Our guest blogger is Emma Sandoe, a Health Care Researcher at the Center for American Progress Action Fund.

Last week, in his invitation to Congressional leaders, President Obama promised to “post online the text of a proposed health insurance reform package.” Expected to be released Monday, 72 hours in advance of the February 25th bipartisan health care summit, the White House proposed reforms will likely be a set of compromises and the best policy ideas taken from the House and Senate passed reform bills.

With members of Congress away during the President’s Day recess, it is likely the package would look more like a collection of general ideas rather than final compromised agreements in legislative text as we have seen in prior bill releases. In recent days, the White House has indicated support for the reconciliation process to pass compromised reforms. So, the differences presented here could create a reconciliation, “fix it” bill to the bill passed by the Senate in December.

Here is what to expect:

– Closing the Doughnut Hole: Midway through the final Senate vote, Democratic Senate leaders promised to include a full closure of the coverage gap in the Medicare prescription drug program. This provision is included in the final House bill, but the Senate bill only begins to make efforts to begin to close it. AARP supported the Senate bill with the understanding the Senate would amend the bill to close the hole.

– Cadillac or Excise Tax Fix: White House aides say the “White House prefers instead to keep the version already agreed upon with unions.” Last month, the White House helped broker a deal between the House and the Senate on the excise tax to protect labor union members’ negotiated health benefits. In recent days, the negotiated deal has lost support among some labor leaders which could lose it support within the House.

– Subsidies: One of the main reasons the House bill is more costly than the Senate version is the greater level of subsidies it gives lower-income individuals. It is important for health insurance to be affordable under the reform proposal and subsidies are a straightforward way of making sure that happens.

– National Exchange: The House pushed hard for this provision last month. It’s sound policy and the President appeared prefer it last month.

– Fixing the Nebraska Deal: The deal to give Nebraska extended Federal Medicaid funds in exchange for Ben Nelson’s (D-NE) vote was never popular with Democrats or Republicans. Now that a reconciliation deal does not hinge on Ben Nelson’s vote, the provision will likely disappear.

What to not expect:

– Public option: The recent resurgence of support of the public option with the letter initiated by Sen. Michael Bennet (D-CO) has been heroic, but in this venue will be a non-starter. This does not preclude the potential addition of a public plan through the reconciliation process at a later point, but it is unlikely the White House will tread on the controversy at this point.

What to watch out for:

– Abortion and Immigration: It will be interesting to see how (or if) the White House handles these issues. On the one hand, not touching abortion and immigration would temporarily sidestep the politically charged arguments that intensified under the debate. However, if the White House wants to present a comprehensive plan that addresses these unresolved issues, it will have to make some choices.

Our guest blogger is Emma Sandoe, a Health Care Researcher at the Center for American Progress Action Fund.

An additional 3.28 million Americans enrolled in the Medicaid program for low income individuals last year, as the economic recession shifted many individuals from employer sponsored coverage to public programs — a trend that further underscores the need for health insurance reform.

A report from the Kaiser Family Foundation shows that enrollment has grown during each six month period since the beginning of the recession. Nationwide the Medicaid program saw a 7.5 percent increase from 2008 to 2009 and Maryland saw a dramatic 20 percent increase. Maryland Medicaid director, John Folkemer said a majority of the increase “was because of the economy.”

A report issued last year found for every one percent increase in national unemployment, an estimated one million more enroll in the Medicaid and SCHIP program and 1.1 million increase in the uninsured. Unlike other public programs, the rise in the numbers enrolling in Medicaid is largely due to job loss since a majority of health insurance is tied to employment.

The rise in enrollment is crippling the states who are already facing lower revenues due to the economic downturn. The stimulus bill passed last year enhanced the federal share, or FMAP, of the cost in order to alleviate the burden on states, but the increase is expected to expire at the end of the year. States have grown to depend on the increased FMAP to ensure this safety net is available for the lowest income individuals.

Recently, some state legislatures have been pushing hard against health care reform, but reform will benefit states and their Medicaid programs. The health care reform bill contain a variety of incentives to help states maintain an increased federal matching rate. If states allow enrollees to participate in medical home projects, engage in prevention programs, and encourage non-institutionalized long-term care programs the states will see more federal dollars in their Medicaid program. The expansion of the Medicaid program to cover 133 percent of the federal poverty level is fully funded by the Federal government through 2016.

The exchange can also act to stabilize the health insurance marketplace. Subsidies and a competitive marketplace within the exchange can keep insurance more affordable. Since health, by nature, is unpredictable, coverage is not a luxury item that can be eschewed during economic decline. By allowing individuals to maintain health care coverage and taking steps to prevent medical bankruptcy, health care reform would enable residents to weather economic storms such as the one we are currently facing.

Our guest blogger is Emma Sandoe, a Health Care Researcher at the Center for American Progress Action Fund.

Today, Department of Health and Human Services Secretary Kathleen Sebelius released a report that shows premiums in the individual market are expected to skyrocket in Connecticut, Maine, Michigan, Oregon, Rhode Island and Washington. This report comes on the heels of the widely-reported Anthem Blue Cross premiums increase of 39 percent in California.

Responding to this report, Karen Ignagni of the America’s Health Insurance Plans (AHIP) released a statement joining the growing argument that “health insurance premiums are increasing in the individual market because of soaring medical costs and because younger and healthier people are dropping their coverage due to the economy.” This is known as adverse selection and leads to higher cost for the remaining covered individuals.

