Who Will Lead?

A headline on Life and Health News this morning caught my eye. It read, “Who will Lead? It referred, of course, to the void left in the Senate by the death of Senator Ted Kennedy. The article pointed out that Kennedy’s death could affect the leadership of the Senate Banking Committee as well as of the Senate Health, Education, Labor and Pensions Committee and discussed the possible changes in the committee leadership roles.

But, this headline got me thinking. Who will lead the healthcare reform movement going forward? I nominate President Barack Obama. Not for his tendencies to respond to massive problems with even more massive spending programs, but because of his ability to inspire and lead people.

I am convinced that we will never solve the healthcare crisis in the U.S. until we can get our citizens to take some personal responsibility for their health status. With obesity rates in 31 states exceeding 25 percent, we are literally a country headed for a heart attack. There is no amount of spending that will be able to change this medical outcome.

What can change this outcome is to get people moving. Get people out of their cars and SUVs and onto bikes and sidewalks. Get people out of the fast food drive through at lunch time and into the gym.

And, who better to lead this charge than Obama. He is clearly the fittest president we have had in years. He is a role model for millions of Americans and he and his wife, Michelle, can lead by their words and their actions.

Kennedy made being fit cool.

During the 1960’s President John F. Kennedy made being fit cool. It is once again time to engage the entire country in a fitness challenge. Maybe this time instead of the touch football games in the yard, it will be three-on-three basketball in the driveway or the park. Who cares? Just move!

The country needs to be told the truth. “Listen, we are running out of money and cannot afford to take care of you when you make yourself sick by your over eating and lack of activity. So what we are going to do instead is help you get healthy and stay healthy.”

Now is the time to scrap the universal healthcare approaches of the past 40 years that focus only on providing coverage, and to look to a future of delivering health by encouraging personal responsibility for avoiding the avoidable. If we can do this, I think, the money will be there for everyone in this country who needs basic medical care and to provide treatment for all health issues that are not the predictable outcomes of lifestyle choices.

Barack Obama is the person who can do this. He is the person who should do this. Ted Kennedy passed the torch to him last summer in Denver. He is the future and he should use his position to shape policy that makes sense for the realities of today and the future.

Did Healthcare Reform Die with Ted Kennedy?

Several news articles this morning attempt to delve into the impact that Senator Edward Kennedy’s death will have on healthcare reform and what he called “the cause of my life,” providing affordable healthcare coverage to all Americans.

The question being asked is will Ted Kennedy’s absence hurt the chances that significant healthcare reform legislation be passed, or will an outpouring of sympathy and respect for the Senator ensure passage of a healthcare bill?

Reuters is reporting that Kennedy’s physical absence on Capitol Hill had already created a void felt by those seeking a deal in the healthcare debate. On the other hand the report says, “Kennedy’s death, with the extensive news coverage and outpouring of affection for him, could actually jump-start the effort for legislation that would be seen as a tribute to his lifetime of work.”

A story in the Guardian noted that with or without Kennedy, President Obama would probably still have run into Republican opposition to healthcare reform, but implied that the Senator may have been able to work for a compromise. Quoting Senator Orrin Hatch of Utah, who had worked closely with Kennedy on social issues, “It is a very one-sided, very liberal bill. I know that Ted would not have done that had he been able to be here.”

Certainly the news out of The White House yesterday that the deficit this year is going to balloon to a record $1.6 trillion will have a sobering effect on those faced with making the decision to endorse legislation that is estimated to cost $1 trillion over the next ten years.

Without Kennedy to work for compromise and facing staggering deficits, it would seem that any major healthcare reform legislation may be now postponed.

Photo credit: Official White House photograph.

An Open Letter to Health Savings Account Owners.

Dear health savings account (HSA) owner:

As a health savings account owner, you know that HSAs work. They are among the bright spots in today’s health care, reducing insurance costs, making coverage available to people who could not otherwise afford insurance, and allowing individuals to choose how they spend their health care dollars instead of the government or the insurance companies.

The current proposals for health care reform in Congress, if passed, will prevent you from having an HSA-qualified health plan ever again.

If you value your HSA, you should contact your representatives today to voice your concern over this threat to end one of the only health care reform ideas that actually work.

