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Recent Developments in Health Care Legislation

RESULTS supports health care reform that strengthens Medicaid to cover all lower-income Americans and expands access to quality care through Community Health Centers. RESULTS continues to endorse a model of a National Health Program, that would expand Medicare, as our long-term goal, but supported passage in health reform in 2010. The most sweeping reform of America's health care system passed the House of Representatives on March 21, 2010. The House passed the Senate health bill, the Patient Protection and Affordable Care Act, by a vote of 219-212. They then followed up that vote by passing the Reconciliation Act of 2010 (H.R.4872), which amends and improves upon the Senate health reform bill, by a vote of 220-211. The Senate passed the reconciliation package 56-43 on March 25. These reforms expand coverage and access to care for millions of low-income kids and families. However, this critical expansion of Medicaid and the very nature of the program are now at risk.

May 2012 Update

In late April, various House committees passed legislation to cut billions in spending, called "reconciliation" bills, to match cuts included in House Budget Chairman Paul Ryan's FY 2013 budget. Specifically these proposals would cut Medicaid and the Children’s Health Insurance Program (CHIP), which could mean 14 million children could lose health insurance according to First Focus's summary. This month, RESULTS returns to an old and effective tool in our advocacy toolbox — generating media. Media advocacy can be very powerful in shaping public opinion and influencing lawmakers. Being an election year where elected officials crave good press, this impact of media advocacy is only magnified. With these recent votes in Congress and an impending vote in the full House on cuts to Medicaid and CHIP (expected May 10), we have plenty of material to work with. We have to remind lawmakers and our fellow constituents that decisions to cut the social safety net are choices. TAKE ACTION: Let’s use this tool this month to generate letters to the editor and op-eds supporting low-income Americans. See our May Action sheet for talking points, and you can tell Congress to get its priorities straight online by sending a letter to the editor telling Congress to reject these misguided cuts to the social safety net. Be sure to tell your senators and representatives by name to oppose these cuts and to support programs that help struggling individuals and families make ends meet. In the alternative, start drafting an op-ed in support of anti-poverty services that you can submit sometime this month. Use our Activist How-To’s to help you get started.

August 2011 Update

On Tuesday, August 2, 2011, the Budget Control Act of 2011 was passed and signed into law. Essentially, this piece of legislation raises the debt ceiling while at the same time outlining procedures for reducing the deficit. For a more detailed outlining of what the Budget Control Act does, refer the August 2 weekly update. Debt ceiling and deficit reduction negotiations were taking place for weeks before the final piece of legislation was passed on both the House and the Senate. During these weeks of negotiation, RESULTS, coalition partners, and individuals around the nation fought to ensure the protection of safety net programs including Medicaid, Medicare, SNAP, and other important health programs.

Fortunately the budget act that was passed protects most of these programs in the first $1 trillion round of cuts. However, not all of these programs will be safe as deficit reduction continues on. A joint committee will be appointed to come up with at least another $1.2 trillion in reductions; this can be achieved through both cuts and reductions. Even programs that were protected in the original round of cuts may be cut by the joint committee. Speculation has it that Medicaid is likely to be one of the first targets by Republican members of the committee. If, however, the committee does not create a plan that passes in both houses of congress and automatic sequestration will take effect cutting $1.2 million in across the board cuts. Most of the programs protected in the first round of cuts will be protected in the sequestration except Medicare. Up to 2% of Medicare’s budget can be cut on the provider side.

TAKE ACTION: Let your members of Congress know that you want them to protect the millions of Americans who rely on Medicaid for basic health care by taking our online e-mail action in support of this vital program.

February 2011 Update

Two years ago President Obama signed the Children’s Health Insurance Program Reauthorization Act. Since then, Medicaid and the Children’s Health Insurance Program (CHIP) have aided over 2 million additional children in the past year alone.  According to Kathleen Sebelius, the Secretary of the U.S. Department of Health & Human Services, Medicaid and CHIP are serving their roles by assisting even more children during the economic downturn. A few of the ways that these programs have reached out to uninsured children is through eligibility expansions and technological enrollment procedures.

In order to continue the positive trend of Medicaid and CHIP expansion, the U.S. Department of Health & Human Services allocated an additional $40 million in grants to support outreach and enrollment activities. This grant will be available to states, school systems, and community-based organizations. 

