December 22, 2009: Senate Approves Manager's Amendment to Health Care Reform Proposal The Senate approved the manager's amendment (S.A. 3276) to the Senate's comprehensive health care reform bill, the Patient Protection and Affordable Care Act (H.R. 3590). The manager's amendment includes federal funding to extend the Children's Health Insurance Program (CHIP) authorization for two additional years (through 2015). Eligible states would still receive a 23 percentage point increase in their CHIP enhanced match rate, but the effective date was changed from 2013 to 2016. The amendment would immediately prohibit insurers from denying coverage to children because of pre-existing medical conditions and would extend Medicaid coverage to children in foster care until they are 26 years of age. S.A. 3276 retains the mandatory Medicaid expansion up to 133% of the federal poverty level (FPL) and the increased federal share for the newly eligible population. However, the language makes several clarifications and adjustments related to the Medicaid expansion, including making it a state option to cover adults at or below 133% FPL beginning April 1, 2010. Under the amendment, enhanced Medicaid funding would be available to states that shifted Medicaid beneficiaries from nursing homes to home- and community-based services. States would be subject to new transparency requirements when developing Medicaid waivers. The amendment would authorize grants to states to test alternatives to civil tort litigation. Final passage of the Senate bill is expected on December 24, 2009. A summary of the manager's amendment is here: http://inside.ffis.org//ff/ManagersSectionBySection_12-19-09.pdf
December 10, 2009: CMS Actuary Releases Cost Estimate of Senate Health Care Reform Bill The chief actuary for CMS released a report of the estimated financial effects of Senate health care reform proposal, the Patient Protection and Affordable Care Act, introduced on November 18, 2009. According to the analysis, the legislation would increase total national health care expenditures by $234 billion, or 0.7%, over the 10-year budget window 2010-2019, compared to current law. The net total increase in federal expenditures for the coverage provisions would be $366 billion and includes a combination of $930 billion in costs for the coverage expansion, $493 billion in savings from the Medicare program, $36 billion in savings from Medicaid and the Children's Health Insurance Program (including a number of cost increases and decreases such as prescription drug changes and reductions in Medicaid DSH expenditures but excluding eligibility expansion), $2 billion in savings from cost containment provisions, $38 billion in savings from a new voluntary long-term care benefit program, and $5 billion in costs for health insurance reforms. Of the $930 billion in federal expenditures for the coverage provisions, the Office of the Actuary attributes $364 billion to provisions expanding Medicaid to all adults under 133% of the federal poverty level and all uninsured newborns. For the report, go to: http://inside.ffis.org//ff/CMS_Chief_Actuary_Senate_Health_Care_Reform_1.pdf
Also, on December 10, 2009, the chief actuary released a report on the estimated effects of the Senate health care reform proposal on the date of exhaustion for the Medicare Hospital Insurance (Part A) trust fund, on Part B beneficiary premiums, and on the average level of Part A and Part B beneficiary coinsurance. The report finds that the legislation would postpone the exhaustion of trust fund assets by nine years to 2026. In addition, Part B premiums and average coinsurance payments would be reduced, after an initial increase. For the report, go to: http://inside.ffis.org//ff/OACT_Memorandum_HR 3590_12-10-09.pdf
November 30, 2009: CBO Releases New Analysis on Health Care Reform and Premiums The Congressional Budget Office (CBO) released an analysis of how the Patient Protection and Affordable Care Act, the Senate's version of health care reform, would affect premiums in 2016, the point at which the provisions would be fully implemented. According to CBO, some premiums in the individual market would be about 10% to 13% higher compared to the average premium in the same year under current law. However, about half of those enrollees purchasing coverage in the individual market would receive subsidies and have their premiums reduced almost 60% compared to current law. CBO also stated that there would be a relatively smaller effect on the average premium for employment-based coverage. The CBO analysis is available at: http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf
November 21, 2009: Senate Approves Motion to Begin Health Care Reform Deliberations The Senate approved a procedural motion that allows the chamber to move to debate the comprehensive health care reform bill introduced by Senate Majority Leader Reid last week. Debate is scheduled to begin on November 30, 2009, and is expected to last through most of December. The Senate bill includes an individual mandate to obtain coverage and financially penalize employers who offer no or unaffordable coverage to their employees. The proposal also would establish health insurance exchanges, provide sliding scale federal subsidies to assist low-income individuals with income between 133% and 400% of the federal poverty level (FPL) afford coverage, expand Medicaid eligibility to 133% of FPL for all non-elderly individuals, and impose an excise tax on high-cost health insurance plans, as well as other fees. The federal government would pay all the costs of covering newly eligible Medicaid enrollees from 2014 through 2016. Beginning 2017, states would pay a share of the costs, which would average about 10%. According to the preliminary analysis by the Congressional Budget Office (CBO), the bill would reduce the federal budget deficit $130 billion over its first 10 years (2010-2019). The legislation is available at http://democrats.senate.gov/. The CBO analysis is available at http://www.cbo.gov/doc.cfm?index=10731.
