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The AP (1/24, Daniel) reports, "Senate Republicans want to box majority Democrats into allowing a health care repeal vote even if GOP lawmakers expect to be on the losing side." While Senate Majority Leader Harry Reid (D-NV), "who controls the Senate agenda, has said" a repeal "bill won't come to a vote, Republican leader Mitch McConnell" (R-KY) yesterday "repeated his promise that a repeal vote will indeed take place." Appearing on Fox News Sunday, McConnell said, "I'm not going to discuss how we'll do it from a parliamentary point of view here. ... If that does not pass, and I don't think anyone is optimistic that it will, we intend to go after this health care bill in every way that we can. It's the single worst piece of legislation that's been passed in my time in the Senate." (reported by NAHU Newswire)
I expect this debate will linger well into the 2012 Presidential election. As expected, the House easily passed legislation yesterday to repeal the new sweeping healthcare law. Most of us believe the repeal effort is likely to fail in the Senate, where Democrats maintain a slim majority, but it fulfills a campaign promise made by Republicans during last year's elections. All House Republicans voted for the repeal, while the vast majority of Democrats voted against it. Three Democrats crossed party lines and voted with the Republican majority. At issue with the repeal debate is how much the law costs and the potential impact repealing it would have on the deficit. Republicans say the law will add $701 billion to the deficit in its first 10 years, while Democrats say repealing it will add $230 billion to the deficit.
In wake of the shooting in AZ, the debate and move to vote on repeal has cooled off for now and apparently moved from this week to the week of January 17. Keep in mind this effort is largely symbolic and not likely to do any more than give newly elected officials the opportunity to represent the position they took during campaigning for office. This year is certainly starting out with lots of uncertainty about the next steps with healthcare reform!
This will not be the last delay we see with PPACA provisions. This requirement was scheduled for plan years beginning Sep. 23, 2010 although the rules remained murky for our clients as they considered whether or not to maintain grandfather status of their plans. The IRS issued a notice on Dec. 22, 2010 available at http://www.irs.gov/pub/irs-drop/n-11-01.pdf, concerning the change in timing for the provision prohibiting fully insured group health plans from discriminating in favor of highly compensated individuals. Interested in providing comments? The Departments anticipate issuing guidance and request additional public comments on the issues that should be addressed. The Notice lists several topics on which comments are requested including the basis of discriminatory benefits and whether employer contributions toward the cost of coverage or the duration or eligibility waiting periods should be treated as “benefits.” Mar. 11, 2011 is the deadline for comments. Comments may be submitted to Notice.Comments@irscounsel.treas.gov. Please be sure to include “Notice 2011-1” in the subject line.
How do you feel about the new healthcare law?
A vote on repeal legislation will take place on January 12, one week after Republicans take control of the House. Reports indicate it will likely pass the House but not the Senate, and of course, the President has his veto pen. There are also indications from the White House that they're relishing this debate, because they think the healthcare law has proved itself to be beneficial and a lot of people will not want to see those benefits go away. Nevertheless, this is the new reality for President Obama.
On December 23, the IRS issued new guidance that allows use of health care debit cards for the purchase of over-the-counter medicines effective January 1, 2011. Previous guidance would have prohibited use of FSA/HRA debit cards for the purchase of OTC drugs. Now, under the new guidance, participants can continue using FSA/HRA debit cards for over-the-counter medications provided the participant has a prescription. This use of debit cards must comply with procedures reflecting those that pharmacies currently follow when selling prescribed drugs. The procedures include requirements that a prescription for the medication be presented to the pharmacy or other vendor that dispenses the medication. Proper records must be retained.
About 1.5 million Americans have limited-benefit medical plans that will not comply with the new healthcare law. Therefore, they will be outlawed by 2014. However, most are going to be allowed to remain in existence for now with the requirement to notify participants clearly how much they fall short of the new standards in the Affordable Care Act. We've always had concerns with these plans because people tend to feel they have adequate protection until they exceed benefit levels. The more limited the benefits, the more likely this is to be a problem for covered individuals. As a trusted advisor we always want to see our clients with adequate coverage and it's difficult to be sure every insured individual understands the limitations of these plans.
We appear to have a Medicare "doc-fix" to delay deep cuts in Medicare payments to docs. Good news, right? This deal, rather bipartisan deal, includes changes in the tax subsidy program that will help fund premiums for some consumers buying insurance through the new insurance exchanges in 2014. It's a $19.2 billion proposal that will be on the Senate floor Wednesday. Supposedly it would be paid for by changing the rules on how the government will recoup overpayments in the subsidy program for people with incomes between 100 and 400 percent of the federal poverty level. Specifically, the program is slated to recoup up to $200 for an individual and $400 for a couple, but the agreement would raise the limits, as well as look for money elsewhere... sound complicate and iffy? It does to me, but I'm all for seeking stability as we sort out the details of the new healthcare reform law!
Department of Health and Human Services is expected to clarify the MLR rules today that govern exactly how much of each dollar is required to be used by insurance companies to pay for direct medical expenses versus administrative costs and profits. Meanwhile newly elected Republicans seem to be galvanized in an effort to repeal the new healthcare law. Not all Republicans support this movement. Some of the biggest players in the system are not willing to support the effort to scrap the law and start over. With 32 million more people in the system, I would certainly expect more than a little pushback from a significant number of hospitals, doctor groups and pharmaceutical manufactures. Also, keep in mind that health insurance companies endured major criticism in the national spotlight and managed to land on their feet with the prospect of insuring these new members with more government regulations. They have invested a lot of resources to design benefits and systems to accommodate the new market place. Would you want to see a total repeal if you were in any of their shoes?