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March 22, 2010

Washington Health Policy Week in Review Archive c0a4053f-1688-483b-a003-b587be14ad76

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House Passes Democrats' Health Care Overhaul Package

By Edward Epstein, CQ Staff

March 22, 2010 -- The House passed an historic health care overhaul package late Sunday, clearing a bill to expand coverage to an estimated 32 million more Americans and passing a separate measure making significant changes to that bill.

The debate was hard-fought and Sunday's roll calls followed months of intense negotiations and legislative haggling that finally gave Democrats a victory the party has sought for nearly five decades.

President Obama applauded the action and praised Democrats for taking what he acknowledged was a tough vote for some. "This is what change looks like," said Obama a short time after in televised remarks from the East Room of the White House.

"At a time when the pundits said it was no longer possible, we rose above the weight of our politics," he said, adding, "We didn't give into mistrust or cynicism or fear. Instead we proved we are a people still capable of big things."

House Speaker Nancy Pelosi then celebrated with her leadership team and called the action "a great act of patriotism" and stressed the legislation as "fiscally sound."

The two measures were pushed forward without the help of a single Republican. By 219-212, the House first cleared the Senate-passed health bill (HR 3590) for Obama's promised signature. Thirty-four Democrats joined all 178 Republicans in opposing the Senate bill.

Republicans then attempted unsuccessfully to shelve the reconciliation measure. The House defeated, 199-232, the GOP motion to send that bill (HR 4872) back to the Budget Committee to add tougher language on abortion funding that was part of a House-passed health bill (HR 3962). Twenty-one Democrats voted with the GOP.

Democrats then turned to the reconciliation bill that reflects deals reached by congressional Democrats and the White House to modify the version earlier passed by the Senate, passing it on a vote of 220-211. Thirty-three Democrats joined Republicans in opposition.

The Senate is expected to take up the bill as early as Tuesday under special budget reconciliation rules that will shield it from filibusters, but not from a blizzard of GOP-sponsored amendments.

For House Democrats, the vote to send Obama the Senate-passed health care bill was a painful one. The legislation offers less generous subsidies than they wanted to help individuals buy health insurance and contains a number of special provisions that critics have assailed as sweetheart deals designed to buy off votes in the Senate the first time around.

Republicans said they will continue to accuse everyone who voted for the bill of supporting the "Cornhusker Kickback," the "Louisiana Purchase," "Gator Aid" and similar provisions that offer some states more Medicaid payments than others. The reconciliation bill would strip some but not all of those provisions.

But once Democrats discovered there was no way to vote on the reconciliation bill ahead of the Senate-passed measure, they accepted the risks and cast their votes.

Long Debate Draws To Close
In closing the rare Sunday debate, Pelosi, D-Calif., cast the vote in historic terms. "Today we have the opportunity to complete the great unfinished business of our society by passing health care reform that is a right, not a privilege for all American citizens," she said.

She also pushed back against Republican criticism that the legislation is socialist or un-American. "This is an American proposal that honors the traditions of our country," she said.

Minority Leader John A. Boehner, R-Ohio, accused the Democrats of recklessly disregarding the will of the American people, who, he said, reject the majority's ideas. "We have failed to listen to America and we have failed to reflect the will of our constituents," he said.

And Boehner had a warning for the Democratic majority: "In a democracy you can defy the will of the people for only so long."

"Shame on you for substituting your will for that of your countrymen," he added.

In floor statements, members on both sides were clearly aware that the more than a year-long fight over health care was drawing to a close.

Majority Leader Steny H. Hoyer, D-Md., said the attacks of Republicans and other opponents of the health package were as wrong as Republican attacks on Social Security, passed in 1935, and Medicare, enacted in 1965. "Those slurs were false in 1935; they were false in 1965; they are false in 2010. And this bill will stand in the same company — for the misguided outrage of its opposition, and for its lasting accomplishment for the American people," he said.

