Comprehensive health care reform--dead or alive?

Comprehensive health care reform--dead or alive? Whether President Obama could deliver on his promise of a majoroverhaul of the nation's health care system was very much inquestion as this publication went to press in early March. Both theHouse of Representatives and the U.S. Senate had passed separatecomprehensive reform bills late last year, but the prospects ofreconciling the bills' differences and achieving enough votes topush a compromise bill through both chambers of Congress were in doubtas the political dynamics had changed dramatically since the Presidenttook office. While most Americans believe that something needs to be done toimprove the nation's health care system--especially healthinsurance companies' coverage policies--shepherding a comprehensivereform package through the Congress has proven to be a monumental taskfor a President who just a year ago appeared to have everything goingfor him, having been elected on a platform of "change" andbacked by a Congress with clear Democratic majorities in both the Houseand Senate. The Case for Reform Evidence suggesting the need for significant reforms is plentiful.The United States United States,officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. has annual per capita [Latin, By the heads or polls.] A term used in the Descent and Distribution of the estate of one who dies without a will. It means to share and share alike according to the number of individuals. expenditures of $7,290 forhealth care, 50% more than any other nation (the Netherlands is next at$4,417). Yet according to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. the World Health Organization, the U.S. ranksonly 37th worldwide in the overall effectiveness of its health deliverysystem, trailing far less-developed countries such as Columbia, Dominicaand Costa Rica. Some 46 to 47 million Americans are without any healthinsurance coverage--not poor enough to qualify for Medicaid, but eithernot prosperous enough to afford insurance, or unable to obtain insurancedue to existing medical conditions See carpal tunnel syndrome, computer vision syndrome, dry eyes and deep vein thrombosis. , or simply unwilling to purchaseinsurance because they are young and healthy and have other financialpriorities. Health care costs have far outpaced the rate of inflation.Employer-sponsored health insurance premiums have doubled in the lastnine years, a rate three times faster than cumulative wage increases.This year, health costs are expected to increase at four times theaverage increase in wage earnings, even as inflation has remainedrelatively flat, according to The Segal Company's 2010 Health PlanCost Trend Survey. Increases in health insurance premiums have been even moredramatic. Anthem Blue Cross-Blue Shield recently asked state regulatorsto approve rate hikes of 56% in Michigan and 39% in California forindividual policies. Slightly less dramatic but nevertheless substantialpremium increases have been seen in most states nationwide. While advances in technology undoubtedly account for part of theincrease in health care costs, practitioners claim that thenation's tort liability system, and the resultant need to practice"defensive medicine," is responsible for much of the highcost. They argue that any comprehensive reform package should includetort reforms. Key Elements of the Democrats' Reform Package Although the House and Senate passed different reform bills latelast year, there are many common elements to both proposals. Theseinclude: * Ban discrimination against people with pre-existing conditions * Eliminate premium discrimination based on gender and limitage-based discrimination * Prevent insurance companies from dropping coverage for people whoget sick * Invest in prevention and wellness, including diagnostic screeningtests * Cap out-of pocket expenses and prohibit lifetime caps * Eliminate the "donut-hole" gap in coverage forprescription drugs * Maintain coverage for those who change or lose their jobs * Create a new insurance marketplace--the Exchange--that allowspeople without insurance and small businesses to compare plans and buyinsurance at competitive prices * Provide new tax credits and subsidies to help people and smallbusinesses buy insurance * Require (or provide strong incentives for) individuals to buyinsurance if they can afford it * Pay for the cost of these reforms through a combination ofMedicare savings and new taxes and fees Differences Between House and Senate Approaches While both the House and Senate-passed versions contained someaspect of each of the above elements, there were some key differencesbetween the two bills. The House bill included a so-called "publicoption," a government-sponsored health plan to compete on theExchanges with private insurers. The Senate bill had no public option.The House would provide more generous subsidies and tax incentives toassist individuals and small businesses to acquire health insurance, butwould also penalize pe��nal��ize?tr.v. pe��nal��ized, pe��nal��iz��ing, pe��nal��iz��es1. To subject to a penalty, especially for infringement of