Health Care « Minnesota Budget Bites

New website tracks long-term trends in the well-being of Minnesota families

August 2, 2010

The Minnesota Budget Project, along with some amazing research partners, are pleased to announce the launch of Minnesota Data Trends, a website that tracks key indicators of family well-being around the state. The site looks at long-term trends in income, housing costs, transportation costs, access to health insurance, employment and other important measures.

Much has been written in the past year about the struggles of average Minnesotans during the Great Recession. Often lost in the immediate focus on the latest unemployment report or foreclosure data are the longer-term trends showing that low- and moderate-income Minnesota have faced challenges for years and conditions are worsening over time.

For example, the recent Great Recession cannot explain all the job loss in Minnesota. The state gained an average of about 36,000 jobs per year between 1981 and 2000, but only 1,000 jobs annually between 2001 and 2009. And as jobs become scarcer, housing costs are rising. For nearly two decades (from 1980 until 2000), only eight percent of Minnesota households were paying more than half their income for housing. By 2008, however, nearly 13 percent of households had this level of cost burden.

The goal of Minnesota Data Trends is to provide reliable, baseline information on issues affecting low-and moderate-income Minnesotans. We hope to focus attention on how multiple trends can together place a severe strain on a family’s budget. Any number of factors could put a family with little financial margin into chaos: reduced hours at work, an unexpected car repair or health care bill, or the loss of child care.

The website also acts as a directory of experts on these important issues. In addition to the Minnesota Budget Project, the collaboration has involved the Affirmative Options Coalition, Children’s Defense Fund – Minnesota, JOBS NOW Coalition, Minnesota Community Action Partnership and the Minnesota Housing Partnership.

On the website you will find graphs showing long-term trends that anyone can download and reprint for free. The website also includes the data source for the graph, a brief paragraph summarizing the trend and contact information for further details.

But this is only a beginning – we’ll keep the website updated as new data becomes available.

-Scott Russell & Christina Wessel

Leave a Comment » | General Information | Tagged: child care, data trends, employment, Health Care, income | Permalink
Posted by Scott Russell

Senate proposes $114 million in cuts to health and human services

April 30, 2010

The Senate health and human services omnibus bill was released Thursday morning with little fanfare, revealing a plan to reduce the state’s budget deficit by $114 million in FY 2010-11.

Like the House bill released earlier this week, the Senate bill does not make many of the cuts to health care and services for vulnerable populations that the Governor proposed.

General Assistance for very low-income adults without children is left untouched.
Eligibility for health care for adults without children on MinnesotaCare is not reduced.
Very low-income elderly and disabled adults will continue to get help paying for meals, housing repairs and fees for guardianship.
The Governor’s unallotment reductions are not made permanent.

However, unlike the House bill, the Senate proposal protects families on the Minnesota Family Investment Program from any direct cuts to their benefits. And the Senate only proposes a few small reductions to mental health grants for children and adults, compared to the significant cuts proposed in the House bill.

The Senate bill (along with the House bill) takes advantage of the opportunity to expand Medicaid to provide health care for very low-income adults without children. The recently passed General Assistance Medical Care agreement – which was intended to provide health care for this population - has been falling apart as nearly every major hospital in the state has announced it isn’t feasible for them to participate in the new system. Expanding Medicaid would provide more certainty for both participants and providers.

There are service cuts included in the Senate bill, although the full implications are still unclear – Thursday’s hearing announcing the bill lasted just an hour and there was very little discussion or testimony.

