s “Face the Nation” over the weekend, Sen. Kent Conrad (D-N.D.) expressed doubt that splitting the legislation would be feasible. “I think it's very unlikely for that to work,” he said. “When you look at the legislative agenda, it's very difficult to see how you put two packages through and coordinate them well.”

Although he now thinks that “anything is possible” with the 111th Congress, it’s the larger issue of abandoning a bipartisan approach that has Tom Schuetz, co-president of Iowa’s Group Services concerned.

“Don’t you think the American public is asking for bipartisan support and a more detailed explanation of exactly what issues the health reform legislation is supposed to address? I think that’s the crux of all of the unrest,” he says. “A perception that Congress is not willing to share details and rushing to a conclusion for political reasons has always created problems.”

Key Lawmakers Urge Obama To Scale Down Healthcare Reform Plans

2009-08-24T05:54:00.000-07:00

Media reports on the healthcare debate continue to paint a grim picture of the President's reform push. The White House is being cast as beset by conflicting agendas in the House and Senate, and comments Sunday by Sen. Joe Lieberman (D-CT) are being interpreted as a signal that Senate moderates may in the end not be on the President's side.

A senator "counted on by Democrats in the healthcare debate showed signs of wavering," says the AP (8/24, Daniel). ABC World News (8/23, Harris), the only network newscast that aired Sunday, reported that the goal of "universal health coverage...seems as allusive as ever."

ABC's Cochran added that on the issue of bipartisanship "the President appears to have intentionally sent conflicting signals. Fearful of losing liberals in the House, the White House says he wants an option for government-run insurance. Fearful of losing moderates in the Senate, the President signals he is willing to consider other options."

USA Today (8/24, Fritze) says that "lawmakers said Sunday...Obama must scale back ambitious plans to overhaul healthcare because ballooning budget deficits are undermining support for more comprehensive and costly legislation." USA Today adds "even Democrats in Congress said that whatever healthcare bill emerges this fall will have to cost less than the $1 trillion price tag contemplated earlier this year." Sen. Kent Conrad (D-ND) said on CBS, "It's going to have to be significantly less than what we've heard talked about. ... We've got to have the deficit reduced as a result of this effort. That is absolutely imperative."

Asked on CNN's State of the Union (8/23, King), "Is it time for the President to hit the reset button" and back a more modest reform package, Sen. Lieberman answered, "In a word, yes. I give the President tremendous credit for taking on the healthcare problem," but "he took it on at a very difficult time that was not of his making. In other words, we're in a recession." Later, Lieberman added, "I think it's a real mistake to try to jam through the total healthcare reform plan that the public is either opposed to or of very, very passionate mixed minds about. It's just not good for the system, frankly, it won't be good for the Obama presidency."

The New York Times (8/24, Berger, Henry) reports that "Lieberman's comments could further complicate Democratic efforts to get a healthcare overhaul passed in Congress. They had been depending on the independent senator to support their efforts, even though he often aligns with Republicans."

This Week in Health Reform: August 21

2009-08-21T12:58:00.000-07:00

The survival of the public plan as the cornerstone of health care reform became the central focus this week as Democrats debated the importance of its inclusion in the final bill. Media reports this morning indicate that suggestions of dividing the bill into manageable parts instead of passing a large health reform package have begun rumbling.

Health Care Reform Activities

Public Option, or Not?: White House Press Secretary Robert Gibbs went on defense this week, insisting that the Administration had not taken the public option off the table following remarks on Sunday from Health and Human Services Secretary Kathleen Sebelius that a public option was "not essential" to reform. White House officials have since been working to calm a swell of criticism from liberals. A group of House liberals sent a sharply worded letter to Sebelius on Monday in which they called backing off a public option a "grave error."

Cooperatives Pushed as Public Plan Alternative: In response to what seemed to be a concession from White House officials on the public option, key senators are taking another look at Sen. Conrad's (D-ND) proposal for member-owned, nonprofit cooperatives. However, GOP leaders have expressed concern over the option. Sen. Kyl (R-AZ) dismissed cooperatives, calling the proposal a "Trojan horse."

Democrats Focus on Insurance Reforms: President Obama stepped up his attacks on the insurance industry in his recent town hall meetings and on his weekly radio address. He promised reforms that would prevent firms from capping coverage or charging "outrageous" fees. President Obama also indicated that people currently with health insurance coverage would be amongst the biggest beneficiaries of his health care reform.

Opinion Polls

Poll Shows Slim Majority Still Favors Health Care Reform: The margin between those who support health care reform and those against it has narrowed in recent months given rising concerns about the reform measures. An August poll shows that 53 percent of the public believes that tackling health reform is more important than ever, compared to 42 percent who say we cannot afford to take on health care reform right now.

Looking Ahead

White House officials and key lawmakers continue to negotiate over August recess in an attempt to prepare a final bill for passage this fall.

Lawmakers are slated to return to Washington September 8th.

Study Indicates Illegal Immigration Will Make Lowering Health Costs Harder

2009-08-20T06:14:00.000-07:00

CongressDaily (8/19, Hunt) reported, "Illegal immigration will make lowering healthcare costs harder," according to a study conducted by the Center for Immigration Studies.

The analysis was based on "data from the 2008 Current Population Survey, which is conducted by the Census Bureau." The study said "immigrants -- legal and illegal -- are almost three times as likely to be uninsured than native-born Americans."

Steven Camarota, the director of research for the Center for Immigration Studies, noted "the majority of immigrants have not finished high school...which means most have low-income jobs that do not provide health insurance, and the low wages mean workers are unable to afford it. Camarota estimated the cost of insuring all immigrants could cost the government $1.5 trillion over the next 10 years."

Meanwhile, "Latino advocacy groups dismissed the study," stating it is "just the latest example in a campaign to erode efforts to ensure that quality, affordable healthcare is available to American families and workers."

Senate Democrats May Split Healthcare Bill to Ensure Passage

2009-08-20T06:12:00.000-07:00

The Wall Street Journal (8/20, Weisman, Bendavid) reports in a front page story that the White House and Senate Democratic leaders have revised their strategy for passing healthcare reform legislation.

Under the new plan, Senate Democrats would split the measure into two parts; the first part, for which some Republican support is expected, would cover new insurance industry regulations. Democrats would pass the second part, which could include provision for a public option or other expensive proposals, under the budget reconciliation procedure, which would only require 51 votes.