Ignagni’s insistence that the premium increases are a result of the recession is a compelling argument for health insurance reform, especially in the individual insurance market. Health reform is needed in any economic climate, and the recession only shines some light on the already existing instability of the market.

Health reform will help prevent premium increases during a recession by creating a stable, well-regulated insurance market within the health insurance exchange. First, the market will not be overwhelmed by sicker individuals because exchange will have a broader, healthier risk pool. The individual insurance requirement ensures that healthier individuals have the responsibility of paying for reform, which will lower costs for all individuals.

Under reform, premiums will likely be more affordable and stable. During times of economic decline, many individuals will qualify for federal subsidies to help pay for coverage. This will prevent healthier individuals from dropping their health coverage when facing financial hardship, which in turn, keeps everyone’s premiums stable.

According to the Congressional Budget Office, health care reform should also lower premiums for a good number of Americans. The design of the exchange does this by creating competition within the marketplace, whereas currently “more than 94 percent of insurance markets in the United States are highly concentrated. ”

Finally, as Kathleen Sebelius noted today, under reform insurers will have to report spending and the premiums they receive from individuals. If the administrative costs and profits exceed the Medical Loss Ratio limit, premium dollars will have to be reimbursed to the consumer. So the insurer’s claim of higher health costs would be verified, before they were passed on to consumers.

The administration responded to Ignagni’s claim by insisting that the insurers “want to defeat reform.” Instead, the insurers have laid out the clearest case to date: the recession demands that reform occur.

Our guest blogger is Emma Sandoe, a Health Care Researcher at the Center for American Progress Action Fund.

The Utah state legislature has touted its insurance exchange as a successful example of state based reform, and according to Speaker Dave Clark (R), it represents “Utah’s chance to show the federal government that Utah knows what’s best for Utah.” Clark and the Utah state legislature have decided that their version of an exchange is superior to the exchanges in the national health care reform bills, but when looking at the number of individuals covered, this could not be further from the truth.

According to recent Census data, 364,000 people in Utah are currently uninsured. Additionally, according to a recent study from the Urban Institute, as many as 258,000 individuals may be eligible for coverage in the exchange under national health care reform. The remaining individuals would likely be eligible for Medicaid with full Federal funding through 2016.

On the other hand, the health insurance exchange in Utah currently only covers 400 individuals and lacks many consumer protections. Prices within the exchange can be 130 percent more expensive due in large part to a lack of regulation.

A recent bill that has passed the Utah legislature but isn’t yet signed into law does make some improvements to these consumer protections which helps create a more attractive market for consumers and insurers. However, late additions and amendments weakened these reforms. And in trying to improve its broken exchange system, the legislature has borrowed ideas from national health care reform. Now, risk will be calculated over a broader market to avoid adverse selection, Utah will ban insurers from using pre-existing conditions to calculate premium within the exchange, and larger employers would be invited to participate.

Last week, the Utah House passed a bill that would allow the state to opt out of Federal health reform. The state would leave a significant amount of money on the table if it intends to do so. Not only will health reform give states a large increase in Medicaid funding, the legislation gives states additional grants for state funded clinics and an ability to pursue additional coverage programs.

Our guest blogger is Emma Sandoe, a Health Care Researcher at the Center for American Progress Action Fund.

The headlines from a poll released yesterday by the Zogby International-University of Texas Health Science Center indicate that the public wants Congress to start over with health care reform and take a step-by-step or incremental approach. The GOP has begun to put together their strategy for next week’s bipartisan health care summit and will undoubtedly cite the headlines of these polls as justifying their calls to start the legislative process over.

But looking deeper at the responses reveals that once again the public agrees with the core elements of reform, but is frustrated with the political process. So what Democrats need to do is explain the core elements of health reform to the public without resorting to the same rhetorical strategies that have been used all year. The White House must capitalize on the President’s ability to effectively convey the complexity of the legislation and the problems of the GOP approach, while Democrats should emphasize these findings from yesterday’s poll:

– Most think competent health care must be comprehensive and coordinated (54.9 percent), cost-effective (47.9 percent), and controlled by patient choices (47.1 percent). The bills make great strides in improving coordinated care, giving individuals more options for coverage, and preventing medical bankruptcy.

– 54.5 percent believe employers should be required to offer coverage. The employer mandate is in the House bill and a weaker “free-rider” provision is in the final Senate bill.

– Ideas in the bills are popular such as eliminating the pre-existing condition exclusion (64.7 percent), paying doctors for the quality of care, standardized forms and paperwork (77.3 percent), the health insurance exchange, preventing women from being charged more for coverage (68.4 percent), and promoting prevention and wellness (64.3 percent).

– More Americans (53.1 percent) believe health care is a human right. A core element of the presidential campaign was this very question. The Democrats must argue they disagree with Republicans on this core philosophical question.

As Princeton health economist, Uwe Reinhardt told the National Health Policy Conference “the White House needs to do a much better job of explaining reform to the public.” The summit can give the White House the opportunity to do just that. And this will be most effective if there is a unified focus on the core aspects of the bill rather than attention on the internal conflicts over details of the excise tax, abortion, and the public option.

The public has seen this debate play out publicly over the past year and it hasn’t helped Democrats in the polls. Republicans will attempt to capitalize on these internal disagreements, but Democrats should focus on the core concepts, which are in the bill, that the public wants.

