It has been widely reported that Senate leaders bought the vote of struck a deal with Nebraska Sen. Ben Nelson to enable him to allow the health insurance reform bill to go forward, and that it provides:
full and permanent federal funding for his state to extend Medicaid eligibility to everyone below 133 percent of the federal poverty level. The bill would require all states to do so, but Nebraska alone would not be required to pay a portion of the additional cost after 2016. And he won concessions for some nonprofit insurers and for providers of supplemental Medicare coverage from a new insurance tax, and he was able to roll back cuts to health savings accounts.
Not only did Sen. Ben Nelson help cut a deal that covers the state's estimated $45 million annual cost of expanding Medicare coverage - all other states will have to share in the cost - insurance companies in Nebraska will get tax and fee breaks.
Insurance giant Blue Cross/Blue Shield of Nebraska, for instance, would pay between $15 million and $20 million less in fees under the Senate bill than it would have without a change the Nebraska Democrat helped broker, according to Nelson's office. Another insurer, Mutual of Omaha, won't have to pay taxes on so-called Medigap insurance that buttresses Medicare insurance used by the elderly.
Unlike the Blue Cross/Blue Shield deal, that tax break will be extended to other companies. Mutual of Omaha spokesman Jim Nolan said he didn't "have a figure to share" about how much the company may save.
A Blue Cross/Blue Shield of Nebraska spokesman estimated that the cost-savings figure released by Nelson's office was probably close to accurate and added that the company didn't ask for the break.
The savings will go directly to consumers, said Pat Bourne, the company's vice president of commercial business and government affairs.
Oh no, there is certainly no reason to believe that BC/BS asked for such a break - they didn't need to do so.
But better is that the "savings will go directly to consumers." RIIIGGGHT!! Do any of you believe that line of bullshit??
If not, then call our senators and your representative and demand that the sweetheart deal that Sen. Nelson was able to get be eliminated from the Conference bill.
The bill will now have to be reconciled with the House version in Conference Committee.
In a prepared statement, Rep. Chellie Pingree wrote:
The vote by the Senate today is like an early Christmas present. It puts us one step closer to real, significant health care reform. Although I still believe in the need for a public option like the one in the bill we passed in the House, both bills will rein in costs, improve coverage for those who already have it and put health care within reach for millions of individuals and small business who currently can't afford it.
There is still much work to be done to reconcile the bill the Senate passed today with the House version, but I am confident we can work out the differences and I look forward taking a final vote on health care reform early next year.
My guess is that even though the markets will be open for only half a day, insurance company stocks will soar in value.
Update: Rep. Mike Michaud sent along this prepared statement:
The Senate took an historic vote today to advance health insurance reform. However, a lot of work remains to be done to reconcile the House and Senate bills. I will continue to work to make sure my concerns are addressed, and I will read and carefully study the details of the final agreement once it is completed to make sure that it is good for Maine. I am hopeful that the best policies from each bill can be adopted and that Congress takes the time to get this right. This issue is too important to rush.
I thank Sens. Snowe and Collins for not prostituting themselves as their colleague Ben Nelson did. I mean really Ben - couldn't you have asked for a corn subsidy too?
And John McCain speaks of comity? I'm more concerned about integrity.
Since the Senate thought it acceptable to allow individual states to ban insurance companies from providing coverage for abortions, a legal medical practice, why didn't the Senate allow individual states to ban insurers from providing coverage for cancer? Or treatment for erectile dysfunction? Or obesity?
Senate Democrats said on Saturday that they had clinched an agreement on a far-reaching overhaul of the nation's health care system, and that they were on track to approve the legislation by Christmas over fierce Republican opposition.
As the Senate convened in a driving snowstorm, Democratic leaders said a breakthrough came when Senator Ben Nelson, Democrat of Nebraska, agreed after 13 hours of negotiations on Friday to back the bill, making him the pivotal 60th vote.
