The House GOP’s vote to repeal the Affordable Care Act’s long-term care program isn’t sitting well with Sen. Jay Rockefeller (D-WV), who is out with an op-ed in Politico this morning, criticizing Republicans for failing to offer any meaningful solution for financing long-term care services. “They view repealing CLASS as a tactical step toward undermining health care reform – without putting forward any real alternatives for families who have nowhere to turn,” he writes:

Repealing CLASS won’t do anything to solve our nation’s long-term care crisis. Legislation rarely starts out perfectly – indeed, the Republicans’ own Medicare prescription drug bill left a huge coverage gap, forcing seniors to pay thousands of dollars out of pocket. It is only because Democrats rejected the ‘throw out the baby with the bathwater’ approach to legislating, and figured out a solution, that this gap will finally be closed and seniors can save millions on prescription drugs.

Lawmakers had designed CLASS to take the strain off of Medicaid — which finances more than half of long-term care — and allow individuals to establish a cash benefit during their working years that would be available if they become disabled. As Rep. Frank Pallone (D-NJ) explained during a Energy & Commerce health subcommittee hearing, “It was very much a notion of personal responsibility and not relying on the government.” But since the administration decided that Secretary Kathleen Sebelius did not have the necessary authority to bring the program in compliance with the health care law’s sustainability provision, the GOP chose to repeal the measure rather than act like lawmakers and actually work to ensure its longevity. The move is calculated to hurt Obama, but will do nothing to address the long-term care time-bomb:

Last night, Sen. John Thune (R-SD) — the sponsor of the Senate bill to repeal the CLASS Act — offered a unanimous consent request to advance a measure that would eliminate the long-term care program to the Senate floor, but was met with an objection from Sen. Jay Rockefeller (D-WV). The West Virginian insisted that the country needs a more sustainable long-term care system and argued that it could be “amended through the legislative process to make it sustainable over the long term”:

ROCKEFELLER: Always our friends on the other side of the aisle appeal something. You can lead people to the same sense of suffering as we found during the pepper commission where people prostrate themselves in order to qualify for medicaid, in which they haven’t a chance at getting some long-term care. [...] Those who are gloating today about the administration’s decision not to carry forward with the class act are not the fiscal heroes they make themselves out to be. They have no answers. They have no answers. They have no alternative.

Watch it:

President Obama’s new deficit reduction plan attempts to address concerns that blending the federal reimbursement rates for Medicaid and the Children’s Health Insurance Program (CHIP) would shift too much costs to the states by delaying its implementation until 2017 and producing a modest amount of savings relative to earlier versions of the plan. But some in Congress are still concerned that the greater cost shift to states would undermine the programs. Sen. Jay Rockefller (D-WV) — a strong proponent of both the Medicaid and CHIP — denounced the Obama’s modified blended rate proposal yesterday, saying it would devastate CHIP:

The proposal doesn’t specifically call for ending CHIP. But Rockefeller said that’s what would happen because CHIP would be a program where states could cut. Rockefeller was asked about the blended rate proposal when he stopped to talk to reporters after the Senate Democrats’ policy lunch Tuesday. “I hate it,” he said. Asked whether he still thinks it would kill CHIP, a prediction he made when the blended rate idea was floated earlier this year, Rockefeller said “it will do a very good job of that. Yeah, that would be my guess. Governors love CHIP until they have to start paying more for it.”

While the administration claims a blended rate would streamline and simplify the reimbursement formulas, states would receive less under a blended rate proposal because the federal government would average the reimbursement rates for all populations into a single rate. Rockefeller and other Medicaid advocates worry that this could signal the beginning of the end for CHIP. The Affordable Care Act requires states to maintain their current CHIP enrollment through 2019, but as CQ’s John Reichard reports, it “only funds them through 2015,” thus setting “the stage for a debate that year about how well the exchanges are doing in providing coverage and whether CHIP is really needed.”

Rockefeller characterized Obama’s cuts to Medicare and Medicaid as “hard” on seniors and the poor and said he would rather raise taxes on the wealthiest Americans. “You have to raise taxes. It isn’t a question of being a Democrat or of being a liberal. Or not being liberal. It’s just math,” he told Reichard.

Out of the many troubling health care repeal amendments in the Korean trade agreement, Sen. Orrin Hatch’s (R-UT) proposal to repeal the maintenance of effort provision for the Medicaid program — which requires states to maintain their enrollment numbers or risk losing federal funding — is possibly the most egregious. It encompasses the Republican approach of “saving” the program by forcing more people off of it — no matter the consequences to the beneficiaries.