a law or official regulation. See Synonyms at punish.2. individuals and employers more severely if they didnot buy insurance. The House package would cost nearly $1 trillion over 10 years,compared with $871 billion for the Senate plan. Both bills would financereform in part by savings from Medicare--principally cuts in payments toMedicare Advantage plans--and in part from new fees and taxes. TheSenate would levy a 40% tax on high-option health plans, referred to as"Cadillac" plans, while the House instead would impose a newsurtax An additional charge on an item that is already taxed.A surtax is a tax on a tax. For example, if a person pays one hundred dollars of tax on one thousand dollars of income, a 5 percent surtax would amount to an additional five dollars. on the wealthy (individuals with over $500,000 income, or couplesmaking over $1 million). The Senate bill would establish a 15-member Independent PaymentAdvisory Board, which would be required to recommend changes to theMedicare program to limit its spending growth. Its recommendations wouldgo into effect automatically unless Congress votes to block them. The House bill contained no such provision. Opposition Mounts, Support Wanes for Comprehensive Reform During the course of the health care debate, Republicans inCongress have remained united in staunch opposition to theDemocrats' reform package. Only a single Republican Congresswomanvoted for the reform bill that passed the House in November by a 220-215tally. Not one GOP Senator voted in favor of the bill that the Senatepassed 60-39 on Christmas Eve. Despite Democrats' determination to move forward withcomprehensive reform, public support for the package dropped sharplylast summer, and has consistently remained at low levels since reachinga nadir last November. According to a telephone poll conducted by theRasmussen Reports Rasmussen Reports is an American public opinion polling firm. Founded by pollster Scott Rasmussen, the company updates its President's job approval rating daily and publishes at least one poll a month for each United States Senate and state governor race on its website. in late February, only 41% of voters favored theproposed health care plan, while 56% opposed it. 61% of those surveyedbelieved Congress should scrap the current legislative proposals andstart from scratch to start (again) from the very beginning; also, to start without resources.- Thackeray.See also: Scratch . Polling conducted in January by the Kaiser Family Foundation The Henry J. Kaiser Family Foundation (KFF), or just Kaiser Family Foundation, is a U.S.-based non-profit, private operating foundation headquartered in Menlo Park, California. disclosed that the least popular elements of the Democrats' reformpackage included the individual mandate to buy insurance or pay a fine;the high cost of the plan; the government's power to define thebasic benefit package; and the tax on "Cadillac" insuranceplans. On the other hand, the polls showed that voters favor someaspects of the proposal, including tax credits for small businesses thatprovide employee insurance; the creation of insurance exchanges; theability of people to keep their current health insurance plans if theywant to; prohibiting insurers from denying coverage based on preexistingconditions; closing the Medicare prescription drug prescription drugPrescription medication Pharmacology An FDA-approved drug which must, by federal law or regulation, be dispensed only pursuant to a prescription–eg, finished dose form and active ingredients subject to the provisos of the Federal Food, Drug, donut-hole; and theexpansion of family coverage to dependents through age 25. Republicans have effectively drummed up grassroots opposition tothe reform package by portraying it as a government takeover of healthcare that will limit consumers' freedom of choice and drive upcosts of care, rather than lowering them. Voters already were angryabout Congress's bailouts of banks, insurance companies and carmanufacturers, and the GOP has been able to parlay that anger and directit toward the health care debate. Voters' anger was manifested last November, when Republicansscored upset wins in Governor races in New Jersey and Virginia.Democrats absorbed an even bigger and more shocking blow on January 19of this year, however, when little-known state legislator Scott Brown Scott Brown may refer to: Scott Brown (DJ) Scott Brown (Scottish footballer) Scott Brown (English footballer) Scott Brown (Welsh footballer) Scott P. Brown, a Massachusetts state senator (R) edged state attorney general Martha Coakley Martha Coakley (born July 14, 1953 in Lee, Massachusetts) is the Attorney General of Massachusetts. She was sworn in on January 17, 2007. The former District Attorney of Middlesex County, Massachusetts, having served from January 1999 to January 2007, she was the District Attorney (D) to fill the seatvacated by the death of Massachusetts U.S. Senator Ted Kennedy For other persons named Ted Kennedy, see Ted Kennedy (disambiguation).Edward Moore "Ted" Kennedy (born February 22, 1932) is the senior United States Senator from Massachusetts and a