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The legislation, the most sweeping overhaul of the nation's health care system in more than a generation, seeks to extend health benefits to more than 30 million uninsured Americans by expanding Medicaid and providing subsidies to help moderate-income people purchase private insurance.
The bill also imposes tight new regulations of the health insurance industry, barring insurers from denying coverage based on pre-existing medical conditions and limiting how much extra they can charge for people based on their age.
The majority leader, Harry Reid of Nevada, racing against the clock to complete the bill by his self-imposed holiday deadline, introduced a 338-page package of last-minute amendments, including the key provisions needed to win Mr. Nelson's support.
* Prohibition on annual or lifetime limits which will be paid to cover specific covered benefits that are essential health benefits under;
* Cap on medical loss ratios at a minimum 85% for large group plans, and a minimum 80% for small groups and individual policies (this means that insurers must spend 85% or 80% of the money they collect in premiums on covering medical costs, and rebate any money underspent).
* Allows individual states to ban any insurance coverage of abortions, which are a legal procedure:
''SEC. 1303. SPECIAL RULES.
''(a) STATE OPT-OUT OF ABORTION COVERAGE.-
''(1) IN GENERAL.-A State may elect to prohibit abortion coverage in qualified health plans offered through an Exchange in such State if such State enacts a law to provide for such prohibition.
''(2) TERMINATION OF OPT OUT.-A State may repeal a law described in paragraph (1) and provide for the offering of such services through the Exchange.
''(b) SPECIAL RULES RELATING TO COVERAGE OF ABORTION SERVICES.-
''(1) VOLUNTARY CHOICE OF COVERAGE OF ABORTION SERVICES.-
''(A) IN GENERAL.-Notwithstanding any other provision of this title (or any amendment made by this title)-
''(i) nothing in this title (or any amendment made by this title), shall be construed to require a qualified health plan to provide coverage of services described in subparagraph (B)(i) or (B)(ii) as part of its essential health benefits for any plan year; and
''(ii) subject to subsection (a), the issuer of a qualified health plan shall determine whether or not the plan provides coverage of services described in subparagraph (B)(i) or (B)(ii) as part of such benefits for the plan year.
* Allows insurers to offer coverage across state lines if "the plan offers a benefits package that is uniform in each State and consists of the essential benefits described in section 1302" and that allows "a State from requiring that benefits in addition to the essential health benefits required under such paragraph be provided to enrollees of a multi-State qualified health plan offered in such State.;"
* Allows employers to give their employees a voucher for the amount the employer would have paid for that employee's health insurance coverage, to be used by the employee to obtain coverage by another plan;
* Expands Federal payments to the Medicare programs of certain states (likely Maine), and this special provision to buy Sen. Ben Nelson's vote:
''(3) Notwithstanding subsection (b) and paragraphs (1) and (2) of this subsection, the Federal medical assistance percentage otherwise determined under subsection (b) with respect to all or any portion of a fiscal year that begins on or after January 1, 2017, for the State of Nebraska, with respect to amounts expended for newly eligi1ble individuals described in subclause (VIII) of section 1902(a)(10)(A)(i), shall be determined as provided fo under subsection (y)(1)(A) (notwithstanding the period provided for in such paragraph).
* Provides incentives for State's to offer home and community-based services as an alternative to long-term nursing home care;
* Provides for funding of the S-CHIP program through 2015;
* Establishes a pregnancy assistance fund for teens and young mothers (Sec. 10212), enable the eligible colleges and schools (grades 7 through 12) to establish, maintain, or operate pregnant and parenting student services. Such funding shall be used to supplement, not supplant, existing funding for such services, including housing, child care, alternate education scheduling, etc.;
* Provides funds to assists pregnant women whom are victims of violent attacks, rape, domestic assault, stalking;
In this week's address, President Barack Obama lists some of the important provisions of the health insurance reform bills in the House and Senate. As always, the text of the message can be found below the fold.
The vote was 51 to 48, with 60 needed for passage. Both of Maine's senators, Olympia Snowe and Susan Collins, voted to allow such re-importation, albeit on the losing side.
