Listen Up

Continuing Action About the "CLASS ACT"

2011-10-27T12:01:00.000-07:00

"Legislators Grill HHS Officials Over Decision Not To Implement CLASS Act.

The Hill (10/27, Baker) reports in its "Healthwatch" blog, "Rep. Frank Pallone (D-NJ) clashed with Health and Human Services (HHS) officials" yesterday at a joint hearing of two subcommittees over the "decision not to implement the healthcare law's CLASS program." Pallone did not dispute the report which found financial problems with the program, but said he thought work should continue. HHS Assistant Secretary for Aging Kathy Greenlee "testified that repeal 'would not serve a helpful purpose' and said HHS wants to work on a new approach to providing coverage for long-term care."

The Washington Times (10/27, Cunningham) reports that "Democrats are digging in their heels over" the CLASS Act. Rep. Henry Waxman (D-CA) is quoted as saying HHS Secretary Sebelius' decision not to implement the program was "the responsible thing to do fiscally and otherwise," but added that "calling for a time out is not the equivalent of throwing in the towel, as Republicans would have the public believe." The Times also quotes Rep. Pallone's comments supporting the program's implementation. Republicans, meanwhile, "grilled Ms. Greenlee and Sherry Glied, assistant secretary for planning and evaluation on when they knew CLASS was untenable." Greenlee is quoted as saying, "It took some time for us to put those models together."

Modern Healthcare (10/27, Zigmond) reports that not only did Pallone "flatly disagree with HHS' decision" to suspend implementation of CLASS, "he also pressed Kathy Greenlee...for the administration to appoint the 15-member advisory council of stakeholders to CLASS that the law requires." Greenlee responded, "I do not want to send a mixed message by saying we're continuing to work on CLASS when we're not. We do want to engage stakeholders." The article notes that she later added "that she would discuss Pallone's concerns with Sebelius."

CQ Healthbeat (10/27, Norman) focuses much of its reporting on Pallone's comments, noting that he "said that a former HHS actuary, Bob Yee, has developed options for CLASS that address potential problems, such as adverse selection." CQ also notes Greenlee's responses to some of Pallone's questions.

Matheson Breaks From Democrats, Calls For Repealing CLASS Act. The Hill (10/27, Baker) reports in its "Healthwatch" blog, "Rep. Jim Matheson (Utah) on Wednesday became the first Democrat to publicly support repealing the healthcare reform law's CLASS program." Matheson said in announcing his decision, "Repeal of the CLASS Act is the right decision and Congress should be considering real common-sense reforms that lower health care costs and allow greater access to quality care." The Hill notes that Matheson "opposed the healthcare reform law, but he also voted against Republicans' bill to repeal the entire law earlier this year."

Reaction to "White House" Decision Regarding CLASS Repeal

2011-10-19T07:54:00.000-07:00

More and more fuel for a health care reform battle.

"Republicans Criticize White House For Opposing CLASS Act Repeal.

The Hill (10/19, Sink) "Blog Briefing Room" reports that Sen. John Thune (R-SD) "says that the White House's rejection of a new rule that would help to repeal the CLASS Act -- a portion of the healthcare reform law intended to provide long-term care insurance that Health and Human Services Secretary Kathleen Sebelius said last week was financially unsustainable -- is 'incomprehensible.'" Thune was referring to comments from White House spokesman Nick Papas, who stated on Monday, "We do not support repeal. ... What we should be doing is working together to address the long-term care challenges we face in this country."

FOX News Special Report (10/18, Baier, 6:08 p.m. EST, 1,971,998) reported, "Republicans say they are mystified after Health and Human Services Secretary Kathleen Sebelius said the Obama administration could not implement" the CLASS Act, which is part of "the health care law, because it would add too much to the deficit, only to have the White House insist it had not been cancelled." The segment noted Sen. Thune's comments.

Modern Healthcare (10/19, Zigmond, Subscription Publication) reports that GOP lawmakers "are pushing to repeal the CLASS Act, the long-term-care insurance measure in the healthcare reform law that HHS officials said the agency will not implement." Rep. Charles Boustany (R-LA), "a physician who serves on the influential House Ways and Means Committee, introduced legislation this year to repeal the provision. On the road in his home district Tuesday, Boustany said he has communicated with the House leadership and that repeal is going to be a 'top priority' between now and when House members return from a weeklong recess next week." FOX News (10/19, Angle) also covers the story on its website.

NYTimes: White House Made "Wise" Decision Not To Implement CLASS. New York Times (10/19, A28, Subscription Publication) says in an editorial, "The Obama administration was wise to suspend a long-term care insurance program that was part of its health care reform package." The CLASS Act, "which was to be financed by the premiums paid by enrollees, seemed unlikely to remain financially solvent in coming decades." Yet, Americans should not "be misled by Republican war whoops proclaiming the demise of this single program as proof that reform is doomed and ought to be repealed. The decision shows a welcome flexibility by the White House that bodes well for carrying out all provisions of the reform law."

Could this be the tip of the ice berg regardiong the future of our new health care reform law.

More as we get it.

-PapaDean

Major Fix May Not Go

2011-10-18T09:22:00.000-07:00

The next chapter.....the CLASS Act repeal comes under fire. Seems the "White House" may try to block the removable.

"White House Opposes Repeal Of CLASS Act.

The Obama Administration's announcement that it would not support repeal of the CLASS Act garnered extensive media coverage on Monday. Sources such as the AP, CQ and The Hill focused on the confusion generated by this decision, as well as the "politically awkward position" in which Democrats have been placed.

"The AP (10/18, Alonso-Zaldivar) reports that White House spokesman Nick Papas stated on Monday, "We do not support repeal" of the CLASS Act. Last week, HHS Secretary Kathleen Sebelius "said the administration would not proceed with the plan because she has been unable to find a way to make the program financially solvent." Now, "the nonpartisan Congressional Budget Office [has] issued a ruling that cleared the way for repealing the CLASS Act, but the administration rejected that step -- and created considerable confusion."

Another AP article (10/18) reports, "In its ruling, CBO said repealing CLASS would have no impact on the deficit. That removes a major obstacle for repeal, because until now CLASS has counted as reducing the deficit by more than $80 billion."

But, The Hill (10/18, Pecquet) quotes Papas as saying, "Repealing the CLASS Act isn't necessary or productive. What we should be doing is working together to address the long-term care challenges we face in this country." However, Republican lawmakers "on Monday called for the immediate repeal of" the CLASS Act "as the issue blew up in the administration's face." The Hill says that the Administration's decision has "put congressional Democrats in a politically awkward position," although "perhaps even more damning is how the White House mishandled the controversy; consumer advocates accused the administration of being disingenuous and gutless."

CQ (10/18, Norman, Subscription Publication) reports that Sen. John Thune (R-SD) "said on the Senate floor that he might be introducing an amendment this week to 'minibus' appropriations legislation to kill the program, thus putting the issue to a vote soon after the mixed messages from the administration were issued."

CQ (10/18, Norman, Subscription Publication) reports that the CBO's ruling "would seem to raise the prospect that Congress will move to formally kill the Community Living Assistance Service and Supports (CLASS) program, which the Department of Health and Human Services (HHS) said on Friday it would not implement. ... A Senate aide said Monday that the program would likely be repealed." Yet, this "also raises questions about how the program's scored savings will be replaced."

The Washington (DC) Examiner (10/18) says in an editorial that it "warned Congress about CLASS many times, most recently last month when we called for its repeal. Sebelius' action last week notwithstanding, it is unclear this week where her boss stands on the future of CLASS, thanks to some curious word-parsing by White House officials."

Next step??

-PapaDean

A Major Fix

2011-10-17T15:09:00.000-07:00

The "Community Living Assistance Service and Supports Act was made part ot the health care bill passed under the current Administration in DC. It has been since it's introduction one of the most unattainable portions of the law. It dealt with providing long term care benefits which would we would start paying premiums for now yet the benefits would be delayed. It also relyed on us being agreeable to substantial tax increases as these benefits came into effect.

Acturaries everywhere (even the Administrations own Acturaries) argued that it could not be funded and would merely increase the debt. We are happy to announce that Ms. Sebelius has finally realized it's flaw.

"CLASS Dismissed

Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced last Friday her recommendation to halt implementation of the Community Living Assistance Services and Supports (CLASS) Act. In letters to congressional leaders, Sebelius wrote that she does not see “a viable path forward for CLASS implementation at this time,” and recommends a halt to the program’s implementation efforts. NAHU has always maintained that the CLASS Act provisions of PPACA were unworkable, and we have consistently called for the repeal of these provisions."

The National Association of Health Underwriters (NAHU) has been instramental in getting these unworkable provisions removed.

More improvements coming.......we hope! Stay Tuned!

PapaDean

Continuing Court Action

2011-06-09T08:26:00.000-07:00

Good morning Clients and Friends:

Below are some reports on the current court activity. One can only speculate that the decisions made here are significant to the "Healthcare" law's future. Either way, we expect the decision to be appealed to the Supreme Court.

