Health law revision suggestions pour in from lawmakers, groups

Kaiser Health News reports that vulnerable Democrats are looking for alternatives to the health law's mandate that nearly all Americans carry health insurance. "Under political pressure as a result of the new health law, Sen. Ben Nelson, D-Neb., has asked the Government Accountability Office to study alternatives to the controversial mandate requiring most Americans to obtain coverage." Because Nelson is from a typically "red" state, Republicans have targeted him as one Democrat willing to play ball on scaling back the law (Vaida, 11/17).

In the meantime, Sens. Scott Brown, R-Mass., and Ron Wyden, D-Ore., are planning to introduce legislation Thursday to allow states to opt out of the mandate sooner than the health overhaul stipulates, Politico reports. "The bill is a significant step on both sides of the aisle. It's an effort by a Senate Democrat to ease one of the law's requirements. And it's the first Republican-sponsored effort to modify — rather than repeal — a provision in the law." The enacted law allows states to set up systems without a mandate on their residents to buy insurance so long as the plan meets the minimum requirements for coverage that the Department of Health and Human Services will lay out. "States can begin applying for mandate waivers in 2017, three years after the individual mandate is set to take effect. … This new legislation would roll the waiver date back to 2014, when the individual mandate comes into effect" (Kliff, 11/17).

CQ Healthbeat: As some lawmakers talk about changing the law, others are pressuring HHS on the law's Medical Loss Ratio rule, which stipulates how much of the premiums insurance companies collect must be spent on medical care. "Under the rules, policies sold to individuals and small groups must spend at least 80 percent of premiums for health care services and quality improvements. For policies sold to larger groups, the minimum is 85 percent. Insurers must give policyholders rebates if the plans pay out less than those amounts. House Energy and Commerce Committee member Marsha Blackburn, R-Tenn., made her case to HHS Secretary Kathleen Sebelius in a letter asking her to allow insurers to count efforts to combat health care fraud as quality improvements. That would improve insurance companies' bottom lines by giving them a more favorable MLR and making rebates less likely" (Adams, 11/17).

The Washington Post's The Plum Line Blog: President Barack Obama is admitting in a Richard Wolffe book that the Democrats were outplayed on the health overhaul debate by Republicans. "Here's the President on page 75: 'You have to give the Republicans credit, just from a pure political perspective, that they used every instrument available to them in the Senate to prolong the process in such a way that helped drive down support nationally, that gave everybody a sense that somehow Washington was broken,' he told [Wolffe]. 'At a time when everybody was worrying about jobs, for us to have to spend six to nine months on this piece of legislation obviously was not helpful'" (Sargent, 11/17).

The Hill: That hasn't stopped Democrats from seeking Obama's help in the upcoming session of Congress, however. "Some Democrats expect Obama to get engaged sooner in legislative debates and to make himself more available to members of Congress, who keep close tabs on the views of their constituents. 'It's about leading early on in the battles to be had in the days ahead, and it's about getting out there,' said Sen. Robert Menendez (N.J.). ... Obama has conceded he spent too much time in 2009 and 2010 focusing on policymaking at the expense of political salesmanship. As a result, the healthcare reform bill that Democrats thought would become a popular success fell flat with voters, costing Democrats on Election Day" (Bolton, 11/18).

The Baltimore Sun's Maryland Politics Blog: "House Democrats are trying to keep the spotlight on Congressman-elect Andy Harris of Maryland. They're demanding that Republicans in Congress declare whether they plan to use taxpayer-subsidized health insurance for themselves and their families, even as they call for repeal of the new health care law. Harris, you may recall, got unwanted publicity on Capitol Hill after he asked about health benefits during a private briefing for 250 newly elected House members, staff and family this week. The Baltimore County Republican was reported to have expressed surprise that the federal health care plan, which is offered to all federal employees and members of Congress, would not start covering new congressmen until almost a month after they are sworn in" (West, 11/18).

The Washington Post looks at the campaign against the law by one of its most strident opponents: "The U.S. Chamber of Commerce astonished even the most jaded Washington-watchers last year when it reported spending nearly $150 million on lobbying. The figure obliterated all previous records and cemented the chamber's reputation as Capitol Hill's most formidable lobbying force. But it turns out that a lot of that money came from an injection of funds from another lobbying powerhouse: America's Health Insurance Plans." AHIP spent $86.2 million toward defeating the health overhaul by giving that money to the U.S. Chamber of Commerce (Eggen, 11/18).

The Chamber's leader is also renewing his call to fight the health law, The Washington Post reports in a related story. "'We have never seen anything on this scale before. It defies all logic and common sense,' Chamber President Thomas J. Donohue said in a speech to the group's board of directors. He vowed to fight many of the new rules outlined in the health-care reform law and the financial overhaul bill. 'We cannot allow this nation to move from a government of the people to a government of the regulators'" (Dennis, 11/17).

But, Donohue "says the trade association has no intention of working against President Barack Obama's re-election in 2012 after spending millions to defeat Democrats in the midterm election," The Associated Press/Bloomberg Businessweek reports. (Kuhnhenn, 11/17).

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.