It's rather shocking to read through the list of those voting against this measure, and it is important to remember how ridiculous it seems compared to what most industrial countries do - their governments bargain with Big PhRMA to reduce the cost of medication.
Our Congress will not vote to allow us to import those cheaper meds, but instead would rather that we pay higher prices.
Writing at Change.org, Lance Armstrong, seven time winner of the Tour de France, writes about cancer
On October 2, 1996, I was diagnosed with advanced testicular cancer. Like most 25 year-olds, I was fearless, ready to conquer the world and, because I was in the midst of changing employers, without health insurance. I was lucky. One of my sponsors, Oakley, stood up for me and threatened to take all of their business elsewhere if their insurance carrier refused to cover me. Without their help, I might not be alive today. Or I might be completely broke, still trying to dig my way out of a massive pile of medical bills.
That kind of luck shouldn't have anything to do with whether the 1.5 million people in the United States who will be diagnosed with cancer this year go broke trying to get the treatment they need to survive.
Cancer is projected to become the world's leading cause of death next year. More than 12 million Americans alone are living with cancer today and, without greater progress in detection, prevention and treatment that number could triple by 2030.
If the cancer epidemic continues to grow as predicted, it will have a devastating effect on our economy. A new Economist Intelligence Unit study commissioned by the Lance Armstrong Foundation pegs the global economic impact of the disease at more than $300 billion in 2009 alone. In coming years, our nation will be forced to spend increasing amounts of money on treatment and on public assistance to patients. Aging populations are already straining public health costs in the United States, so the rise in cancer means an ever greater percentage of our national budget will be devoted to health care.
That's the big picture. But the disease also has a devastating personal economic impact. According to a study published in the Journal of the American Medical Association, cancer survivors in the U.S. were 37 percent more likely to be unemployed than those who have not been afflicted by the disease. This is a health and economic crisis on par with the worldwide recession.
The economic downturn that began in 2007 is only now showing signs of easing. Our government has made history-setting stimulus efforts to stabilize our financial systems. It would be easy to simply say, "Sorry...we have to wait to fight cancer."
The problem is cancer won't wait.
Put plainly, the impact of diseases like cancer won't subside with the recovery of economic markets. The threat they bring grows, minute by minute. Increasing investment now to combat that threat, even in the midst of a recession, will pay substantial dividends in the decades to come by driving down the costs of treatment and public assistance.
We must advocate for effective, high-quality and comprehensive health services. The issues are complex and deserve the most constructive debate leading to progress; not piecemeal changes but thoroughly comprehensive changes.
To this day, my family and I remain on Oakley's insurance plan. We are the lucky ones. We can no longer allow luck to determine the fate of people with cancer.
Please join Lance by adding your voice to this petition and telling Congress that no American should be denied health care due to pre-existing conditions or changes in employment.
By a nine vote margin (Roll Call 369), the Senate rejected an amendment to its version of the health insurance reform bill that would have severely restricted poorer women's access to affordable abortions.
Maine's senators, Olympia Snowe and Susan Collins, were the only Republicans to vote against the amendment (you can't leave office soon enough Judd Gregg). Seven Democrats voted for the measure.
The Senate will begin debate today on an amendment to its version of the health insurance reform bill, introduced by Ben Nelson (D-NB). Nelson promises that it will be as identical to Stupak as it can be, which would (link):
Prohibit federal funds for abortion services in the public option. It also prohibits individuals who receive affordability credits from purchasing a plan that provides elective abortions. However, it allows individuals, both who receive affordability credits and who do not, to separately purchase with their own funds plans that cover elective abortions. It also clarifies that private plans may still offer elective abortions.
It's been assumed that both of Maine's senators would vote against this restriction, but after hearing this report from Josie Wong on MPBN, it's not so clear.
Sen. Collins appears to want to maintain the status quo, that is the Hyde amendment that bars Federal funds from being used to perform abortions:
"The underlying bill makes very clear that federal funds cannot be used for abortion. That is current law, that is what we ought to stick with."