The Senate proposes a one-time reduction in Children and Community Services Act grants to counties for social services (which Senator Berglin says could be offset by expected federal funds). The House proposed a permanent reduction.
The Senate includes some cuts to child care assistance, which will increase the barriers for low-income parents trying to work.
The bill adopts the Governor’s proposed limit to the number of individuals with disabilities that can access home-based Medicaid services, which enables them to avoid being moved into a more expensive and confined institutional setting.
There is a 10 percent reduction in MinnesotaCare reimbursement rates to providers for services to adults without children over 75 percent of the federal poverty guidelines.
The Senate also cuts in-home supportive services for low-income elderly Minnesotans.
The bill proposes a surcharge on hospitals, nursing homes, facilities for individuals with disabilities, and HMOs to draw down federal dollars. These entities would get a corresponding increase in their reimbursement rates to keep them whole, although private-pay nursing home residents could see an increase in their costs.

There are additional cuts in funding to nursing homes, hospitals and other health care providers, but most of these reductions don’t take effect until FY 2012.

The Senate Health and Human Services Committee is expected to vote on the bill on Monday, sending it on to the full Senate Finance Committee.

-Christina Wessel

Leave a Comment » | Budget Proposals, Health Care | Tagged: CCSA, child care, disabilities, general assistance, Health Care, medicaid, MFIP, MinnesotaCare | Permalink
Posted by Christina Wessel

Federal health care reform may offer another option for GAMC

April 7, 2010

Recently, the Governor signed the bill that preserves General Assistance Medical Care (GAMC) for very low-income adults without children in Minnesota. Although the GAMC agreement meets the most important need of offering health care for this very vulnerable population, no one is quite satisfied with the solution. (For more information on the history of the GAMC compromise and the impact of federal health care reform, check out the updated GAMC issue brief we just released.)

The passage of the federal health care reform legislation, however, offers a new possibility for providing health care for this population. The federal bill expands Medicaid (known as Medical Assistance in Minnesota) to cover all individuals under age 65 with incomes up to 133 percent of the federal poverty guidelines (FPG) starting January 1, 2014. The federal government would pick up 100 percent of the cost for the first three years.

The bill, however, also includes a provision that allows several states – including Minnesota – to expand coverage to childless adults up to 133 of FPG starting April 1, 2010.

There are some positive aspects to taking advantage of this “early expansion option,” particularly when we compare it to the recently approved GAMC compromise:

The federal parameters cover the entire GAMC population, which is childless adults with income up to 75 percent of FPG ($677 a month for a single adult). In fact, the state could opt to cover adults without children with income up to 133 of FPG ($1,200 a month for a single adult).
The benefit set under Medical Assistance (MA) would be clearly defined and would likely be better than benefits under the GAMC compromise.
Health care providers would get higher reimbursements than they get under the GAMC compromise.
The federal government would pay for 50 percent of the costs of the expanded MA program from FY 2010 to FY 2013, with the federal share increasing starting in FY 2014.

However, there are some important issues that are giving policymakers pause:

The details about the federal health care bill are still emerging, so administrators are trying to assess how quickly the state could design and implement an MA program for this population that would meet federal requirements.
Although the federal government would pay for half the costs if we choose the early expansion option, the federal government would pay 100 percent of the costs for three years to cover this population if we wait until 2014. If Minnesota chooses early expansion, the federal share would gradually increase starting in 2014 until the state would eventually receive the same matching rate as all other states in 2019.
Even though the federal government would cover half the costs to expand MA, taking advantage of the early expansion option would still cost the state more than the GAMC compromise in the next biennium. That’s because the GAMC compromise is significantly underfunded in the FY 2012-13 biennium, drastically reduces payments to providers and leaves the patient benefit set uncertain. Adopting the early expansion option would require the state to meet federal standards for provider payments and patient benefits.

For now, the Governor and legislature have agreed to proceed with implementing the GAMC compromise. However, there are likely to be many more discussions as to if and how the state could take advantage of this federal option for covering Minnesota’s childless adults.

-Christina Wessel & Scott Russell

2 Comments | Health Care | Tagged: federal health care reform, GAMC, Health Care, medicaid, Medical Assistance | Permalink
Posted by Christina Wessel

Policymakers reach agreement on General Assistance Medical Care

March 12, 2010

After months of negotiations, the Governor and legislature have reached an agreement that would preserve access to General Assistance Medical Care (GAMC) – which provides health care for thousands of very low-income Minnesotans. Both the Senate and House health and human services committees held hearings on the bill on Thursday.