November 7, 2009: House Passes Health Care Reform The House approved H.R. 3962, the Affordable Health Care for America Act. It would require most Americans to obtain health insurance and would impose penalties if they do not. Employers with more than $500,000 in annual payroll would be required to provide coverage or pay a tax penalty of up to 8% of payroll. The bill also expands Medicaid to 150% of the federal poverty level beginning in 2013. The federal government would pay 100% of the cost of the expansion in the first two years and 91% thereafter.
The bill extends for six months (through June 30, 2011), the enhanced Medicaid match provisions that are part of ARRA (see Issue Brief 09-44). It also would offer subsidies to help moderate-income people buy health care coverage that meets certain federal standards. Insurance plans would be offered through a newly established national insurance exchange where people could shop for coverage. The bill would make a number of changes to the rules for health insurance plans, including prohibiting denial of coverage for pre-existing conditions or denial of care when someone becomes sick, a practice known as rescissions.
The measure is paid for through a number of new fees and taxes as well as cost reductions in some areas of Medicare, with the net cost of the coverage provisions totaling approximately $894 billion over the 10-year budget window (2010-2019). Before the House debate, the administration issued a Statement of Administration Policy in support of the measure. Sen. Reid has stated that he will bring a bill to the Senate floor for debate as soon as possible. The two chambers will need to negotiate and approve a final bill. The text of the bill and related documents are available at http://rules.house.gov/. The cost estimate for the bill as introduced on October 29, 2009, incorporating the manager's amendment from November 3, 2009, is available at http://www.cbo.gov/doc.cfm?index=10706.
November 6, 2009:House Health Care Reform Bill Includes ARRA FMAP Extension, Issue Brief 09-44
October 29, 2009: House Releases Merged Health Care Reform Bill The House released legislative language for a comprehensive health care reform proposal, the Affordable Health Care for America Act (H.R. 3260). The bill combines language approved earlier this year by the three primary committees of jurisdiction. Beginning in 2013, the proposal would expand Medicaid to cover all non-elderly individuals with income at or below 150% of the federal poverty level (FPL), as compared to 133% FPL in the committee measures. The federal government would pay 100% of the cost of services for Medicaid expansion enrollees for the first two years. Beginning in 2015, the federal share would drop to 91%. The bill also extends the FMAP provisions under ARRA for two quarters, through June 30, 2011. Additional information on the bill, including the preliminary analysis from the Congressional Budget Office, is available at: http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1687:health-care-reform&catid=169:legislation&Itemid=55
October 13, 2009: Senate Finance Committee Passes Health Care Reform Measure The Senate Finance Committee passed a 10-year, $829 billion health care reform proposal, "America's Healthy Future Act of 2009." The comprehensive measure contains several provisions affecting Medicaid, including a proposal to expand Medicaid to 133% of the federal poverty level (FPL) for all parents, adults under 65 years of age without dependents, and children. The proposal would also require all individuals to purchase health insurance and provide federal subsidies to help low-income individuals in purchasing such coverage; create new state-operated insurance options for low-income individuals between 100% and 200% FPL; establish federal minimums for health insurance rating standards; and change the tax code as part of an effort to reduce the proposal's cost and reduce the rate of growth in health insurance. Prior to moving to the Senate floor, the bill needs to be combined with the Senate Health, Education, Labor and Pensions (HELP) Committee bill (S. 1679) that passed in July 2009. The Finance Committee proposal, which includes all adopted amendments, can be found at http://finance.senate.gov/sitepages/legislation.htm.