But then read what Sen. Snowe has to say:
In a statement, Snowe says, "I will continue to protect coverage options for women when they are using their own personal funds to purchase health insurance."
From this, it sounds like Snowe could very well support Nelson's amendment. It never hurts to call and remind her how you feel about it:
FireDogLake has established a nationwide phone bank to call House members that voted in favor of the Stupak-Pitts amendment to the Affordable Health Care for America Act, H.R. 3962. The amendment would basically ban insurers from covering all abortions, whether the insurance was through the public option or private.
You can volunteer to call targeted Democratic members that supported Stupak by clicking on the logo at the right.
Jane Hamsher of FDL was on Democracy Now! this morning; listen/watch here.:
AMY GOODMAN: Prominent blogger Jane Hamsher has launched a national phone bank campaign to target districts of the representatives who voted for the anti-abortion Stupak amendment. The campaign is called "One Voice for Choice." Jane Hamsher joins us now from Washington, DC, founder of the blog FireDogLake.com.
Jane, welcome to Democracy Now! Explain what this campaign is all about, and in the process, exactly explain what the Stupak amendment is and whether you think it will be included in the Senate bill.
JANE HAMSHER: Well, the Stupak amendment, it was introduced by Bart Stupak, a congressman who began on July the 1st of this year getting signatures from fellow anti-choice members of the Democratic Party in the House to be able to keep any abortion funding out of the healthcare bill. But he went much further than that. That's already the law of the land. That's the Hyde Amendment. But he went much further than that, and they say that no insurance company offering insurance on the exchange, whether it's funded with government money or not, can offer elective abortion coverage. And that threatens to take away abortion coverage from just about any insurance policy, because even the private insurance plans for reinsurance of big companies that have their employees insured can be affected by it, because money for that is provided under the plan.
Ben Nelson will introduce an amendment, but he would have to get sixty votes in the Senate-or, I'm sorry, he'd be able-yeah, I think you have to get sixty votes in the Senate in order to be able to get it into the bill. So I don't really think that it's going to be in the Senate bill. However, Nancy Pelosi has privately been telling people that she can't pass a bill in the House without it. So, even though Diana DeGette got a letter of forty-one members of the House to say they would vote against any bill that didn't have one, the fact is that she had that letter before the last vote, and all of them did vote for it. Furthermore, they won't say who their names are on that letter, and it's been my experience as someone who's run these kinds of whips before that unless those names are public, these people have-feel like there's nothing that they're accountable to, and in the end they'll do it.
So we took a look at the sixty-four members of the Democratic Party who were the ones who voted for the Stupak amendment, and we looked at what was going on and thought, well, how can we micro-target them in order to be able to use the leverage that we can create by people having phone banks and calling into their districts in order to be able to affect them? You're looking at people who are very scared about the 2010 election. They are in close districts. They feel like they have to appeal to Republicans in their districts in order to get votes. And they're voting for the Stupak amendment because they think that it will make them more popular in 2010.
Sen. Ben Nelson (D-Neb.) will attempt to strengthen language in the healthcare reform bill prohibiting federal funding of abortion, he said.
Nelson, a key swing vote on the overall bill and an opponent of abortion rights, specifically said he would base his amendment on language authored by Rep. Bart Stupak (D-Mich.) that passed in the House's healthcare bill - and ignited a firestorm among Democrats and supporters of abortion rights that quickly spread to the Senate debate.
Nelson said he and other senators, "perhaps" including Democrats, plan to introduce an amendment "something like Stupak" on the Senate floor. The prospects of such an amendment passing, however, are slim. Republican abortion-rights opponents include Nelson's home-state colleague, Sen. Mike Johanns, have conceded they cannot muster the 60 votes they would need to attach the Stupak language to the Senate bill.
Both of Maine's senators are strong supporters of a woman's right to choose, but they might need to be reminded of that. You can call them:
It must be remembered that these folks just don't dream this stuff up on their own - it is an organized campaign, and people like Rep. Michele Bachmann are only too happy to play their part.