Another Democrat, Debbie Wasserman Schultz of Florida, said the bill was essential and urgently needed. "Our current system is broken. It's un-American. The nightmare ends tonight," she said.

Republicans warned that the bill would saddle businesses with new taxes and force all Americans to buy coverage they may not want. "This bill is not what the American people want," said John Kline of Minnesota, ranking Education and Labor Committee member. "They are imploring us to start over.

"This is our last chance to stand with the American people who sent us here and start over," Kline added.

Referring to the bill, Peter Roskam, R-Ill., said, "Just because it's historic doesn't mean it's good."

Throughout the debate, Democrats took turns touting bill's provisions they are gambling will become popular — expanding health care coverage, controlling the spiralling cost of insurance and promising the legislation will protect consumers from insurance company abuse.

"There are times in history when action is required," said Jim McDermott, D-Wash. Joseph Crowley, D-N.Y., called it "a crisis that has to be dealt with."

Republicans rejected the legislation as a high-cost government takeover that would impose hardships on employers and cripple the economy. Many called it a "budget-buster," and "Pelosicare."

"The American people have spoken. They don't want a government takeover of health care," said Dave Reichert, R-Wash.

Support for Rule
In the day's first real test, the House adopted a rule for debate paving the way for Sunday's climactic votes. The rule was adopted on a 224-206 tally.

Democratic leaders were all but assured of victory on their health care legislation when they and the White House struck a deal Sunday afternoon with Bart Stupak, D-Mich., leader of a holdout group of anti-abortion Democrats who wanted assurances that nothing in the legislation would permit use of federal funds to cover abortions.

The holdouts agreed to vote for the package after Obama promised to issue an executive order once the legislation is enacted that offered the reassurance they sought.

The deal, according to Stupak, put the Democrats' vote tally "well past 216," the total needed for passage.

Still, the vote on the rule (H Res 1203) was the first on which members had to actually go on record in a chain of decisions that will have ramifications not only for the nation but also for their own political survival.

Indeed, GOP members kept up a barrage of attacks on the legislation even as hundreds of protestors massed outside the Capitol shouting, "Kill the bill!"

Democratic leaders had hoped to spare their members a direct vote on the Senate bill (HR 3590). For days, there had been speculation that the House Rules Committee would issue a self-executing rule that would have deemed the unpopular Senate bill passed once the House passed the reconciliation bill reflecting changes negotiated by House Democrats, their Senate counterparts and the White House.

But on Saturday, Democrats scrapped that idea after they said the Senate parliamentarian ruled that they could not vote on the reconciliation bill before they cleared the Senate bill. The Congressional Budget Office told the House leadership that it would be impossible for it to score the legislation if it were enacted in that order.

At that point, Democrats reverted to a more straightforward order of consideration for the bills — bracing for GOP attacks on them for supporting a bill that contained special deals, even though many of those deals would be removed if the Senate clears the reconciliation bill and the president signs that measure too, as he has promised.

Republican members pounced as expected, as the rule was considered. "This bill has special deals for special folks," said Ted Poe, R-Texas.

Others taunted the Democrats, warning the only thing they could be sure of at this point was enactment of the Senate bill they dislike. Shouting matches erupted on the floor.

Democrats weren't swayed, however much they may have rued the state of play. The finish line is in sight, they held fast.

First posted March 21, 2010 6:44 p.m.

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Embracing Obama's Executive Order, Anti-Abortion Holdouts Fall in Line

By Clea Benson, CQ Staff

March 21, 2010 -- For months, Bart Stupak of Michigan and a group of fellow House Democrats withheld support for their party's health care overhaul unless leaders would agree to include House-passed language to impose an ironclad ban on federal funding of abortion.

But on March 20, as a critical series of votes approached, members of Stupak's bloc came to the realization that Democratic leaders were gathering enough votes to pass the overhaul no matter how the abortion opponents voted. So they agreed to a side deal with the Obama administration: The holdouts agreed to support the legislation and, in exchange, President Obama agreed to issue an executive order to clarify that no taxpayer dollars could be spent on abortion in the reconfigured health care system.