In addition, FFIS has attached a revised version of its verbal summary that outlines the changes included in the proposal related to Medicaid and the Children's Health Insurance Program. FFIS has also attached a document that highlights issues for states to consider when estimating the impact of health care reform on state Medicaid costs.
October 2, 2009: Senate Finance Committee Finishes Consideration of Health Care Reform The Senate Finance Committee completed consideration of its version of health care reform legislation. A committee vote is expected this week, once the Congressional Budget Office (CBO) develops a preliminary cost estimate. The chairman's mark has been revised to reflect the amendments that were adopted throughout the process. The revised text is available at: http://finance.senate.gov/sitepages/Americas_Healthy_Future_Act.html.
One amendment that was approved would keep the current structure of the Children's Health Insurance Program (CHIP). States would be required to maintain income eligibility levels for currently eligible children in Medicaid and CHIP until December 31, 2019. In addition, states would receive a 23 percentage point increase in the CHIP match rate through FY 2019. States would also receive an increase of 0.15 percentage points in their Medicaid match rate to offset the additional state costs due to the Medicaid maintenance-of-effort provision.
The bill must now be merged with the bill approved in July by the Senate Health, Education, Labor, and Pensions Committee.
September 23, 2009: House Energy and Commerce Panel Approves Health Care Reform Measure The House Energy and Commerce Committee approved a second package of amendments to the House health care reform legislation (H.R. 3200), as part of an agreement reached when the panel ran out of time to consider the changes during a July markup of the bill. The measure will be sent to the House Rules Committee as a recommendation to be added to the July 31, 2009, committee-passed measure. One amendment approved would provide states with technical assistance to improve coordination for dual eligibles (those who qualify for both Medicare and Medicaid). Other approved changes would:
1. clarify that manufacturers do not need to pay rebates to Medicaid for drugs purchased by Medicaid managed care organizations (MCO) if the MCO already received a drug discount through the 340B program; 2. award grants to communities for the development of integrated health care delivery systems; 3. seek to foster greater price and quality transparency by requiring hospitals to report data on charges for common services and Medicare and Medicaid reimbursements. The text of the measure is available at http://energycommerce.house.gov/
September 16, 2009: Health Care Reform Proposal The Senate Finance Committee released America's Healthy Future Act of 2009, the committee's health care reform proposal. Modifications to the chairman's mark were released September 22, 2009.
The Senate Finance Committee continues to mark-up the legislation. The chairman's mark (including modifications), a summary of proposed amendments, and the Congressional Budget Office's analysis are available at: http://finance.senate.gov/sitepages/legislation.htm
FFIS expects to release additional work on the Senate Finance Committee's estimates, focusing on the underlying assumptions and the sensitivity of the estimates to those assumptions.
FFIS's summary table outlines the proposed changes to Medicaid and the Children's Health Insurance Program (CHIP) and compares those changes with existing law.
FFIS's numeric table of the Senate Finance Committee proposal.
Charts released by the Senate Finance Committee showing state-by-state estimates of the impact of its proposal on state Medicaid/CHIP costs:
September 16, 2009: Senate Finance Releases Health Care Proposal The Senate Finance Committee released America's Healthy Future Act of 2009, which is the committee's health care reform proposal. Modifications to the chairman's mark were released today. In addition, mark-up began today and is expected to continue for several days. The chairman's mark, the revised chairman's mark, a summary of proposed amendments, and the Congressional Budget Office's analysis are available at: http://finance.senate.gov/sitepages/legislation.htm
FFIS is currently reviewing the proposal and cost estimates and expects to release additional information in the coming days.
July 9, 2009:Medicaid Expansion Prominent in Health Care Reform Proposals, Issue Brief 09-23
