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Senate Plan for High-Risk Pools Has Pluses, Minuses for California

Now that the Senate has cleared the procedural threshold to begin debate on Democrats’ health care reform legislation, HHS joined other supporters of the proposal in campaigning to build support for reform.

On Nov. 24, HHS Secretary Kathleen Sebelius released reports highlighting benefits that each state would derive from health care overhaul proposals under consideration in Congress.

According to the HHS report, enacting reform proposals would provide an immediate opportunity for many medically uninsurable Californians to get coverage. Under Section 1101 of the Senate proposal, the newly created high-risk pool would be open to people with pre-existing conditions who have been uninsured for at least six months.  The program would end by Jan. 1, 2014, when new health insurance exchanges are slated to be up and running.

The program would appear to be a boon for Californians on the wait list for enrollment in the state’s own high-risk pool — the Major Risk Medical Insurance Program, or MRMIP.  MRMIP’s enrollment cap was reduced from 8,101 to 7,100 last year, and enrollment in the program has dropped by about one-third because of budget limitations since Gov. Arnold Schwarzenegger (R) took office in 2003.

The Senate’s high-risk pool would be subject to the same kind of fiscal limitations that have moved California regulators to cap enrollment in MRMIP.  The proposal would permit the HHS secretary to stop accepting applications for the high-risk pool once it has exhausted the $5 billion the proposal would appropriate for the program and premiums no longer cover claims.  The Congressional Budget Office estimates that this would happen in mid-2011.

Because the Senate bill would supersede state laws for their own high-risk pools, MRMIP subscribers could face steep increases in what they would have to spend under the new program.  The Senate’s proposal would tie limits on out-of-pocket costs for coverage through the pool to similar limits for high-deductible plans linked to health care savings accounts — currently, $5,950 for individuals and $11,900 for families.  MRMIP caps out-of-pocket costs at $2,500 for individuals and $4,000 for families.

The Senate proposal, however, makes no mention of a benefits cap, which could aid Californians enrolled in the pool.  MRMIP caps annual benefits at $75,000 per beneficiary and has a lifetime maximum benefit of $750,000 for individual beneficiaries. 

More details on provisions of the Senate bill, prospects for passage and efforts to shape the debate are provided below. 

What’s in the Senate Bill

  • The Senate health care reform bill (HR 3590) would extend the solvency of Medicare’s Hospital Insurance trust fund by at least two years, new Congressional Budget Office analyses of the bill show, CQ Today reports. The scores also reveal that $118 billion in cuts to Medicare Advantage plans over the next decade would lead to a reduction in MA benefits and prompt 2.6 million beneficiaries to sign up for traditional Medicare by 2019 (Wayne, CQ Today, 11/21).
  • The legislation would create a new Independent Medicare Advisory Board to rein in Medicare spending, but the board’s power would be more limited by the current Senate bill than earlier versions of the legislation, according to a CBO analysis. Limits on the board’s power to set payments to hospitals, doctors, hospices and several durable medical equipment suppliers mean that nearly $410 billion in annual Medicare spending would be outside of the board’s purview, according to CQ Today (Armstrong, CQ Today, 11/22).
  • The Senate bill no longer contains a proposal to eliminate the antitrust exemption currently granted to health insurance companies, HealthLeaders Media reports (Masterson, HealthLeaders Media, 11/23). Democrats wanted to strip insurers of the exemption — which was granted in 1945 — in order to make health and malpractice insurers accountable under antitrust laws that ban price-fixing, bid-rigging and dividing markets between them (California Healthline, 9/21).


  • Senate Democrats have abandoned any intentions to invoke the budget reconciliation process, a fast-track parliamentary strategy that would allow them to avoid a Republican filibuster and advance the health reform bill to the floor, CQ Today reports (Wayne, CQ Today, 11/17). Under the reconciliation process, Senate Democrats would need a simple 51-vote majority, instead of the required 60 votes, to pass the legislation (Dennis, Roll Call, 11/17).
  • On Nov. 23, Sen. Charles Schumer (D-N.Y.) said that Democrats are determined to pass a health reform bill, with or without Republican support, the AP/Boston Globe reports (AP/Boston Globe, 11/24). Schumer added that both moderate and liberal Democrats likely will have to make concessions to ensure passage of a final reform bill (O’Brien, “Blog Briefing Room,” The Hill, 11/23).