"This bill was going to go through," Stupak said at a March 21 news conference, during which he was joined by several other anti-abortion Democrats. "So therefore, to protect the sanctity of life, what was our best enforceable option?"

Among the legislators present were Marcy Kaptur and Steve Driehaus of Ohio, Kathy Dahlkemper of Pennsylvania, and Alan B. Mollohan and Nick J. Rahall II of West Virginia.

The deal did little to defuse the passionate debate over abortion, though. Almost as soon as Stupak finished his remarks, Republicans and the U.S. Conference of Catholic Bishops dismissed the executive order as a fig leaf that would not carry any weight.

"The law of the land trumps any executive order, which can be reversed or altered at the stroke of a pen by this or any subsequent president without any congressional approval or notice," House Minority Leader John A. Boehner, R-Ohio, said in a statement.

"Make no mistake, a 'yes' vote on the Democrats' health care bill is a vote for taxpayer-funded abortions," he added.

Some Democrats who oppose abortion took similar stands. Daniel Lipinski of Illinois did not appear at Stupak's news conference, and he said earlier in the day that he was "not part" of discussions on the executive order.

White House communications director Dan Pfeiffer responded that Obama's order would uphold existing bans on abortion funding in federal law.

"The health care legislation's restrictions against the public funding of abortions cannot be circumvented," Pfeiffer said.

During negotiations on the overhaul plan (HR 3590, HR 4872), Democratic leaders dispensed with the House abortion language and replaced it with a Senate provision that abortion foes deem less restrictive. Lawmakers like Stupak are concerned that funding in the legislation for community health centers and other programs could actually be used to provide abortion services, because individual sections of the bill dealing with the programs are silent on the issue.

Congressional Democratic leaders and the White House have maintained that the Senate language addresses all possible circumstances in which abortion could be provided.

And House lawmakers favoring abortion rights said Sunday that they signed off on the executive order precisely because it does not go beyond the Hyde amendment, which has been renewed in annual appropriations bills since the 1970s and bars federal funding for abortion unless the pregnancy is the result of rape or incest or threatens the woman's life.

"We said we would compromise to current law in making this a health care bill, not an abortion bill, and that's exactly what the executive order does," said Diana DeGette, D-Colo.

The key part of the executive order states: "The Act maintains current Hyde Amendment restrictions governing abortion policy and extends those restrictions to the newly-created health insurance exchanges. Under the Act, longstanding federal laws to protect conscience . . . remain intact and new protections prohibit discrimination against health care facilities and health care providers because of an unwillingness to provide, pay for, provide coverage of or refer for abortions."

Meeting with Pelosi
Neither side took credit for coming up with the language. Around noon on Sunday, lawmakers said they were summoned to the Capitol offices of Speaker Nancy Pelosi, D-Calif., to meet with White House staff. Two groups of lawmakers — one supporting abortion rights and one opposing abortion — were then sent to separate rooms to review a draft of the executive order. Within hours, the Stupak camp rallied behind the health care overhaul.

But both sides predicted that the fight would continue.

"We think it's something we can fix later," DeGette said. "We would like to overturn the Hyde amendment."

Stupak acknowledged that he would have preferred a strong statutory ban over an executive order. But he said there was little hope that such language could get through the Senate under the reconciliation procedure Democrats used.

"We cannot get more than 45 pro-life votes in the Senate," he said, adding that he would continue to work on legislation to strengthen abortion restrictions after the health care overhaul was passed.

Alan K. Ota and Alex Wayne contributed to this story.

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Health Bill's Deficit Reduction Rests on Future Policy Changes

By Alex Wayne, CQ Staff

March 18, 2010 -- To achieve huge projected deficit reductions in its second decade, Democrats' final health care bill assumes two major future policy changes that may never come to pass.

