Federal Health Care Reform

Information Update January 27, 2010

As Congress considers options for reforming the nation's health care system, opinions vary on which of these options would have the greatest potential for success. One of the primary goals is to design a system to reduce health care costs and improve access to care. In 2007, national health care expenditures reached $2.2 trillion and have been projected to reach $4.4 trillion by 2018. In addition, there were more than 43 million Americans without health coverage in 2008. Determining which of the elements of our current system should be changed and which should be expanded will be critical in moving forward.

Exactly how federal reforms will affect the states is the question NCSL will be asking. NCSL policy supports federal initiatives to explore a broad range of approaches and financing mechanisms to improve our health care system. States are a key stakeholder in this process of reform and will be responsible for implementing many of the changes that emerge from this debate. NCSL will be following the activities in Congress and providing legislators and legislative staff current information on the latest proposals, and how it may affect their states. 

New Developments 

What Happens Now!

January 27, 2010

With the election of Scott Brown to the U.S. Senate from Massachusetts on January 19th the path of health reform legislation changed. The loss of the 60th vote in the Senate has forced Democrats to reevaluate their strategy moving forward. House Majority Leader Steny Hoyer (D-Md.) said Democrats need to have a healthcare game plan in place by the first week in February. Hoyer has laid out four potential options he and other Democrats agree have hope of movement in the current environment: Pass a smaller series of health reform measures; pass the Senate bill along with a companion bill to “fix” certain aspects of the Senate bill and have the Senate use the reconciliation process to pass the “fix”; pass the Senate bill in its current form; or abandon healthcare reform efforts altogether. As reported in the Wall Street Journal, House Democrats met January 26th to discuss their course for action. Several proposals were made that the House adopt the bill passed by the Senate in December and then have the House and Senate modify that bill through a reconciliation. By using budget reconciliation passage of the bill would only require a simple majority of 51 votes. However two Democratic Senators who voted for the Senate bill originally and face tough reelections this year have said they would fight any effort to pass the measure through reconciliation. Senator Blanch Lincoln (D-AR) said, "I am opposed to and will fight against any attempts to push through changes to the Senate health insurance reform legislation by using budget reconciliation tactics that would allow the Senate to pass a package of changes to our original bill with 51 votes. I have successfully fought for transparency throughout Senate deliberations on health care, and I will continue to do so. I will not accept any last-minute efforts to force changes to health insurance reform issues through budget reconciliation, and neither will Arkansans. We have worked too long and too hard on this reform effort – we need to get it right." Senator Evan Bayh of Indiana has said  "My concern is that if reconciliation is used, that will really destroy any prospects for bipartisan cooperation on anything else for the remainder of this year. That would be a regrettable state of affairs, something I think the American public would not react well to." The web publication Politico has reported that as many as eight Democratic Senators have said they oppose or have strong reservations about moving the bill through Congress via the reconciliation process.

Resources for information on the reconciliation process:

• CRS Report for Congress--The Budget Reconciliation Process: The Senate's "Byrd Rule" (March 20, 2008)
• The House Rules Committee.

NEW CRS Reports

A Comparartive Analysis of Private Health Insurance Provisions of H.R. 3962 and Senate-Passed H.R. 3590 (January 8, 2010)

A Comparative Analysis of Private Health Insurance Provisions of H.R. 3962 and S.Amdt. 2786 to H.R. 3590 (December 16, 2009)

House-Senate Comparison of Key Provisions in Health Reform Legislation 

U.S. Senate Approves H.R. 3590

Early on December 24th the U.S. Senate voted 60 to 39 to approved an amended version of H.R. 3590, the Patient Protection and Affordable Care Act. Now the bill moves forward to the reconciliation process with the House approved version as Congress reconvenes. Democrats are hopeful of producing a final bill before the President's State of the Union Address. Several issues must still be worked out, including the possibilities of a public option, finance mechanisms to cover the cost of the reform measures, and abortion coverage before compromise can be reached. Conferees who will carry out the task of reconciliation in January have yet to be appointed in either chamber. CBO estimates that an additional 31 million Americans who are currently uninsured would receive coverage under the changes in the Senate bil,l and it would result in a net reduction in federal deficits of $132 billion over the 2010-2019 period. 

CBO analysis of the effects of tort reform proposals on health care costs:

• Letter to the Honorable John D. Rockefeller IV (December 10, 2009)
• Letter to the Honorable Orrin G. Hatch (October 9, 2009)

Health Reform Legislation in Congress

NCSL Activities and Documents 

Letters

• January 12, 2010. NCSL letter to Congressional leader urging an extension of the federal Medicaid matching funds that were made available in the American Recovery and Reinvestment Act.
• December 15, 2009.  NCSL letters to Congress urging an extension of the enhanced Medicaid match established in ARRA.
  
  House Letter
  
  Senate Letter
   
• October 21, 2009.  NCSL letter to the leadership of the Senate offering recommendations on issues of concern in health reform to states. 
   
• September 23, 2009.  NCSL letter to the leadership of the Senate Committee on Finance expressing critical issues to states for consideration during the markup of the America's Health Future Act of 2009.

Analysis  

• NCSL Comments on the Policy Paper: Policy Options for Expanding Health Care Coverage (May22, 2009)
• Federal Health Care Reform Comparison of Baucus and Obama Plans and NCSL Policy  

Webinars

• NCSL Six Part Webinar Series- States Checking Up on Health Reform, beginning November 20th. Registration available online.
• November 23, 2009 Medicaid Presentation (36 page pdf document) by Robin Rudowitz, Principal Policy Analyst, Kaiser Commission on Medicaid and the Uninsured, Kaiser Family Foundation, and Joy Johnson Wilson  Federal Health Policy Director, NCSL.
• November 20, 2009. Private Insurance Provisions Presentation (12 page pdf document) by Brian Webb, Manager of Health Policy and Legislation, National Association of Insurance Commissioners.

NCSL Conference Calls on Federal Health Care Reform for legislators and legislative staff. Presentations by Joy Johnson Wilson, NCSL Federal Affairs Counsel and Health Policy Director

 Additional Resources

NCSL staff contacts: Joy Johnson Wilson, Federal Affairs Counsel, Health Policy Director at joy.wilson@ncsl.org or Rachel B. Morgan RN, BSN, Senior Health Policy Specialist at rachel.morgan@ncsl.org.