Here is the backbone of how the compromise works:

Initially, there will be a temporary bridge program that will basically extend the current GAMC program for two months (through April and May), at a cost of $28 million. Payments to health care providers would be at 37 percent of current reimbursement rates (except for prescription drugs, which are maintained at current levels).

Starting June 1st, the bill creates two “tiers” of hospitals. The first tier consists of hospitals that currently serve a substantial share of the GAMC population (about 17 hospitals). These hospitals could develop a “coordinated care delivery system” to serve the GAMC population in their area. These delivery systems are intended to coordinate all aspects of the health care needs of enrollees, helping patients receive preventative services and avoid costly emergency services. To create the delivery system, hospitals would negotiate contracts with local providers and clinics to ensure that GAMC recipients have access to all necessary care. The goal is to ensure that 80 percent of the GAMC population has access to one of these coordinated care delivery system. GAMC recipients would have to enroll in one of the available delivery systems (or be assigned to one) and receive all non-emergency care through that system. Hospitals would be paid through a lump sum reimbursement determined by the hospital’s recent share of GAMC business. Non-hospital health care providers would negotiate their reimbursement rates with the hospital implementing the coordinated care delivery system. In all, there is $71 million available in FY 2010-11 (and $131 million in FY 2012-13) to reimburse these coordinated care organizations.

The second tier consists of all other hospitals, currently serving about 20 percent of the GAMC population. For the first six months (June through November), these hospitals would be reimbursed for providing hospital care to GAMC enrollees out of a $20 million uncompensated care pool. It is hoped that during these six months, these smaller hospitals would work to develop coordinated care delivery systems within their area. After those initial six months, the uncompensated care pool would end, and reimbursement for GAMC services could only be obtained if a health care provider was part of a coordinated care delivery system.

The total cost of the program for FY 2010-11 is $164 million ($28 million for the two-month bridge program, $71 million for the coordinated care pool, $20 million for the uncompensated care pool and $45 million for prescription drugs). The bill is funded through a number of sources, including transfers from the Health Care Access Fund, drug rebate money, operating reductions to the Department of Human Services, reductions in adult mental health grants to counties, and reducing special payments to hospitals serving a large share of low-income patients.

The positives. It seems almost everybody agrees on a few things:

The bill will maintain eligibility for the people it was intended to help – very low-income adults without dependent children.
The bill preserves accessible and affordable prescription drug coverage. This is extremely important because many of these folks have mental health issues and chronic health conditions.
The bill will protect the financial integrity of the Health Care Access Fund (HCAF) in the current biennium.
Passing something is better than passing nothing.

The challenges. Unfortunately, there are also some very significant concerns.

Although eligibility for the program is maintained, it is not clear what kinds of health care services will be included. With the exception of prescription drug coverage, coordinated care organizations can adopt a pre-defined benefit set, or create their own (subject to approval by the Department of Human Services).
This program is severely underfunded. The reimbursement rates for hospitals and other providers will only be a fraction of what they are receiving under the current GAMC program. Hospitals will be asked to assume a significant amount of the financial responsibility for delivering GAMC services. The state’s costs are capped, the hospitals’ costs are not.
Due to the lack of funding and the administrative challenges, there is a lot of uncertainty over whether hospitals will choose to become coordinated care organizations. That means access to services for GAMC recipients could vary significantly throughout the state.
The new program is funded, in part, by reductions to mental health grants. Advocates are concerned that this could undermine the progress that has been made in this area since the mental health reform initiative in 2007 .

