March 31, 2010
This Week in Health Reform
Federal Legislative Overview: President Signs “Patient Protection and Affordable Care Act”House Democrats passed their landmark health care overhaul, the “Patient Protection and Affordable Care Act,” (PPACA) on a party-line 219-212 vote late on March 21. A little more than a day following, on March 23, President Barack Obama signed the legislation into law at a White House ceremony.
Additionally, the House passed H.R. 4872, the “Health Care and Education Affordability Reconciliation Act” (Reconciliation Bill), which is a package of amendments to the PPACA. The approved Reconciliation Bill then went back to the Senate, where it needed to be voted on – and potentially amended – before it would be ready for President Obama’s signature.
On March 25, by a vote of 56 to 43, the Senate approved the Reconciliation bill with some modifications, and sent it back to the House for yet another vote. Democrats Ben Nelson (D-NE), Mark Pryor (D-AR) and Blanche Lincoln (D-AR) joined Republicans in voting “no.” Johnny Isakson (R-GA), who is ill, did not vote.
In the final vote on current health care reform legislation, the House approved – by 220 to 207 – the same version of the health reconciliation bill, H.R. 4872 that was approved earlier in the day by the Senate. This bill was signed into law by President Obama on March 30. The final version of the reconciliation bill is virtually identical to the version that the House approved on March 21. The only difference is that two student loan provisions were removed during the Senate floor debate.
The combined package costs $940 billion, and is expected to expand health care coverage to 32 million Americans while cutting the deficit by $143 billion over the next 10 years.
A spokesman for House Republican Whip Eric Cantor (R-VA) said Republicans are now shifting their efforts against the health legislation to a campaign aimed at repealing the law and replacing it with their own solutions. Both the Senate and the House began the two-week Easter recess on March 27.
Overview: Tax Extenders Package
Along with the Reconciliation legislation, lawmakers were also focused intensely on passing another extension of expiring provisions including the Medicare physician payment “fix,” unemployment benefits and the eligibility period for premium assistance for COBRA and state continuation coverage. Senate leaders attempted to pass by unanimous consent a 30-day extenders package, H.R. 4851, which was approved by the House on March 17. Senator Tom Coburn (R-OK) objected to the unanimous consent request because of his concern that the bill did not include budget offsets. Senate Democrats and Republicans then reached an agreement to pass a one-week extension with budget offsets, but House leaders objected to this approach. As of this writing, it appears that efforts to pass an extenders bill have reached a stalemate. The Senate passed an adjournment resolution that day allowing the Senate to conduct legislative business through March 31 (cutting into the aforementioned Easter recess), although the “next steps” in the extenders debate are highly uncertain at this time.Timeline
These are among the more than a dozen features of the new health care law that would take effect in 2010 under the measure passed on March 21, 2010.Some of the items that go into effect in the first year include:
Coverage of children: Parents will be allowed to keep their children on their health insurance plan until age 26, unless the child is eligible for coverage through a job. Insurance plans cannot exclude pre-existing medical conditions from coverage for children under age 19, although insurers could still reject those children outright for coverage in the individual market until 2014.
Tax credits for businesses: Businesses with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 50 percent of the cost of their premiums.
Changes to insurance: All existing insurance plans will be barred from imposing lifetime caps on coverage. Restrictions will also be placed on annual limits on coverage. Insurers can no longer cancel insurance retroactively for things other than outright fraud.
New help for some uninsured: The bill would create a temporary high-risk insurance pool for people with medical problems who have been rejected by insurers and have been uninsured at least six months. In 2014, insurers would be barred from rejecting applicants based on health status.
Government oversight: Insurers must report how much they spend on medical care versus administrative costs, a step that later will be followed by tighter government review of premium increases. There is no mention of a Public healthcare option in this version of the bill.
Some of the items that go into effect in 2014 include:
Insurance Mandate: Requirement that all Americans carry insurance or face a government fine. People in their 20s would be given the option of buying a "catastrophic" plan that would have lower premiums. The coverage would largely only kick in after the individual had $6,000 in out of pocket expenses.
Rules requiring insurers to accept all applicants, even those with health problems, and an expansion of state Medicaid programs.
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