Our guest blogger is Emma Sandoe, a Health Care Researcher at the Center for American Progress Action Fund.

Last week, House Minority leader John Boehner (R-OH) sent a letter to the White House with a list of requests for the February 25th bipartisan health care reform summit. In it, he asked the White House to post the text of a compromised bill online:

If the President intends to present any kind of legislative proposal at this discussion, will he make it available to members of Congress and the American people at least 72 hours beforehand? Our ability to move forward in a bipartisan way through this discussion rests on openness and transparency.

Well, the White House sent its official invites to Congressional leaders late Friday, and the text of the invite suggests that a final compromise between the House and Senate health bills will, in fact, be posted online prior to the meeting.

So according to Boehner’s statement from last week, this means there is an ability to move forward in a bipartisan way. But he apparently thinks differently now:

“A productive bipartisan discussion should begin with a clean sheet of paper,” Boehner said in a statement. “We now know that instead of starting the ‘bipartisan’ health care ‘summit’ on Feb. 25 with a clean sheet of paper, the president and his party intend to arrive with a new bill written behind closed doors exclusively by Democrats — a backroom deal that will transform one-sixth of our nation’s economy and affect every family and small business in America.”

Boehner’s request shows the Republicans appear confused and once again have chosen obstruction over honest engagement. With its invite, the White House has adhered to several more of Boehner’s demands, including inviting the Congressional Budget Office and allowing additional staff and Congressional leaders to attend. Yet, the Republicans still aren’t assuaged.

While Boehner argues there is little point to meeting if the final bill has already been negotiated, consider the alternative. If Congressional leaders were to meet without any formal proposals, this discussion would become one regarding hypotheticals rather than concrete policies. By posting the a compromised bill online, Democrats and the White House are putting their cards on the table, hoping Republicans will show theirs as well. What will be posted online will not be a final bill. The White House would not post legislative language of a final House and Senate compromise, if such a compromise truly existed. Rather, what ends up online will likely be a series of proposed compromises, which could have the potential for improvement through honest negotiations, if the Republicans were willing.

Our guest blogger is Emma Sandoe, a Health Care Researcher at the Center for American Progress Action Fund.

As Democratic and Republican leaders make their final preparations for the February 25th bipartisan health summit, Republicans continue to argue for selling insurance policies across state lines — a provision already in both the House and Senate bills.

This weekend David Herszenhorn of the New York Times noted that while Republicans and Democrats may agree on the idea of selling across state lines, their respective paths to accomplishing this goal couldn’t be more different. Some experts argue, if done incorrectly this could become “a race to the bottom.”

Republicans argue the current insurance system, in which each state has its own set of regulations, restricts competition in the marketplace with the added barrier of 50 different sets of insurance regulations. Their proposal allows the health insurer to self-designate a “primary state” “whose covered laws shall govern the health insurance issuer” and avoids regulations in other states by allowing insurers to market policies without adhering “to all of the consumer protection laws or restrictions on rate changes of the state.” U.S. territories such as the Virgin Islands, Guam, American Samoa and the Northern Marianas were given the title of “states” in the Republican bill under the definition of a “primary state.” This could lead to insurers finding sanctuary in less regulated havens.

Despite claims that selling policies across state lines would serve to expand insurance options and lower costs to consumers, the Congressional Budget Office found older and sicker individuals who continue to purchase in-state expanded coverage plans would likely pay more under the Republican proposal. The ability to sell across state lines coupled with meager benefit standards induces insurers to cover fewer benefits and move their operations to states, or territories, with the least regulation.

Rep. John Shadegg (R-AZ), a long time proponent of selling across state lines, argued, “if you turn on the television station at night…you see Allstate and Geico and Progressive and State Farm pounding each other’s heads in…You never see that kind of advertisement for you and I to go out and buy health insurance.” While more competition is needed in the health insurance market, a desire for greater competition should not put benefit standards at risk. Transparent and accessible information on policies, the health insurance exchange, and enforceable fair practices in the health insurance market will go a long way to increase competition without reducing benefits under comprehensive reform.

The House and Senate bills, meanwhile, provide for more regulated “compacts” to “facilitate the purchase of individual health insurance coverage across State lines.” The House bill allows residents of one state to buy health coverage from another state and the laws applied would be determined between the states. The Senate bill also allows states to enter “compacts” with other states, but rather than negotiate which laws would apply, the laws from the original state where the policy is issued or written would govern the policy.

Theoretically the plans sold under the Office of Personnel Management would also achieve the goals of selling policies across state lines, although the Congressional Budget Office cast doubts on the chances insurers would participate.

HCAN has responded to Anthem Blue Cross’s rate hikes (the company is a subsidiary of WellPoint) in the California individual market by releasing a report demonstrating how premium increases have been feeding insurer profits, not paying for health care costs. “The report finds that the top five largest for-profit insurance companies increased their profits by $12.2 billion last year while dropping coverage for 2.7 million Americans“:

As a group, WellPoint, Aetna, UnitedHealth Group, Humana and Cigna saw their profits jump 56 percent in 2009 up $4.4 billion over the previous year, according to the report. Four out of five companies saw profits increase while insuring fewer people. Cigna increased earnings by 346 percent while UnitedHealth shed 1.7 million beneficiaries. Aetna, which increased its membership and percentage of premiums spent on medical care, was the only company to see less income in 2009 than 2008.