Couple these court activities with the McKenzie report that approximately 30% of businesses will drop employer medical insurance plans by 2012, and we have dramatic changes in employee benefits looming.

I am interested in your thinking. You can post comments on this blog or just e-mail me (dbyus@comcast.net).

-Papa Dean

"Judges Suggest Healthcare Mandate Sets Congressional Overreach Precedent.

The Obama Administration's latest appeal of a challenge against the healthcare law is being called the most important.

The Los Angeles Times (6/9, Savage) reports, "If the Obama administration had any doubt that its signature healthcare law faces a severe challenge in court, it was erased soon after Chief Judge Joel Dubina opened the proceedings" in Atlanta. Dubina said, "'I can't find any case like this. ... If we uphold this, are there any limits' on the power of the federal government?" In fact, by the end of "nearly three hours of argument Wednesday, the three-judge panel of the 11th Circuit Court of Appeals seemed prepared to declare at least part of last year's law unconstitutional."

The AP (6/9) reports, "All three judges on the 11th Circuit Court of Appeals panel questioned whether upholding the landmark law could open the door to Congress adopting other sweeping economic mandates." The judges "did not immediately rule on the lawsuit brought by 26 states, a coalition of small businesses and private individuals who urged the three to side with a federal judge in Florida who struck down the law." Yet, "the pointed questions about the so-called individual mandate during almost three hours of oral arguments suggests the panel is considering whether to rule against at least part of the federal law to expand health coverage to tens of millions of Americans."

The Washington Post (6/9, Aizenman) reports, "One judge, Frank M. Hull, appeared more sympathetic to the law -- at one point interrupting an attorney for the states to tell him that his central argument 'doesn't get me very far.'" Still, "the case before the US Court of Appeals for the 11th Circuit could offer the armada of Republican state leaders who have taken on the law their best chance of a win during stage two of a multi-pronged, protracted legal battle widely expected to end in the Supreme Court."

The New York Times (6/9, A17, Sack, Subscription Publication) reports that this is "perhaps the weightiest of the dozens of challenges to the Obama health care law," and "because of the political heft of the plaintiffs and the intellectual firepower of the lawyers," it "has garnered the most attention." The Times adds, "Among 31 separate legal challenges to the law, five cases have yielded decisions on the merits from lower-level district court judges. Three judges appointed by Democratic presidents upheld the law, while two Republican appointees rejected all or part of it." This "panel includes Judge Frank M. Hull, who was named by President Bill Clinton; Judge Stanley Marcus, a Clinton appointee who had previously been placed on the District Court by Ronald Reagan; and Chief Judge Dubina, who was appointed by the first President Bush."

According to the Wall Street Journal (6/9, Adamy, Subscription Publication), the judges expressed doubts about the Administration's argument in support of the individual mandate, yet they also questioned the states' contentions about activity versus inactivity. Meanwhile, Judge Dubina appeared sympathetic to the states' argument that the Medicaid expansion mandated by the law was tantamount to coercion by the Administration.

Similarly, Politico (6/9, Haberkorn) reports that three "11th Circuit Court of Appeals judges also were receptive to the government's argument that the health care market is different from all others and needs that kind of regulation -- giving the law's supporters some hope that the appeals panel would side with them." The panel's "questions were mixed enough to give encouragement to both sides in the oral arguments in the multistate lawsuit, the most significant of the legal challenges against Obama's health care overhaul."

USA Today (6/9, Biskupic) reports, "Acting US Solicitor General Neal Katyal, defending the law, stressed the special nature of health care and the insurance market today. He said billions of dollars in costs incurred by people without insurance are passed on to people who carry insurance." But, attorney Paul Clement, "representing 26 states that have challenged the health care law, argued that Congress lacked the authority 'to compel people to engage in a transaction,' that is, to buy insurance."

The Hill (6/9, Baker, Pecquet) reports in its "Healthwatch" blog that this "highly charged case is on track for a hearing in the US Supreme Court, which could rule just months before the 2012 election. A ruling against the mandate would undermine key provisions of President Obama's signature healthcare law, notably its ban on denying people coverage because they are sick."

Additional coverage is provided by the Christian Science Monitor (6/9, Richey), Bloomberg News (6/9, Harris, Davidson), Reuters (6/9, Beasley, Brown), CNN (6/9, Mears), National Journal (6/9, McCarthy, Subscription Publication), Atlanta Journal-Constitution (6/9, Rankin), and CQ (6/9, Norman, Subscription Publication). "

And Now The Courts

2011-06-02T10:10:00.000-07:00

For almost a year now we have not posted comment on this "Blog". This has been because every thing seemed to be up for question. Many appeals and objections have been filed, a new majority was elected in the U S House, and there has been a great deal of controversy over the law it's self. Much of that is about to come to an end, we think.

It seems that the courts are finally going to get into the act and determine if the mandatory purchase of health insurance will hold. (See Below)

I personally believe it is wrong to require a person to buy anything. At the same time, I believe that this law will be ineffective unless everyone has insurance. Is there a solution that solves both of these concerns. Yes, two.

One, we can go to a government run and paid for insurance system. A single payer system as it is known. Many countries have done this and the great majority are going into bankruptcy because of it. At the same time these countries have developed very oppressive rationing of care systems.

Two, we can start over and develop reform that will solve both the access and costs dilemmas which are the big two, while at the same time preserve the free market. The free market is ultimately the answer to the cost problem. Look at some of the other essentials of life that are working through the free market....Food, Clothing, and Shelter. At the same time a plan through private charity and/or government to assist the disabled/unable would solve the access problem and at a much more reasonable cost.

At any rate it seems wise to watch the courts for the next few weeks to see how they decide on the required purchase provisions of the current law. This might cause us to revert to one of the alternatives mentioned above.

Regards -Papa Dean

"Circuit Court Faces Legal Standing Issue Before Taking Up Insurance Mandate.

The New York Times (6/2, Sack, A18, Subscription Publication) reports that a three-judge panel of the Sixth Circuit Court of Appeals "seemed eager on Wednesday to rule on whether it is constitutional for the Obama healthcare law to require that uninsured Americans buy medical coverage," but they "must first decide whether the plaintiffs still have legal standing to sue, after one disclosed that she recently bought health insurance from her employer." During 90 minutes of arguments, Acting Solicitor General Neal Katyal said the insurance mandate "does not so much require individuals to buy coverage as it does regulate the way they pay for healthcare they will inevitably consume."

The Wall Street Journal (6/2, Kendall, Subscription Publication) says that two of the judges were appointed by Republican presidents, and both were skeptical of some of Katyal's assertions.

Politico (6/2, Haberkorn) reports, "The Thomas More Law Center told the 6th Circuit Court of Appeals that it has a right to bring its suit -- which it filed with several individuals -- challenging the constitutionality of the law's requirement to buy insurance. The group asked the court to overturn a lower court's decision to uphold the law." Notably, some "legal experts have said the group may no longer have standing now that the key plaintiff, Jann DeMars, told the court last week that she obtained insurance for her child in October," after having "argued that the mandate was too much of a financial burden."

Bloomberg News (6/2, Harris) reports, "The Cincinnati panel is the second of three US appellate courts that will consider the merits of the dispute over a five-week span. A US appeals court in Richmond on May 10 heard argument on appeals of two conflicting rulings." Meanwhile a third "panel in Atlanta is set to hear the government's appeal of a federal judge's Jan. 31 decision to find the entire act invalid." CQ (6/2, Norman, Subscription Publication) also covers the story."

Tax Preperation Day

2010-07-09T12:43:00.000-07:00

You might want to consider and study some of these pretty closely.

-PapaDean

__________________________________________________

Six Months to Go Until The Largest Tax Hikes in History

From Ryan Ellis on Thursday, July 1, 2010 4:15 PM

BREAKING: In just six months, the largest tax hikes in the history of America will take effect. They will hit families and small businesses in three great waves on January 1, 2011:

First Wave: Expiration of 2001 and 2003 Tax Relief

In 2001 and 2003, the GOP Congress enacted several tax cuts for investors, small business owners, and families. These will all expire on January 1, 2011:

Personal income tax rates will rise. The top income tax rate will rise from 35 to 39.6 percent (this is also the rate at which two-thirds of small business profits are taxed). The lowest rate will rise from 10 to 15 percent. All the rates in between will also rise. Itemized deductions and personal exemptions will again phase out, which has the same mathematical effect as higher marginal tax rates. The full list of marginal rate hikes is below:

- The 10% bracket rises to an expanded 15%

- The 25% bracket rises to 28%

- The 28% bracket rises to 31%

- The 33% bracket rises to 36%

- The 35% bracket rises to 39.6%

Higher taxes on marriage and family. The “marriage penalty” (narrower tax brackets for married couples) will return from the first dollar of income. The child tax credit will be cut in half from $1000 to $500 per child. The standard deduction will no longer be doubled for married couples relative to the single level. The dependent care and adoption tax credits will be cut.

