Seeking to avert the collapse of major health care legislation, the White House and Democratic leaders in Congress face a crucial decision about whether to use a procedural maneuver that would allow them to advance the bill despite the loss of their 60-vote majority in the Senate.The maneuver, known as budget reconciliation, could allow President Obama and his party to muscle the legislation through Congress with a simple majority vote in the Senate. But it carries numerous risks, including the possibility of a political backlash against what Republicans would be sure to cast as parliamentary trickery. The procedure is also subject to complex rules that could make it difficult for Democrats to include all the provisions needed to win approval of the bill, especially among rank-and-file House Democrats. For instance, it might be difficult to include provisions related to insurance coverage for abortions.Still, for Mr. Obama, it may be the only route available to win passage of the sort of ambitious overhaul that he has pressed as his top domestic priority. And the White House and Congressional leaders have known all along that they might need to employ the tactic to finish a health bill.”The idea that at any given time the Senate would have 60 votes was not what we would call the most ironclad assumption,” the House speaker, Nancy Pelosi, said at a news conference on Thursday. “We have always thought, what if? You know, what if the policy decisions are such that they can’t get 60 votes for it?”Senior Congressional aides said that lawmakers and the White House were increasingly focused on a plan by which the House would adopt the health care bill approved by the Senate on Dec. 24, with any changes made in a separate bill using the budget reconciliation maneuver. But Democratic leaders are no longer confident that rank-and-file House Democrats would be willing to go along. The victory by the Republican, Scott Brown, in Massachusetts last Tuesday not only denied Democrats their 60th vote, but raised a specter of fear for Democrats over the midterm elections. Some Democrats said that regaining the support of the caucus could depend heavily on what Mr. Obama says in his State of the Union speech on Wednesday.Republicans, however, have made clear that they will portray Mr. Obama and Democrats as trying to use a hardball tactic to win passage of the health care legislation.”Less than a week after the Massachusetts special election, the Obama administration is vowing to ‘stay the course’ and double down on the same costly, job-killing policies that are leaving America’s middle-class families and small businesses high and dry,” said the House Republican leader, Representative John A. Boehner of Ohio. Some Democrats seem prepared to give up on a health care bill or to put it off for several weeks. Others have begun calling for a sharply scaled-back measure that they hope could win bipartisan support. But it is unclear if Republicans would cooperate even on a modest bill. In the meantime, aides have been trying to devise a process by which the Senate could make changes to its health bill on a reconciliation measure even before the House voted on the Senate-passed health bill. Some lawmakers said House Democrats might have to vote first. The House could approve the Senate bill and send it directly to Mr. Obama, eliminating the need for any more votes. But House Democrats have refused to do so because they oppose numerous provisions in the Senate measure, including one that provided extra federal aid solely for Nebraska. Some House Democrats have also voiced opposition to an deal that the White House and labor unions reached on a proposed tax on high-cost, employer-sponsored medical insurance plans.Passing even a modest reconciliation bill to make changes to the Senate health measure would not be easy. The mere mention of reconciliation infuriates many Republicans, even though they occasionally used the tactic when they were in the majority. At least one Democrat who opposed the maneuver earlier in the heath care debate, Senator Kent Conrad, Democrat of North Dakota and chairman of the Budget Committee, said he could go along with its limited use, depending on the specific changes to the health bill.

New York Times Article

If you’re considering individual health insurance coverage, you have to do some comparison shopping to find a plan with the right benefits and price to fit your needs. You’ll find there are many plans available to choose from: lower-cost basic benefit plans, more comprehensive benefit-rich plans, HSA-compatible plans and short-term temporary plans. How do you know what’s right for you?

This is the first of three blog posts focusing on helping you assess your needs so you can make a sound decision. First, you’ll want to answer the question “What health benefits will I use?” so you’ll have an idea of how much coverage you need in a plan.

It helps to break the question down into smaller parts:

• Do I need to utilize PPO network doctors and hospitals?
• How often do I or other covered individuals visit a primary doctor? Specialists?
• Do I need coverage for prescription drugs?
• Do I want supplemental accident coverage?
• Do I want other optional benefits?
• Do I need coverage primarily for the “big ticket items” like accidents and illnesses?