While I normally don't do this, I will copy and paste an entire blog entry from the White House site, this written by Macon Phillips:
Ed. Note: Opponents of health reform appear to have run out of fresh smears against health insurance reform and have started recycling old debunked attacks. In response to those that brought up this attack that Politifact proved false months ago, we simply bring back this classic Reality Check first published on October 1, 2009.
Last night Minnesota Congresswoman Michele Bachmann questioned health insurance reform, raising the spectre of school-based "sex clinics" that would take students to "have their abortion, be back and go home on the school bus that night":
It means that parents will never know what kind of counsel and treatment that their children are receiving. And as a matter of fact, the bill goes on to say what's going to go on -- comprehensive primary health services, physicals, treatment of minor acute medical conditions, referrals to follow-up for specialty care -- is that abortion? Does that mean that someone's 13 year-old daughter could walk into a sex clinic, have a pregnancy test done, be taken away to the local Planned Parenthood abortion clinic, have their abortion, be back and go home on the school bus that night? Mom and dad are never the wiser.
Critics of the Democratic health care proposal have been increasingly raising concerns that the plan would provide taxpayer-subsidized abortions (a claim we address here). The Liberty Counsel, a conservative group, puts a different twist on that concern, alleging that Page 992 of the bill "will establish school-based 'health' clinics. Your children will be indoctrinated and your grandchildren may be aborted!"
The claim comes from a long list of items allegedly in the bill that is posted on the group's Web site and has been widely circulated in a chain e-mail. The list looks a lot like one that we checked in July, based partly on blog postings by Peter Fleckenstein on his blog Common Sense from a Common Man. In fact, the Liberty Counsel says it adapted its memo from Fleckenstein's original work.
...
We spoke with Sarah Speller at the Liberty Counsel, who told us that the group had been getting a lot of calls about the memo and that everyone there was very busy as a result. However, she assured us that "as far as our office can tell, everything in the overview is accurate. That's about all I can tell you," she said. "I'm just relaying what I've been told to say."
That's not persuasive. We see no language in the three main versions of the bill that would allow school-based clinics, which have a long history of providing basic health services to underprivileged students, to provide abortions. Nor would the clinics even be new - they have been around for three decades. So we rate the claim Pants on Fire!
In the last year, the industry has raised the wholesale prices of brand-name prescription drugs by about 9 percent, according to industry analysts. That will add more than $10 billion to the nation's drug bill, which is on track to exceed $300 billion this year. By at least one analysis, it is the highest annual rate of inflation for drug prices since 1992.
The drug trend is distinctly at odds with the direction of the Consumer Price Index, which has fallen by 1.3 percent in the last year.
Drug makers say they have valid business reasons for the price increases. Critics say the industry is trying to establish a higher price base before Congress passes legislation that tries to curb drug spending in coming years.
In response to this, Rep. Chellie Pingree had this to say in a prepared statement:
The drug companies promised us they would deliver $8 billion in savings into the health care system. What they failed to tell us was that they apparently planned to jack up prices by $10 billion first. It sounds like classic bait and switch scheme to me.
I can't think of a worse time for the drug companies to suddenly start charging so much more for their products. With American families struggling economically and inflation at near record lows, there is just no excuse for it.
No real surprise here. After all, the oil industry jacks up the price at the pump when crude oil prices rise, and then keep the price of gasoline high long after the cost of crude has fallen.
In his testimony (pdf warning) before the Senate Committee on Commerce, Science and Transportation, former insurance exec Wendell Potter explained how medical loss ratios (MLR) are used to determine a companies profits:
The top priority of the for-profit companies is to drive up the value of their stock. Stocks fluctuate based on companies' quarterly reports, which are discussed every three months in conference calls with investors and analysts. On these calls, Wall Street investors and analysts look for two key figures: earnings per share and the medical-loss ratio, or medical-benefit ratio, as the industry now terms it. That is the ratio between what the company actually pays out in claims and what is left over to cover sales, marketing, underwriting and other administration expenses and, of course, profits.
