This Week in Health Insurance Reform : EasyToInsureME

January 13, 2010

This Week in Health Reform

House and Senate
The Senate passed its health care reform legislation, the Patient Protection and Affordable Care Act of 2009 (H.R. 3590) on December 24, 2009. With both pieces of legislation now passed – the House legislation, the Affordable Health Care for America Act (H.R 3962), was passed on November 7, 2009 – House and Senate leadership must now reconcile the differences. Instead of moving into the conference committee to reconcile the bills, Democratic leadership has agreed to implement a “ping-pong” approach where the House will take up the Senate bill, amend it, and then send it back to the Senate for approval. Reiterating his commitment to signing health care reform legislation by the State of the Union address (the date of the Address has not been confirmed yet), President Obama has met with key Democrats multiple times during the last week and is supportive of this approach, which is said to be an easier procedural tactic and will take less time.

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Senate Majority Leader Harry Reid (D-NV) still has the challenge of maintaining the Democrats’ 60-vote majority for two procedural votes in the Senate. This first is a vote on a motion to proceed to debate the legislation and the second is a vote on cloture that will allow Senators to proceed to the vote itself. The final vote on the full legislation will only need 51 votes. Speaker Nancy Pelosi (D-CA) needs 218 votes in the House of Representatives.

While the “ping-pong” approach may seem easier than holding a formal conference committee, there are still numerous provisions in the Senate bill that might prove to be contentious issues for Democrats trying to marry the two pieces of legislation. One main priority is the way both bills are financed. The House Democrats prefer a tax on the wealthiest U.S. residents, while Senate Democrats want to tax high-cost “Cadillac” health insurance plans. It is suggested that a hybrid of the two is most likely to appease both groups. Among other provisions, many House Democrats are not supportive of either bill’s language on abortion, stating that they have a coalition of 41 members who will vote against the legislation if the abortion provisions are not amended. Other differences include national exchanges proposed in the House, while the Senate would like to see state-based exchanges; higher subsidies for the lowest-income Americans and an expansion of Medicaid in the House legislation.

The full Senate remains on recess until January 19.

Overview: NAIC Writes Speaker Pelosi and Majority Leader Reid
On January 6, The National Association of Insurance Commissioners (NAIC) wrote House Speaker Nancy Pelosi (D-CA) and Majority Leader Harry Reid (D-NV) to provide their input as the House and Senate begin to reconcile the differences in their prospective health care reform bills.

In its letter, the NAIC highlights important points about the need for a strong individual mandate, the implications of health care reform in non-guarantee issue states, concern over Federal rate approval processes and minimum loss ratios (MLR) at 80 percent for the individual market, as well as comments about the importance of Congress focusing on proposed effective dates for numerous insurance market reforms. Other issues discussed include high-risk pools and new vouchers programs.