The return of the Death Tax. This year, there is no death tax. For those dying on or after January 1 2011, there is a 55 percent top death tax rate on estates over $1 million. A person leaving behind two homes and a retirement account could easily pass along a death tax bill to their loved ones.

HHS Draft Regs are Beginning

2010-06-14T08:42:00.000-07:00

6-14-10

"The New York Times (6/14, A11, Pear) reports, "The White House on Monday will issue new rules that strongly discourage employers from cutting health insurance benefits or increasing the costs of coverage to employees, administration officials say." These "rules limit the changes that employers can make if they want to be exempt from certain provisions of the health care law passed by Congress in March. Many employers want the exemption," or grandfathered status, "because it allows them to keep their existing health plans intact with a minimum of changes." Notably, over "170 million Americans have employer-sponsored insurance."

The Wall Street Journal (6/12, Johnson, subscription required) reported that the Obama Administration is working on regulations that could cause many employer health plans to lose their grandfathered status. Initially, the law was supposed to allow some of these plans to continue to exist, even if they lacked certain requirements. But, under the new regulations being drafted by HHS, plans could lose this grandfathered status if, for instance, they increased employees' costs from 20% to 30%. Increasing deductibles by more than a certain amount could also have the same effect.

The AP (6/11, Alonso-Zaldivar) reports that "over and over in the healthcare debate," President Obama "said people who like their current coverage would be able to keep it." But, "in just three years, a majority of workers -- 51 percent -- will be in plans subject to new federal requirements, according to midrange projections in the draft." Republicans "said Obama broke his promise."

Employers May Pass On More Healthcare Costs To Employees Because Of Reform. Walecia Konrad wrote in the New York Times (6/12, B6) Patient Money column that "now is when big employers are busy assembling their" health insurance "benefits packages for 2011. And this year, they are having to factor in the new health law's requirements, said Pearce R. Weaver, Jr., a senior vice president at Fidelity Consulting Services." To comply with provisions in the new healthcare law, employers are "extending health insurance coverage to uninsured dependents up to age 26, eliminating any lifetime or annual caps on coverage, and paying 100 percent of some preventive care." Notably, some analysts say that certain provisions "will add an extra 2 to 3 percent in cost increases, pressuring employers to engage in even more cost-sharing with employees -- whether through higher premiums, co-payments or other out-of-pocket costs."

Small Business Tax Credit

2010-05-18T12:29:00.000-07:00

Many of you have asked about the "Tax Credit" for small business. Here's the guidance that we have received so far.

"The guidance clarifies that small businesses can receive the credit not only for traditional health insurance coverage, but also for add-on dental, vision and other limited-scope coverage.

The employer must meet the requirements for limited-scope coverage that are similar to those that apply for single coverage. The employer must offer to pay at least 50% of the premium.

“Small businesses face unique challenges to providing health insurance for their employees, including higher costs and fewer choices,” said Treasury Secretary Timothy Geithner in a statement. “The small-business health care tax credit in the Affordable Care Act provides an important incentive to help small businesses overcome these challenges and cover the cost of health insurance for the hardworking Americans they employ,” he added.
The Affordable Care Act, which was approved by Congress in March and signed into law by President Obama, included the small-business health care tax credit, which took effect this year. The credit is designed to encourage small employers to offer health insurance coverage for the first time or maintain coverage they already have.

However, many small businesses are wary of the health care reform bill. On Friday, one of the largest lobbying groups for small businesses, the National Federation of Independent Business, said it was joining a lawsuit by 20 state attorneys general and governors filed against the health care insurance mandate.

In general, the federal health care tax credit is available to small employers that pay at least half the cost of single coverage for their employees in 2010. The credit is specifically targeted to help small businesses and tax-exempt organizations that primarily employ moderate- and lower-income workers.

For tax years 2010 to 2013, the maximum credit is 35% of premiums paid by eligible small-business employers and 25% of premiums paid by eligible employers that are tax-exempt organizations.

The maximum credit goes to smaller employers — those with 10 or fewer full-time equivalent employees — paying annual average wages of $25,000 or less. The credit is completely phased out for employers that have 25 FTEs or more or that pay average wages of $50,000 per year or more.

Because the eligibility rules are based in part on the number of FTEs, not the number of employees, businesses that use part-time help may qualify even if they employ more than 25 individuals.

Eligible small businesses can claim the credit as part of the general business credit starting with the 2010 income tax return they file in 2011. For tax-exempt organizations, the IRS will provide further information on how to claim the credit. Because the tax credit’s matching rate is highest for employers with 10 or fewer FTEs, the number of hours worked is an important factor in calculating the credit.

The new guidance allows employers to choose among three different methods of determining hours to minimize their bookkeeping duties while receiving the maximum tax credit for which they are eligible.

Employers can look at actual hours of service, or can use simple rules of convenience to estimate hours based on total days or weeks of service. Because the tax credit is effective for 2010 but was not enacted until March 23, some small businesses that are providing health insurance in 2010 may not meet all the requirements for a qualifying health insurance offer.

To ensure that these businesses benefit from the credit, the Obama administration is providing special transition relief for tax year 2010. The transition rules simplify the requirements for what constitutes a qualifying health insurance offer while maintaining the core requirement that an employer make a significant contribution to the employee’s coverage."

Hope this help you with your planning.

-Papa Dean

COSTS

2010-05-12T08:52:00.000-07:00

Good Morning All-

The CBO has come out with their take on costs for the new health care bill. Below is what they have to say according to the "AP".

"The AP (5/12, Alonso-Zaldivar) reports, "President Barack Obama's new health care law could potentially add at least $115 billion more to government health care spending over the next 10 years, congressional budget referees said Tuesday. If Congress approves all the additional spending called for in the legislation, it would push the ten-year cost of the overhaul above $1 trillion -- an unofficial limit the Obama administration set early on." According to the CBO, "the added spending includes $10 billion to $20 billion in administrative costs to federal agencies carrying out the law, as well as $34 billion for community health centers and $39 billion for Indian health care."

-Papa Dean

Regs begin to flow

2010-05-10T08:15:00.000-07:00

Good Monday Morning-

Well, as expected, the "regs" are beginning to flow. Below are some of the info that came out last week.

"Federal agencies released several new pieces of guidance this week on the implementation of PPACA provisions. The new guidance includes updated information from the IRS on the new small-business tax credit regarding employer contribution amounts, information released by HHS on the employer reinsurance program for early retirees and state health information Web portals and preliminary guidance from CMS on the Medicare coverage gap discount program."

"The IRS guidance helps determine the amount of the new tax credit for eligible small employers that make “non-elective” contributions toward their employees' health care premiums by establishing wihat the average small-group premium amount for 2010 will be for each state. The new credit is based on a percentage of the lesser of:
the amount of “non-elective” contributions paid by the small employer or
the amount of “non-elective” contributions the employer would have paid if an employee were enrolled in a plan with a premium equal to the average premium for the small-group market in the state where the insurance is provided."

"HHS issued guidance in the form of an interim final rule on the Early Retiree Reinsurance Program, which becomes effective on June 1 and will reimburse qualified employers and other plan sponsors for up to 80% of claims costs between $15,000 and $90,000 incurred by employers in providing group health benefits to early retirees. The program also applies to claims filed by their spouses, surviving spouses and dependents. Reimbursements will be made on a first-come, first-served basis, and it is expected that the amount of eligible reimbursements will substantially exceed the program’s $5 billion in federal funding."

"Additionally, HHS released an interim final rule and request for comments adopting the categories of information that will be collected and displayed on its consumer Web portal as required under PPACA. The rule specifies that the portal, which must be available no later than July 1, will include information about tax credits for small businesses available under Tax Code Section 45R. In addition, a health insurance issuer's tax identification number will be used to support the structure of the database so that data can be easily retrieved to support uploading information the portal test site."

CMS also issued preliminary guidance for Medicare Part D plan sponsors regarding the Medicare Coverage Gap Discount Program. In closing the coverage gap, CMS has proposed making manufacturer discounts on coverage gap claims available to beneficiaries at the point of sale beginning in 2011. Part D sponsors are expected to prepare their 2011 bids by June 7, 2010."

Have a great week.........Spring may be here......finally!!

-Papa Dean

Dental Details

2010-05-05T08:02:00.000-07:00

Good Morning All-

Little, if anything has been written or discussed about the impact of the new health care reform law on dental care or dental insurance. Granted there is little in the law that addresses dental, particularly in comparison to medical, but there is a bit. Below we have quoted a summary of what is effected and what is not effected in the dental industry by this new law. Some of this may change as we get more of the "regs" from HHS. But now here's where it stands.

"Which provisions do not impact dental coverage?

Extension of Dependent Age Limit to 26 - medical only
Removal of Lifetime Dollar Limits - medical only
Removal of Annual Maximums - medical only
Tax on high-value benefits plans (aka “Cadillac Tax”) - medical only

Which provisions will impact dental coverage?