RESULTS' 2010 Health Reform Summary Chart

Last Updated: April 19, 2010

Issue	RESULTS Position	Senate Patient Protection and Affordable Care Act with House Reconciliation Act of 2010 (Final Health Reform bill)	Senate Patient Protection and Affordable Care Act (H.R. 3590) -- passed 60-39	House Affordable Health Care for America Act (H.R.3962) -- passed 220-215
Strengthening and Expanding Medicaid	Expand Medicaid to include everyone at or below 150% of the federal poverty line (FPL). Provide for automatic increases in federal funding during economic downturns, i.e. counter-cyclical financing. Finance Medicaid expansion with 100 percent federal financing. Preserve existing Medicaid benefits for current and new enrollees.	Expands Medicaid eligibility to everyone below age 65 at or below 133 percent FPL, beginning in 2014. Federal government pays 100 percent of the expansion for 3 years (2014-16); 95 percent in 2017; 94 percent in 2018; 93 percent in 2019, 90 percent in 2020 and beyond. Payments to primary care doctors treating Medicaid patients must be equal to payments to Medicare doctors in 2013 and 2014; full federal financing for this increase. No provisions for counter-cyclical funding.	Expands Medicaid eligibility to everyone below age 65 at or below 133 percent FPL, beginning in 2014. Federal government pays 100 percent of the expansion for 3 years through 2016. States would then bear some of the financial responsibility, up to 10 percent, for the cost of the expansion. No provisions for counter-cyclical funding. No language on increasing Medicaid reimbursement rates. All newly eligible adults will be guaranteed a benchmark benefit package that at least provides the essential health benefits.	Expands Medicaid coverage for everyone below age 65 up to 150% of the FPL, beginning in 2013. Federal government pays 100 percent of the expansion for 2 years until 2015, then lowers it to 91% thereafter. No provisions for counter cyclical funding, but the House bill does provide $23.5 billion to continue higher federal funding for Medicaid to help states during the current economic downturn. Medicaid reimbursement rates for primary care will increase to Medicare within three years. Preserves existing Medicaid benefits for current and new enrollees.
Community Health Centers (CHCs)	Increase funding for CHCs and the National Health Service by $14 billion over the next 5 years (the House version).	Improves access to care by increasing funding for CHCs  by $11 billion over 5 years (2011-2015): $9.5 billion to serve nearly 20 million new patients and to enhance their medical, oral, and behavioral health services and $1.5 billion to expand and improve existing facilities and construct new sites. Also includes $1.5 Billion for the National Health Service Corps to place an estimated 15,000 primary care providers in underserved communities.	Improves access to care by increasing funding for CHCs and the National Health Service Corps by $10 billion over 5 years (effective fiscal year 2011); establishes new programs to support school-based health centers (effective fiscal year 2011) and nurse-managed health clinics (effective fiscal year 2010).	Improves access to care by increasing funding for CHCs and the National Health Service by $14 billion over 5 years; establishes new programs to support school-based health centers (effective July 1, 2010) and nurse-managed health centers (effective 2011).
National Health Care Program (Single Payer)	RESULTS has endorsed a National Health Program as our long-term goal for health reform (H.R.676 and S.703).	Does not include a national health care plan.	Does not include a national health care plan. Senator Sanders introduced an amendment, Amendment 2837, for consideration during the Senate debate on health reform. It would have replaced the current Senate healthcare bill with a single-payer system as set forth in S.703. Senator Sanders withdrew the amendment before a vote to facilitate timely passage of the Senate bill.	Does not include a national health care plan. Rep. Anthony Weiner (D-NY-9) withdrew his amendment that would have replaced the provisions in the bill with those of H.R.676 and create a national health program.
Public Health Insurance Plan	RESULTS supports creating a strong, non-profit, public health insurance plan as an option for people to choose. The "public option" would provide stable, affordable coverage while promoting cost effectiveness throughout the system.	Does not include a public health insurance option.	Does not include a public health insurance option.	Creates a national public health insurance plan, which will be available through the new national health insurance exchange. Only available to those who are uninsured or are not already covered by an employer-based or public health plan. The plan would reimburse providers based on negotiated rates. A stronger version based on Medicare reimbursement rates was not included.
Children's Health	Children should receive a child-specific benefit package at least as good as current CHIP and Medicaid enrollees, whether covered by a government program or by insurance purchased through the Exchange. Ideally, all children would be covered by plans based on the model of Early and Periodic Screening, Detection and Treatment (EPSDT).	Same as Senate bill.	Requires states to maintain current income eligibility levels for children in Medicaid and CHIP until 2019 and extends funding for CHIP through 2015. CHIP benefit package and cost-sharing rules will continue as under current law. Beginning in 2015, states will receive a 23 percentage point increase in the CHIP match rate up to a cap of 100%. CHIP-eligible children who are unable to enroll in the program due to enrollment caps will be eligible for tax credits in the state Exchanges.	By increasing the eligibility for Medicaid to 150% FPL (see above), the House bill will move about 2.3 million children from CHIP programs into Medicaid where they'll be guaranteed a more comprehensive set of benefits and protected from high out-of-pocket costs. But, the House repeals the CHIP program and requires enrollees in separate state CHIP programs with incomes above 150 percent of FPL to obtain coverage through the Exchange beginning in 2014. Children with incomes above 150 percent of FPL enrolled in Medicaid and states will receive enhanced CHIP match rate for those children starting in 2014.
Financing	RESULTS supports progressive financing for health care that does not add to the deficit or unfairly burden individuals and families with lower incomes.	Financed primarily through savings generated by reform, a tax on more expensive health plans beginning in 2018 (family plans worth $27,500 or more), and an expansion of Medicare tax to include net investment income for individuals earning more than $200,000 per year ($250,000 per couple); other smaller miscellaneous revenue provisions are also included.	Bill costs $848 billion over ten years, reducing the federal deficit by $127 billion during that time. Financed through savings generated by reform, a tax on expensive insurance plans ($8,500 or higher for an individual, $23,000 for a family of four), an increase in the Medicare payroll tax persons earning over $200,000 per year ($250,000 for couples), and a 5 percent tax on elective cosmetic surgery.	Bill costs $1.05 trillion over ten years, reducing the federal deficit by $109 billion during that time. Financed through savings generated by reform and a 5.4 percent tax on individuals earning over $500,000 per year ($1,000,000 for couples).