Compare your plan alternatives side-by-side to see which plans offer the level of coverage you’re looking for. You’ll see that some plans offer very basic coverage while others provide a wider range of benefits and more flexibility with plan choices and benefit options. You may like the benefits on one plan more than another’s, but you may find its price to be outside of your comfort zone. That’s why the next step is to think about how each benefit affects the plans’ cost. In my next post, I’ll give some tips to help you find a plan with the right coverage and price. There are some tricks to getting the benefits you need while staying within your budget. Prepare yourself to answer this question:

“How much can I afford to spend?”

In the meantime, visit Celtic’s Consumer Learning Center to learn more.

Hopefully the cottage industry in health care reform paranoia can calm down now. No one in Washington is talking about strategies to short circuit the election results in Massachusetts this week in which state Senator Scott Brown, soon to be the Republican’s “41st vote,” upset the Democratic candidate in a special election. While some dismayed Democrats did consider ways of passing legislation before Senator Brown is sworn into office, there was never really a chance that would happen.

One reason Senator Brown won was a reaction to the hubris Democrats in Congress displayed over the past 12 months concerning health care reform. Favors were dealt out to key lawmakers party favors at a kid’s birthday if that’s what it took to secure their votes. A temporary exemption from an excise tax on expensive health insurance policies was crafted for unions to get their support. Deals were brokered with large pharmaceutical companies and others to get them on-board. This is politics as usual, practiced by Democrats and Republicans alike.

Engaging in politics as usual, however, was the problem: voters in 2008 expressed their desire for change. Politics as usual is exactly what the public did not want.

Given this reality, Democrats passing a health care reform bill by jamming something through would be political malpractice of the highest order. Besides, there were never enough rank-and-file lawmakers in the caucus willing to go along with such silliness. So, not surprisingly, instead of passing health care reform by manipulating the rules, Democrats are now taking a breather, gathering their thoughts and developing a strategy for moving forward.

After some reflection, Democratic leaders will realize the scope of health care reform they can pass is extremely limited. Expensive, intrusive reforms are no longer an option. This doesn’t mean they can’t pass some version of reform. It just means that the reform they can pass will need to be less expensive, less comprehensive, and less intrusive than they had hoped.

What health care reform can be passed, and how long it will take, will depend in large part on which of two strategies the White House and Congressional Leaders choose to take.

President Barack Obama, Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi can either pursue health care reform that gains the vote of the fewest number of Republican lawmakers necessary or legislation that can earns support from a meaningful percentage of Congressional Republicans. Following the former strategy would see them negotiate almost exclusively with Senators Olympia Snowe and Susan Collins. Seeking truly bi-partisan reform would require negotiating with a far larger group.

The bare minimum strategy will be tempting. It requires the least amount of compromise. As I wrote the other day, they could bare the current legislation down to its cost containment provisions, health insurance reforms, and some of the less expensive ideas to expand coverage to more Americans. Such a scaled-back bill might get the support of either Senator Snowe or Senator Collins – or both. (Who knows, even Senator Brown might be supportive. He does have to run for re-election in Massachusetts in 2012. He won the special election by positioning himself as an independent and downplaying his Republican affiliation. Showing his independence from hard-line Republicans is a reasonable political strategy for him.)

The problem with the bare minimum strategy is its what got Democrats into their current mess. By pursuing health care reform that never had a chance of gaining broad support, President Obama, Senator Reid and Speaker Pelosi assured a long, politically ugly legislative process – one that required the kind of deal making that voters, especially independent voters, had voted to change in 2008.

Instead, Democrats could take the advice of House Majority Whip Jim Clyburn, who observed, “Medicare wasn’t done in one fell swoop. You lay a foundation and you get this thing done over time.” If Democrats had taken this approach from the beginning health care reform might have been enacted already. Instead months were spent battling over issues like a government-run health plan that neither Republicans nor enough moderate Democrats could support. While hanging tough for a liberal wish list pleased their base (for awhile), it was inevitable moderate Democrats would determine the final health care reform package.

To gain sufficient Republican votes, Democrats will have to be willing to accept fairly limited reforms for now. They will need to include some meaningful malpractice reform. Democrats needs not include every and any provision Republican demand. Their goal is not to pass a bill by unanimous consent. Democrats just need to offer enough to peel off a significant number of Republicans – say 12 in the Senate and 35 or so in the House. Legislation with meaningful malpractice reform and a low sticker price could do that. Is this realistic? Well, there are a number of Republicans running in moderate seats, too. Running for re-election as a candidate who “opposed President Obama at every turn” is not a recipe for job security in such seats.