New annual fee being imposed on Health Insurance providers (beginning 2013) To help fund health care reform, health insurers will be subject to a new annual fee beginning in 2013. Each carrier's fee will be based on their specific 2013 market share – total insured premium for medical, dental and vision.
Potential impact:
Pricing for dental benefits could increase to reflect the new annual fee that health insurers will be required to pay
Pediatric dental coverage provision (beginning in 2014) Health Insurers will be required to package pediatric dental and vision benefits with a medical plan as part of the “Essential Health Benefits Package” (EHBP) in the individual and Small Group market (100 or fewer employees). At this point, standalone dental plans sold through the state-sponsored insurance Exchanges (to be established in 2014) can be used to satisfy the pediatric dental requirement.
Potential impact:
Details around this specific provision are still being clarified, but there is the potential that this provision will impact both the purchasing of standalone dental benefits, as well as administration of those plans. "

Have a great May..........Spring is coming, I think!!! :-)

-Papa Dean

Implementation Fights Heating Up

2010-04-27T10:49:00.000-07:00

Below are a few examples of what we see as many fights that will be waged to influence the "Reg" making process. We just want everyone to be aware of this process and it's effect on you. We'll do are best to keep you informed.

-PapaDean

CMS Actuary Says Healthcare Law Will Not Slow Growth Of Health Spending.
The New York Times (4/24, Pear) reported that an analysis by Centers for Medicare and Medicaid Services Chief Actuary Richard Foster concludes that the new healthcare law "will not slow the overall growth of health spending, because the expansion of insurance and services to 34 million people will offset cost reductions in Medicare and other programs." In his report, Foster said "some provisions of the law, including cutbacks in Medicare payments to health care providers and a tax on high-cost employer-sponsored coverage, would slow the growth of health costs. But he said the savings 'would be more than offset through 2019 by the higher health expenditures resulting from the coverage expansions.'" Republicans "said the report vindicated their concerns about the law," while the Obama Administration "pointed to bright spots in the report and insisted that the law would help bring down costs."
WSJournal: New Democratic Bill Shows Health Law Didn't Address Costs. Under the headline "ObamaCare Mulligan," the Wall Street Journal (4/26, subscription required) editorializes about current Democratic efforts to pass legislation that would give states the ability to reject health insurance premium hikes. The very existence of the new bill, the Journal contends, proves that the President's assurance that his reform bill would "lower costs for families and for businesses and for the federal government" was inaccurate. Moreover, the Journal describes the new Democratic proposals as price controls, as goes on to criticize other provisions in the bill intended to produce savings.

Stakeholders Seek To Influence HHS Implementation Of Healthcare Law. USA Today (4/27, Fritze) reports, "The debate in Congress over President Obama's health care law is done," but the "battle over how to carry out the law is just getting started." As a result, "dozens of special-interest groups that helped shape the 10-year, $938 billion health care measure over the past year...are gearing up for a second wave of lobbying as the Obama administration prepares to implement the law." The Chamber of Commerce, which opposed the measure, "is fighting to protect businesses that might be required to provide insurance," while AHIP "is providing data and suggestions" to HHS. Notably, HHS "declined to discuss industry attempts to influence implementation, but Secretary Kathleen Sebelius said in a statement that the department is 'working closely with states, insurers, providers, and other partners...we want to hear from everyone."
Chamber Of Commerce Advises Businesses About Healthcare Law While Criticizing It. CQ HealthBeat (4/27, Norman, subscription required) reports, "The US Chamber of Commerce is lambasting the new healthcare law, yet, at the same time offering advice to befuddled businesses large and small as portions of the law kick into effect as soon as later this year." This "puts the business group in an odd place, though one where it has many opportunities to publicly poke at the holes it sees in the overhaul's fabric. Bruce Josten, executive vice president for government affairs at the chamber, said Monday that his organization opposed the law (PL 111-148) out of the belief it will fail to lower rising health care costs and in the end will in fact increase them." Nevertheless, "'the fact of the matter is we have a new law,' he said, describing it as a 'stimulus bill for actuaries, benefit consultants and compliance attorneys.'"

2010-04-19T09:03:00.000-07:00

Interest Groups Seek To Influence Implementation Of Healthcare Law.
The AP (4/17, Fram) reported, "The fight over President Barack Obama's healthcare overhaul hasn't ended, it's simply shifted to a wider arena. All sorts of special interests -- business, labor, medical, consumer, and ideological -- are now focused on how the new law shaping the nation's healthcare system will be carried out." In addition, they are "turning lawmakers' votes into ammunition for this year's congressional campaigns and beyond." The AP said, "Supporters and opponents alike hope to influence the drafting of regulations to implement the 2,500-plus pages of healthcare legislation. Agencies such as the Department of Health and Human Services are in the early stages of writing those rules, a process that can take months or even years."

We will try to stay on top of the "regs" as they come out of each agency.

-PapaDean

Tax Credit

2010-04-16T09:29:00.000-07:00

Here's the first major provision that will affect most of you that are "small business".

04/14/2010 Small Business Health Care Tax Credit

Earlier this month, we told you about the passage of the Patient Protection and Affordable Care Act (PPACA). More information has been made available about a provision in that Act that gives a tax credit to certain small employers who provide health care coverage to their employees. Key Facts:
The tax credit, effective Jan. 1, 2010, can cover up to 35% of the premiums a small business pays to cover its workers.
In 2014, the rate will increase to 50%.
Both small for-profit and small not-for-profit organizations are eligible.
The FAQ from the IRS provides detailed information on the credit as it applies for 2010 - 2013, including information on transition relief for 2010.

We understand that you must pay at least 50% of your employee's premium to qualify for this credit.

PapaDean

Potential Potholes

2010-04-15T08:56:00.000-07:00

I ran across an article today that illustrates one of the potential problems we must avoid if the new Federal Health Care Reform is to be successful. As many of you know much of the Federal Reform was patterned after the Massachusetts plan. The article below points out where we need to be aware.

"Massachusetts State Senator's Bill Would Control Health-Insurance Costs For Small Businesses.
The AP (4/15) reported that on April 14 at a breakfast meeting of the Greater Boston Chamber of Commerce, Massachusetts "Senate President Therese Murray (D-Plymouth) said...that her plan to control healthcare insurance costs for small businesses is critical to jump-starting the" state's economy. The proposed legislation, which the senator plans to file within the next 30 days, "helps small businesses by ensuring that health insurance carriers offer affordable products, addresses rate volatility, and makes sure premium payments are spent on healthcare, and not administrative costs or salaries." She is asking "healthcare providers to contribute $100 million this year to insurers for reducing small business premiums," and also plans to propose a bill to replace the fee-for-service system of provider reimbursement.
"Massachusetts hospital executives are reviewing Senate President Therese Murray's call for providers to contribute $100 million to help reduce soaring healthcare costs paid by small businesses, but they made no commitment to follow the lead of Partners HealthCare, which has pledged $40 million this year," the Boston Globe (4/15, Kowalczyk, Weisman) reported. The Globe captures reactions from Tufts Medical Center, Beth Israel Deaconess Medical Center, and Children's Hospital Boston, all of which remain "cautious about following Partners." Meanwhile, the Massachusetts Hospital Association remains "noncommittal."
State Health, Hospital Executives Blame Consumer Habits For Escalating Healthcare Costs. The Boston Herald (4/15, McConville) reports that at the same Chamber of Commerce breakfast at which Murray discussed her proposed bill, Massachusetts "hospital and insurance heavies blamed fat-slob consumers rather than their own practices for escalating health-care costs, sparking a blaming-the-victim outcry from public health experts." In response to remarks on individual responsibility to healthcare made by Jack Connors of Partners HealthCare and Paul Guzzi of Blue Cross Blue Shield, Boston University public health professor Alan Sager stated, "Sure, individual responsibility matters, but the responsibility for efficient, affordable, high-quality health care for all Americans falls on everybody who works in health care."
BGlobe Says Small Businesses Need More Help From Insurers And Hospitals To Keep Health Costs Down. The Boston Globe (4/15) editorializes that proposals in the bill Murray plans to introduce "are all sensible lifelines to small businesses. Missing from Murray's plan, though, is the governor's proposal for legislative authority to hold down the rates that hospitals and doctors are getting." The Globe asserts that "business owners will get minimal relief on their premiums if their insurers succeed in curbing their administrative costs, only to confront ballooning levels of reimbursements for providers." Calling the $40 million contribution by Partners Healthcare "a positive gesture," the Globe nevertheless concludes that "struggling small businesses need a lot more help -- from insurers and hospitals."

-Papa Dean

The "Regulation" (Regs) Process

2010-04-14T08:55:00.000-07:00

Now that health care reform has been made law, we must go through the process of creating the "regs". These are the published means that each agency will use to administer the law as they interpret it.

Since there are at least five federal agencies that will be involved in this regulation process, we can expect a number of positions to be taken as the laws components take effect (see link to time line posted below). Some of these "reg" decisions could be significant in how you conduct your health care affairs in the future. Some also could fire up some controversy. For these reasons we will be watching this process closely. As these "regs" are defined we will let you know what they are and how we see adjustments to be made. Keep in mind that this is now an almost ten year process.

