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Archive for December 20th, 2009

Seems we might be nearing passage of a “Health Care Bill” in the Senate.  Cloture vote is scheduled for this Monday at 1pm and Vote on the final Bill is scheduled for 7pm on Christmas Eve. 

The latest amendment was revealed on Saturday and here are some of the highlights:

  • Cuts to Medicare Advantage:  Seems like all states with the exception of Pennsylvania, New York, Florida and, possibly, Nebraska, will be having their Medicare Advantage reimbursements cut (via a competitive bid system).  In these states which carved out special deals, it seems the deals will favor the urban areas.
  • Cuts to Medicare.  In addition to the cuts to Medicare Advantage, there will be cuts to provider reimbursements.
  • Filling the Prescription drug “Doughnut Hole”.
  • Easier access to some Preventative Benefits under Medicare
  • Changes to the Medicare Advantage and Part D Open Enrollment and Annual Enrollment periods (starting in 2011)
  • No Doc Fix.  The Physician’s fee schedule fix was not included in the Senate compromise bill.  This (undoubtedly) will be fixed by this Congress (that’s basically why the AMA supported the bill).  The estimated cost is $200 Billion over 10 years, but this will likely happen in another bill to keep the cost out of Health Care reform.
  • Medicaid Expansion.  Some cost will be shifted to the states with the exception of one state – Nebraska.
  • No Underwriting – No denying coverage, no pre-existing conditions exculsion.
  • Weak Mandate – Penalty for not purchasing “Qualified Coverage” will be $75/year phasing up to $750/year in the 10th year.
  • Tax on Health Insurers.  (Except Mutual of Omaha, Blue Cross of Nebraska and Blue Cross of Michigan)
  • Tax on Medical Providers
  • Tax on Indoor Tanning Salons
  • Tax on “Cadilac” Health Benefits
  • Increase in Medicare Tax on Individuals making $200k or more or couples making $250k or more.  Tax will increase from 1.45% to 2.35% or 90 basis points.
  • Mandated Medical Loss Ratio.  80% mandated MLR for Individual and Small Group and 85% mandated MLR for Large Group.
  • Subsidies for Health Insurance.  Many families (even in the middle class) will be getting subsidies to purchase health insurance.  The susbidies will only apply to plans bought within the “Insurance Exchange.”
  • Private Insurance Option managed by the Office of Personnel Management (this is the entity which oversees the Federal Employees plans).  At least one of these options must be a non profit (Blues plan maybe?).

This could amount to the single worst piece of legislation ever devised.  The “palm greasing” (Nebraska, Louisana, Florida, New York, Michigan, Vermont and Pennsylvania got sweetheart deals) will undoubted lead to others wanting to “get theirs” and mushroom the cost of this into the stratisphere.

About 1/2 of the “projected” cost of this will come from cuts to Medicare which (historically) don’t occur.

The impact on the Small Group and Invididual Health Insurance markets is not realistically contemplated by the CBO in this bill.

That’s enough for now!

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