As Sen. Jay Rockefeller (D-WV) pointed out in a recent letter to Hatch, according to the Congressional Budget Office, the provision would result in substantial coverage erosion for children in the CHIP program:

– By 2013, 400,000 people will lose their Medicaid and CHIP coverage. Two thirds of those dropped from coverage will be children.

– Half of all states will end their CHIP programs by 2016. One quarter of states are expected to end their program even earlier, in 2015, while remaining CHIP programs are expected to scale back coverage.

– By 2016, the number of those expected to lose CHIP coverage will climb to 1.7 million people, with 700,000 left uninsured.

Interestingly, as a long-time proponent of extending health care coverage to children and a co-sponsor of the original CHIP bill in 1997, the Hatch of yesteryear would have opposed these cuts. Here he is in 2006, praising the program on its 10-year anniversary: “When we drafted this legislation in 1997, our goal was to cover the several million children who had no insurance coverage. We have gone a long way in meeting that goal, but we are clearly not there yet. Coverage of these uninsured children should still be our top priority.”

The National Association of Insurance Commissioners is inching closer towards defining the regulations that would require insurers to spend 80 to 85% of their premium dollars on health care. As The Hill reports, NAIC “approved model medical loss ratio regulations on Thursday” and sent Health and Human Services Secretary Kathleen Sebelius “a letter outlining several factors that need to be addressed as the guidelines are implemented.” Throughout the process, the key concerns have revolved around how to define medical services, which federal taxes can be excluded from the calculations, and whether or not companies can aggregate the ratios across different plans.

Insurers have waged a strong campaign to loosen the reporting requirements, leading Sen. Jay Rockefeller (D-WV) — who has led the charge in pressuring the NAIC to live up to the letter of the law and hold insurance companies accountable to its spirit — to write a letter to the NAIC urging the panel to “reject the health care industry’s eleventh-hour lobbying campaign to erode key consumer protections—protections that will help Americans finally get the care they pay for and deserve“:

In particular, the large for-profit insurers are asking you to ignore the plain-language definition of “health insurance issuer” in the ACA and other federal statutes, and allow insurers to aggregate their large group medical loss ratio data across state lines and business entities. As I discussed in my May 7 letter, allowing insurers to aggregate their medical loss ratio at a national level deprives the consumers of individual states of the new medical loss ratio law’s most important protections. Under the health insurance companies’ proposal, consumers in a state with medical loss ratios falling below the law’s new requirements would have no right to rebates, as long as the health insurance company’s overall national average remained above the law’s new requirements.

As regulators charged with implementing the ACA’s medical loss ratio provision, you have proceeded in good faith and through a transparent process to make sure that consumers and businesses get a better value for their health insurance premium dollars. Medical loss ratios aggregated at the state and entity level reflect the actual market conditions consumers and businesses in your state face when they are trying to buy health insurance. Insurance companies should not have the carte blanche to avoid paying rebates to consumers in states where they sell low-value plans.

The draft guidelines require issuers to break them down and account for the MLRs separately at every business unit in every state preventing them from obscuring some low MLR plans. The NAIC is preparing to vote and send their final recommendations to Sebelius sometime next week.

Just days after HHS Secretary Kathleen Sebelius warned insurers against using the early benefits in the health care law to justify unreasonable premiums increases, Sens. Max Baucus (D-MT) and Jay Rockefeller (D-WV) have written to the CEOs of WellPoint, UnitedHealth Group, Aetna, Health Care Services Corp., and CIGNA, saying insurers are “mistaken” if they believe they can continue to blame double digit premium increases on reform.” “This level of misinformation is not acceptable,” the two write, pointing out that the early benefits should not increase costs by more than 2 percent on average:

And if an insurer thinks it can continue to impose double-digit premium increases, while providing fewer health benefits and enjoying record surpluses, it is again mistaken. There have been too many reports of insurance companies imposing insurance premiums increases at will with little oversight or public accountability. We are committed to ensuring that premium increases are fair and justified. [...]

We have and will continue to strongly encourage states and HHS to use their existing authority as well as the authority created under the Affordable Care Act to its fullest to ensure that premium increases across the country are justified and communications are honest. We will continue to work toward ensuring that the federal and state governments have the necessary resources and authority to review potentially unjustified premium increases and to hold insurance companies accountable.

Baucus and Rockefeller pledge that they “are committed to ensuring that consumers are treated fairly and will closely examine any potentially misleading communications to consumers,” but there is actually little the federal government can do — outside of publicly shaming insurers or passing a federal rate review law — to hold insurers accountable.

As Sebelius explained today, “it’s a real catch-22. The law assumes that states will regulate rates, that that’s the best marketplace. This is really a state-based bill…only if they abdicate that responsibility or say that they don’t want to participate do we have kind of the back-up responsibility.”

For ways the federal government can pressure states to hold down unreasonable rates, click here.