Health insurance is one of the only businesses where you can make more money by shedding customers and selling less product. And the insurers certainly have. The patchwork of state regulations governing the individual market allow insurers to cherry pick the healthiest applicants and drop those with the most expensive claims. It’s a smart business strategy but it doesn’t work very well for the patient, which is presumably a concern for lawmakers.

Democrats have responded by proposing a plan that establishes new standards for insurers and sets a federal floor of protections that prohibit some of the most egregious industry practices. You’ve heard most of this before: the legislation would prevent pre-existing condition exclusions, lifetime and annual limits, and other abuses. The bills “would greatly reduce the number of people enrolling in individual market plans. Instead of signing up for these high cost, low benefit plans, individuals can join together in a broader pool within the health insurance exchange to lower costs.” It’s a fairly good deal and according to the Congressional Budget Office, it should lower premiums for a good number of Americans and change the trajectory of health care spending (slow the growth of national health care expenditures).

And Republicans are also feigning concern. “If the argument is that the WellPoint hike means we need reform, well, ‘duh,’” said Michael Steel, spokesman for House Minority Leader John Boehner. “But our proposal holds down costs, without the trillion-dollar government takeover.”

No, their proposal reinforces the problems of the individual market. The House Republicans’ plan, which extends coverage to just 3 million Americans would leave 52 million Americans uninsured by 2019. And that’s because it deregulates the individual health insurance market by permitting insurers to override state-based consumer protections and sell sub prime policies across state lines. They want insurers to sell policies from the Northern Mariana Islands! In fact, it’s unlikely that the GOP would be able to qualify for coverage under their own plan — which, incidentally, does nothing to control general health care spending. (More on that here.)

So it’s a tale of two parties. Democrats are using the rate hikes to argue in favor of reform that would ameliorate the problem, Republicans are using it to hawk a proposal that would result in higher costs for the overwhelming majority of Americans. Republicans are trying to sell you the kind of deregulation that contributed to the rate hikes in the first place.

The White House has sent a letter to Congress formally inviting Republican and Democratic leaders to the February 25th health care summit. The letter lays out the rough framework for discussion and strongly implies that the President will unveil the final package of compromises between the Senate and House health care bills ahead of the meeting:

Since this meeting will be most productive if information is widely available before the meeting, we will post online the text of a proposed health insurance reform package. This legislation would put a stop to insurance company abuses, extend coverage to millions of Americans, get control of skyrocketing premiums and out-of-pocket costs, and reduce the deficit.

It is the President’s hope that the Republican congressional leadership will also put forward their own comprehensive bill to achieve those goals and make it available online as well.

While it’s unclear what exactly the White House is proposing, the letter’s phrasing — Obama hopes Republicans “will also put forward their won comprehensive bill” — suggests that the administration is planning on posting something beyond a set of principles or talking points.

Meanwhile, the Republican House Leadership has written a letter to President Obama asking him to suspend negotiations ahead of the summit. “[W]e were taken aback by a report in the Tuesday, February 9 edition of Politico stating that President Obama ‘hopes to walk into the Feb. 25 summit with an agreement in hand between House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid on a final Democratic bill, so they can move ahead with a reform package after the sit-down.’”

“To ensure we can move forward in good faith, we ask that you publicly disavow these reports and assure the American people that Democratic Leadership is not putting together any kind of backroom deal or plotting any kind of legislative trickery to pass it,” the letter said.

This morning, Fox & Friends covered President Bill Clinton’s hospitalization by asking if the President would have been treated for his heart problems “if the health care reform had gone through.” “Would he have gotten those stents?” host Brian Kilmeade asked in-house health reform expert Peter J. Johnson Jr.

Johnson admitted that “under a lot of protocols he would have gotten those stents,” but suggested that if the government adopted best practice methods using comparative effectiveness research, “perhaps hundreds of thousands of people like the president” would receive a cheaper, less effective, treatment:

JOHNSON: If the government decides to adopt the Peter Orszag, budget director, architect of health care, method and put in regulations that say there is a gold standard, there is a best practice based on the literature, perhaps hundreds of thousands of people like the president, I’m not going to make a determination…if the new standard is save money, best practices, does President Clinton or you or I who needs it get the stent under that new regimen of health care effectiveness?

Watch it:

Conservatives have long used comparative effectiveness research (CER) to further their claim that health care reform would ration treatments based on cost, impose a one-size-fits-all standard for medicine, and keep doctors from prescribing more expensive and effective procedures. But this line of thinking misunderstands the purpose of CER and ignores legislative language that specifically prohibits the government from applying research findings to coverage decisions. CER is a recommendation, not a mandate. (See pg. 1652 of the Senate bill or pg. 769 of the House bill).

Rather than making arbitrary decisions based on cost, CER — which compares clinical outcomes of alternative therapies used to manage the same condition — would provide doctors with unbiased information about the most effective treatments, help doctors and patients make better informed decisions, and improve the quality of care. Properly conducted CER will actually promote faster adoption of personalized care, not one-size-fits all medicine.

As Alan Garber of Stanford and Sean Tunis of the Center for Medical Technology Policy point out, “far from impeding personalized medicine, CER offers a way to hasten the discovery of the best approaches to personalization, providing more and better information with which to craft a management strategy for each individual patient.”

Indeed, CER could have actually improved treatment for heart disease by exposing harmful procedures and informing health care providers about best practices. The course of treatment, however, will always be left to the patient and their doctor.