member of the Democratic Party. (D).Kennedy had held the seat for nearly 47 years, since 1962. Brown'selection deprived Democrats of the 60th Senate seat that they need topass legislation in the face of a Republican filibuster filibuster,term used to designate obstructionist tactics in legislative assemblies. It has particular reference to the U.S. Senate, where the tradition of unlimited debate is very strong. It was not until 1917 that the Senate provided for cloture (i.e. . President Unveils a "New" Plan, and Hosts a BipartisanHealth Forum With little progress having been made in bridging the differencesbetween the House and Senate-passed reform bills, President Obamareleased a new proposal for comprehensive reform on February 22 thisyear. The President's "new" plan is really not new atall, but was based on the Senate bill, with a few key changes made toattract support of House Democrats--and, the President hoped, at least afew Republicans from both chambers. Like the Senate bill, the President's compromise proposal doesnot include a public option or an individual mandate to buy insurance.But it does increase direct subsidies and tax incentives to makeinsurance more affordable for individuals and businesses, and imposespenalties on those who don't purchase insurance. Also similar tothe Senate bill, the President's proposal would tax Cadillac healthplans, but raises the applicable policy threshold to $10,200 forindividual plans and $27,500 for families. To help pay for reform, thePresident would extend the Medicare payroll tax Payroll TaxTax an employer withholds and/or pays on behalf of their employees based on the wage or salary of the employee. In most countries, including the U.S., both state and federal authorities collect some form of payroll tax. to unearned income Unearned IncomeAny income that comes from investments and other sources unrelated to employment services.Notes:Examples of unearned income include interest from a savings account, bond interest, tips, alimony, and dividends from stock. . Toattract Republican support, the new plan adds provisions to fight waste,fraud and abuse. The President's proposal would increase the10-year cost of the Senate bill from $871 billion to $950 billion. In an effort to promote his plan and move the debate forward, thePresident hosted a bipartisan health care summit on February 25.Although the summit featured a considerable amount of substantivediscussion, it failed to produce any meaningful movement toward apackage of reforms that would garner bipartisan support. How Would Clinical Labs Fare Under Health Reform? Under both the House and Senate-passed bills, clinical laboratories(and nearly all other non-physician providers) would be called upon tomake some sacrifices to defray de��fray?tr.v. de��frayed, de��fray��ing, de��fraysTo undertake the payment of (costs or expenses); pay.[French d��frayer, from Old French desfrayer : des-, the cost of health reform. Currently,labs receive an annual Medicare fee schedule update equal to the CPI (1) (Characters Per Inch) The measurement of the density of characters per inch on tape or paper. A printer's CPI button switches character pitch.(2) (Counts Per I adjustment minus 0.5%. Thus, if the annual inflation rate (as reflectedin the CPI index) is 3.0%, the lab fee schedule would increase by 2.5%for the next 12 months. The House bill would replace the -0.5% adjustment with an annual"productivity adjustment," which is expected to range between-1.1% and -1.6%. During years in which the inflation rate is very low,the productivity adjustment could reduce the fee schedule update belowzero. The Senate bill would also replace the flat -0.5% adjustment withan annual productivity adjustment. Unlike the House version, the Senatebill would not allow the fee schedule adjustment to drop below zero onaccount of the productivity factor. However, the Senate bill wouldfurther reduce the fee schedule by 1.75% for calendar years 20112015.This additional reduction could drop the fee schedule update below zero. Both the House and Senate bills would extend the "grandfatherclause grandfather clause,provision in constitutions (adopted 1895–1910) of seven post–Reconstruction Southern states that exempted those persons who had been eligible to vote on Jan. " permitting independent laboratories to receive directpayments for the technical component for certain inpatient pathologyservices--the House would extend the grandfather for two years and theSenate for one year. Both bills would require preventive ser vices,including screening tests, to be offered as part of basic health carecoverage, without copayments. To be eligible for coverage initially, thepreventive service the duty performed by the armed police in guarding the coast against smuggling.See also: Preventive must have an "A" or "B" ratingfor effectiveness by the U.S. Preventive Services Task Force. The compromise proposal released by the President on February 22did not detail how provider savings would be achieved, but because hisplan was based on the Senate legislation, it probably tracks that billin terms of how labs would fare. What's Next