After months of touting the transparency of health reform negotiations, Congressional leaders retreated behind closed doors to start the task of merging together the five major healthcare reform bills that have passed out of various Committees. As healthcare annual spending tops $2.4 trillion, the stakes are high as Congress faces conflicting pressures to expand coverage and curtail spiraling costs.
A handful of major issues and many smaller ones remain unresolved. The two chambers disagree on how to pay for the legislation, with the Senate preferring a tax on high-value insurance policies as the main revenue-producing measure, and the House favoring a surcharge on millionaires. Liberal Democrats want to penalize companies that do not provide coverage to their employees; moderate Democrats would take a less punitive approach. And many lawmakers are concerned about the affordability of insurance policies Congress would require people to buy under an individual mandate.
So the question remains– can consensus be reached in a Congress that remains sharply divided on the details of reform?
A Closer Look at the Debate
In the House
Leaders in the House have proclaimed they can produce a public plan using Medicare rates, but it is unclear they really have the 218 votes required for such an approach. On the other hand, the Medicare for Everyone, or “Medicare Part E,” rebranding of a public option has managed to sway at least some moderate House Members, as has confirmation of a deal struck in the Energy and Commerce Committee to eventually increase Medicare rates in rural areas. What is clear now is that a “robust,” federally-administered, nationwide public plan will be included in the House bill.
The House does intend to include some of the “fees” initially proposed in the Senate Finance bill, with keen focus on the medical device fee. We understand that Speaker Pelosi told concerned Members that the House tax would be $20 billion, assessed to profits (rather than fees assessed to all revenues, as in the Senate bill).
Without a pathway to a final bill or comprehensive Congressional Budget Office (CBO) scores, House floor action appears unlikely before the week of November 9. Given its ability to move legislation more quickly, however, the House could be on the floor as late as the week of November 16 and still pass their bill prior to Thanksgiving recess.
In the Senate
Progress in the Senate continues at a slow pace. Despite positive statements by principals, negotiations at the staff and Member level have been difficult and sometimes contentious. While no “deadline” for the talks has been set, leadership has privately directed that final legislation be scored by the CBO and ready for the floor by November 9. Several key staff are increasingly skeptical that the deadline can be met.
While Senator Olympia Snowe has not shifted her position that a “trigger” must be associated with any potential public option, other key moderates appear to be softening. Senator Ben Nelson and others have expressed openness to an approach that would allow states the ability to opt out of a federally-run public plan. While there are not yet 60 votes for the opt-out approach, the middle ground of the conversation does appear to have shifted meaningfully to the left, with a federally backed public plan more likely than before. Use of Medicare rates by the public plan(s) continues to be highly unlikely in the Senate, or in the final bill.
Major Provisions
Following is an overview of the provisions in each of the major bills that passed out of Committee earlier this year. While the merged bills could look quite different, it is useful to see varying provisions being considered as the next phase of the debate unfolds.
Senate Finance
• Cost projected to be $856 billion over 10 years
• Creates health care affordability tax credits to help low and middle income
families purchase insurance in the private market
• Provides tax credits for small businesses to help them offer insurance to their
employees
• Allows people who like the coverage they have today the choice to keep it
• Reforms the insurance market to end limits on pre‐existing conditions and health status
• Eliminates yearly and lifetime limits on coverage
• Creates web‐based insurance exchanges that would standardize health plan
premiums and coverage information to make purchasing insurance easier
• Gives consumers the choice of non‐profit, consumer owned and oriented plans
(CO‐OP)
• Standardizes Medicaid coverage for everyone under 133 percent of the federal poverty level
• Requires adoption of standardized electronic administrative transactions to drive efficiency, reduce errors and lower costs
Senate Health, Education, Labor, & Pensions (HELP)
• State health insurance exchanges
• Government-run, public health insurance option to compete with private insurers to drive costs down
• Individual insurance mandate, with some exceptions for those who cannot afford coverage
• Employers with 25 or fewer employers also exempt from penalties
• Prohibiting insurers from denying coverage based on their health status
• Promoting quality through financial incentives for providers
• Coverage of preventive health services
• Extending coverage for dependent adults until age 26
• No lifetime or annual limits on individual or group health insurance policies
House Tri-Committee (Committees on Energy and Commerce, Ways and Means, and Education and Labor)
• Creation of a public insurance option
• Expanding access to health insurance
• Standardized benefits packages
• Provisions to end premium increases or coverage denials for "pre-existing" conditions
• Eliminating co-pays for preventive care
• "Affordability credits" to make premiums affordable
• Caps on out-of-pocket expenses
• Employer mandate- pay or play
• Guaranteed catastrophic coverage
Senate Finance Comes Out Strong on Administrative Simplification
All of the major healthcare reform bills include provisions that support healthcare administrative simplification, but the Senate Finance language remains by far the strongest. Specific provisions include:
• Timeline for accelerating existing HIPAA transactions
• Adds electronic funds transfer (EFT) as a required transaction
• Single set of operating rules for eligibility verification, claims status, claims remittance/payment, and EFT developed by a qualified non-profit entity, reviewed by NCVHS
• Rule to create unique health plan identifiers
• Requirement that health plans file a certification statement by Dec. 2013 that their data and information systems comply with the most current published standards for four transactions: eligibility verification, claims status, claims remittance/payment and EFT
• Requirement that by2014, no Medicare payment under Part A or Part B be made other than by EFT or an electronic remittance
Emdeon Supports Sensible Policies, Practical Solutions
Emdeon supports and promotes sensible public polices and practical solutions that make healthcare efficient. Our goal has been to help reframe the healthcare reform debate and focus on actions we can take today to take costs out of the system. Key areas like administrative simplification, program integrity/fraud and abuse, third party liability cost avoidance and public beneficiary management offer billions in potential annual savings.
The U.S. Healthcare Efficiency Index™, launched by Emdeon in 2008, identified $300 billion in savings over 10 years from automating the most basic healthcare administrative transactions. Emdeon has worked to raise awareness of these potential savings that can free up dollars to pay for delivery of care or offset costs of longer term reforms.
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Congress begins task of merging five health reform bills into one