This is not a stand against health reform. In fact, HSAs are part of the solution:

  • 8 million Americans are covered by HSA plans, more than all SCHIP plans and more than the entire population of 39 separate states.
  • 30% of HSA Owners say they would be uninsured without their HSA.
  • Preventive care is free below the deductible in over 95% of group plans.
  • HSA Owners represent average Americans in terms of age and income.
  • 82% of HSA owners are satisfied with their HSA and only 4% would not recommend an HSA to a friend or family member
  • President Obama continues to promise that if you like your plan you can keep it.

This is where you can help. In short, health reform bills approved by key committees in the House and in the Senate could eliminate HSAs, if passed. On the surface everything looks fine, but the fine print is where the problem lies:

Buzzword: Actuarial equivalence – this means your HSA health plan will not qualify to be sold in government mandated “exchanges,” because your HSA contributions and your employer’s HSA contribution will not count.

Buzzword: Minimum credible coverage – The government will decide what benefits have to be provided below the deductible for a health plan to be allowed to be sold on the “exchange.” Since HSAs only allow preventive care to be provided under the deductible, any additional benefits that are added will disqualify all plans from HSA eligibility.

Buzzword: Health Commissioner – The draft bills give all the power over hundreds of items to a new Health Commissioner or HHS Secretary, assuring that bureaucrats will make all the significant decisions regarding your health care coverage.

If you like your HSA, now is the time to make your voice heard:

  • Send an email directly to your elected representative and senators.
  • Attend a local health care town hall meeting and voice your concerns about reform that would eliminate HSAs.
  • Share your story of how HSAs are helping you stay healthy and get care when you are ill or have an accident.

Thank you in advance for being willing to contribute to the debate and help pass reform legislation that preserves health care choices and a healthy economy for all Americans.

Senate Finance Committee Considering Excise Tax on Health Benefits.

Word is coming out of the Senate Finance Committee that consideration is being given to imposing an excise tax on health care benefits that exceed a specified threshold beginning in 2013. Although the threshold amount has not been finalized, reports suggest that the Committee may be considering $21,000 for family coverage. Reports also indicate that contributions to Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs) and Health Reimbursement Arrangements (HRAs) would be included in determining whether the health benefits package exceeds the threshold. If employees receive benefits exceeding the overall threshold employers and/or insurers would pay a 35 percent excise tax on the amount in excess of the threshold.

In addition, reports indicate that the Senate Finance Committee is also considering imposing a $2,000 cap on contributions to FSAs beginning in 2013. This, coupled with a House plan to eliminate the use of HSAs and FSAs for over the counter drugs, is placing the burden of financing healthcare reform squarely on the shoulders of middle class workers.

Here are some fundamental problems with these ideas:

  • FSAs, and more recently HSAs, have become important health care tools for both employers and their employees. They help Americans afford their out-of-pocket health care costs. Even under a reformed health care system, patients will still face out-of pocket expenses and we need these tools to help us afford these expenses.
  • Placing additional caps on the contributions that may be made to these accounts will disproportionately harm patients with chronic illnesses who tend to face very high out of pocket costs.
  • Further capping contributions to FSAs and HSAs is effectively a tax on health care and a tax on middle class Americans.
  • Including FSAs and HSAs in the calculation of the excise tax threshold will cause employers to scale back or eliminate these plans (and potentially dental, vision, and other health benefits) to ensure they don’t exceed the overall cap on employee benefits and trigger the excise tax.
  • Imposing an overall cap would be extremely complex and burdensome for employers. Employers would have to calculate the excise tax for each employee and their varying benefits and coverage levels and likely have to account for benefits provided to spouses and dependents under their employer’s plan.

Below is a list of Senate Finance Committee members and their contact information. If you value your FSA or HSA, this is the time to reach out to one or more of the committee members and let them know where you stand.