Earlier this week, Massachusetts Governor Deval Patrick introduced legislation giving the state insurance commissioner “authority to review and reject rates charged by hospitals, physician groups, medical imaging centers, and insurers.” The commissioner could “reject premium hikes ‘significantly higher’ than 3.2%, the current medical inflation rate, and prevent health insurers in the small business market from “raising premiums by more than 1.5 times the rate of medical inflation.”

Patrick’s proposal follows a recent report released by Massachusetts Attorney General Martha Coakley, which concluded that “insurance companies pay some hospitals and doctors twice as much money as others for essentially the same patient care” because hospitals and dominant physician groups with the greatest market leverage are “able to demand the most money.”

Deval’s new legislation tries to prevent providers (and payers) from using their leverage to artificially inflate prices and it relies on a strategy popular in the 1970s and 1980s, when at least 30 states — including Massachusetts itself — used all-payer rate setting to contain health care spending. Lawmakers established rate boards that considered “the differences in labor markets and how much a hospital pays in wages; the amount of charity care the hospital does; and whether it treats a large number of severely ill patients” and set rates accordingly.

By setting prices at the actual cost of delivering services, lawmakers hoped to reduce wasteful spending and spur efficiency — while freeing hospitals from the uncertainly of annual rate negotiations with insurers. And it worked. At least, a little. One study found that from 1982 through 1986, “all-payer ratesetting reduced hospital expenditures by 16.3 percent in Massachusetts, 15.4 percent in Maryland, 6.3 percent in New York, and 1.9 percent in New Jersey, compared with the national average.” Other studies disagreed and during the conservative revolution of the 1980s, most states abandoned the practice in the hopes that managed competition could deliver lower rates. Today, Maryland is the only state that continues to maintain an all-payer rate setting system, but the strategy is also used in France, the Netherlands, Japan, Australia and Germany.

The indispensable Maggie Mahar notes that “a review of the Maryland plan published in a recent issue of Health Affairs reports that, since 1976, state regulation of hospital rates has saved $40 billion. Had a similar system been in place over the same period of time for all states, savings would have totaled $1.8 trillion or more.” The Maryland system is “widely regarded as having created a market in which payments are predictable, transparent, and fair, and in which profits have not suffered as a result,” Mahar argues. “Providers are protected from having to negotiate rates with payers; payers, meanwhile, are shielded from the high markups attached to hospitals services in other states; and patient access to hospital care is protected.”

But it’s not clear how much money Massachusetts would save. A recent RAND study of 12 options for reducing health care spending in the state ranked traditional hospital all-payer rate setting as the second most likely tool for changing the trajectory of health care growth, but concluded that “there were no ‘silver bullets’ that, alone, would reduce the rate of growth in health spending to that of GDP.” The report concluded that, “at a maximum, hospital rate setting could reduce health spending in Massachusetts by nearly 4 percent between 2010 and 2020.” RAND warns however, that providers could try to undermine rate setting by unbundling certain services, increasing admissions or length of stay.

Patrick’s legislation reads like a very modified rate-setting proposal which, if it has support from the providers — in Maryland the hospitals actually introduced the idea — could put Massachusetts on the road to lowering costs. It’s one of many solutions the state should be considering.

Politico reports that retiring Sen. Judd Gregg (R-NH) could help the White House “save” the health care bill and broker a deal with Democrats. “It’s clear already that Gregg’s restless energy is drawing him back into the fray, and the New Hampshire conservative brings both a proven ability to swing Republican votes and a background in health care and deficit issues,” the paper writes, noting that Gregg is “promoting his own lower-cost approach focused on preventive care and guaranteed catastrophic coverage for all families.”

But Gregg’s viability as a deal maker has less to do with his energy and more with his health care plan. Despite Gregg’s instance that Democrats need to “reset” health care talks by abandoning “the House or Senate-passed partisan bills,” his health care plan actually resembles core elements of the Senate legislation. No need to add Gregg’s solutions, they’re already in the bill:

	Gregg Proposal	Senate Bill
Individual Mandate	“Requires proof of health insurance for every American over age 18 and requires insurers to offer coverage to all applicants, regardless of health status.	The bill has an individual mandate and guarantee issue requirement.
Affordability Credits	“The proposal includes direct subsidies for low-income individuals..up to 300% of the Federal Poverty Level (FPL).”	The bill includes subsidies up to 400% FPL.
State-based Exchanges	“The proposal directs states to create points of entry for low-income families and individuals… Mechanism design and functions of the point of entry (state-based insurance exchange, regulator, etc.) would be left up to the states.”	The bill relies on state-based exchanges.
Limiting Tax Exclusion	“The proposal limits the extent to which employer-paid health insurance premiums and health spending from FSAs and HSAs are excluded from taxation.”	The tax on Cadillac health care plans limits the amount of health care spending excluded from taxation.
First Dollar Coverage For Prevention	The proposal provides first dollar coverage for preventive benefits and disease management with nominal co-payments for related office visits.	The Senate bill also excludes prevention services from co-payments or high deductibles.
Employee Wellness Program	“To provide employers with the opportunity to further develop incentive-based wellness programs, the proposal modifies the Health Insurance Portability and Accessibility Act (HIPPA) to allow rewards for wellness programs to exceed 20 % of the cost of employee-only coverage under a group health plan.”	Permits employers to vary insurance premiums by as much as 30 percent for employee participation in certain health promotion and disease prevention programs.
Reducing Hospital Readmissions	Payment incentives to encourage hospitals to reduce HACs and readmission rates for potentially preventable conditions	Adjusts payments for hospitals paid under the inpatient prospective payment system based on the dollar value of each hospital’s percentage of potentially preventable Medicare readmissions.
Accountable Care Organizations	“CMS would develop a voluntary program in which hospitals, multispecialty group practices and large primary care groups would establish organized delivery systems to care for chronically ill patients.”	Establishes a demonstration project that allows qualified pediatric providers to be recognized and receive payments as Accountable Care Organizations (ACO) under Medicaid, Rewards Accountable Care Organizations (ACOs) that take responsibility for the costs and quality of care received by their patient panel over time.