State Actions

  • A least 11 states plan to use bills or ballot questions to block aspects of pending health reform legislation, providing “crucial hints” about which states will try to opt out of a proposed public health insurance plan option as well, The Hill reports. The Congressional Budget Office has estimated that one-third of states would opt out of the Senate’s public plan, limiting the public option pool to three to four million U.S. residents — about one million less than the House’s version (Romm, The Hill, 11/21).

Shaping the Debate

  • On Nov. 22, Republicans criticized Sen. Mary Landrieu‘s (D-La.) vote for the procedural motion to begin debate on the Senate health care reform bill (HR 3590), alleging that her vote came as a result of a trade-off added to the bill that would give more Medicaid funding to the state and calling her vote the “new Louisiana Purchase,” The Hill  reports (Fabian, The Hill, 11/21). Roll Call reports that Senate Majority Leader Harry Reid (D-Nev.) helped secure Landrieu’s vote by including a provision into the bill that would provide increased Medicaid funds for states recovering from major disasters, such as Hurricane Katrina (Pierce, Roll Call, 11/21).
  • On Nov. 19, America’s Health Insurance Plans announced its opposition to the Senate health reform bill, arguing that it would drive up premium costs for those already insured. The group’s statement was similar to the one it made earlier this month in reference to House legislation (HR 3962) (Ackley, Roll Call, 11/19).
  • During a meeting on Nov. 19, members of the Republican Governors Association said that the Senate health care bill would place a financial burden on their states at a time when they are already “overburdened” with increased Medicaid costs, the New York Times‘ “Prescriptions” reports. According to Gov. Mitch Daniels (R-Ind.), many Democratic governors feel the same way but are reluctant to cross the White House by publicly opposing the legislation (Nagourney, “Prescriptions,” New York Times, 11/19).
  • AARP and the American Medical Association have launched a joint ad campaign in support of the Senate reform bill, which they say would benefit Medicare, The Hill‘s “Blog Briefing Room” reports (Fabian, “Blog Briefing Room,” The Hill, 11/23).
  • House Republicans urged AARP to rescind its support for the Democrats’ health reform legislation in the wake of a CMS report indicating that cuts to Medicare under an overhaul could prompt some providers to stop accepting Medicare patients, CongressDaily reports. The organization said it will continue to endorse the Democrats’ plan (Hunt, CongressDaily, 11/18).
  • Outside groups that back health reform are launching a multimillion-dollar advertising campaign to defend about one dozen House Democrats who voted for reform and are vulnerable in upcoming elections, Roll Call reports. The ads come after the lawmakers were surprised by ad campaigns launched by groups opposed to reform immediately after the House approved its reform bill on Nov. 7 (Newmyer, Roll Call, 11/18).
  • Plastic and cosmetic surgeons have criticized a 5% tax on elective cosmetic surgery procedures included in the Senate’s health care reform bill, saying that it would target working women and baby boomers, be difficult to collect and might not generate the projected amount of revenue, Roll Call reports. The tax, which some call the “Botax,” is expected to generate $5.8 billion in revenue over 10 years (Roth, Roll Call, 11/19).
  • The International Brotherhood of Teamsters has announced its opposition to the excise tax on “Cadillac” health plans in the Senate health reform bill. Labor unions such as the Teamsters have been an ally of the administration on health reform and other issues (Miller, Washington Times, 11/19).
  • Citizens for Responsibility and Ethics, a government watchdog group, has filed a complaint with the Office of Congressional Ethics alleging that Rep. Michele Bachmann (R-Minn.) violated House rules by falsely portraying a recent “tea party” protest event held at the Capitol as a press conference and misusing her official Web site to advertise it, Roll Call reports. OCE officials declined to say whether the allegations will be reviewed (Yachnin, Roll Call, 11/18).
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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