For more details, see the Kaiser Foundation Side-by-Side Comparison of bills.

New Health Reform Resource: HealthCare.Gov

Find out about how Health Care Reform will affect you, your family and the lives of millions of low and moderate income Americans at http://www.HealthCare.gov. This new website is an outstanding source of information and opportunities. Especially interesting:

• website's timeline which demystifies how and when aspects become law

• available in English and Spanish

• find health insurance plans' pricing and benefits in all 50 states and the District of Columbia

• more transparent price estimates allowing Americans to easily compare health insurance not health insurance companies

HHS (the U.S. Department of Health and Human Services) and the Faithful Reform in Health Care will be offering guided walk-through of HealthCare.gov this Thursday, October 14, at 2 pm ET. RSVP for the call-in details.

For those interested in engaging further, we suggest you also join Faithful Reform in Health Care’s "What I like about Health Care Reform" Campaign. "By sharing information about how the Affordable Care Act contributes to our vision of health, wholeness, and human dignity for all, we are claiming our role in moving toward a more compassionate and just health care future."

New Health Reform Resource: HealthCare.Gov

Find out about how Health Care Reform will affect you, your family and the lives of millions of low and moderate income Americans at http://www.HealthCare.gov. This new website is an outstanding source of information and opportunities. Especially interesting:

• website's timeline which demystifies how and when aspects become law

• available in English and Spanish

• find health insurance plans' pricing and benefits in all 50 states and the District of Columbia

• more transparent price estimates allowing Americans to easily compare health insurance not health insurance companies

HHS (the U.S. Department of Health and Human Services) and the Faithful Reform in Health Care will be offering guided walk-through of HealthCare.gov this Thursday, October 14, at 2 pm ET. RSVP for the call-in details.

For those interested in engaging further, we suggest you also join Faithful Reform in Health Care’s "What I like about Health Care Reform" Campaign. "By sharing information about how the Affordable Care Act contributes to our vision of health, wholeness, and human dignity for all, we are claiming our role in moving toward a more compassionate and just health care future."