If Democrats succeed in passing bi-partisan reform they’ll have laid the foundation for future health care reform efforts. But what if Republicans unify behind a strategy of blocking reform of any kind, regardless of how moderate that reform might be? Such a strategy would just confirm that the GOP is the party of politics as usual. And in 2010 that’s not an image voters are likely to reward.

According to the article “Covering the Bases: Possible Options If You Miss Open Enrollment” by Amy Rubino on hometownglenburnie.com, there is no annual open enrollment period for Medicare Supplement Insurance medigap plans, similar to purchasing individual health insurance.

Medicare Part D and Medicare Advantage Plans have certain times you can enroll but it’s a little different for Medigap plans, which are designed to fill in the missing pieces of Original Medicare.  The article points out that the best time to think about enrolling in a Medigap plan is within the first 6 months that you are both age 65 or older and enrolled in Medicare Part B.

The reason this is the best time is because during this 6 month period the health insurance company that sells you the Medigap policy cannot refuse to sell you a plan and cannot charge you more because of pre-existing conditions.  There are also some other specific situations that would grant you guaranteed right to purchase a Medicare Supplement Insurance plan regardless of your health conditions.

The health care reform package being finalized by Congressional Democrats and the White House is chock full of benefits for specific states and interest groups. Some of that is inevitable in any legislation, regardless of the party in power. But the health care reform bill is widely viewed as an extreme example – we’re talking cotton candy level on the sweetness scale.

Now a Democratic Senator is trying to tone down the glucose level of the health care reform bill. Senator Russ Feingold has sent a letter to Senate Majority Leader Harry Reid and House Speaker Nancy Pelosi requesting that “sweeteners” be removed from the final health care bill, January 14, 2010 “originally inserted to win over the support of certain members of Congress.” In the letter, Senator Feingold recognizes that there are “valid policy or fairness reasons why certain states or interests may receive seemingly different treatment.” However, he specifically cites “unmerited Medicaid assistance to certain states and carve-outs to avoid cuts to certain Medicare Advantage plans” he describes as “indefensible.” These provisions, he charges, “are intended to provide an undeserved windfall to specific states” and should be removed from the health reform bill.

Senator Feingold is right, both from a public policy perspective and from a political view. Both Democrats and Republicans engage in the practice of securing votes by inserting provisions into bills aimed at benefiting a specific Senator’s home state. That’s the American way. Really, it is.

But health care reform is complicated, controversial and sensitive. Hyper-sensitive. This is an issue that has generated charges of the American government threatening to kill old people, death threats against members of Congress, and outrageous hyperbole that only the CFO’s at Fox News and MSNBC could love. More significantly, this legislation is also going to impact every American in a highly personal way and significantly impact one-sixth of the nation’s economy. An issue like this should not be subjected to politics as usual. Removing the sweeteners makes sense.

Not that anyone asked, but I don’t think the deal struck yesterday with the unions yesterday falls into the sweetener category (at least not what we know so far. Apparently the deal postpones a tax on rich health plans until 2018, but only for coverage required by labor agreements and for state and local government workers. The compromise also removes vision and dental plans from the calculation of the value of a plan and raises the threshold for taxation from $23,000 for family coverage to $24,000. There are also adjustments for older workers and women.

The reason why I don’t view this deal as a pay-off for union support is because the nature of union agreements means a transition period make sense. Collective bargaining agreements have been made pursuant to the rules in effect today. These rules encourage unions to trade-off wage increases for enhanced (and more expensive) health benefits. To now change the rules without allowing time for new negotiations seems a bit unfair. Whether five years is needed for the transition or a shorter period of time would be sufficient is a level of detail I can’t address.

The same logic should apply to whatever mandated medical loss ratios wind up in the final bill. Health care reform is likely to require health plans to spend a minimum of 80 percent (for individual and small group coverage; 85 percent for large group plans) on claims payments. The legislation passed by the Senate would impose this requirement effective January 1, 2011. yet health plans have contracts in place with brokers, vendors and others that were made under the old rules. To now change those rules and impose spending requirements is both unfair and impractical. The disruption and pain resulting from failing to provide an adequate transition to mandated medical loss ratios will be felt not just by brokers and insurers, but by consumers and voters as well.

Should President Obama, Senator Reid and Speaker Pelosi eliminate the political sweeteners in the health care reform legislation they’re writing? Yes. Should they eliminate transition periods that ease the transition to the new world they’re creating? Yes. And those transition period should be offered to unions and health plans.