To be sure, Gregg’s proposal is significantly smaller than the Senate alternative. He relies on catastrophic coverage, encourages the individual market and certainly doesn’t invest enough in public health or adequately regulate insurers.

But the similarities undermine Gregg’s claim that the Senate bill is a hyper partisan plan and bolster the progressive argument that Democrats have already compromised with Republicans both in person and in substance. Republicans have simply refused to budge — and that’s a point that bears repeating.

Rep. Paul Ryan (R-WI) appeared on MSNBC this afternoon to argue that “the party in power has to be willing to legitimately collaborate with the minority party.” In other words, Democrats should “scrap” the existing “fiscal train wreck” of a bill and accept the GOP’s incoherent incremental approach to reform:

RYAN: And we really do have a huge problem with this health care bill they’re trying to jam through. The architecture of this health care bill, which we believe, represents a government take over of the health care system—we ought to scrap that, start over, and let’s go down the list of fixing the problems that need fixing—uninsurables, people who have preexisting conditions, making health care more affordable.

Watch it:

But just because Republicans “believe” something, doesn’t mean it’s true. In fact, Ryan’s entire rant is fairly inaccurate. The House health care bill would actually reduce the deficit by $138 over 10 years and allow private insurers to compete in a new regulated environment. The government would referee a broken market place that allows insurers to use the patchwork of state regulations to game the system to their advantage; it wouldn’t take anything over or “run” insurers. The government lays some ground rules for minimum creditable coverage and standard benefit packages and evens the playing field, forcing insurers to compete on quality of care rather than risk selection.

It’s a moderate approach that actually incorporates many Republican ideas. But if Ryan believes that these provisions don’t do enough to control health care spending or that Congress will never follow through on its promises to cut the identified waste, then he should fight to strengthen the language. Or, he can try and explain how his own rather radical health care reform proposal could compliment the existing bill.

There is no doubt that the two parties present two different ideologies to reform and the House and Senate health care bills already reflect this. If Republicans are hoping to tilt the final legislation in their favor, then they need to develop a more constructive way for presenting their ideas as improvements to the existing legislation, not as replacements for an entire years’ worth of hard work and compromise. Of course, that’s assuming that Democrats are still willing to pass comprehensive reform.

Newt Gingrich and John Goodman — the father of health savings accounts — have offered 10 ideas for President Obama to consider at the February 25th bipartisan health care summit. At least half are already part of the House or Senate health care bills (in one form or another) and the rest are of varying quality.

As a whole, Gingrich’s overarching vision would continue to shift the cost and risk of health insurance from the employer or the government to the individual. From large risk pools — in which the costs of coverage are spread across a large number of healthy and sick people — to a party of one.

The full run-down is below, but Gingrich’s prposal to “save” the Medicare program is worthy of extra attention:

Don’t cut Medicare: “The reform bills passed by the House and Senate cut Medicare by approximately $500 billion. This is wrong.”

GINGRICH Of 2010, MEET GINGRICH OF 1995: The health care proposals eliminate a lot of the waste and fraud in the Medicare system and get rid of the overpayments to private insurers participating in Medicare Advantage. Traditional Medicare is not “cut”, in fact reform would extend the life of the Medicare trust fund. But the irony here is stark. As Speaker of the House, Gingrich sought to cut 14% from projected Medicare spending over seven years and force millions of elderly recipients into managed health care programs or HMOs. “We don’t want to get rid of it in round one because we don’t think it’s politically smart,” he said. “But we believe that it’s going to wither on the vine because we think [seniors] are going to leave it voluntarily.”

Read the rest: Read more

In the midst of President Obama’s call for new Republican health care proposals, Matt Corley digs up this idea from retiring senator Kit Bond (R-MO). Bond is proposing “giving Medicare enrollees a voucher to buy health insurance on their own.” “You’re going to have to means-test the benefits,” he said, adding that upper income retirees wouldn’t “get much of a voucher.”

In essence, Medicare enrollees would receive a voucher to either purchase traditional coverage in Medicare or buy into a private insurance program. The idea sounds simple enough, but it’s actually fairly radical. Republicans want to transform Medicare from a fixed benefit to a fixed contribution. Beneficiaries would have to make up the difference between the value voucher and the cost of a particular health insurance plan — an amount that will only increase over time as health care costs outpace the value of a income-based voucher. The voucher will buy less coverage every year, forcing seniors to pay more for the same coverage. Essentially, they’re shifting the cost of insurance from the government to the individual.

As one analysis of a voucher proposal concluded, “this approach would undermine the basic protections offered by Medicare as a social insurance program, by relegating lower-income beneficiaries to lower-cost, and possibly lower-quality, plans.”

