MARCH 26, 2010

This Week in Health Care Reform     

Health care reform legislation passed the House this week on a party-line vote. Late Sunday night, House Democrats approved the Senate health care reform package, sending the legislation to President Obama for his signature. On Tuesday, President Obama signed the underlying bill into law, yet the House has yet to finalize the package of "fixes" that will alter the final implications of the legislation.

Health Care Reform Negotiations

House Democrats Pass Health Care Reform Package: The House of Representatives approved the Senate health care reform bill Sunday night by a vote of 219 to 212. The vote marks the climactic finale to a year-long debate over health care reform. In the final vote, 34 Democrats joined all House Republicans in voting against the measure. Shortly thereafter, the House also passed a package of "fixes," by a vote of 220-211, that was sent directly to the Senate for its approval through reconciliation. On Tuesday, President Obama signed into law the Senate health care reform bill, called the "Patient Protection and Affordable Care Act."

Republicans Force Senate to Send the Reconciliation Bill Back to the House: Shortly after the President signed the Senate bill into law, Senators began deliberations on the reconciliation bill. Reconciliation protocol restricts Senators to 20 hours of debate on the measure, but it does not limit the number of amendments that can be filed. In an expression of opposition to the bill, Republicans filed 29 amendments to the reconciliation package.

After 10 hours of continuous debate, Republicans were successful in eliminating two provisions related to college financial aid in the non-health care portion of the bill. The Senate parliamentarian ruled early Thursday morning that those two provisions violated the chamber's rules, sending the legislation back to the House for a new vote. As a result, on Thursday afternoon, the Senate voted on the reconciliation bill without those two provisions and sent the bill  back to the House for a vote on final passage. The House vote will likely come Thursday evening.

What Does This Health Care Reform Legislation Mean: While the health care reform bill extends insurance coverage to 32 million more Americans by 2019, the legislation has other far-reaching implications that will be phased in sooner, during a multi-year implementation period.

Several features of the new health care overhaul bill that would take effect in 2010 under the measure passed Sunday include:

* New product requirements beginning 6 months after enactment, including:
o Coverage for dependents up to age 26
o No lifetime maximum benefit limits
o And no cost sharing on preventive care for certain policyholders
* Temporary federal high risk pools;
* Tax credits for small employers; and
* Prohibition on pre-existing condition exclusions for children (beginning 6 months after enactment).

Most Americans will have until 2014 to purchase insurance or pay a penalty. Other elements of the bill that will not take effect until at least 2014 include insurance marketplaces called "exchanges"; rules requiring insurers to accept all applicants regardless of pre-existing conditions, and an expansion of state Medicaid programs.

A number of experts question whether health care reform will really drive down insurance premiums. America's Health Insurance Plans ( AHIP), the trade group representing health insurers, outlines a series of concerns related to the legislation including a lack of provisions that address underlying health care costs, improve quality of care or ensure a stable risk pool. In addition, AHIP expressed concerns regarding new taxes on health coverage, which will likely increase premiums.

Additional Activities

Obama's Executive Order on Abortion Funding: On Sunday afternoon, prior to the final House vote on health care reform, President Obama agreed to issue an Executive Order that would uphold the ban on federal funding for abortion . In so doing, he secured about a half-dozen votes from anti-abortion Democrats, led by Rep. Bart Stupak (D-MI), who previously opposed the legislation. On Wednesday, President Obama signed the Executive Order banning the government from spending federal money to pay for abortions through plans offered on the insurance exchanges created under the measure.

States Filing Lawsuit to Fight Provision of Health Care Reform Bill: In response to the new health care reform legislation, states across the country have filed lawsuits asking the courts to declare the law unconstitutional and to bar its enforcement.