Many people worked very hard for the last several months to find a way to ensure continued health care coverage for this extremely vulnerable population. This nine-month discussion has been an example of how policymakers and the public can work together to develop a solution that reforms the system instead of just reducing funding. Unfortunately, many feel that the final bill falls short of real reform. However, this is an important time to celebrate the grassroots efforts to get this bill passed – it was the input from thousands of ordinary Minnesotans that kept the pressure on policymakers to reach an agreement and maintain health care coverage.

-Christina Wessel

3 Comments | Budget Proposals, Health Care | Tagged: Health Care, HCAF, GAMC | Permalink
Posted by Christina Wessel

State’s Health Care Access Fund faces a deficit too

January 5, 2010

The Health Care Access Fund (HCAF) was created in 1992 to fund MinnesotaCare – a public health insurance program that provides access to affordable health care for working Minnesotans. Funding for the HCAF comes primarily from a tax on health care services (the provider tax) as well as premiums paid by the enrollees. Although the state’s general fund has been running a deficit in recent years, the HCAF has been generating enough revenues to cover the costs of MinnesotaCare.

Not for long, due to recent policy decisions.

In mid-December, the Health Care Access Commission met to discuss the solvency of the HCAF. As things stand right now, the HCAF will start running a deficit in FY 2011. Due to a law that is currently in place, the general fund will help keep the HCAF solvent through the end of FY 2011 (June 30, 2011). However, starting July 1, 2011 (FY 2012), that deal ends and the HCAF is on its own. By the end of FY 2012, the HCAF is projected to face a $371 million deficit. And by the end of the next biennium, the deficit will rise to $839 million.

Why is the HCAF facing a deficit?

Two contributing factors are enrollment increases among adults without dependent children and the rising cost of covering that population. But these changes only account for one-third of the cost increases for this biennium and just one-fourth of the cost increases in the FY 2012-13 biennium.

The big reason is the elimination of General Assistance Medical Care (GAMC) for extremely low-income adults without dependent children. GAMC was paid for out of the state’s general fund, so the Governor’s action to eliminate the program helped solve the state’s general fund deficit. For now, the Department of Human Services (DHS) is opting to automatically transition former GAMC recipients to MinnesotaCare. That means the costs for covering these individuals will now be paid out of the HCAF. This action provides some short-term relief and ensures that many of these very vulnerable individuals maintain coverage. However, this isn’t a permanent solution to the problem because:

MinnesotaCare isn’t well suited to some of the unique challenges facing the GAMC population (such as homelessness, mental health problems and chemical dependency), and
The HCAF can’t afford it.

Once the HCAF officially starts running a deficit on July 1, 2011, current law requires DHS to begin removing people from MinnesotaCare. Unless something changes, nearly all childless adults could lose access to health care coverage within a few years. DHS officials estimates that by FY 2013, they will need to disenroll 92,000 adults without dependent children in order to eliminate the HCAF’s deficit – or about 99 percent of all childless adults enrolled in MinnesotaCare (this includes the childless adults that used to be on GAMC, as well as other childless adults on MinnesotaCare).

Is there a way we can keep health care coverage for these vulnerable adults and protect the solvency of the HCAF? We really hope so. Fortunately, there are several proposals under consideration and the House and Senate have already been holding hearings to get the process moving.

-Christina Wessel

Leave a Comment » | Health Care | Tagged: GAMC, HCAF, Health Care | Permalink
Posted by Christina Wessel

A first look at the Senate health care reform bill

November 20, 2009

Senate Majority Leader Harry Reid has unveiled the long-awaited health care reform bill that he hopes to bring to the Senate floor for debate. The Patient Protection and Affordable Care Act would reduce the number of uninsured Americans by 31 million at a cost of $849 billion over ten years, according to the nonpartisan Congressional Budget Office (CBO). Furthermore, CBO estimates that the bill would reduce the federal budget deficit by $130 billion over the next ten years.

So how does the Senate bill measure up against the Minnesota Council of Nonprofits’ health care principles, and what are some of the major differences from the House bill?