But that’s only the beginning. If Medicare becomes a fixed premium program, it will be much easier for Washington to control Medicare costs by simply trimming the level of the fixed contribution — undermining the health security of America’s poorest senior citizens.

President Barack Obama hinted that he may incorporate some Republican tort reform proposals into the existing health care reform legislation, but warned that “bipartisanship cannot mean simply that Democrats give up everything they believe in, find the handful of things Republicans have been advocating for and then we do those things.” “There’s gotta be some give and take..and that’s what I hope is accomplished,” Obama said of the forthcoming February 25th health summit:

Let’s establish some common facts. Let’s establish what the issues are, what the problems are and let’s test out, in front of the American people, what ideas work and what ideas don’t. And if we can establish that factual accuracy about how different approaches would work then I think we can make some progress. And it may be that some of the facts that come up, are ones that make my party a little bit uncomfortable.

Watch it:

“If it’s established that by working seriously on malpractice and tort reform, that we can reduce some of those costs, I’ve said from the beginning of this debate, I’d be willing to work on that,” Obama said. “On the other hand, if I’m told that that’s only a faction of the problem and that’s not the biggest driver of health care costs, then I’m also going to insist ‘okay, let’s look at that as one aspect of it, but let’s do what we were going to do,’” Obama added.

The Congressional Budget Office (CBO) has recently estimated that common Republican tort reform proposals — like capping awards for noneconomic damages — could save the federal government $54 billion over 10 years, but some progressives have questioned the budget office’s conclusion. In a letter to CBO director Douglas Elmendorf, Sen. Jay Rockefeller (D-WV) argued that the new CBO report reverses years of precedent and relies on academic studies that actually undermine the savings projection. “CBO has repeatedly concluded that cost savings associated with medical malpractice reforms would be minimal and the at evidence concerning defensive medicine is ‘inconsistent,’” Rockefeller wrote, noting that the budget office has previously determined that “the effect of medical malpractice reform “would be relatively small — less than 0.5 percent of total health care spending” and would “save [only] $5.6 billion over 10 years.””

In September, Obama directed Health and Human Services Secretary Kathleen Sebelius to authorize “demonstration projects in individual states” to test various approaches to tort reform. The Senate health care bill includes money for such demonstrations.

While in the Senate, Obama also co-sponsored “legislation aimed at reducing both medical errors and lawsuits through a program known as Sorry Works, rooted in the idea that injured patients value an apology as much as money.” That legislation would have given physicians who disclosed their errors “certain protections from liability within the context of the program, in order to promote a safe environment for disclosure.“

This morning, during a panel discussion at the Academy Health National Health Policy Conference, a top Pelosi policy aide said that the reconciliation process was “the only way” for Democrats to salvage health reform in the aftermath of the Massachusetts election. “There is only one way to get it done at this stage of the game and that’s a process that the Speaker has outlined,” Wendell Primus, Pelosi’s legislative director said. Congress would have to pass the Senate health care bill alongside a package of fixes using reconciliation.

“The House would have to take up that first because it would involve revenue changes and then the Senate would pass it and then I think hopefully with the passing of that legislation, the House, only then would take up the Senate bill and pass it.”

“The trick in all of this is that the President would have to sign the Senate bill first and then the reconciliation bill would be signed second and the parts of the reconciliation bill that trump the relevant portions of the first signed bill.” “You would really have to use the fact that a later enacted bill takes precedent over a previously enacted bill to achieve the right outcome.” Primus added. He predicted that the reconciliation package of fixes would have to increase the threshold on the Cadillac tax, include more affordability credits, close the donut hole in the Medicare Part D drug benefit, and eliminate the Cornhusker Kickback.

Other Congressional aides agreed with Primus’ assessment and argued that it would be almost impossible to put together a smaller package that achieves any of the Democrats’ objectives because many provisions are interconnected. The staffers also predicted that if Congress fails to pass health care reform before the budget window closes, it’s unlikely that future administrations would take-up the effort.

In October, Rep. Eric Cantor (R-VA) cautioned President Obama against negotiating with Iran. “The unfortunate reality for President Obama is that there is absolutely no evidence that Iran is willing to reach any agreement acceptable on U.S. terms,” Cantor wrote in an editorial for POLITICO. “The key point is that we have been down this road before – and it has reached a dead end.” Obama should demand immediate concessions “No exceptions, no excuses,” Cantor insisted.

But his warning against negotiating with a stubborn partner does not extend to the health care debate. Although Republicans have chosen to demagogue the health care reform for the better part of a year, Cantor is still asking President Obama to abandon the existing legislation. While we’re not comparing the GOP to Iran, if the President were to adopt Cantor’s own policy for engagement, Republicans would be excluded from any further negotiations.

No illusions on Iran Health reform
By REP. ERIC CANTOR

It’s a defining moment for the administration and its new policy of engagement with our enemies Republicans. As Iran Republicans moves inexorably towards becoming a nuclear power obstructionist minority, the U.S. Obama will join Great Britain, France, Russia, China and Germany House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid Thursday [February 25th] in Geneva at the Blair House in an effort to prod the Islamic Republic Republicans to change course. The unfortunate reality for President Obama is that there is absolutely no evidence that Iran is Republicans are willing to reach any agreement acceptable on U.S. terms – much less use negotiations for any purpose other than to buy more time for its illicit nuclear enrichment activities obstruction.