August 2010 Update: Congress Passes Funding to Protect Medicaid, but Uses Food Stamp (SNAP) Benefits to Offset Costs

After months of trying, the Senate passed a bill that would provide temporary funding to states to help with Medicaid and teachers’ salaries by a vote of 61-39 on August 5. The House came back in session for one day on August 10 to pass the Senate bill 247-161. In 2009, Congress passed a temporary funding increase for Medicaid to help states maintain the program during the economic downturn; that funding runs out in December. However, states are still facing severe budget challenges and have requested an extension of this funding while the economy continues to recover. This bill would extend this funding another 6 months. Without it, states will be forced to cut vital services and lay off thousands of workers. Economist Mark Zandi estimates that the money will help save 150,000 jobs. A new paper from the Center on Budget and Policy Priorities shows just how much each state stands to gain from passage of this bill.

RESULTS is pleased that Congress passed this important aid to states. This funding is essential in making sure states maintain important basic services. It also helps temporarily prevent a destabilization of Medicaid, which will be critical in reducing the number of uninsured when it is expanded in 2014 as part of health reform. But the news is not all good. First, the amount is one-third less than what was sought back in the spring meaning that if the economy does not recover soon, states will be facing the same problem in 2011. Zandi estimates that states will have to cut 250,000 over the next year without more stimulus spending. Also, part of the money used to pay for the funding comes from future benefits in the Supplemental Nutrition Assistance Program (SNAP). As with the child nutrition bill, RESULTS rejects the practice of taking needed money from critical anti-poverty programs to pay for other anti-poverty programs. We should not be using the poor to fund the poor.  These are the tough choices we sometimes have to make. But it demonstrates the vital importance of people who advocate for America’s poor. It is only strong grassroots advocates like you who can shape the debate in a way that these tradeoffs are never considered. Thank you for all you do.

June 2010 Update: Great Overview of Health Reform at the RESULTS Conference, While Efforts to Protect Medicaid Fail

RESULTS joins our allies in calling on Congress to pass a critical extension of temporary funding for state Medicaid programs. On May 28, the House passed H.R. 4213, the American Jobs and Closing Tax Loopholes Act of 2010, 215-204. The bill contains some provisions that will help American workers and low-income families make it a few extra months this year, including extending unemployment insurance benefits (UI), the Temporary Assistance for Needy Families (TANF) Emergency Fund, and investing $1 billion in summer jobs for youth. Despite these much-needed extensions, the House’s final bill did not include funding for state Medicaid programs, as well as the additional COBRA subsidy passed in 2009 to help unemployed workers keep their health insurance. The Senate included funding for Medicaid in their package but the package failed to garner the 60 votes needed for passage. We will continue to support efforts to strengthen the Medicaid program. You can also use our online alert for calls to members of Congress.

This year's International Conference featured a review of health reform legislation and how it can build momentum for a national health program. This session was led by Metro NY Health Care for All and co-chair of the Board of the Universal Health Care Action Network (UHCAN). See his PowerPoint presentation and handout. During lobby meetings on Capitol Hill, RESULTS volunteers thanked members of Congress for their work on health reform and urged them to support efforts to provide Medicaid funding for the states. See our Health Care for All and Child Nutrition Power Point Presentation, House Health Care for All Request Letter (Word) and Senate Health Care for All Request Letter (Word).

March 2010 Update: Health Reform that Expands Coverage and Access for Low-Income Americans Becomes Law!

On March 23, President Obama signed the Senate’s Patient Protection and Affordable Health Act into law, after the House of Representatives passed the bill on March 21, 219-212. Then on March 25, the Senate and House both passed H.R.4872, the Reconciliation Act of 2010, which amends and improves the Senate health bill. Earlier today, President Obama formally completed the reform process by signing the reconciliation bill into law. So now that the enactment of this reform bill is complete, what exactly is in the final bill? Here are the provisions in the bill related to RESULTS priorities for Health Care for All, plus some of the financing provisions:

Medicaid Expansion

• In 2014, the Medicaid health program will expand to cover all persons earning up to 133 percent of the federal poverty line (in 2010, $29,326.50 for a family of four). This expansion is expected to provide 15 million uninsured persons with coverage by 2019.
• The federal government will finance 100 percent of this expansion for three years (2014–2016). In 2017, federal funding will drop to 95 percent, 94 percent in 2018, 93 percent in 2019, and 90 percent in 2020; it will remain at 90 percent thereafter.
• Payments to doctors who provide primary care services to Medicaid patients will be raised to the same level as Medicare payments in 2013 and 2014. This is expected to increase access to care as more doctors take on Medicaid patients. The federal government will pay 100 percent of the cost for these increases.
• All new enrollees in Medicaid will be guaranteed a base benchmark package that covers at least basic health services.
• States may begin expanding their Medicaid programs to cover adults without children beginning next month, but will not receive additional federal funding to cover these persons until 2014.

Community Health Center Expansion

• Funding for community health centers (CHCs) increases by $11 billion over five years (2011–2015); $9.5 billion for expanding services and $1.5 billion for facilities and construction. It is estimated that this expansion will allow CHCs to serve an additional 20 million people.

• The National Health Service Corps will get $1.5 billion over five years. The NHSC provides loans and scholarships to medical students who agree to serve in areas where there are physician shortages after graduation, many times in CHCs. This funding is expected to help train 15,000 new primary care providers.
• Health reform also establishes new programs to support school-based health centers and nurse-managed health clinics.

TAKE ACTION: Thank members of Congress by writing letters to the editor to thank Congress for passing health reform. Use our online Letter to the Editor Action Alert and the March Action sheet to brush up on the benefits of reform.

Also, as noted above, reimbursement rates for doctors treating Medicaid patients will increase in 2013. However, this increase only takes place for two years, just as the Medicaid expansion is getting under way. After that, they will decrease again unless Congress extends the new payment rate. When following up with members of Congress, urge them to work with their House and Senate colleagues to make these increases permanent. You can use our e-mail alert to contact them about this issue.

February Update: Work to Craft Final Health Reform Bill Continues Behind the Scenes

As The New Republic’s Jonathan Cohn reportedy, lawmakers are still working to get health care done and progress is being made. Outside the limelight, it seems House and Senate leadership still have their eye on the proverbial ball. The thinking is that if health reform is no longer front and center as it has been, lawmakers can have space to craft a deal that can pass. There are still issues to work out and a procedural path forward is not yet set, but it appears that the reports of health reform’s death were greatly exaggerated.

However, we cannot take anything for granted. Without pressure from the grassroots, be it subtle or blunt, the will to complete reform would wither away. Fortunately, the Washington switch to the topic of jobs presents us with a great opportunity. RESULTS supports efforts at creating jobs, especially for low-income people in the U.S., and one effective way to create jobs is by investing in anti-poverty programs. Investing in programs that help people meet basic needs, like food, shelter or health care, cause positive changes in the local and national economy.

For example, a recent report from the Kaiser Family Foundation shows the significant positive effect that Medicaid spending has on the economy of the states, from creating jobs to increasing income. As you know, both health reform bills in Congress make significant investments in Medicaid above current levels, thus amplifying this effect. In fact, the Center for American Progress estimates that if health reform passes, between 250,000 and 400,000 new jobs per year will be created over the next ten years.

TAKE ACTION: Take the February Action. Write a letter to your representatives and senators urging them to pass health reform (and expansions to low-income tax credits) in 2010. Remind them that these investments will help millions of individuals and families struggling in poverty, help create jobs, and revive our economy. Specifically, urge your members of Congress to weigh in with Senate Majority Leader Harry Reid (D-NV) and House Speaker Nancy Pelosi (D-CA-8) to enact meaningful health reform (most likely by enacting the Senate’s bill and a reconciliation package) that includes an expansion of Medicaid to 150 percent of poverty, increased reimbursement rates for providers in order to improve access to care, and federal financing to help states.

January Update: Health Care Reform Bills Bypass Conference

The Senate created a Christmas Eve drama with passage of its health care reform bill, the Patient Protection and Affordable Care Act. Due to Independent Senator Joe Lieberman's opposition to a public plan, and the need for his vote, Senate leadership jettisoned the public option. And due to Republican delaying tactics, the single-payer amendment of Senator Bernie Sanders (I-VT) was withdrawn and the CHIP amendent of Senator Bob Casey (D-PA) never made it to the floor.

