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Kennedy, Baucus Announce Early June Health Overhaul Markups

By John Reichard, CQ HealthBeat Editor

April 20, 2009 -- The chairmen of the two key committees that will lead Senate efforts to craft health overhaul legislation announced Monday that they plan early June markups of very similar legislation that "can be quickly merged into a single bill for consideration on the Senate floor."

"We have a moral duty to ensure that every American can get quality health care," Sens. Edward M. Kennedy, D-Mass, and Max Baucus, D-Mont., said in a letter to President Obama announcing the late spring markup schedule. "We must act to contain the growth of health care costs to ensure our economic stability; to help American businesses deal with the health care challenge; and to make sure that we are getting our money's worth." Kennedy chairs the Senate Health, Education, Labor and Pension Committee and Baucus the Senate Finance Committee.

The timetable suggests that the committees won't hold hearings on the measures prior to a markup. A Baucus aide said the actual legislation, which is still being drafted, would be unveiled when it goes to markup.

In other overhaul-related developments, the Pharmaceutical Research and Manufacturers of America (PhRMA) and the left-leaning advocacy group Families USA said they will team up to push for expansion of the Medicaid program, subsidies to fund the purchase of health insurance by individuals, and a cap on out-of-pocket costs to protect families hit by big health bills.

"One of our goals in the proposal is to establish a nationwide Medicaid eligibility at 133 percent of the federal poverty limit," a PhRMA source said. "Several million uninsured Americans can get coverage through this." A second goal is "to provide subsidies for moderate-income individuals and families in a reformed market," the source said. The two lobbying organizations won't specify subsidy levels, but the source noted that "of the 47 million uninsured Americans, about 30 million uninsured Americans have incomes 200 percent of the federal poverty level or below. So overall, about 65 percent of uninsured Americans could be eligible for a subsidy if it were set at 200 percent."

The organizations plan an afternoon press briefing Tuesday to announce the details of what they said would be a multimillion-dollar campaign to promote the changes. Other elements of the proposal call for revamping the insurance market to prevent companies from denying coverage based on health status and allowing the use of Medicaid funds to buy private coverage if doing so saves Medicaid money. Insurers have said they would agree to stop denying coverage based on health status if individuals were required to buy coverage, a mandate that would assure a mix of good and bad risks to allow them to absorb the cost of claims for people with costly medical conditions.

Meanwhile Finance Committee staff prepared Monday for the first of three "roundtables" that will serve as a form of hearing on health overhaul approaches under consideration by the panel. The committee plans private meetings in which members will be asked to react to legislative proposals it is considering.

Baucus and Sen. Charles E. Grassley of Iowa, the top Republican on the Finance Committee, prepared questions they plan to ask participants at the first roundtable session, scheduled for Tuesday. For example, they plan to ask Glenn Steele, the head of the Danville, Pa.–based Geisinger Health Clinic, whether the system's model of "integrated care" in which doctors and hospitals collaborate to control casts can be widely applied elsewhere in the United States. Another likely question is "what tools does Geisinger provide to its staff to empower them to provide high-quality and efficient care?"

They plan to ask Glenn Hackbarth, chairman of the Medicare Payment Advisory Commission, what role a stronger primary care role, "bundled" payments covering both hospital and doctor care and payment systems rewarding quality and efficiency could play in controlling costs. They plan to query Mark McClellan of the Brookings Institution about the feasibility of setting up "Accountable Care Organizations to combine unaffiliated providers into health care teams to boost efficiency and quality."

Questions also are planned for American Hospital Association President Rich Umbdenstock about industry concerns about payment systems that reward quality and efficiency; Aetna Executive Ron Williams on the feasibility of competitive bidding in the Medicare Advantage program; Debra Ness of the National Partnership for Women and Families on the impact on patients of revised payment systems; Alan Korn of the Blue Cross–Blue Shield Association on incentives to improve coordination of care by providers; and Peter Lee of the California Business Group on Health about the employer perspective on revised payment systems.

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