Engaging Iran Republicans on the nuclear health care issue is nothing new. Attempts by Great Britain Max Baucus, France Harry Reid and Germany Nancy Pelosi from 2003 to 2005 2009 to 2010 to negotiate a suspension of the Islamic Republic’s nuclear program Republican filibusters were an exercise in futility. As both sides talked, IranGOP only stepped up its enrichment activities obstructionism. In the same vein, Iran Republicans rejected a generous U.S.-supported Western Baucus/Gang-of-six package of political and economic concessions offered three years several months ago by the West Democrats in exchange for a stop to Iran’sthe GOP’s nuclear program obstructionism.

The key point is that we have been down this road before – and it has reached a dead end. This time around we simply don’t have the luxury of time.

[...]

That’s why tomorrow on February 25h in Geneva Blair House our bottom line must be an immediate halt to Iran’s nuclear enrichmentGOP obstructionist capabilities. No exceptions, no excuses.

[...]
Yet even as we head into negotiations predestined to fail, the temptation remains to bury our heads in the sand, hope and pray that somehow this time Iran will act differently, and play along with Iran’s the GOP’s stalling game. This is a mistake because it gives Iran the GOP the idea that regardless of what it says or does, the West the Democrats will inevitably come crawling back to the table out of desperation.

President Obama is following through on his controversial pledge for the United States to sit down and talk with Iran Republicans. But in doing so he cannot be afraid to call Iran’s the GOP’s bluff and pursue a different course. [...]

House Minority Leader John Boehner (R-OH) and Republican Whip Eric Cantor (R-VA) have written a letter to President Obama asking him to abandon the current health care reform bills and eliminate “the possibility of reconciliation” before convening his February 25th health summit:

If the starting point for this meeting is the job-killing bills the American people have already soundly rejected, Republicans would rightly be reluctant to participate. Assuming the President is sincere about moving forward in a bipartisan way, does that mean he has taken off the table the idea of relying solely on Democratic votes and jamming through health care reform by way of reconciliation?

Given the GOP’s reluctance to negotiate on health care reform and the Democrats’ repeated overtures at bipartisanship, Obama shouldn’t abandon a legislative tactic that subjects legislation to a simple majority vote. After all, reconciliation was designed to help bring spending and revenues in line with the fiscal policy and lower the deficit — which health reform would undoubtedly accomplish.

The GOP has repeatedly used the reconciliation process to enact its agenda. In 2001 and 2003, Republicans broke with tradition and used the reconciliation to “enact a large tax cut that greatly increased federal deficits and debt.” During the 1990s, Republicans pushed through key provisions of their signature legislative agenda, the Contract with America, using budget reconciliation.

As rising GOP star Rep. Paul Ryan (R-WI) pointed out in April, Democrats have the “right” to pass health care reform through the reconciliation process. “It is their right. It is what they can do,” Ryan admitted. In June, former Senate Majority Leader Bill Frist (R-TN) said of the reconciliation process, “But it’s legal, it’s ethical, you can do it. And it has been suggested and accepted by the administration, pretty directly that if it came down to it, they’re going to drive this thing through a fifty-vote door. ”

Rep. Tom Price’s (R-GA) reaction to President Obama’s February 25th health care summit pretty much sums up the Republican response: accuse the Democrats and the President of not reaching out, while they’re reaching out.

In other words, break the Olive Branch in half and pretend that the term compromise — which, the Merriam-Webster dictionary defines as “settlement of differences by arbitration or by consent reached by mutual concessions — really requires Democrats to abandon their plans and accept the Republican proposals.

From Price’s priceless statement:

It seems the only play the President knows how to run is a hollow PR blitz. Republicans welcome honest discussion, but this event reeks of political gamesmanship. Throughout this debate, Republicans have been stiff-armed from participating, our plans ignored, and our ideas blatantly misrepresented. It’s quite telling that only now, once the President’s plan is considered to be on political life support, does the White House seek input from Republicans.

The fact that the President has indicated he is still completely wedded to a government takeover of health care demonstrates that despite the rhetoric, he just hasn’t gotten the message from the American people. Americans have no interest in handing personal medical decisions to the government and are sick of Washington’s unchecked growth and power.

The only constructive discussions will start with a blank sheet of paper. The American people have soundly rejected the President’s big-government approach to health care, and tinkering at the margins of it will not bring about bipartisan consensus. Enacting positive health care reform still remains possible, but it will require the President to accept that his plan is a non-starter with the American people.

The truth is, Republicans are lucky to receive any hearing at all. After all, Sen. Max Baucus (D-MT) attempted to reach a bipartisan health care bill for months, only to produce produce a fairly watered down proposal that every Republican — with the exception of Sen. Olympia Snowe (R-ME) — abandoned. As Baucus remarked some months later, “we worked very hard to get a bipartisan bill. That side of the aisle started working with us but gradually they began to bleed politically,” Baucus said. They realized “that they would do a better chance in the 2010 elections by just not working with us, but just attack attack attack attack attack and try to score political points to defeat any honest effort to get health care reform.”

This is a take-two for bipartisanship and it’s up to the Republicans to meet the Democrats half way. They can either turn the event into “a hollow PR blitz” that “reeks of political gamesmanship” or abandon all of the government-takeover nonsense and figure out how to make reform work. The summit will be what Republicans make of it.