In 2019, according to a Congressional Budget Office report on the bill, Democrats propose to suddenly slow the growth of subsidies intended to help people purchase insurance plans through new state-based marketplaces called exchanges. In the same year, they would speed up the growth of an excise tax on high-cost insurance plans.

According to the CBO report, the subsidies would average about $5,200 per person in their first year, 2015. They would grow by $100 in 2016, $200 in 2017 and $300 in 2018 – but the growth slows to $200, on average, in 2019.

Meanwhile, the premium costs that would trigger the excise tax would grow by the rate of inflation plus one percentage point in 2019, the first after it takes effect. But in 2020, according to the CBO, the threshold to trigger the tax would grow at general inflation, as opposed to the Senate bill, which retained the extra percentage point. That difference would cause the reach of the tax to expand faster.

The CBO says that the two changes are a big reason the final health bill would achieve huge reductions in the deficit in its second decade —between one-quarter and one-half of a percent of gross domestic product, which Democrats say amounts to $1.2 trillion.

If provisions of the health bill aimed at controlling the growth of health care costs are successful, the two policy proposals might not be an issue. But if not, future Congresses will likely come under considerable political pressure to increase subsidies and slow the growth of the excise tax.

Rep. Joe Courtney, D-Conn., who led House Democrats' opposition to the excise tax, said the latest version of the proposal would not cause him to vote against the bill. Delaying the start date until 2018 for all plans would allow enough time for the purchasing exchanges to be established and for all plans to have the option to use those exchanges, which should help contain costs by encouraging competition and increasing risk pools.

"Really, it would become a very tiny slice of America that would really be exposed to the tax," Courtney said on Thursday. "And if it's not, four Congresses and a new president will have a chance to intervene."

One change Democrats plan for the health bill could reduce the likelihood that health care costs are brought to heel. According to the CBO, the final bill would weaken a proposed commission on Medicare payment policies. The CBO says that savings from the board would total only $13.3 billion in its first 10 years — $14.7 billion less than under the Senate bill.

But Democrats would more than make up for that loss of revenue by extracting bigger savings from the Medicare Advantage program. The CBO says that the final bill would cut federal funds for private Medicare Advantage plans by $132 billion over ten years, $13.7 billion more than in the Senate bill. And the bill would yield an additional $70.4 billion in savings from a line item that the CBO labels — without explanation — "Medicare Advantage interactions." That is $53 billion more than in the Senate bill.

It would cut the growth of Medicare payments by $157 billion, $9.9 billion more than the Senate bill. Some of those additional savings would be used to make bonus Medicare payments to primary care physicians — $8.3 billion over 10 years, according to the CBO.

The final bill also would not as severely reduce payments to hospitals treating high numbers of uninsured patients — so-called disproportionate share hospitals. The payments would be reduced by about $36 billion over 10 years, $7 billion less than under the Senate bill.

Richard Rubin contributed to this story.

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CBO Sets $940 Billion Price Tag on Final Health Care Bill

By Alex Wayne and Edward Epstein, CQ Staff

House Democratic leaders touted their final health care overhaul package Thursday, as the Congressional Budget Office posted its preliminary official cost estimate and President Obama again delayed a planned trip to Asia.

Speaker Nancy Pelosi, D-Calif., said, "This is historical. He wants to be here for the history."

The House is expected to vote Sunday afternoon on the final package, with floor action to follow in the Senate as early as next week. Obama put off his trip until June to help in the final push.

Pelosi predicted the CBO analysis will ease the doubts of some wavering House Democrats and said, "We feel very strong about where we are, how we proceed."

But she and her leadership team are still trying to nail down the 216 votes among Democrats they will need to pass the bill.

Top Democratic aides and Pelosi have been saying that until the CBO report came out and the final language of a bill amending the Senate-passed health legislation (HR 3590) was ready, leaders couldn't really whip members for their votes. But now, Pelosi said, she will go all-out. "We're going to share these numbers more fully with our members," she said.

She said that Republicans and private health insurance companies who oppose the Democrats' bill are going to do everything they can before the House vote to keep Democrats from reaching 216 votes.