To win favor of powerful analysts, for-profit insurers must prove that they made more money during the previous quarter than a year earlier and that the portion of the premium going to medical costs is falling. Even very profitable companies can see sharp declines in stock prices moments after admitting they've filed to trim medical costs.
In other words, for every dollar that it receives in premiums payments, an insurer will typically reimburse between 75 and 90 cents to health care providers for their services, with the remaining used to cover businesses expenses and profit.
In theory, should premiums and overhead expenses remain constant, the only way for an insurer to increase earnings is to reduce what it pays out in medical expenses. Insurers do this now by refusing to enroll people with pre-existing conditions, and/or denying claims because of them.
Such practices would be banned in the health insurance reform bill, the Affordable Health Care for America Act (H.R. 3962).
Bruce Webb noted an interesting section in H.R. 3962, and writes about it in his excellent blog Angry Bear. Sec. 102 places a cap on MLR:
That final sentence simply guts the insurance companies current business which involves widening the spread between premium dollars collected and medical care actually provided. This sentence sets a hard limit on raising premiums while managing the risk pool to exclude those actually being likely to make claims. The tighter you manage your enrollment the harder it is to actually hit your mandated MLR, and every time you raise premiums you have to demonstrate that you have increased payouts to that same degree. Or else you have to rebate the difference.
In the original House Tri-Committee Bill this language was included in Sec. 116 and a site search on that term will pull up a series of posts on this dating back to July. And I have diaried on this elsewhere, yet somehow almost everyone has simply missed the significance of this.
Sec. 102 includes this:
(a) In General- Each health insurance issuer that offers health insurance coverage in the small or large group market shall provide that for any plan year in which the coverage has a medical loss ratio below a level specified by the Secretary (but not less than 85 percent), the issuer shall provide in a manner specified by the Secretary for rebates to enrollees of the amount by which the issuer's medical loss ratio is less than the level so specified.
What this means is that in no case can an MLR fall below 85%, that is, for every 85 cents an insurer reimburses care providers, it can only collect another 15 cents in premium costs.
By capping profits, this section is meant to control the rate at which premiums increase, since insurers will be no longer be able to refuse to honor pre-existing conditions, the only way to ensure continued growth in profits is to increase premiums.
Obviously, capping MLR does nothing to limit the rate of increase in actual medical costs.
But also included in Sec. 102 is a provision that sunsets the cap:
Sunset- Subsections (a) and (b) shall not apply to health insurance coverage on and after the first date that health insurance coverage is offered through the Health Insurance Exchange.
And my question is why is this sunset provision in the bill?
"We won because [the Democrats] need us," Stupak said. "If they are going to summarily dismiss us by taking the pen to that language, there will be hell to pay. I don't say it as a threat, but if they double-cross us, there will be 40 people who won't vote with them the next time they need us -- and that could be the final version of this bill."
The Honorable Nancy Pelosi
Speaker
U.S. House of Representatives
H-232 Capitol
Washington, DC 20515
Dear Madam Speaker:
As members of Congress we believe that women should have access to a full range of reproductive health care. Health care reform must not be misused as an opportunity to restrict women's access to reproductive health services.
The Stupak-Pitts amendment to H.R. 3962, The Affordable Healthcare for America Act, represents an unprecedented and unacceptable restriction on women's ability to access the full range of reproductive health services to which they are lawfully entitled. We will not vote for a conference report that contains language that restricts women's right to choose any further than current law.
This afternoon, Willy Ritch, Communications Director for Rep. Chellie Pingree, told me that Rep. Pingree intends to sign onto this letter upon her return to Washington.
While not unexpected, it is great to see Rep. Pingree out in front of this issue. That some would restrict a woman's access to a legal procedure simply because they may be of lesser means is unconscionable, and again Rep. Pingree demonstrates her unflagging support of the rights of all women to control their own bodies.
DIRIGO BLUE is available as an