Here is the link to the timeline of effective dates of the various components:

http://www.nahu.org/How%20the%20Health%20Care%20Reform%20Legislation%20Will%20Impact%20Your%20Employer%20Clients%20329%20revised.pdf

PapaDean

What's Next?

2010-03-29T09:31:00.000-07:00

OK.........Health Care Reform is now the law of the land. The bill (H.R. 3590) passed and the Reconciliation bill passed right behind it with no meaningful changes to the original.

There are, however, still some questions about what kind and how many "back room" deals it took to finalize it. After all this is the way DC works no matter who is in office, so we know they are there. We just don't know the details. So......what's next?

Well, first there are some good provisions in this bill, and some bad ones. We will only know which will be more in play as time go along. And time is a key here. After all, by the time most of the provisions of this bill take effect, Mr Obama will either be out of office or a "lame duck" President. So will Health Care be high on his political agenda..........I doubt it unless there is a concerted effort soon to repeal it.

Now, repeal? There seems to be discussion about this from the bill's opposition, but the reality (if history serves) is that repeal in the foreseeable future is unlikely. However, some states have taken up the banner of going after some provisions on legal grounds. The one that is fore front in the news is the mandate for all people to carry insurance. Repeal of this could be a slippery slope. Let's take a look at what would likely happen if the "all must be insured" mandate were removed.

Because of the bill being passed with all provisions somewhat dependent on all the others, if this "all insured" one is removed, here is what is likely to happen. 1. The young and healthy will opt out (after all they can wait until they get sick to buy insurance.....remember, no pre-existing limits, guaranteed issue of coverage, etc). 2. That leaves the burden of costs to a group of people already or about to be on claim. 3. The adverse selection here is likely to run most commercial carriers out of the market because only the exchanges with the government subsidies available will be able to survive. 4. What's left is Nationalized Health Insurance with a cost structure that borders on bankrupting the country.

Now, the above is most likely not to happen. But you can see how serious repealing just a portion can get. Example: the state of Washington lost their entire individual health insurance market for six years in the 90's due to a process of partial repeals of law just like the one described above.

And finally today, we will start to channel our energy toward those adjustments that need to be made by our clients, businesses in general, and individuals. Fortunately time is on all of our sides as this new law phases in over the next eight years.

So, stay tuned.........More to come....

-Papa Dean

Health Care Reform or Politics?

2010-03-17T15:08:00.000-07:00

Robert Samuelson's article from Monday's "Newsweek Web" posting says it all (see below). We need health care reform, not more politics!

-Papa Dean

"A Cost-Control Mirage
Obama is telling people what they want to hear about health care, not what they need to know.
By Robert J. Samuelson Newsweek Web Exclusive
Mar 15, 2010 Updated: 1:18 p.m. ET Mar 15, 2010

"What we need from the next president is somebody who will not just tell you what they think you want to hear but will tell you what you need to hear." —Barack Obama, Feb. 27, 2008

One job of presidents is to educate Americans about crucial national problems. On health care, Barack Obama has failed. Almost everything you think you know about health care is probably wrong or, at least, half wrong. Great simplicities and distortions have been peddled in the name of achieving "universal health coverage." The miseducation has worsened as the debate approaches its climax.

How some people try to mitigate the cost of staying healthy.

There's a parallel here: housing. Most Americans favor homeownership, but uncritical pro-homeownership policies (lax lending standards, puny down payments, hefty housing subsidies) helped cause the financial crisis. The same thing is happening with health care. The appeal of universal insurance—who, by the way, wants to be uninsured?—justifies half-truths and dubious policies. That the process is repeating itself suggests that our political leaders don't learn even from proximate calamities.
How often, for example, have you heard the emergency-room argument? The uninsured, it's said, use emergency rooms for primary care. That's expensive and ineffective. Once they're insured, they'll have regular doctors. Care will improve; costs will decline. Everyone wins. Great argument. Unfortunately, it's untrue.
A study by the Robert Wood Johnson Foundation found that the insured accounted for 83 percent of emergency-room visits, reflecting their share of the population. After Massachusetts adopted universal insurance, emergency-room use remained higher than the national average, an Urban Institute study found. More than two-fifths of visits represented non-emergencies. Of those, a majority of adult respondents to a survey said it was "more convenient" to go to the emergency room or they couldn't "get [a doctor's] appointment as soon as needed." If universal coverage makes appointments harder to get, emergency-room use may increase.
You probably think that insuring the uninsured will dramatically improve the nation's health. The uninsured don't get care or don't get it soon enough. With insurance, they won't be shortchanged; they'll be healthier. Simple.
Think again. I've written before that expanding health insurance would result, at best, in modest health gains. Studies of insurance's effects on health are hard to perform. Some find benefits; others don't. Medicare's introduction in 1966 produced no reduction in mortality; some studies of extensions of Medicaid for children didn't find gains. In the Atlantic recently, economics writer Megan McArdle examined the literature and emerged skeptical. Claims that the uninsured suffer tens of thousands of premature deaths are "open to question." Conceivably, the "lack of health insurance has no more impact on your health than lack of flood insurance," she writes.
How could this be? No one knows, but possible explanations include: (a) many uninsured are fairly healthy—about two-fifths are age 18 to 34; (b) some are too sick to be helped or have problems rooted in personal behaviors—smoking, diet, drinking or drug abuse; and (c) the uninsured already receive 50 to 70 percent of the care of the insured from hospitals, clinics and doctors, estimates the Congressional Budget Office.
Though it seems compelling, covering the uninsured is not the health-care system's major problem. The big problem is uncontrolled spending, which prices people out of the market and burdens government budgets. Obama claims his proposal checks spending. Just the opposite. When people get insurance, they use more health services. Spending rises. By the government's latest forecast, health spending goes from 17 percent of the economy in 2009 to 19 percent in 2019. Health "reform" would probably increase that.
Unless we change the fee-for-service system, costs will remain hard to control because providers are paid more for doing more. Obama might have attempted that by proposing health-care vouchers (limited amounts to be spent on insurance), which would force a restructuring of delivery systems to compete on quality and cost. Doctors, hospitals and drug companies would have to reorganize care. Obama refrained from that fight and instead cast insurance companies as the villains.
He's telling people what they want to hear, not what they need to know. Whatever their sins, insurers are mainly intermediaries; they pass along the costs of the delivery system. In 2009, the largest 14 insurers had profits of roughly $9 billion; that approached 0.4 percent of total health spending of $2.472 trillion. This hardly explains high health costs. What people need to know is that Obama's plan evades health care's major problems and would worsen the budget outlook. It's a big new spending program when government hasn't paid for the spending programs it already has.
"If not now, when? If not us, who?" Obama asks. The answer is: It's not now, and it's not "us." Pass or not, Obama's proposal is the illusion of "reform," not the real thing. "

"Robert Samuelson is also the author of The Great Inflation and Its Aftermath: The Past and Future of American Affluence and Untruth: Why the Conventional Wisdom Is (Almost Always) Wrong."

The Gloves Are Off

2010-03-09T09:48:00.000-08:00

Mr. Obama seems to have taken the gloves off to promote his health care program.

No question that the health insurance companies are more a part of the problem than a part of the solution. And I have regularly pointed out that any meaningful reform must include reform of our health insurance system. But to say that the insurance companies represent the only place reform is to be fostered, is terribly short sighted.

This is a master political approach however. Everybody knows that the "big bad" insurance companies are easy to hate. But for the government to take over this industry is insane. What do we do about the huge legal costs of malpractice control? What happens to the highly controllable excess cost in drugs? When do we recognize the terrible mismanagement of our biggest insurance company, medicare. How do we justify the repressive mandates under which the insurance industry must operate? I could go on and on.

Remember the government closed down the "Mustang Ranch" in NV in 1990 for income tax evasion. And because of the law they were forced to continue running it. It failed. Now, if the government can't succeed in running a Whore House and selling Whiskey, then how can we expect them to run our insurance industry?

Whoa is Me!!

Papa Dean

Does Citizen Input Make Any Difference?

2010-03-02T08:04:00.000-08:00

Good Morning!

Again we make clear.........health care and health insurance need major reform! But they need a lot more and a lot less than is currently on the table from the House bill, the Senate bill, or the White House proposal. Let's look at the cost drivers instead of the pork barrel opportunities (see previous postings).

Below we see the attitude in DC. "Pass this legislation at any costs even if it is flawed"!

"In Push For Health Reform, Obama To Green-Light Reconciliation Strategy."