Pelosi wouldn't confirm that she plans to use a so-called self-executing rule to clear the Senate-passed health care bill (HR 3590) and pass the accompanying reconciliation bill (HR 4872).

Republicans, who used the self-executing rule dozens of times when they were in control of the House, are sharply attacking Democrats for possibly using the parliamentary device for such major legislation. They want an up or down vote on the Senate bill.

Making the Numbers Work
House Majority Leader Steny H. Hoyer, D-Md., called the legislation the largest deficit-reduction legislation since 1993. CBO, in a preliminary score posted late Thursday morning, reported that the bill would cost $940 billion over 10 years, but thanks to reductions in Medicare spending and tax increases, it would reduce the deficit by a net of $138 billion during that period and by $1.2 trillion in its second decade.

To achieve that huge second-decade deficit figure, Democrats propose indexing to inflation only, rather than inflation plus one percentage point, the threshold at which high-cost "Cadillac" health insurance plans would trigger an excise tax. That means the tax's scope would grow even faster than in the Senate bill, because health insurance premiums tend to rise faster than inflation.

The bill would create state-based exchanges, or marketplaces, where individuals without employer-provided insurance could buy health coverage. Federal subsidies would be available to help cover the cost for many purchasers.

In the first five years of the exchanges, they would provide more generous subsidies for people buying policies than the Senate bill proposed. But in 2019, they propose to suddenly reduce the rate of growth of the subsidies to something closer to that of the Senate bill.

House Republicans said Democrats were "spinning for partisan gain" and accused them of "double counting" Medicare savings.

The final measure, according to a Democratic source, would pare the annual growth in Medicare expenditures by 1.4 percentage points per year, while closing the "doughnut hole" gap in prescription drug coverage and extending the program's solvency by at least nine years. It also would extend health insurance coverage to about 32 million people who currently lack it, leading to coverage of an estimated 95 percent of Americans.

Senate Fight
Hoyer said he is confident, but not certain, the bill would survive parliamentary challenges in the Senate, where Democrats intend to pass it under fast-track budget reconciliation procedures. That would permit passage of the bill by a simple majority rather than the 60 votes otherwise needed to surmount a filibuster.

"I won't say that I have 110 percent confidence with every judgment being made," Hoyer said. "I have 110 percent confidence that we have tried to make sure we are in compliance with the requirements [of reconciliation] and the anticipated rulings" by the Senate's parliamentarian.

Senate Republicans are expected to lodge points of order against provisions they suspect may not meet the strict budgetary rules of the reconciliation process. If their challenges are upheld by the chair (advised by the parliamentarian), it would require 60 votes to waive the point of order.

Hoyer said he has sought assurances from Senate Majority Leader Harry Reid, D-Nev., that the reconciliation measure can pass the Senate without changes.

"Sen. Reid has assured us there will be representations made, sufficient for House members to rely on as fact, that if they pass something it won't be changed or not passed in the Senate," Hoyer said.

He dismissed Republican criticism of the "deeming" procedure Democrats plan to use in the House. Instead of voting directly on the Senate bill, which many House Democrats call deficient, the rule governing debate on the reconciliation bill may "deem" the Senate bill cleared once the rule is adopted and the reconciliation bill is passed.

Hoyer likened it to adopting a conference report, the traditional method of completing legislation. "When you vote for the rule, you will vote for the Senate bill," he said. "But I will say, however, that the Senate bill will not pass unless it is amended, as a conference report would do. What we are doing is a process which in fact carries out exactly what you would do in a conference report."

The only difference, he said, is that the Senate bill will be amended after it is passed, instead of before.

House Rules Chairwoman Louise M. Slaughter, D-N.Y., said her panel could meet early Saturday, March 20.

Hoyer announced the House would convene at 1 p.m. Sunday, but the vote on health care would not begin until after 2 p.m. in keeping with the leadership's promise that members would have a full 72 hours to review the text of the final bill. That text was posted shortly after 2 p.m. Thursday on the Rules Committee's web site.