1. Support for small employers, including nonprofit employers. Unlike the House bill, the Senate bill does not include a mandate requiring employers to offer health insurance coverage to employees. However, medium and large employers would pay a fee if the federal government provides subsidies so that their employees can purchase coverage. Tax credits of up to 50 percent of premiums would be available to small businesses and small nonprofits to make coverage more affordable.

2. Make health care affordable for low-income Minnesotans. The bill mandates that nearly all individuals obtain health care coverage, but includes an exemption for economic hardship. The bill includes premium tax credits and cost-sharing assistance to help households with incomes between 133 percent and 400 percent of the federal poverty line (up to $88,000 for a family of four) to afford health insurance.

Medicaid, the joint federal-state health care program for low-income people, would be simplified and expanded in 2014 to cover Americans under age 65 with incomes below 133 percent of the federal poverty level. This is a smaller expansion than in the House bill, which would cover people with incomes up to 150 percent of the federal poverty level.

3. Provide adequate federal funding. The Senate bill has different funding sources than the House bill, such as a new fee on insurance companies when they sell high-cost health insurance plans and a 0.5 percent increase in the Medicare payroll tax for individuals who earn more than $200,000 and couples who earn more than $250,000.

The federal government would pay 100 percent of the cost for people who would now qualify for Medicaid under the proposed expansions through 2016, and in future years would cover an average of 90 percent of the cost. This is a critical step for ensuring that the federal government does not shift too much of the cost of health care reform to the states.

4. Contain unsustainable cost increases. The bill creates health insurance exchanges to help make coverage more affordable and accessible. The bill also includes a public health insurance option, but with a provision permitting states to opt out.

The Senate bill also includes numerous insurance reforms, including prohibiting insurers from discriminating based on pre-existing conditions, imposing lifetime limits on benefits, rescinding coverage except for fraud, and establishing eligibility rules that discriminate in favor of higher-wage employees.

Majority Leader Reid hopes to bring the bill to the Senate floor in the near future, with debate expected to proceed for approximately two to three weeks. Reid will need to garner 60 votes again to cut off debate (cloture) and proceed to a final vote. If the Senate passes its bill, conferees will be appointed to work out the differences between the House and Senate bills before a final vote on a conference report.

Stay tuned for further details in the continuing health care reform debate.

-Steve Francisco

Leave a Comment » | Health Care | Tagged: federal, Federal Budget, Health Care, health care reform, medicaid | Permalink
Posted by Steve Francisco

MinnesotaCare is not the solution for GAMC population

November 12, 2009

Earlier this year, Governor Pawlenty line-item vetoed and then unalloted General Assistance Medical Care (GAMC) – a health care program that currently serves between 35,000 and 40,000 adults without children in Minnesota. As a result, this program will end on March 1, 2010. There has been a great deal of concern about what will happen to these thousands of Minnesotans when their access to health care disappears.

Last Friday, the Minnesota Department of Human Services (DHS) announced that 28,000 of these adults without children will be automatically transitioned to another state health care program – MinnesotaCare.

Problem solved?

No way, say the experts.

Why isn’t MinnesotaCare a viable option for this population? Well, here are just a few reasons:

Transitional MinnesotaCare, the program these individuals will initially be transferred to, does not provide the same level of benefits as GAMC. There is a $10,000 yearly cap on inpatient hospitals stays, plus higher copayments on hospital stays, non-preventative doctor visits and prescription drugs. And unlike GAMC, if a patient is unable to afford the copayment, the provider is legally allowed to refuse them service in the future. Remember, for most people to qualify for GAMC, their income has to be below the poverty level (75 percent of poverty to be exact). For example, a couple must earn less than $911 a month to be eligible. At that income level, after paying for food, housing, utilities and transportation, there’s not much left over for health care. These are extremely low-income and extremely vulnerable people in our state.
This automatic transition to MinnesotaCare will only last for the remainder of the individual’s current eligibility for GAMC. In other words, within one to six months, all of these individuals will lose their eligibility for Transitional MinnesotaCare and will have to renew their application for the regular MinnesotaCare program or lose coverage. The GAMC population, however, is made up primarily of individuals facing significant problems, including chemical dependency, mental illness and homelessness. Not exactly people who have the ability to just sit down at the kitchen table and work through a daunting and confusing stack of application forms and then wait patiently for a few months while their application is reviewed. Their lives are unstable and most of them didn’t enroll in GAMC until a health care crisis landed them in the hospital. One of the unique aspects of GAMC is that it provides retroactive coverage. A patient can apply for GAMC when they enter the hospital and get coverage from the date of application. With MinnesotaCare, however, coverage starts once the application has been approved anywhere from 45 t0 60 days later - so health care providers are left to foot the bill.
Another problem is money. GAMC is funded by the state’s general fund. MinnesotaCare is funded through the Health Care Access Fund (HCAF). Moving this high-need population onto MinnesotaCare is going to increase the costs of MinnesotaCare by adding a large group of people with substantial health care needs. It’s estimated that this shift will cause a deficit in the HCAF by 2011. And guess what – if the fund is projected to run a deficit, the law requires DHS to begin disenrolling people. Who is first on the list for losing health care? Adults without children. This shift to MinnesotaCare not only jeopardizes future access to health care for the 28,000 GAMC enrollees being moved to MinnesotaCare, but an additional 35,000+ adults without children who are already enrolled in MinnesotaCare.

It’s clear that while moving GAMC participants onto MinnesotaCare may provide a little temporary relief to this population, it is not a solution. GAMC was created precisely because this population faces extraordinary challenges and could not be served by other health care options. So the only real solution is to restore GAMC. Since the state is likely to be facing continued budget deficits, we’ll need to raise additional revenues to get GAMC back again.

-Christina Wessel

Leave a Comment » | Health Care | Tagged: GAMC, general assistance medical care, HCAF, Health Care, Health Care Access Fund, MinnesotaCare | Permalink
Posted by Christina Wessel

House-passed health care bill advances many of nonprofits’ priorities

November 11, 2009

The health care bill passed by the U.S. House of Representatives on Nov. 7 would extend health insurance coverage to 36 million uninsured Americans. The bill represents a major step forward in addressing several key priorities of Minnesota’s nonprofits.

The House bill passed by a vote of 220 to 215. Minnesota’s Congressional delegation was split with Representatives Ellison, McCollum, Oberstar and Walz voting yes and Representatives Bachmann, Kline, Paulsen and Peterson voting no.

Here’s how the House bill measures up against the Minnesota Council of Nonprofits’ health care principles:

1. Support for small employers, including nonprofit employers. The House bill includes a new employer mandate requiring employers with annual payrolls of $750,000 or more to either provide coverage to their employees or pay a penalty of 8 percent of their payroll (businesses with payrolls between $500,000 and $750,000 would pay a smaller penalty if they did not provide insurance). Businesses and nonprofits with annual payrolls less than $500,000 are exempt.

Small businesses with 10 or fewer employees and $20,000 or less in average wages are eligible for tax credits to help them provide coverage for their employees. Smaller credits are available to businesses with 25 or fewer employees or average wages of $40,000 or more. Unfortunately, the same assistance is not available to small nonprofits, even though they face the same high health insurance premiums as small for-profit businesses. The Senate bill makes small nonprofits eligible for assistance. This issue will need to be resolved by a House-Senate conference committee.

2. Make health care affordable for low-income Minnesotans. The House bill includes a mandate that all individuals obtain health care coverage by 2013 (very low-income individuals are exempt). The bill includes significant assistance to help low-income individuals afford health insurance. Individuals and families with incomes up to 400 percent of the federal poverty level ($88,000 for a family of four) would get subsides on a sliding scale to help them buy coverage. Those with incomes closer to the poverty level would get bigger subsidies compared to those with higher incomes.