 In comparing the Senate passed bill with that passed in the House, the latter is on the whole more progressive, especially in its greater expansion of Medicaid coverage and higher funding levels for CHCs. Key negotiators from the House and Senate have bypassed the normal conference committee procedure and are meeting informally to meld the two bills. They are also consulting with the White House. Clearly House Speaker Nancy Pelosi (D-CA) and Senator Harry Reid (D-NV) are critical negotiators to whom we can direct communications through our members of Congress.

The January Action Sheet and January 9 conference call provide key messages for you to deliver to your senators and representatives regarding the conference bill outcomes we want to see: Medicaid expansion to 150 percent of the FPL, the highest level of federal funding for Medicaid as soon as possible, and more accessible health care through increased Medicaid reimbursement rates to providers that might otherwise not accept Medicaid patients.

December Update: Senate Health Care Debate Begins

The Senate is back from the Thanksgiving holiday, after voting 60 to 39 on November 21 to move ahead with debate on health care reform. The Senate debate is expected to last several weeks, potentially up to or beyond the December holiday recess.

The Congressional Budget Office (CBO) has released an analysis of the Senate’s Patient Protection and Affordable Health Care Act that provides some good news for advocates for reform. The analysis shows that the average health insurance premium for people receiving premium subsidies in the new health insurance exchange would be nearly 60 percent lower than current law. Since about 57 percent of those in the exchange will be eligible for subsidies, these means a huge decrease in premium costs for a majority of exchange enrollees. For those in the exchange who do not qualify for subsidies, premiums would increase 10–13 percent according to the CBO. For those who have employer-based insurance, premium could see slight increases (about 1 percent) or slight decreases (0–3 percent).

Keep your networks prepared to act at any time during these next several weeks as key votes come up on possible amendments concerning Medicaid, community health centers, the public health insurance option, and single-payer option. RESULTS will keep you up-to-date on the debate and let you know by e-mail or phone when calls are needed and what to say. Let your networks know that calls will be needed throughout December if we are going to get a strong health reform bill passed. See the November Action for details on building a community action network for health reform. Also, please see our updated Laser Talk that features the exchange between RESULTS staff person Jos Linn and RESULTS volunteer Ted Meyers on the November national conference call. You can use all or parts of this exchange in engaging others in health reform advocacy.

November Update: House Passes Legislation, Senate to Start Floor Debate Soon

The House of Representatives passed the Affordable Health Care for America Act (H.R.3962), 220 to 215. All Republicans except Rep. Cao of Louisiana (R-LA-2) and 39 Democrats voted no. The House bill has some very encouraging changes around RESULTS’ 2009 priorities for health reform. They are:

• The bill expands Medicaid to cover all persons at or below 150% of the federal poverty line (FPL).
• The Medicaid expansion is 100% financed by the federal government until 2015, and then states must pay for 9% of the expansion.
• Medicaid reimbursement rates for primary care (i.e., how much the government will reimburse providers for their services), will be increased to the same rates as Medicare by 2012, ensuring that more providers take Medicaid patients.
• Community health centers are authorized to receive gradual funding increases, from $1 billionmore in 2010 to $4 billion more in 2015.
• A public health insurance option is included in the bill. Reimbursement rates for the plan will be negotiated with providers in local areas, not based on Medicare rates.

The Center on Budget and Policy Priorities (CBPP) issued an analysis (PDF), saying that the House bill makes significant progress in the areas of expanding coverage, ensuring affordability, slowing the growth in health care costs, and reforming the health insurance market. It will reduce the number of uninsured by two-thirds by 2019 and reduce the budget deficit by $104 billion over ten years.

Senate Majority Leader Reid would like to start floor debate on a merged Senate bill next week, before Congress breaks for Thanksgiving week, but that is looking less likely since the Congressional Budget Office has not completed scoring the provisions to be included in the package.  Republican senators have requested to debate the bill for at least four weeks, so expect long days as well as weekend sessions once the Senate takes up a bill. The Democratic leaders' goal is to complete floor action on a health care bill by Christmas. 

