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Archive for December, 2009

Health Care Reform passed its biggest hurdle to date with a 1:01 AM cloture vote earlier this morning.  The measure passsed 60-40 on a strict party line vote.  This clears the way for the bill to be brought up for passage in a vote scheduled for 7pm on Christmas Eve.

Here is analysis of the measure which includes Senate Majority Leader Harry Reid’s (NV) “manager amendment” which was released on Saturday, December 19th.

More details on the vote are available in this New York Times story.

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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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Here is a link to the article from the Life and Health Underwriter.

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Here is a link to a C-SPAN video and transcript of comments made by Senator Crapo of Idaho.  Senator Crapo highlights a provision in the Senate Bill which would carve out Medicare Beneficiaries in 3 counties (Miami-Dade, Broward and Palm Beach) from the cuts to Medicare Advantage.  The provision was inserted by Senator Nelson of Florida to protect Medicare Beneficiaries in his home state.  Appartently, other Senators are seeking similar protections for their constituents, however, they are voting against extending this protection to all Medicare Beneficiaries.  The cost to protect Medicare Advantage in these 3 counties in Florida is projected to be $5 Billion over 10 years.

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Here is a link to NAHU’s Washington Update.  Needless to say, there’s a ton of information to report on.  There’s a good analysis of the Senate’s Health Reform compromise, although it’s difficult to evaluate because many of the details are sketchy. 

Also, here is a link to a memo sent to Senators Reid and McConnell underscoring the importance of Insurance Agents in helping consumers navigate Health Insurance Choices.

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Thanks to Ken for giving me this link.  Interested blog post on the Senate’s Compromise to shelve the Public Option in favor of Privately-Run Insurance plans regulated by the OPM and an expansion of Medicare benefits to those who are “exchange eligible” and ages 50-64.  Seems that the Docs and Hospitals have real problems adding more folks to Medicare where they are already getting under paid.  This would result in even more “Cost Shifting” to Private Insurance via Employer Group and Individual under 65 (or should I say under 50?) Health coverage.

Meanwhile, the Senate is awaiting CBO scores for this compromise, but the compromise might already be sunk!

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Ritter Insurance Marketing makes it easy to register for upcoming Learning Opportunities with Aetna!  Simply click here to get registered (you must be logged in to register) to attend one of the upcoming live training sessions or webinars.  Coming this week:

  • California Medicare Products – December 15th in Chino, CA
  • Florida Individual Products – December 15th, 17th Webinar
  • Florida Consumer Portal Training – December 15th Webinar
  • Florida Individual Training – December 15th in Altamonte Springs, FL
  • New York Medicare Products – December 16th in Uniondale, NY
  • Virginia, Maryland and Washington DC Individual Products – December 16th and 21st Webinar
  • Michigan Individual Products – December 17th Webinar
  • New York Medicare Products – December 22nd at 100 Park Ave, New York, NY

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This story comes from the Philadelphia Inquirer.  IBC (one of the largest health insurers in Pennsylvania) is facing large losses.  This is due to reduced revenue in it’s Commercial Group market as Employer Groups lay off employees and drop their health insurance.

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Here is the full story from the AP.  The study was done by the Office of the Actuary which is under Health and Human Services.  The study looked at the OVERALL impact of Health Care Reform being proposed and not just the impact on the Federal Budget (where tax increases offset additional costs).  Interestingly, they found that Health Care spending would increase by 0.7% MORE with reform than if we did NOTHING! 

They also questioned the feasibility of cutting $493 Billion from Medicare without causing reductions in service.  The actuaries tried to evaluate whether future Congresses would hold fast on implementing the cuts or whether providers would be able to convince Congress in future years to restore some of the money.  This is similar to the current situation arising from the Deficit Reduction Act (DRA) of 1997 where “Medicare Sustainability Models” are mandating a 21% cut in the Physician’s Fee Schedule, however, Congress avoided such cuts every single year they were mandated by DRA.

The Actuaries also question the sustainability of the Long Term Care Insurance Plan which was also inserted into Health Care Reform.  Their reasoning here is that the plan would attract significant numbers of people in poor health which would result in an “insurance death spiral” as premiums escalate at an uncontrolable rate.

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Here is the full story from the NY Times.   Ironically, Drug Reimportation was originally supported by President Obama.  However, the White House and the Pharmaceutical Industry struck a deal earlier this year which did not include reimportation.  Now, Democratic leaders have stopped debate on the Reimportation Amendment on fears that it would PASS.  The amendment has bi-partisan support and would save the Federal Government almost $20 Billion over the next 10 years according to the CBO.  The fear is that if the amendment passes, the Pharmaceutical industry would drop its support of the Health Care Reform bill.

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