Medicaid, the joint federal-state health insurance program for low-income people, would be simplified and expanded to cover all individuals not eligible for Medicare with incomes up to 150 percent of the federal poverty level ($33,075 per year for a family of four). This expansion of Medicaid could eventually cover the 35,000 very low-income Minnesotans losing their General Assistance Medical Care (GAMC) due to Governor Pawlenty’s line-item veto and unallotment earlier this year. However, this expansion would not go into effect until 2013, so there could remain a gap in coverage.

The bill eliminates the existing gap in coverage for participants in the Medicare Part D prescription drug program (the “donut hole”) whereby enrollees continue to pay their premium but receive no benefit.

The House bill would also cap annual out-of-pocket costs, ban insurers from charging higher premiums to people with pre-existing medical conditions and prohibit insurers from charging older adults premiums that are more than twice as much as younger adults.

3. Provide adequate federal funding. According to the nonpartisan Congressional Budget Office (CBO), the House bill would cost just under $900 billion over 10 years but would not add to the federal budget deficit. In fact, the bill is expected to reduce the deficit over 10 years. The main financing provision in the bill is a progressive surtax of 5.4 percent on individuals with adjusted gross income more than $500,000 a year and couples with adjusted gross income more than $1 million a year.

We have argued that federal health care reform should not shift significant costs to the states. In the House bill, the full cost to expand Medicaid would be paid by the federal government in 2013 and 2014. After 2014, the federal government would pay 91 percent of the additional cost and states would pay 9 percent.

4. Contain unsustainable cost increases. The bill creates a National Insurance Exchange where individuals and small employers will be able to shop for coverage among competing private insurance plans. States would be permitted to opt out and create their own exchange if they meet certain federal requirements.

The House bill also includes a new public health insurance option to be developed by the Department of Health and Human Services. Under the public option, the federal government would negotiate reimbursement rates with health care providers. The public option would have to meet all of its costs from premiums collected.

The bill includes changes to Medicaid and Medicare designed to improve the quality of care, enhance efficiency and eliminate overpayments to private insurers under Medicare Advantage. Eliminating such overpayments along with other Medicare Advantage savings would lower Medicare spending by $170 billion over ten years, according to the Center on Budget and Policy Priorities.

Now the action moves to the Senate. The CBO is expected to deliver a “score” or price tag for the Senate health care bill later this week, after which the Senate may take up the bill on the floor. Expect the Senate debate to go on for several weeks, with many amendments. After the Senate completes its work, a House-Senate conference committee will work out differences between the House and Senate versions of the legislation.

While Majority Leader Harry Reid recently suggested that the Senate may not vote on its bill until early next year, President Obama reiterated that he hopes the Senate will vote soon and that a final House-Senate conference committee report can reach his desk before the end of the year.

If you want to dig deeper into the details, a helpful bill summary is available from the House committees who worked on the bill.

-Steve Francisco

Leave a Comment » | Health Care | Tagged: federal, Federal Budget, Health Care, health care reform, health insurance, medicaid | Permalink
Posted by Steve Francisco

MCN/MCF conference addresses health care reform

November 6, 2009

Jan Malcolm, former Minnesota Commissioner of Health, says fixing the federal health care system is more doable than people think. True, reform legislation is estimated to cost nearly $1 trillion over the next decade. But the federal government is expected to spend $35 trillion on health care in the next 10 years, Malcolm says. And the current system has lots of room for improvement.

“We get horrible value for what we spend,” she says. “It doesn’t make it easy politically; [the money] is there to be saved.”

Malcolm, who is now CEO of Courage Center, made her comments today at the joint conference of the Minnesota Council of Nonprofits and the Minnesota Council of Foundations. She made the following points about potential savings:

The U.S. spends 50 percent more per capita than any other country on health care.
We rank 37th overall in a World Health Organization analysis of population health and system effectiveness.
The only place we rank #1 is in life expectancy at age 80

Malcolm says improving the health care system will take a long-term commitment. She makes a powerful case for the need to pass a health care reform bill, but reminds us that what happens this year is not the end of the journey.