Obama had been scheduled to begin a trip to Asia on March 21, after delaying it once already to help Democrats round up votes.

Hoyer indicated that he would prefer that the president stay in Washington that day. "I think the president's presence helps," he said, in response to a question. "But need it? The president's been talking to folks, he's been working it. Wherever the president is, he can talk to them on the phone."

Obama took the hint. Later that day, White House Press Secretary Robert Gibbs said the president was putting off his trip until June to focus on the health care fight.

First posted March 18, 2010 10:34 a.m.

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Groups Urge Easier Standard for Proposed Incentive to Promote Health Information Technology

By John Reichard, CQ HealthBeat Editor

March 15, 2010 -- Doctors and hospitals are urging the Obama administration to ease its proposed standard to qualify for Medicare and Medicaid bonus payments for using health information technology. Too few doctors would be able to meet the standard, frustrating efforts under economic stimulus legislation to spur adoption of "health IT," providers warn.

In response to the complaints, Health and Human Services Secretary Kathleen Sebelius said that the administration doesn't want to go too easy. "A lot of American medical practices are seriously behind what's going on in other parts of the world," she said Monday.

"We are trying to get physicians on the escalator toward meaningful use, and we want to set the first step at the right level," said David Blumenthal, the head of the Office of the National Coordinator for Health Information Technology. Blumenthal said he couldn't comment specifically on the provider reactions because of the pending rule-making proceeding.

Sebelius and Blumenthal spoke in a telephone news briefing to announce $162 million in grants to 16 states to promote the development of statewide systems to exchange health data. The systems would exchange medical data among doctors, hospitals, insurers, employers and other participants in the health care system.

The American Medical Association said in comments Monday that the proposed rule to promote the meaningful use of health IT should drop an "'all or nothing' approach and require physicians to meet five of the 25 proposed objectives and measures instead of all 25." It said the final version of the rule should "eliminate the objectives and measures that don't directly apply" to the adoption of electronic health records, "such as checking insurance eligibility electronically."

In addition, it should "revise the definition of meaningful use for certain hospital-based physicians to broaden eligibility for the federal incentive programs," the American Medical Association said. It also recommended that the final rule should "reduce the number of quality measure reporting requirements and allow physicians to identify only three clinically relevant measures."

Studies of adoption of electronic health records (EHRs) "clearly show that it takes more time for smaller practices to adopt and implement EHRs because they have fewer resources and support," the American Medical Association said. "Aggressive timelines and criteria during the initial stage of the incentive program will only serve to undermine this effort."

The Federation of American Hospitals, which represents for-profit hospitals, agreed that the all-or-nothing provision should be eased. It also said the Health and Human Services Department (HHS) should revisit its regulatory timetable for adoption of health information technology because of the slower-than-expected launch of a program to certify that technology is "interoperable" — that it meets standards allowing it to be used with other providers' systems.

To qualify for the Medicare and Medicaid bonus payments, doctors and hospitals have to use IT certified as interoperable.

"This delay has lead to uncertainty in the marketplace and hesitation on the part of providers to make a substantial capital investment in products that may prove not to be a pathway to achieving meaningful use," the federation said in a March 9 comment letter.

The federation said it wasn't calling for an end to the start of penalties in 2015 for failing to make meaningful use of technology, but it added that the deadline for full implementation should be moved back to 2017.

The Medical Group Management Association has urged a one-year delay in the first stage of three proposed stages for adopting health IT. The proposed rule calls for the first stage to occur in 2011 and 2012; the association wants it to run through 2013.

HHS said in a news release that the $162 million in grants will help states develop plans that create non-proprietary data exchange systems meeting national standards. States play a critical role in the development of such systems, HHS said. Their development also will make it easier for providers to qualify for higher Medicare and Medicaid payments going to meaningful users of health IT, Blumenthal noted.

