The first of what will be days of lengthy debate on the Senate floor started Monday with Senate Majority Leader Harry Reid (D-NV) at the beginning of the five-hour session promising late nights and even Saturdays and Sundays throughout the month of December—or however long it takes to complete the reform bill, he said.
"Nothing can be more important that this," he said in the opening minutes of the Senate session. "The next few weeks will tell us a lot about whether senators are more committed to solving problems or creating them."
Senate Minority Leader Mitch McConnell (R-KY) followed Reid on the Senate floor by saying that "Americans don't want this bill to pass ... all surveys indicate that," he said. "Most people will see insurance premiums go up. That's not what American people are working for, and it's certainly not reform."
McConnell proposed alternative measures to the current healthcare bill, such as getting "rid of junk lawsuits," stronger healthcare fraud and abuse prevention efforts, and improving ways for smaller businesses to purchase insurance through groups or across state lines.
The first amendments also were presented on Monday. Sen. Barbara Mikulski (D-MD) introduced what she called an amendment to increase preventive health services for women "at little or no cost to the patients." She explained that it would be equivalent to giving all insured individuals "access to the same preventive services" available at the federal level for employees.
The amendment does not mandate screening protocols, for instance, such as mammograms. That needs to be discussed between patient and physician, she said. However, the amendment focuses on eliminating "one of the major barriers to accessing care—cost—by getting rid of high copays and high deductibles," she said. "This amendment is important because it will save money and save lives by reducing the top diseases killing women today."
Sen. John McCain (R-AZ) introduced an amendment that would send the Senate bill "back to the Finance Committee with instructions to report the bill to the Senate without these irresponsible cuts" to Medicare, he said. Slashing Medicare by nearly $500 billion "to create a new federal healthcare entitlement is not healthcare reform," he added.
Sen. Robert Casey (D-PA) also introduced an amendment he said would "protect and ensure healthcare coverage for low income children." The amendment would continue full funding for the Children's Health Insurance Program (CHIP) through 2019, ensure affordable coverage and high-quality benefits for children and make it easier for families to enroll in the program.
"We have had some victories in the effort to prevent the dismantling of CHIP, but there is more work to do in order to preserve and improve health care coverage for children," he said.
The Congressional Budget Office (CBO) on Monday released its latest analysis of the Senate healthcare reform bill, the Patient Protection and Affordable Care Act, and depending on what side of the aisle you listen to, it will either reduce—or increase—health insurance premiums in several years.
The CBO was responding to a request from Sen. Evan Bayh (D-IN) about how health reform proposals would impact premiums paid for health insurance in various markets.
At the White House and on the floor of the Senate on Monday, the CBO analyses was cited for showing that while the bill would increase premiums in 2016, for instance, among people who buy their own insurance, most people in that market would see an overall decline—compared to the costs anticipated under current regulations. This would be the result of government subsidies—which would cover almost two thirds of their premiums—would mean lower costs.
The legislation would have much smaller effects on premiums for employment based coverage, CBO Director Douglas Elmendorf said in his blog. Among the small group market, which is defined in this analysis as consisting of employers with 50 or fewer workers, CBO estimated that the change in the average premium per person resulting from the legislation could range from an increase of 1% to a reduction of 2% in 2016.
Among the larger group market, which is defined as consisting of employers with more than 50 workers, "the legislation would yield an average premium per person that is zero to 3% in 2016—relative to current law," he said.
In her blog, White House Health Care Reform Director Nancy-Ann DeParle wrote on Monday: "Contrary to what many thought when this process began, the health reform bills represent the biggest deficit reduction legislation since the 1997 Balanced Budget Act."
However, Republicans saw a different message from the CBO. CBO has indicated that the bill "will actively increase premiums for Americans and their families," Senate Minority Leader Mitch McConnell (R-KY) said on the floor of the Senate Monday shortly after debate on the reform bill began. "So a bill that is being sold as reducing costs is actually driving them up."
Industry groups also saw a different message as well. "This is the latest report to confirm that the current healthcare reform proposal fails to bend the healthcare cost curve and will result in double digit premium increases for millions of Americans," said Robert Zirkelbach, America's Health Insurance Plan press representative, in a statement.
AHIP added that subsidies will not lower premiums. "Subsidies are essential to helping low and moderate income families afford healthcare coverage ... but in the same way that Pell Grants do not lower the cost of college tuition, subsidies do not reduce underlying medical costs."
Health Management Associates, Inc., has acquired the 492-bed Sparks Health System in Fort Smith, AR. Terms of the deal were not disclosed.
"We are very pleased to welcome the Sparks Health System, its employees and physicians to the Health Management family of hospitals," Gary Newsome, HMA's president/CEO said in a media release. "Today marks a new and exciting chapter in healthcare delivery for the Sparks Health System and the Fort Smith region."
Naples, FL-based HMA owns and operates 55 hospitals, with approximately 8,400 licensed beds, in non-urban communities located throughout the United States.
Stericycle Inc. says it has agreed to a Department of Justice demand to sell off some of its medical waste collection businesses in four states to settle an antitrust lawsuit and finalize its $182.5 million acquisition of MedServe Inc.
DoJ's Antitrust Division said in a media release that the acquisition "as originally proposed, would substantially lessen competition in infectious waste collection and treatment services to hospitals and other critical healthcare facilities in Kansas, Missouri, Nebraska and Oklahoma, resulting in higher prices and reduced service."
The Antitrust Division and attorneys general in Missouri and Nebraska filed a civil antitrust lawsuit Monday in U.S. District Court in Washington, DC, to block the transaction. At the same time, DoJ and the two attorneys general filed a proposed settlement with Stericycle. If the settlement is approved by the court, it would resolve the competitive concerns alleged in the lawsuit.