"In a speech Wednesday, President Obama is expected to rally Congress to pass healthcare reform bill through the Senate's reconciliation process. AFP (3/2) notes that "this...would require the House to pass the Senate bill," and "the Senate to vote on a revised version of the legislation after the House has a chance to make changes to it." The New York Times (3/2, A14, Calmes, Herszenhorn) reports that the President "will begin" his "climactic push to rally restive Congressional Democrats to pass major healthcare legislation by hammering the argument that the costs of failure will be higher insurance premiums and lost coverage for individuals and businesses." White House Chief of Staff Rahm Emanuel tells the Times "Obama on Wednesday 'will talk about the merits of the legislation, mainly about the costs of doing nothing versus the cost of doing something and what this will accomplish.'"
The Wall Street Journal (3/2, Meckler, subscription required) reports that a White House official indicated that Obama will not specifically refer to "reconciliation" in his remarks, even as he endorses the strategy that will include that procedure. The Journal includes a quote from House Minority Leader John Boehner (R-OH), who says, "Trying to jam their latest job-killing back-room deal through Congress using this procedural trick would be a serious mistake." However, the Journal adds that reconciliation has been utilized in the past to approve healthcare bills -- such as SCHIP and the COBRA law.
Republicans are reportedly readying their own strategy to block reconciliation. Roll Call (3/2, Drucker, subscription required) reports that "Senate Republicans are preparing to wage a unified floor and message war to block" the procedure "and lay the groundwork for what they hope will be big electoral gains in November. ... Still under development is the legislative strategy, which Republicans hope will tie the majority party in knots and force vulnerable Democrats to take politically damaging votes -- if it doesn't derail reconciliation altogether." Roll Call adds that "any reconciliation vehicle might have to go through either the Finance Committee, the Health, Education, Labor and Pensions Committee or the Budget Committee -- or two out of the three. ... Republican operatives say GOP Senators on any of those committees would replicate the minority's floor strategy during deliberations required to report out a reconciliation bill."
Sen. Orrin Hatch (R-UT), in the Washington Post (3/2), writes that "America's Founders gave us a system of governance designed to limit government power and maximize liberty. ... That can be frustrating for those with ambitious agendas, but everyone benefits by respecting those checks and balances even as we fight over policies." Hatch urges Obama to take "the reconciliation procedure off the table. Let's move forward instead with bipartisan legislation that doesn't abuse the Senate's rules but that does address the challenges our country faces."
Business Roundtable Says Reform Should Be "National Priority." The New York Times (3/2, A14, Calmes, Herszenhorn) reports that "Obama's emerging message against higher insurance costs was seconded on Monday by the Business Roundtable, a Washington group representing major corporations. ... In a statement, the group's president, John J. Castellani, repeated its position that overhauling the health insurance system should be 'a national priority' given the burden of rising expenses on individuals, the government and especially employers."

And these Congress People gave themselves a pay raise in 2010 and 2011 plus a raise in benefits while most of us are taking a cut in income and/or loss in jobs.

Something wrong in DC, folks...........both sides of the aisle!

As Pop, (my Grandad), use to say; "It may be time to throw the bums that are in, out; and time to vote the bums that are out, in!" (Only he used a less endearing term than "bum".... :-)....)

-Papa Dean

Will they use Reconciliation or not?

2010-03-01T08:47:00.000-08:00

It seems now that the President is pushing Congress to go to a simple 51% vote in the Senate.
Also Ms. Pelosi says she has the votes to pass health care in the House.

But, which bill will prevail? The House bill, the Senate bill, or the Presidents suggested provisions? And does the House have the votes to pass the Senate bill? Or does the Senate have the votes to pass the House bill? Or do either have the votes to pass a bill developed from the suggested provisions of the White House?

Meanwhile, many of us in this industry wonder if we will still be in business at this time next year. Or if instead we all will be living with the same flawed health care system that has developed over the last many years.

Maybe it's time for DC to come together, forget the political posturing, reform health care, and do it in a fashion that is best for our country.

Ahhhhh, to dream on a Monday morn!

-Papa Dean

The Health Care Summit

2010-02-26T15:06:00.001-08:00

OK! Here's the best summary on yesterdays "Health Care Summit" hosted by President Obama.

Summit Standoff
By Grace-Marie Turner
The consensus among most pundits and reporters was summed up by The Wall Street Journal's Peggy Noonan in her column today: "Boy, that didn't work."
The White House expected a slam dunk, building on what it considered a triumph at the House Republican retreat in Baltimore a month ago, so it could convince rank-and-file Democrats that the time has come to get health reform done.
I was at the retreat in Baltimore, invited to do a session on health reform for members, and was in the room during that remarkable 70-minute exchange.
In the world of cable news, optics are everything. In Baltimore, the president was on stage, flanked by flags and behind a microphone and podium looking down on Republicans who were sitting around tables at lunch. The considerable substance of the dialogue was subordinate to the staging.
Yesterday, with everybody seated around a table at Blair House talking with each other as equals, it was clear that Republicans held their own on health care -- an issue that they clearly are taking ownership of. Even though they received less than half the airtime, they used it to make coordinated arguments on behalf of a step-by-step approach to reform.
The summit was not the game-changer the White House hoped it would be.
The question now will be whether there is the political will to go forward with a smaller bill that very likely could pass this Congress, or whether the White House is going to continue to insist on passing a wildly unpopular, comprehensive overhaul of one-sixth of our economy that three out of four Americans reject.
President Obama opened the summit by saying that Republicans and Democrats are not far apart on health reform because they share concerns about growing deficits and rising health costs.
But the debate showed the two sides have very different approaches to solving those problems. The president's plan and the House and Senate bills rely on more regulation and scores of new government programs to control our wayward health sector; Republicans believe in providing incentives for more competition, consumer choice, and price transparency to force changes in the marketplace.
Politico summed it up well: "So the parties walked out of Blair House almost exactly the way they walked in -- completely at odds over the best way to fix the health insurance system. There were modest efforts around the edges to find common ground -- on reining in waste and fraud and keeping the deficit in check -- but no broad agreements on the shape of reform."
I was actually in Little Rock, Arkansas, yesterday giving a speech so I watched the summit in pieces -- for a while in the Little Rock airport. Late in the afternoon, I saw six or eight traveling businessmen sitting around a bar watching CNN's broadcast of the summit, clearly interested in the debate. The country still is paying attention. The details matter.
So what's next? While the focus is on Majority Leader Harry Reid's determination to use the budget reconciliation process to jam a health reform bill through the Senate, the real drama is in the House.
Speaker Pelosi needs to convince rank-and-file members that they will have to swallow hard and pass the Senate bill so it can then be "fixed" through reconciliation. If she had the votes, the bill would be on the floor in a day. She doesn't.
The summit didn't move the needle. That said, the White House still is absolutely, positively determined to pass this legislation, so we await the next act.
Single-payer setback: It didn't help the cause of single-payers who are in love with the Canadian health care system when the premier of Newfoundland secretly traveled to the United States for heart surgery.
Danny Williams, 60, made the situation worse in an interview after the surgery at Mount Sinai Medical Center in Miami, Florida. "This was my heart, my choice, and my health," he said from his condominium in Sarasota. "I did not sign away my right to get the best possible health care for myself when I entered politics."
Yikes! Tell that to the hundreds of thousands of Canadian citizens who can't afford to buy their way out of the Canadian health care system and must wait months and months for care -- care that Premier Williams clearly didn't think made the grade as "the best possible care."

Whats Next? Who Knows!

-Dean

Happening?

2010-02-25T09:55:00.000-08:00

Good Morning All-

Since I have been out of town for the last couple of weeks, nothing has been posted. "Sorry 'bout that".

Actually a few things have taken place.

One, the President acts as if the current health care issue is still going to be passed. I wonder!

Two, the President has come out with his "health care bill" just before he has invited leaders from both parties to meet and discuss ideas for reform. Sounds like, "here it is boys and girls, so whatever you all come up with, this is what it will be."

Three, the Congress is actually passing some legislation on a bi-partisan basis.
Example:
The Washington Post (2/25, Pershing, Bacon) reports that in "one of two legislative victories that showcased a new Democratic strategy of winning Republican support by advancing popular measures" on Wednesday, the House passed a measure 406-19 "aimed at repealing the health-insurance industry's decades-old antitrust exemption." The second victory the Post notes is the approval of a $15 billion jobs bill in the Senate.
Focusing on the "overwhelming" approval of the antitrust bill, CNN (2/25) reports that "liberal Democrats have said a repeal would help inject competition into the healthcare industry while reducing consumer costs." The 19 votes against were Republican. The Hill's (2/24, Fabian, subscription required) Blog Briefing Room also reported that the bill passed "overwhelmingly."
CQ Today (2/24, Ethridge, subscription required) noted that "Democratic aides said the bill faces a possible filibuster threat in the Senate, although Majority Leader Harry Reid of Nevada supported similar legislation last year."
The Politico (2/24) "Live Pulse" blog called the vote "a rare bipartisan achievement," reporting that "the measure was the first installment of Speaker Nancy Pelosi's dual-track strategy for passing smaller healthcare measures ahead of the Democrats' more sweeping bill. If party leaders fail to approve their bigger bill, Pelosi could revive this small-ball approach to make many of the changes they're seeking in the historic healthcare package." Reuters (2/25, Bartz) and CongressDaily (2/25, subscription required) also cover the story.

So, things are looking up now that we can see some movement toward going after specific areas that need to be reformed. Though I expect nothing of this nature will come out of the President's meeting today, we'll see!