On Feb. 12, HHS announced $385 million in awards for the development of data exchanges. The latest grants close out funding for the data exchange development under the economic stimulus law.

Blumenthal declined to predict when the first state would have a data exchange system operating, but noted that Rhode Island is a pacesetter in this area.

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AHIP Says Overhaul Measure Would 'Pull the Plug' on Medicare Advantage

By John Reichard, CQ HealthBeat Editor

March 19, 2010 -- The endorsements from health care lobbies seemed to be rolling in smoothly for the House Democratic leadership's reconciliation package Friday — until mid-afternoon, when America's Health Insurance Plans weighed in with a bombshell.

In its strongest statement to date on the impact of health care overhaul legislation on the private health plan side of Medicare, AHIP said the measure "will end Medicare Advantage as we know it."

The insurance lobby said the reconciliation package, HR 4872, would trim $202 billion from Medicare Advantage over 10 years.

"The last thing Congress should do is pull the plug on a program that enhances the health and financial security of 11 million seniors across the country," AHIP Press Secretary Robert Zirkelbach said in the statement.

Enrollment in Medicare Advantage has surged in recent years with plans receiving much more generous payments than providers in traditional fee-for-service Medicare. If plans slash benefits and start pulling out of the program, Democrats are likely to face many complaints from seniors. MA enrollment makes up 24 percent of total Medicare enrollment.

Zirkelbach declined to say whether AHIP would urge MA members to call lawmakers this weekend to complain or what plans it has for ads based on the claim that Medicare Advantage is headed for the ash bin.

"Seniors in Medicare Advantage are going to be shocked when they learn of the impact this legislation will have on their health care coverage," Zirkelbach said when the question was put to him.

Insurance industry consultant Robert Laszewski said "AHIP's assessment is correct. Compared with the Senate bill, the House is increasing the insurance subsidies while gutting the revenue that was to come from the controversial tax on higher cost 'Cadillac' plans. To pay for it all, House Democrats have increased the size and scope of the Medicare payroll tax on high income people and hit Medicare Advantage plans a lot harder."

"The Senate bill would have left some opportunity for health insurers to continue to offer this product but the latest proposal will likely mean a seven-year phase-out of the program altogether," he said. "While I expect AHIP to make a lot of noise about this in the next two days, it is really too late. The train has left the station on a health care bill that will end Medicare Advantage — at least a program with the better benefits as we have known it."

A retired Medicare Advantage plan executive who declined to be identified said, "AHIP has been activating and enlarging its senior grassroots network for some time and not just recently." But "I do not see this effort as having the potential to block House passage as the administration has effectively convinced the House Democrats that the MA program is overpaid, that it does not provide quality care and that it denies essential care to the elderly," the executive said.

Private health plans in Medicare originally were paid 95 percent of average rates for fee for service providers, but that percentage this year is expected to be 109 percent.

A section-by-section Democratic summary of the reconciliation bill says that it would freeze MA payments in 2011. Starting in 2012, payment differences compared with traditional Medicare would be narrowed. "Benchmarks will vary from 95 percent of Medicare spending in high-cost areas to 115 percent of Medicare spending in low-cost areas," the summary says. "The changes will be phased in over 3, 5, or 7 years, depending on the level of payment reductions. The provision creates an incentive system to increase payments to high quality plans by at least 5 percent."

Earlier in the day, the senior lobby AARP endorsed the reconciliation package, as did the American Medical Association and the American Academy of Pediatrics.

"For every American who has struggled without access to health insurance —and for all those at risk of losing their current coverage with the next job loss, illness or premium hike — this package presents the best hope to offer health security for them and their families," AARP said in a statement.

The AMA said the measure isn't perfect but should be passed because the status quo is intolerable. Asked whether the AMA had received assurances from Democratic leaders that they would push a permanent repeal of the flawed physician payment formula later this spring, AMA President James J. Rohack didn't answer directly. "We are pushing very hard in our communication to get this thing finished before this Congress adjourns," Rohack said.

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