MemberDC Office PhoneDistrict DirectorDistrict Phone
Lincoln(202) 224-4843Donna Kay Yeargan(501) 375-2993
Kyl(202) 224-4521Kim Wold(602) 840-1891
Carper(202) 224-2441Larry Windley(302) 573-6291
Nelson(202) 224-5274Celeste Brown or
Sherry Hupp Davich
(407) 872-7161
Grassley(202) 224-3744Bob Renaud(515) 288-1145
Crapo(202) 224-6142Layne Bangerter(208) 334-9044
Roberts(202) 224-4774Chad Tenpenny(913) 451-9343
Bunning(202) 224-4343Debbie McKinney(859) 341-2602
Kerry(202) 224-2742Drew O’Brien(617) 565-8519
Snowe(202) 224-5344Gail Kelly(207) 945-0432
Stabenow(202) 224-4822Teresa Plachetka(517) 203-1760
Baucus(202) 224-2651Barrett Kaiser(406) 657-6790
Conrad(202) 224-2043Marty Boeckel (West)
Scott Stofferahn (East)
(701) 258-4648
(701) 232-8030
Menendez(202) 224-4744Michael Soliman(973) 645-3030
Bingaman(202) 224-5521Terry Brunner(505) 346-6601
Ensign(202) 224-6244Sonia Joya(702) 388-6605
Schumer(202) 224-6542Martin Brennan(212) 486-4430
Wyden(202) 224-5244Lisa Rockower(503) 326-7525
Cornyn(202) 224-2934David James(512) 469-6034
Hatch(202) 224-5251Melanie Bowen(801) 524-4380
Cantwell(202) 224-3441Chris Endresen(206) 220-6400
Rockefeller(202) 224-6472Rochelle Goodwin(304) 347-5372
Enzi(202) 224-3424Robin Bailey(307) 682-6268

Healthcare Without a Public Option Should not Quiet the Debate.

The headlines this morning are all about the Obama Administration softening its position on the need for a public option as part of a health care overhaul. Democrats say that it will not pass the House without such a plan and Republicans say that they cannot support any bill that includes it.

The administration has hinted for months now that they could live with out a public option as long as the bill that emerges from the three House committees and two Senate committees some kind of a health plan that will provided completion to private insurers. This could possibly be a co-op, they say.

I think the Los Angeles Times analysis of the move is right on target. The Times noted that, “Obama angered some liberals but took a big step toward winning over moderate Democratic lawmakers — a trade-off that sharply improves the chances Congress will approve the overhaul.”

I also believe that the move takes some of the heat out of the Town Hall Meetings. The public option is a lightning rod issue for those wanting to find the lowest common denominator in this debate. The public option = government-run healthcare = socialism = bad – end of argument.

Let’s hope that this not quiet the debate. Remember, the bill that has emerged from the House is over 1,000 pages in length. There are still enough drastic changes in the bill to keep benefits attorneys and regulators busy for the next 30 years. And, let’s not forget the cost is still estimated to be over $1 trillion.

The Elimination of Consumer-Directed Health Plans is Real.

During this week’s healthcare Town Hall Meeting in Portsmouth, NH, President Obama said, “Where we do disagree, let’s disagree over things that are real, not these wild misrepresentations.”

After hearing some of the wild misrepresentations – even some of which that have come from political pros who should know better – I agree. Let’s keep the debate real.

So for starters, let’s talk about the promise that we keep hearing about keeping our current plan if we like it. President Obama has repeatedly told the American public, “If you like your health care plan, you’ll be able to keep your health care plan, period. No one will take it away, no matter what.”

That sounds good. It is suppose it is to make us feel secure in the fact that we will not all be forced to join some public plan that would make us change doctors and wait in line for treatment. It just is not true.

Take for instance Health Saving Accounts. According to America’s Health Insurance Plans (AHIP), there are at least 8 million people enrolled in these types of health plans which couple a lower premium with a higher deductible and a tax-advantaged Health Savings Account (HSA) that can be used to pay for a large number of health care needs.

These HSA plans are in jeopardy of going away under the health reform legislation that has come out of three House committees and one Senate panel that have drafted the legislation as it stands today.

Why? Let’s look at Section 122 of HR 3200, the House version of the bill. This section is intended to set standards for all health plans guaranteeing that Americans will have access to essential benefits – as defined by the federal government.

One test of whether a plan meets the minimum benefits standards is something called Minimum Actuarial Value. Here is how this is defined in the bill:

Section 122 (3) MINIMUM ACTUARIAL VALUE-IN GENERAL- The cost-sharing under the essential benefits package shall be designed to provide a level of coverage that is designed to provide benefits that are actuarially equivalent to approximately 70 percent of the full actuarial value of the benefits provided under the reference benefits package described in subparagraph (B).