As passed out committee, the Senate bill is not as strong as the House bill in terms of investments in coverage and access for low-income Americans. It's important that we urge our senators to follow the House's lead and expand the Medicaid to all persons at or below 150 FPL and do so sooner than 2014, doctors are reimbursed at the same rate or better than Medicare (like in the House bill), ensure that newly eligible persons receive the same benefits as current enrollees, and the federal government should provide 100 percent of the financing for the expansion. Language in the bill describes coverage at a minimum "bronze" level; new Medicaid enrollees will not have access to traditional benefit package which includes assistance with transportation costs and critical mental health services. Senate Finance Committee staff members insit this means that the "bronze" level coverage will be a minimum standard established by the federal government for implementation by the individual states.

October Update: Full House and Senate to Consider Health Reform Legislation in Coming Weeks

The Senate Finance Committee passed its bill, the America’s Healthy Future Act of 2009, on October 13. The vote was 14 to 9, with all thirteen Democrats and one Republican, Senator Olympia Snowe (ME), voting yes.

Now that the Finance Committee has passed its bill, it is up to Senate leadership must now merge the Finance Committee and Health, Education, Labor and Pensions (HELP) Committee bills together. The key senators negotiating the merger are Sens. Chris Dodd (D-CT), Max Baucus (D-MT) and Majority Leader Harry Reid (D-NV). The White House is also participating in the process. It is hoped that a final merged bill will be ready sometime this week. If that happens, floor debate in the Senate could begin as soon as next week. Floor debate in the Senate is expected to take 3 to 6 weeks.

The House continues to move toward a floor debate. Right now, the House is working to craft a final version of its bill, the America’s Affordable Health Choices Act. It is expected that floor debate in the House will begin in late October or early November and may last up to a week before the final vote.

September Update: Health Reform Moving Forward

There has been a great deal of attention on what kind of health care reform Congress will present to the American people. Above you can see what the relevant House and Senate Committees have proposed so far. The House proposal includes both a Medicaid expansion, an increase in community health center funding, as well as a public health insurance option to compete with private plans. The House Energy and Commerce, Education and Labor, and Ways and Means committees, which make up the "Tri-committee", passed H.R.3200, America's Affordable Health Choices Act, out of their respective committees in July. Each committee made some changes to the bill, although its basic structure remains intact. The House is expected to submit one final version and begin debate on H.R.3200 in early October.

The Senate Health, Education, Labor and Pensions (HELP) Committee, chaired by the late Senator Ted Kennedy (D-MA) (due to Sen. Kennedy's battle with cancer, Senator Chris Dodd (D-CT) acted as Chair in his absence), completed their mark-up of the Affordable Health Choices Act on July 14. The latest HELP Committee proposal is said to cover 97 percent of people at a cost of $611.4 billion over ten years, according to the non-partisan Congressional Budget Office. Much of the overall savings and coverage expansion stem from including a public health insurance option and a mandate for employers of more than 25 people to provide insurance to employees. Following Senator Kennedy's death on August 25, 2009, Sen. Tom Harkin (D-IA) assumed the chairmanship of the Senate HELP Committee.

Finally, after months of negotiations among six senators on the committee (Chairman Max Baucus (D-MT), Ranking Member Charles Grassley (R-IA), Sen. Jeff Bingaman (D-NM), Sen. Kent Conrad (D-ND), Sen. Mike Enzi (R-WY) and Sen. Olympia Snowe (R-ME)), Chairman Baucus released his proposal for health reform, called America's Health Future Act. See the section below for more details about the Finance Committee bill.

Once the Finance Committee completes its mark-up, Senate leadership will work to combine it with the Senate HELP committee bill. Once that is done, the bill will be submitted for floor debate and vote, which is expected to happen sometime in October. While Senate Democrats and the White House continue to seek a bipartisan bill, most experts expect little or no Republican support. In the House, where majority rules, this will not prevent a bill from moving forward. In the Senate, however, 60 votes will be needed to overcome a likely Republican filibuster and move forward. If reform supporters are not able to garner 60 votes, the bill will stall in the Senate.

However, there is a procedural mechanism by which a bill could still move forward in the Senate. This procedure, called "reconciliation", is a budgetary tool that allows legislation to move forward in the Senate with only a majority vote (51 votes). However, reconciliation may only be used for provisions that impact the budget. In health reform, provisions for expanding Medicaid, community health centers, and creating a public health insurance option would likely qualify for reconciliation, since they impact the federal budget. Other areas may not, e.g. insurance market reforms (eliminating pre-existing condition exclusions and policy rescissions, capping out-of-pocket expenses in private plans), which are beneficial to consumers but do not impact the budget. Senate leaders are wary of using reconciliation but have also indicated that they will do so if necessary. Pursuant to the budget resolution passed earlier this year, the reconciliation process may not be used for health reform before October 15.