-Dean

2010-02-08T09:07:00.000-08:00

2-8-2010

Nuff Said!

Obama invites Republican leaders to televised health reform meeting.
Media reports are generally casting President Obama's invitation to GOP leaders to participate in a televised healthcare reform meeting as a political maneuver – one that could potentially boost the Democratic case in upcoming election campaigns. Most reports, however, give the planned February 25 gathering little chance of breaking the healthcare reform logjam. The President's invitation, made on CBS during the Super Bowl pre-game show, is receiving coverage in major print media outlets this morning. AFP (2/8, Collinson) refers to a "new political gambit" by the President "to salvage his top domestic priority, which is on life support." Failing "to pass the historic healthcare bill would cast deep doubt on prospects for Obama's already pared-down reform agenda, and inflict a damaging blow on his political authority."

Health Care on GroundHog day

2010-02-02T10:22:00.000-08:00

I have avoided posting anything on the healthcare front for several days. The Mass. election has thrown everything into caos.

That having been said, there does seen to be trends surfacing currently.
1. The Speaker, Mrs Pelosi, has taken a position that health care will pass no matter what (one must keep in mind that, unlike some of her partys members, she is very unlikely to loose here seat in the up coming election and therefore can afford this position).
2. Several states (11 at last count) have begun legislative action to prohibit federal mandates to take effect in their state. My understanding is that federal law takes president here. But the action by these states seems to be sending a message to DC.
3. The "Administration" is signaling that they may be re-thinking their approach to health care reform. Hummmmmm!

Where does that leave us?

Well, in this authors view, the three things above are good. If Mrs. Pelosi continues her push she very well could keep reform alive. Many of us strongly agree that we desperately need to reform the system. If numbers two and three above continue, then it is likely we will get more and broader numbers of our national law makers heard on the subject. I believe this could get some of the components that need to be in the reform put into the reform (Example: Tort, Competion of across state line purchasing, Changes in drug company pricing their R&D, etc).

Remember, the original objective of reform was to (1.)lower cost and (2.)increase access. Neither of the bills currently on the table do either adequately. Maybe a re-thought out reform package will!

We'll see........Hope so!

Papa Dean

1-20-2010 Who Would Have Thunk It!

2010-01-20T08:21:00.000-08:00

The surprise upset in the Massachusetts special election yesterday will certainly have a huge effect on the pending health care legislation. What exactly this effect will be is open to speculation. However, here is what some of the pundits of the press think:

The healthcare push, the AP (1/20, Alonso-Zaldivar) reports, is "not dead," but was sent "to the emergency room in fragile condition." While Democratic leaders are exploring avenues to push a bill through, media reports cast those efforts very much as an uphill battle.

So much so that the New York Times (1/20, A13, Hulse) reports that "House Democrats appeared to rule out the idea of quickly approving a Senate-passed healthcare measure and sending it to President Obama." In fact, DCCC chairman Chris Van Hollen (D-MD) took a clear shot at the Senate measure last night, saying, "Healthcare was also part of the debate, and the people of Massachusetts were right to be upset about provisions in the Senate bill like the Nebraska purchase and other special deals."

The Washington Post (1/20, Murray, Montgomery) likewise, reports that "the White House and Democratic leaders in Congress spent Tuesday searching for ways to keep their hard-fought healthcare overhaul alive," but "no workable Plan B emerged."

The Democratic stance moving forward may have been affected by statements from a number of Democrats who are expressing misgivings about the options put forth so far. USA Today (1/20, Kiely, Fritze) notes that "Massachusetts Rep. Barney Frank (D), a strong supporter of the healthcare legislation, said Brown's victory means Congress will have to 'start over on healthcare.' He said he will vote against any bill rushed to the floor before Brown can be sworn in."

I tend to agree with all of the above, though I certainly don't intend to indicate that I am a profit of upcoming political action. That having been said, it seems that any action that get congress back to a review of the health care reform process is a plus for small business people like us. After all, we need to remember that the two main objectives originally were to cut the "out of control" inflation of health care costs, and to give access to those Americans who can't get insurance. Neither of these were adequately addressed by either the House or Senate bills, in my opinion.

So, without even going into the distasteful "back room" deals that seem to be flowing from this Congress (particularly the Senate), this election would bode well for all of we small business owners and employees who are so critical to the stability and growth of our economy.

We'll watch it closely!

-Papa Dean

1-16-2010 We all need to take action

2010-01-15T15:37:00.000-08:00

Clients: We have concerns over key issues that are being considered behind closed doors.

At this critical stage of health care reform negotiations, we highly recommend that you weigh in with your elected officials including the White House about key issues that will affect you and your employees and the ability to continue to have a quality, affordable health benefits plan.

Of particular concern to us are the special interest deals that are being made behind closed doors that will create perverse incentives in our health care system and shift costs onto all Americans. This, at a time when our shared goals should be to make our health system more balanced and equitable. You can review some of the special interest deals in past postings to this blog, as well as most all of the news organization's web sites and the weeks re-cap below.

Please take a few moments to share your thoughts with Congress and the White House. We encourage you all to weigh in with your own voices on these issues.

Here's the re-cap of what we know happened this week. More happened, I'm sure, behind those closed doors, but we won't know the details of those things for awhile.

-Papa Dean

From: The National Association of Health Underwriters
January 15, 2010.

"Hidden from C-SPAN cameras or any other kind of public scrutiny, Democratic congressional leaders and the Obama administration were hard at work this week seeking to reach a deal on the broad outlines of a final health care bill by Friday or Saturday, and President Obama is promising to sell it to the public.
The President went to Capitol Hill late Thursday to reassure House Democrats who had assembled for their annual issues conference and to promise that once a bill is passed and signed into law, he will launch an all-out campaign to sell its provisions to the American people.
Democratic leaders and Democratic committee chairmen held a marathon negotiation session Thursday at the White House on sticking points between the House and Senate bills (H.R. 3962, H.R. 3590). They hoped to build on a breakthrough reached earlier on financing of the huge package, so that the proposal can be sent to the Congressional Budget Office (CBO) for analysis of its costs and benefits. It will likely take CBO several days, possibly a week or longer, to produce a cost estimate necessary before a vote.
Labor leaders who spent much of Wednesday at the White House battling to ease the burden of the Senate’s proposed excise tax on high cost employer-provided health insurance plans, announced a supposed deal that they discussed Thursday with House Democrats. The deal, however, appears unlikely to soothe the concerns of House opponents of the excise tax.
Under the Senate-passed legislation, the 40% excise tax would be assessed on health plans that cost more than $8,500 for individuals or $23,000 for families. A higher limit of $9,850 for individuals and $26,000 for families would be allowed for retirees over 55 but not yet eligible for Medicare, and for workers in high-risk professions, such as law enforcement, firefighting, and construction.
Union leaders and President Obama agreed on a plan that would bump up the threshold before the 40% tax is imposed to $24,000 for a family—a $1,000 increase from the Senate-passed bill (H.R. 3590)—while excluding vision and dental insurance from being counted toward the threshold beginning in 2015. Individuals would see their thresholds rise $400 (to $8,900) under the compromise.
The threshold levels would also be adjusted to account for age, gender, and geographic areas to keep people in high-cost groups from being disproportionately impacted by the tax.
Most controversially, the pact with labor unions would gradually phase in the excise tax for workers subject to collective bargaining agreements. The excise tax would be subject to a transition period for collectively bargained health care plans, as well as health care plans for all state and local government workers.
While the excise tax would go into effect in 2013 for most plans, collectively bargained and state and local plans would not be taxed until 2018. These same plans would be allowed to enter into the proposed health care exchanges in 2017, AFL-CIO President Richard Trumka told reporters.
White House aides and Trumka defended the phase-in period for workers under collective bargaining agreements, saying that transition periods are common in legislation and are already used throughout other parts of the health care reform bill. Trumka said the change is akin to the five-year transition period the insurance companies have to phase in all the costs. As the costs are being phased in, he said, the plans need a couple of years to be able to make the adjustments.
The announced compromise would of course lower the revenues generated by the high-cost excise tax provision: the Senate bill would generate about $150 billion over 10 years and the compromise would reduce that figure to around $60 billion. Because of this, negotiators are looking for ways to fill the hole with further savings from various health care sectors. Industry lobbyists said pharmaceutical companies could be asked to contribute further savings between $10 billion and $20 billion over 10 years, in addition to the $80 billion they have already committed to providing.
The Senate bill would index the threshold to the rate of growth using the consumer price index for all urban consumers plus one percentage point, but opponents have argued that the index would still result in a growing number of middle class households with health insurance that falls into the category of so-called “Cadillac” plans over the next decade. The White House did agree to allow the thresholds to be adjusted upward, however, if health care inflation is above the assumptions for inflation between 2010 and 2013. That change would keep more households from being affected by the excise tax immediately after the new provisions go into effect.
White House aides speaking on condition of anonymity said President Obama made the deal because he strongly believes the excise tax is needed to help drive down long-term health care costs, but he does not want the legislation to be paid for “on the backs of the middle class.” This is despite the fact that President Obama during the 2008 campaign strongly opposed and attacked Sen. John McCain’s proposals to convert the employer tax exclusion and for the first time begin to tax health benefits.
Meanwhile, five Democratic senators this week urged the Senate Majority Leader Harry Reid of Nevada to include a “fail-safe mechanism” in the final version of major health care legislation in order to guarantee the hundreds of billions of dollars in projected government savings that are intended to help pay for the bill.
In a letter to Mr. Reid, the five senators urge that the legislation include some sort of fast-track and fail-safe mechanism that they said would give Congress “the tools to keep cost under control should the current savings estimates fail to materialize.”
The letter was signed by Senators Evan Bayh (IN), Michael Bennet (CO), Kay Hagan (NC), Claire McCaskill (MO) and Mark Warner (VA)."