for Health Reform? As noted above, the health care summit convened by the President inlate February failed to move the ball toward a bipartisan reformpackage. With the Senate having one too few Democratic votes to survivea filibuster following Scott Brown's victory in Massachusetts,Congressional Democrats were thus faced with a number ofless-than-appealing options: (1) Go back to square one and try tofashion a package of smaller, incremental reforms that could attractenough Republican support to pass; (2) have the Senate pass thePresident's latest proposal using the reconciliation process--aparliamentary procedure parliamentary procedureor rules of orderGenerally accepted rules, precedents, and practices used in the governance of deliberative assemblies. They are intended to maintain decorum, ascertain the will of the majority, preserve the rights of the minority, that requires only 51 votes to pass and is notsubject to filibuster --with the support of enough House members to passthe bill through that chamber as well; (3) have the House enact theexisting Senate-passed bill verbatim, then after the President signs it,enact compromise amendments to it through a new bill that would bepassed through reconciliation; or (4) drop health reform altogetheruntil after the midterm elections this November. As we went to press, the White House increasingly appeared to favorthe third option above, i.e., having the House pass the version of themeasure that cleared the Senate with 60 votes in December. The Senatewould then pass changes to the bill to satisfy some demands of HouseDemocrats. That Senate vote would take place under the reconciliationprocess, requiring just 51 votes to pass. Using the reconciliation process--a vehicle originally intended toenact budget-related legislation--to push major health care reformacross the finish line would be politically risky, especially in view ofthe voter dissatisfaction registered in the New Jersey, Virginia andMassachusetts elections during the past few months. Nevertheless,because Obama has made health reform such a major part of his agenda,his presidency cannot afford a total failure to enact significantreforms. State Legislative Update--Licensure Bills Considered As the 2010 legislative sessions got underway, at least threestates were considering bills related to the licensure of clinicallaboratories and/or lab personnel. Georgia--House Bill 994 was introduced in the Georgia GeneralAssembly The Georgia General Assembly is the state legislature of the U.S. state of Georgia. It is bicameral, being composed of the Georgia House of Representatives and the Georgia Senate. on January 28, 2010. Among other provisions, the bill wouldrepeal the State's existing law requiring the licensure of clinicallaboratory facilities. Although it is a facility licensure law, thecurrent statute also contains education and certification standards forlab personnel. The law was introduced by four cosponsors at the behestof the Department of Community Health, which has asked to be relieved ofits licensing jurisdiction over clinical labs due to budget constraints.If the bill were enacted as introduced, oversight of clinical labs inGeorgia would revert to the federal CLIA CLIAClinical Laboratory Improvement Amendments of 1988 Congressional legislation that promulgated quality assurance practices in clinical labs, and required them to measure performance at each step of the testing process from the beginning to the end-point of a program. The Georgia StateSociety of AMT See vPro. opposes HB 994. No action on the bill had occurred bypress time. Minnesota--A lab personnel licensure bill (HF 1249) deferred fromlast year's legislative session received a hearing before theMinnesota House Licensing Division Committee on February 25, 2010.Members of the Minnesota licensure coalition testified in favor of thebill; however, a representative of the American Association ofBio-analysts opposed the bill based on its requirement of abachelor's degree for MT/CLS licensure. The bill was also opposedbehind the scenes by several large hospitals in the State. Following the February 25 hearing, it was apparent that thecommittee would not vote favorably on the bill, so its proponents askedthat it be tabled rather than risk having it defeated by a committeevote. The bill was therefore tabled, and no further licensure activitywill occur at least until next year's legislature convenes. Missouri--As this column went to press, Missouri State Senator DanClemens was preparing to reintroduce a licensure bill promoted by theMissouri chapter of ASCLS ASCLS American Society for Clinical Laboratory Science . Similar legislation had been introduced ineach of the past four years, but had not been reported favorably out ofcommittee. AMT has been given the opportunity to comment on prior drafts ofthe legislation, and some of AMT's concerns have been addressed insubsequent versions. We will monitor developments in Missouri anddetermine what position AMT should take with regard to any licensurebill that is introduced. by AMT Legal Counsel Michael N. McCarty Brickfield, Burchette, Ritts & Stone, P.C.