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« Legislative News Health Reform Legislation Expected on Senate Floor Soon
By Paul Beddoe
NACo Associate Legislative Director
Health care reform legislation is expected to be on the Senate floor in the next several weeks after the Senate Finance Committee passed its version of health care legislation. According to news reports, Majority Leader Harry Reid (D-Nev.)will combine the Finance version with a more liberal proposal from the Senate Health Committee.
Sen. Max Baucus (D-Mont.), chair of the Finance Committee, said in an interview with the Associated Press after the vote that he hopes his bill survives the merger process without major changes.
“The bottom line here is we need a final bill, a merged bill that gets 60 votes,” Baucus said. “Our goal is to pass health care reform, not just talk about it.”
The nonpartisan Congressional Budget Office (CBO) released its preliminary assessment — or “score” — of the Senate Finance Committee’s version of health reform legislation, Oct. 7, estimating that over 10 years, the bill would provide coverage for 94 percent of Americans at a cost of $829 billion and reduce the deficit by $81 billion. The CBO estimate paved the way for the final vote on the bill, highlighted by Maine Sen. Olympia Snowe’s sole Republican assent.
Finance Committee Bill Highlights
The bill would, among other things, require most legal U.S. residents to obtain health insurance; set up highly regulated health insurance market places — or “exchanges” — through which uninsured individuals and families purchase coverage with federal affordability subsidies on a sliding scale; expand Medicaid to everyone with incomes below 1.3 times the federal poverty level, including childless adults. It would cover costs in part by imposing an excise tax on higher-premium insurance plans and cut Medicaid disproportionate share hospital (DSH) payments by $22 billion.
“Our balanced approach to health reform has paid off yet again with the news today that the America’s Healthy Future Act remains fully paid for, begins to reduce the federal deficit within 10 years and makes significant reductions in federal debt over the next several decades. Most importantly, it improves and expands health care coverage for tens of millions of American families,” Baucus said in a statement.
The committee’s ranking member, Sen. Charles Grassley (R-Iowa), was quick to point out that CBO scored the bill as deficit-neutral because its coverage expansion is paid for with billions of dollars in new taxes and fees.
“Uninsured individuals would pay a tax for not obtaining government-approved health insurance,” Grassley said in a statement. “Employers who already offer health insurance would face a penalty if their workers choose subsidy-eligible insurance. With all of this, the bill spends nearly a $1 trillion and still leaves 25 million people without health insurance.”
NACo has supported moving towards the goal of health insurance coverage for all Americans by expanding existing public health insurance programs like Medicaid and the State Children’s Health Insurance Program (SCHIP) but has urged Congress to fully cover the cost of expansion.
The Finance Committee bill would provide states with an increased federal medical assistance percentage (FMAP) for the newly eligible Medicaid populations, leaving them to fund about 10 percent of the cost.
The CBO analysis estimates that the bill would increase state spending on Medicaid by approximately $33 billion over 10 years. It also assumes that states will be able to keep their spending increases to that level by reducing other coverage and benefits in their Medicaid and SCHIP programs.
“Expanding Medicaid eligibility is an effective strategy for decreasing the number of uninsured Americans,” said NACo President Valerie Brown, “but I know from painful experience in Sacramento that states will never be able to increase mandatory Medicaid spending by $33 billion without making deep cuts to programs that serve other vulnerable populations and shifting significant costs to counties.”
Meanwhile, Senate Democratic leaders are already working to merge the Finance Committee bill and the Affordable Health Choices Act (S. 1679) reported out by the Health, Education, Labor and Pensions (HELP) Committee in July.
Senate Health, Education, Labor and Pensions (HELP) Committee Bill
The HELP bill contains a number of provisions important to counties, including mandatory funding to support local public health prevention and wellness interventions; programs to improve access to health care services in underserved areas and to reduce health disparities, including increases for the education and training of health professionals. Advocates are concerned that these provisions may be in jeopardy as the leaders attempt to keep the combined measure’s price tag under the president’s $900 billion top line.
House Health Reform Bills
Meanwhile, members of House Speaker Nancy Pelosi’s (D-Calif.) staff have confirmed that Democratic leaders are nearing the end of the protracted negotiations with individual members and factions over how to merge the three versions of the America’s Affordable Health Choices Act (H.R. 3200). When the final bill is ready, it will be submitted to CBO for a score and posted online for 72 hours before going to the floor.
The House bill includes an expansion of Medicaid to everyone under 1.3 times the federal poverty level with 100 percent FMAP for the newly eligible population until 2015 after which states will receive 90 percent FMAP.
H.R. 3200 would also increase Medicaid physicians’ and other practitioners’ reimbursement rates for primary care services to 100 percent of the Medicare rates by 2012, with 100 percent federal financing for the increase initially and 90 percent FMAP after 2015. The Senate Finance Committee bill has no similar provisions.
H.R. 3200 also limits the cuts to DSH to $10 billion between 2017 and 2019 and calls for a study to make recommendations on targeting remaining DSH payments.
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