1-15-2010 A Hurtful Compromise?

2010-01-15T09:44:00.000-08:00

"White House brokers deal with unions on taxing high-cost health plans."

"In a front-page story, the Washington Post (1/15, Montgomery, Shear) reports that the agreement" "broke the last major logjam blocking enactment of far-reaching health care legislation." The "breakthrough" agreement "would exempt union members from a proposed surtax on expensive insurance plans until 2018, five years after the legislation would take effect."
"The changes would lessen and delay the impact of the tax on workers and would reduce the amount of revenue collected," the New York Times (1/15, A1, Pear, Greenhouse) reports in a front-page story. "Labor leaders hailed the deal and said they were prepared to fight for passage of the legislation."

This deal apparently also includes state employees. Is it fair or right to penalize and place the burden of paying for health care reform only on the millions of employees of small business that are non-union (and state GOVERNMENT workers)? This is a real slap in the face to those of you, (most who are invited to read this blog), who run businesses that in fact create most of the employment (at least new employment) in this country. Yes, almost all of you have plans that are considered "Cadillac"!

I'm having a hard time with this being a good thing. But I have tried to avoid the political commentary (i.e. buying votes) that COULD go with it. OH Well! Our Congress, same ol', same ol" same ol'!! :-(

-Papa Dean

1-14-2010 A Bill Yet?

2010-01-14T10:09:00.000-08:00

It is difficult to think about health care except for the folks in Haiti. Our hearts and prayers go out to all of them. (Hopefully some donations to the Red Cross or some organization like it, also).

It's good we don't feel like saying much about the health care movement, because there isn't much movement to discuss.

Mr. Obama held an unusually long meeting at the White House yesterday. In attendance were the two principal players Mr. Reid and Mrs. Pelosi. A few other Executive branch leaders also sat in.

While it is reported that Mr. Obama made clear his desires, nothing was conclusively decided. Suggestions are that the government run plan is almost dead. And the House feels like they are "negotiating with a gun at their head" and are somewhat resentful to being forced to accept more of the Senate version.

While I believe the Senate version and the House version both need major changes to get the job done properly, the Senate version seems to be better. So, if the Senate version prevails with more provisions, I believe it will be better for the individual and small business.......we'll see.

-Papa Dean

1-12-10 Tuesday

2010-01-12T09:46:00.000-08:00

OK, today's big movement seems to be around the "Cadillac" plan and it's tax ramifications. (See yesterday's post below, to refresh how many of us are covered under "Cadillac" plans.) This charge is being lead by the unions of course. Here is some "leak" news as reported by a couple of newspapers.

The AP (1/12, Werner) describes the labor leaders as "irate," and reports that AFL-CIO president Richard Trumka "said there was a frank discussion at the nearly two-hour White House meeting with about a dozen heads of the country's biggest labor unions."

Only the New York Times (1/12, A13, Stolberg, Greenhouse) has quotes from an anonymous administration official hinting that the President intends to offer a comprise to his union supporters........
" The anonymous union official "said it was clear that there would be some sort of excise tax in the final bill, but that the president 'threw out some new concepts' in how it might be designed." Rep. Joe Courtney (D-CT), "who has been leading opposition to the tax on high-cost health plans, said he did not see any path to imminent compromise."

The articles go on to say that the union leaders threaten to cause an election melt down like 1994. My experience tells me that is a big hammer. Politicians of both parties, when one visits them in DC, focus first and foremost on how an issue will affect re-election.

Fun ain't it :-)

1-11-2010 Monday Movement on Health Care

2010-01-11T10:51:00.000-08:00

We have both good and bad news. One must, however, remember all the discussions about the final bill are going on behind closed doors by a select few. Therefore, all the news (including that listed below) is coming from what can be gleened from a few conversation and some nosiness. Let's start with some good news.

The good news is that the congressional budget office (CBO) now projects the the Senate version of this legislation will insure an additional 34 million legal residents instead of the original estimate of 31 million. However, another report indicates that this same Senate version will only insure 94% of the legal citizens in the USA as opposed to the House version at 96%. This second report also says that the American Hospital Association sent a letter to Mr. Reid and Mrs. Pelosi to adopt the House version of this provision OR reduce the cuts in Medicare hospital payments being proposed to pay for this expanded coverage.

What, Reduced Medicare payments? Yep, this is one of the ways Congress is proposing to pay for the new health care program. A couple of other ways being proposed to cover costs are:

$750 annual penalty for employers who do not provide insurance benefits for their employees. Currently this is for any employer who has any employee who qualifies for government subsidy and for employers over 50 employees. However, verbal reports indicate that discussions are going on to reduce the 50 to a lower number........we'll watch this one.

Also there is proposed an annual fee of $600 per employee for any employer who has a waiting period for coverage of over 60 days. No more 90, 180, 365 day waiting periods no matter the type of business and the circumstances of your over-all benefit program. If this holds, this will cause major change for some of you.

But what might be the biggie is this "Cadillac Plan" provision that the unions are so up in arms against. There are a couple of concerns here. One is that a tax is proposed on insurers who issue these plans. Obviously, that tax will be passed through to the consumer in the form of premium increase. The other is that employer premium paid for a "Cadillac " plan would be considered income to the recipient. This means higher income taxes paid by the person on the plan.

So you say, well the persons getting "Cadillac" coverage should pay more for it. Let's look at who that would be. One, almost all union plans come under the definition of "Cadillac". Two, approximately 90% of the folks on "Cadillac" plans earn under $250,000 per year, and approximately 50% of the folks on "Cadillac" plans earn under $100,000 per year. What happened to the pledge that no costs or taxes would be placed on the middle class? And by the way, all HSA and HRA plans are currently include in the definition of................you got it......."Cadillac"!

If this holds, me thinks there is some "forked tongue" speaking going on in DC!! Has that ever happened before. :-) :-(

That's all I have for today. More as things develop.

1-8-2010 Health Care Standing

2010-01-08T12:02:00.000-08:00

As of this Friday morning here's what it looks like.

The House & Senate have decided to develop the compromise bill behind closed doors and with only a few participants. This means that the opposition from both parties will be eliminated from input into the final bill.

The House (Mrs Pelosi) seems agreeable to accepting much of the Senate (Mr Reid) bill with not much argument. The Senate still needs 60 votes to get through some of the procedural voting to bring the bill to the floor for a final vote which needs only 51 votes to pass it.

Some areas of concern:

Minimum loss ratios (the amount the insurance companies must spend on claims and expenses) must be 85%. To our knowledge the highest level of any company in the country is around 75% and some of these companies are loosing money at that level. We suspect that this requirement will cause a reduction in benefits or an increase in premiums or both.

Some new taxes are set to start upon enactment of the bill and all to become effective in the next year, while most of the benefits don't kick in until 2014. Pay now...be insured 4 years from now??!!

It may be that the regulation of the insurance plans will shift to a federal entity. State regulation as is now seems to be more in line with the differences for peoples of different regions of the country.

The mandates of required insurance coverage on small business (pay or play) plus the individual required to carry insurance at a minimum level may have some constitutional questions and most certainly will have a cost increase effect.

These seem to be the biggest reasons that consumers will find these bill problematic. The biggest thing that we find problematic is still the fact that the original objective was to halt inflating cost of health care and give access to the folks who don't have health insurance. Neither bill (nor do we suspect that the final bill) accomplishes either of these objectives. Have these objectives become less important than maybe some other desires of our Congressional and Executive leaders?

2010-01-05T16:29:00.000-08:00

We have created this "blog" in order to stay ahead of the confusing world of health care reform. No questions in any body's mind that reform of our industry is long over due. However, so far the federal congress has failed to reform in such a manner as to meet the basic objectives.

These objectives were to start with lowering the cost of health care and giving more people access to basic care. Neither the bill from the House or from the Senate has accomplished this task. Maybe the compromise bill will address this.....We'll see!

Today (1-5-10) we learned that the House and Senate leadership will meet with their party's leaders and a White House contingency to work out the compromise bill to be sent back to both houses for the final vote. Can they do that....leaving out the opposition and over 40% of our elected representatives? We believe this will cause some controversy.