“What passes won’t be perfect,” she says. “We will have to keep working on it.”

And the wheels are spinning fast. One version of the health care reform bill is expected to come to a floor vote in the House this Saturday. That particular bill does not include nonprofits in provisions that allow small for-profit employers to get subsidies to help them afford health insurance for their employees. MCN has drafted a sign-on letter to members of Congress supporting health care reform and equal treatment for nonprofits. The deadline to participate is Nov. 13.

Tim Delaney, president and CEO of the National Council of Nonprofits, promoted the sign-on letter at the conference. He praised Rep. Betty McCollum for leading efforts to try to get nonprofits covered in the tax credit portion of the bill. If the bill is going to give relief to small businesses, Delaney said, “why not to small nonprofits which are set up for public good?”

-Scott Russell

Leave a Comment » | Federal Budget, Health Care | Tagged: Federal Budget, Health Care, health care reform | Permalink
Posted by Scott Russell

Pelosi unveils modified House health care reform bill

November 2, 2009

House Speaker Nancy Pelosi has unveiled the long-awaited House health care reform bill that will go to the floor for debate beginning late this week. The so-called “merged bill” was negotiated by the House Democratic leadership with the leaders of the three House committees that reported different versions of health care legislation this summer: Education & Labor, Energy & Commerce and Ways & Means.

A summary of the new House bill from Speaker Pelosi shows that it would achieve several of the objectives outlined in MCN’s position statement on health care reform by expanding Medicaid coverage to make health care affordable for more low-income Minnesotans, by providing adequate federal funding without increasing the federal budget deficit, and by helping to contain unsustainable cost increases by implementing strategies such as the public option.

According to the Washington Post, the bill would provide health insurance coverage to 36 million Americans who are currently uninsured, either through private insurance, a public option, or Medicaid.

Key features of the bill include:

An individual mandate requiring most individuals to purchase coverage.
An employer mandate requiring employers to either provide coverage or pay a penalty. Small firms with annual payrolls below $500,000 would be exempt.
Medicaid eligibility levels would be simplified and raised to 150% of the federal poverty level (about $16,200 annual income for an individual). (The original House bill proposed raising Medicaid eligibility to 133% of the federal poverty level).
A new national health insurance exchange that would offer consumers a choice of private insurance plans and a federal public option.
New restrictions on insurance companies, including a ban on denial of coverage for pre-existing conditions and a new review process on premium increases.
Establishment of a new voluntary long-term care insurance program to be financed through payroll deductions.

According to Speaker Pelosi, the House bill meets President Obama’s criteria of having a price tag below $900 billion over ten years, fully paid for, and reducing the deficit in the long term. An official price tag or “score” is expected early this week.

The bill also includes improvements to make Medicare and Medicaid more efficient, including closing the gap in Medicare Part D coverage for medicines and a study on geographic disparities in Medicare reimbursements, among others.

In a bow to moderate and conservative Democrats in her caucus, Speaker Pelosi endorsed a modified public option in which reimbursement rates for health care services would be negotiated between the federal government and health care providers, instead of basing reimbursements on Medicare rates. Many representatives representing rural constituencies, including most of Minnesota’s Congressional delegation, have previously expressed strong concerns about regional disparities in Medicare reimbursement rates.

All eyes are on conservative “Blue Dog” Democrats who may hold the fate of the House bill in their hands. Initial reactions to the new House bill from some Blue Dogs seemed to be favorable. Republican House members appear to be solidly opposed to the bill. While Speaker Pelosi concedes that she may not yet have the 218 votes needed in hand, the trend is clearly moving in the direction of gaining support to pass the bill.

Your organization still has time to join our sign-on letter to the Minnesota Congressional delegation in support of comprehensive health care reform.

-Steve Francisco