"Without the divestitures required by the department, critical healthcare facilities in Kansas, Missouri, Nebraska, and Oklahoma would have faced higher prices," said Christine A. Varney, assistant attorney general in charge of the DoJ's Antitrust Division.
Stericycle announced that it had agreed to the government's demands, and said it expects to complete the MedServe acquisition by the end of December.
DoJ said Stericycle and MedServe are the only two firms competing for customers that generate large quantities of infectious waste in Kansas, Missouri, Nebraska, and Oklahoma. Under the proposed settlement, Stericycle and MedServe must divest all of MedServe's infectious waste collection and treatment services to large customers in Kansas, Missouri, Nebraska, and Oklahoma to a "viable purchaser" approved by DoJ. These assets include MedServe's Newton, KS, treatment facility, and its transfer stations in Kansas City, KS, Oklahoma City, Omaha, and Booneville, MO.
Lake Forest, IL-based Stericycle is the nation's largest provider of infectious waste collection and treatment services, with operations in nearly all of the contiguous 48 states. In 2008, its U.S. sales were $858 million. Bellaire, TX-based MedServe is the nation's second-largest provider of infectious waste collection and treatment services and operates in 25 states, with total revenues of $35.6 million in 2008.
Medicare and Medicaid underpayments to the nation's hospitals relative to the cost of care rose more than eight-fold, from $3.8 billion in 2000 to $32.4 billion in 2008, the American Hospital Association reported in its latest release of annual reimbursement fact sheets.
The difference is borne by payments from health plans and other government and private payers, says Caroline Steinberg, AHA vice president for trends analysis.
Medicare is only a slightly better payer than Medicaid, and neither pays 100% of the cost of care for beneficiaries, according to the AHA. For Medicare, hospitals on average received 91 cents for every dollar in cost of care in 2008 and for Medicaid, it was 89 cents. Steinberg said that in 2007, Medicare paid the same, 91 cents, but Medicaid paid one cent less, 88 cents.
Steinberg says this does not reflect the true current picture, which is even worse because of the economic downturn in the last year.
"The majority of our hospitals are telling us they're seeing significantly more patients that are uninsured," which translates to even more undercompensated and uncompensated care, Steinberg says. During economic recessions, she says, patients tend to show up at hospitals when they are sicker because when they lose health coverage, they tend to delay care until they need it.
"It's a bit of a misconception that people go to the emergency department for non-urgent conditions," she says.
The AHA also reported that nationally, uncompensated care—care provided for which there is no reimbursement at all—has continued to rise, from $21.6 billion in 2000 to $31.2 billion in 2006 to $34 billion in 2007 and to $36.4 billion in 2008.
The AHA issued its findings in two sets of fact sheets, one on underpayment by Medicare and Medicaid, and the other on uncompensated hospital care, also called charity care or bad debt.
The fact sheets are issued annually by the AHA based on the organization's annual survey and reflect the economic health of some 5,010 hospitals nationwide.
Robert Zirkelbach, director of strategic communications for America's Health Insurance Plans, says the rising trend only means higher costs for families and employers with private coverage. The average family of four is paying $1,500 a year in higher premiums to offset underpayments from Medicare and Medicaid, he says.
It's important to understand in the context of health reform discussions, he adds, "any public health plan that pays close to Medicare rates will exacerbate the cost shift to people with private coverage."
He says the AHA's grim picture of low reimbursement to hospitals, an amount that must be supplemented by private payers, does not take into account the added burden from uncompensated care provided by physicians.
After almost a year of maneuvering over policies and politics, the Senate officially began debate on the legislation to overhaul the nation's healthcare system, but it remained uncertain how long the deliberations would last or how much the bill would change before it comes to a vote, the Los Angeles Times reports. With Republicans united in opposition and conservative Democrats and the Senate's two independents continuing to express reservations, Majority Leader Harry Reid (D-NV) faced a challenge in building the filibuster-proof majority needed for passage, reports the Times.
The Congressional Budget Office announced that the Senate health bill could significantly reduce costs for many people who buy health insurance on their own, and that it would not substantially change premiums for the vast numbers of Americans who receive coverage from large employers. The eagerly awaited report provided Democrats with ammunition against Republicans who have criticized the bill on the ground that it would raise costs for a majority of Americans, the New York Times reports.
As the Senate opened debate on a plan to overhaul the nation's healthcare system, congressional budget analysts said the measure would leave premiums unchanged or slightly lower for the vast majority of Americans. The findings contradict assertions by the insurance industry that the average family's coverage would rise by thousands of dollars if the proposal became law. The CBO said the legislation would lead to higher average premiums in the relatively small and troubled individual market. But that extra cost would buy better coverage, the CBO said, and hefty federal subsidies would drive down payments by nearly 60% on average for low- and middle-income families, the Washington Post reports.
Six Massachusetts community hospitals, squeezed by the economic downturn and the state budget crunch, are set to file a lawsuit seeking millions of dollars from the state for unpaid healthcare services. The suit charges that Massachusetts violated a law requiring adequate reimbursement to hospitals for patients insured by the government. The hospitals contend the state set repayment rates so low they do not cover the cost of such medical care, the Boston Globe reports. The plaintiffs are part of a group of "disproportionate share hospitals," institutions at which at least 63% of patients, mostly low-income or elderly, are covered by public insurance plans such as Medicaid or Medicare.
Millions of unemployed Americans face the prospect of a huge increase in health insurance costs due to the expiration of the government's COBRA subsidy. The American Recovery and Reinvestment Act, passed in February, launched a temporary government program to subsidize the cost of buying health insurance through a former employer's plan after a layoff. However, the COBRA subsidy was designed to last no more than nine months for each person who was unemployed. Hundreds of thousands who got this subsidy when it was first made available in March are slated to roll off the program December 1.