Depending upon the method used to calculate this 70 percent of the full actuarial value the benefits provided consumer-directed health plans as we know them today could go away. So much for keeping the plan that you have and that you like. Without overtly being singled out in the legislation, HSAs would effectively be rendered illegal under this bill because they would not meet the government’s definition of minimum benefits.

This is despite the fact that in a report dated May 2009, the American Academy of Actuaries, says that, with respect to consumer-directed health care plans:

“Generally, all of the studies indicated that cost savings did not result from avoidance of appropriate care and that necessary care was received in equal or greater degrees relative to traditional plans. All of the studies reviewed reported a significant increase in preventive services for CDH [consumer directed healthcare] participants. Three of the studies found that CDH plan participants received recommended care for chronic conditions at the same or higher level than traditional (non-CDH) plan participants. Two studies reported a higher incidence of physicians following evidence-based care protocols.”

Does it make sense to effectively kill a health insurance approach that has proven its ability to reduce costs while placing increased emphasis on preventive care? I thought that these were major goals for the reform package. Eight million people are going to be very disappointed to learn that they were not told the truth by their President and their Congressional delegates.

But hold on, there is still some hope that Congress will correct this situation before a final bill is rendered for a vote. One of the final amendments to HR 3200 offered up during the House Education and Labor Committee mark-up of the bill may help you hang onto your HSA at least a little longer – IF you are part of a group plan.

Submitted by Rep. Petri (R- WI), and accepted by unanimous consent of the committee, was an amendment that placed at the end of subsection 102 of HR 3200 language to provide an exception to consumer-directed health plans and arrangements. In part the amendment says, “…in the case of a group health plan which consists of a consumer-directed health plan or arrangement (including a high deductible health plan within the meaning of section 223 (c) (2) of the Internal Revenue Code of 1986), such group plan shall be treated as acceptable coverage under a current group health plan for purposes of this division.”

Section 102 of HR 3200 (in case you have lost track) is the part of the House bill that says it will protect your choice to keep your current coverage. It grandfathers existing group health plans for five years before they will have to comply with the government’s idea of what a health plan should consist. If you have an individual plan today, you will not be guaranteed that you can keep you current plan as the bill stands now.

The Petri amendment is a start to protecting consumer-directed health plans and HSAs, but even it has a long way to go to make it into the final bill. When Congress reconvenes in September the three House bills on healthcare reform will need to be merged to produce a final consolidated version that can be voted on by the entire House.

Meanwhile, two committees in the Senate have also taken up healthcare reform. The Committee on Health, Education, Labor, and Pensions (HELP), chaired by Sen. Ted Kennedy (D-MA), and the Senate Finance Committee chaired by Sen. Max Baucus (D-MT).

Of these two committees, the Finance Committee is attempting to develop the most bi-partisan bill and has yet to present a final draft for mark-up.

The committee has reached out to many sectors for input on the legislation they are drafting. One group they consulted was the HSA Council which has proposed language to the committee that would allow for HSA-type plans to meet the actuarial minimal requirement that no doubt will be in the bill they are now writing.

In a memo to a committee staffer dated July 30, 2009, Kevin McKechnie, staff director of the HSA Council, acknowledged that “…considerable confusion can exist on how to establish the actuarial value of HSAs.” He suggested the following definition be adopted by the committee:

“In determining the actuarial value of an HSA qualified HDHP, this amount must recognize both the value of the HSA qualified contribution to the Health Savings Account from any source and the health insurance benefits.”

By making the contributions made to HSAs by employees and their employers count towards actuarial minimum requirement HSAs could continue to be a viable and useful plan option well into the future.

If you have an HSA and you want to keep it now is the time to act. Help President Obama and this Congress keep the promise they have been making to us. Contact a member of the Senate Finance Committee and ask them to endorse the adoption of the above language in their bill. While you’re at it let your representatives know that you would like to see similar language in the House version of the bill.

This certainly isn’t as much fun as showing up at a town hall meeting and telling your elected representative where you think he/she should spend their after-life. Nor, is it as entertaining as speculating about some eerie death panel that would convene to tell us when to pull the plug on grandma. For eight million Americans this is real, and now, according to the President, is the time to disagree about the things in healthcare reform legislation that are real.