Assuming both the House and Senate pass health reform bills, a conference committee would be formed with leaders from both chambers to work out the differences. Any final bill approved by the conference committee would need to be voted on again by the full House and Senate before being sent to the president for signature or veto. The White House has indicated it would like to have a bill on the president's desk by Thanksgiving.

Senate Finance Releases Its Draft Bill

On September 16, Senate Finance Committee Chairman Max Baucus (D-MT) unveiled his long awaited health reform bill, the America's Healthy Future Act. The bill would cost $856 billion over ten years. Here is an overview of some of the key provisions in this bill:

• Expansion of Medicaid for everyone living at or below 133 percent of the federal poverty line (FPL) in 2014; states would be required to pay for part of this expansion
• Premium subsidies for low-income persons who are not Medicaid eligible up to 300 FPL
• A requirement that all individuals obtain insurance by 2013; failure would result in a $3,800 annual penalty
• No employer-mandate to provide health coverage
• Creation of regional non-profit health insurance co-operatives to compete with private insurers
• Creation of state-based health insurance exchanges where people could go to buy insurance; participating insurers would meet strict requirements to participate in the exchange, e.g. no pre-existing condition exclusions, no charging high rates based on health history
• To help pay for these changes, the bill would impose an excise tax on health plans in excess of $8,000 for an individual plan and $21,000 for a family plan

RESULTS welcomes the Senate Finance Committee producing a bill because it once again moves the health reform process forward, which was stalled until the committee acted. We are also very pleased that the bill matches the House in expanding Medicaid everyone at or below 133 percent FPL. However, the lack of full federal financing is troublesome. This would place a heavy burden on already cash-strapped states and potentially force them to cut the program in other areas.

In addition, while the bill does provide subsidies for lower-income persons to buy insurance, they are not as generous as the House and HELP Committee health reform bills. This will make it harder for working families to buy coverage. Also, a provision that would force employers to pay a penalty for workers that go on public health programs like Medicaid could encourage employers not to hire lower-income workers.

We are also concerned that the bill lacks a public health insurance option for people to choose as an alternative to private coverage. The "public option" is not only important in providing an affordable insurance alternative to consumers; it will also help reduce costs for the entire system, which is essential to reform. The Baucus plan does include non-profit cooperatives, but most experts agree that these would be ineffectual in reducing costs and promoting competition. In fact, the non-partisan Congressional Budget Office says that health co-operatives "seem unlikely to establish a significant market presence in many areas of the country."

The Baucus bill has been met with a lukewarm reception. No Republicans have pledged to support it, despite months of bipartisan negotiations and concessions. In addition, several Democrats, including Finance Committee members Jay Rockefeller (D-WV) and Maria Cantwell (D-WA) have pledged to vote no in committee unless significant changes are made. The Finance Committee mark-up will begin the week of September 21, with many amendment proposals expected from both Republicans and Democrats.

The High Cost of Doing Nothing - More Deaths, More Debt

A new study from Harvard Medical School estimates that nearly 45,000 people die each from lack of health insurance in the United States. This more than doubles estimates from an Institute of Medicine study done several years ago, which put the number at 22,000 per year. The study finds that people who lack health coverage at 40 percent more likely to die than those with private coverage. This stems from the lack of access to care for uninsured persons and medical breakthroughs for preventable disease, from which those with insurance benefit.

In addition, a report released May 21, commissioned by the Robert Wood Johnson Foundation and prepared by the Urban Institute, examines the cost of inaction on health care reform. Health Reform: The Cost of Failure shows, "If federal reform efforts are not enacted, within 10 years the cost of health care for businesses could double, and the number of uninsured Americans could reach 65.7 million - with middle-income families hardest hit."

These startling statistics once again highlight the absolute necessity of meaningful health reform now. When opponents say we cannot afford reform at this time, remind them of these costs to all of us in blood and treasure that comes from doing nothing.