Health Insurance Reform Outlook August 2009

1. Health Insurance Reform OutlookAugust 2009

2. Three Committees of jurisdiction in the House (aka tri-committees) are Ways and Means, Education and Labor and Energy and Commerce. Democratic chairmen of each committee and their related subcommittee chairs worked over this spring to draft what was originally called the tri-committee bill and is now known as H.R. 3200. They drafted the bill for the most part independently without input from stakeholder groups, the rest of the Democratic Caucus or even other Democrats on their committees. A discussion draft of the bill was released in June, then hearings were held in each Committee on a revised version of the legislation. The goal of the Democratic House leadership and the Obama Administration was to complete the Committee mark-ups of the legislation by mid-July and pass a measure on the House floor just before departing for the August Congressional recess on July 31. Background—House of Representatives

3. House Ways and Means Committee passed its version of H.R. 3200 on 1:16 am July 17 following a one-day mark-up. Three Democrats joined with all 15 GOP Committee members to oppose it. All 25 GOP amendments were defeated The $1 trillion bill would be financed primarily by Medicare cuts and a 544 billion surtax on the adjusted gross income of upper-income Americans House Ways and Means Committee

4. Education and Labor passed their version of HR 3200 on July 17th too after an all-night mark-up the day before. All GOP amendments were rejected and three Democrats also joined with the GOP in opposition to the bill. Approved amendments included an expansion of the sizes of businesses allowed to buy coverage in the exchange and an indefinite expansion of COBRA until the exchange is up and running. House Education and Labor Committee

5. Intention was to markup HR 3200 over three days (July 20-22) so as to have final bill ready to vote on the House floor on July 30. This schedule would have met President Obama’s goal of a bill passed out of the House by the start of the August recess. But after only one day, the mark-up was postponed. Seven conservative blue dog Democrats on the committee said they wouldn’t support the bill in its current form. House Energy and Commerce Committee

6. Dissention in the Ranks "If the bill fails it will be because of disagreement among the Democrats." -House Minority Whip, Rep. Eric Cantor (R-VA)

7. All night negotiations led to amendments that enough Blue Dogs would support for passage. Amended version included specific language guaranteeing licensed agent the ability to sell both private coverage and the public plan. Five Blue Dogs still opposed the measure. The Committee still has 60 amendments to vote on after the recess is over. Progressives are still claiming that they will not support the Blue Dog language on the government-run public plan. Three versions of the bill still have to be “married” together. Progressive-controlled Rules Committee gets to set the parameters for floor debate in September. Unity?

8. The two committees of jurisdiction in the Senate are the Health, Education, Labor and Pensions (HELP) Committee and the Finance Committee. Senator Kennedy and the HELP Committee began holding meetings with stakeholders and committee members about draft legislation right after the 2008 election. HELP discussions were initially bipartisan, but eventually those talks tapered off. Senator Baucus and the Finance Committee released a health reform white paper in December 2008 and began bipartisan discussions and regular stakeholder meetings shortly thereafter. Senate Finance Committee released a series of three “policy option” papers in May on cost containment and quality, coverage and financing issues, that were widely considered to be a first draft of legislation. Senate HELP Committee released a comprehensive bill, the American Health Care Choices Act in early June. Finance Committee was expected to release its version of a comprehensive reform bill shortly thereafter, but even though bipartisan negotiations on the measure continue daily an official draft has yet to be released. Senate Legislation—Background

9. Senate HELP Committee • The Senate HELP Committee passed their version of the bill after a two-week mark-up on July 15. • The original bill was widely criticized as a Kennedy staff draft. • Senator Dodd took control of the mark-up in Senator Kennedy’s absence. • Legislation is still troubling but vastly improved. • Includes Hatch amendment to specifically allow licensed agents to sell insurance in the “Gateway.”

10. Senate Finance Committee Bipartisan Talks Continue • Senate Finance Committee is conducting bipartisan negotiations. • Options papers released in May but actual legislation hasn’t been completed, let alone released to the public or marked up. • Chairman Baucus has pledged they will be done by September 15. • Discussions include cooperatives instead of a public plan, no employer mandate, financing the bill, structure of the exchange and rating rules. • Original draft contained problematic language requiring agents to abide by Medicare Advantage marketing and commission rules.

12. Private Insurers = Villains “They are the villains in this. They have been part of the problem in a major way. They are doing everything in their power to stop a public option from happening. And the public has to know that.” Speaker Pelosi, July 30, 2009 “The truth is we have a system today that works well for the insurance industry, but it doesn't always work well for you.” President Obama, July 29, 2009

13. Senate Democrats have begun to publicly wonder how long bipartisan negotiations should continue. Use of the Budget Reconciliation process to pass health reform is their big stick. But there are a lot of reasons why privately Senate leaders will admit that they would be much better off with a bipartisan bill. Senate Democrats—Plan B?

14. Quinnipiac University Poll – July 27-August 3: 59% of people disagree that Congress should pass reform if only Democrats support it vs. 36% that agree 72% of people think reform will add to deficit despite the President’s pledge vs. 21% who think he will keep his pledge 61% of Americans would rather purchase health care from the private sector vs. 25% from a government program This up from 53% in July and includes 63% of independents 66% of people think they will pay higher taxes as a result of reform plan http://www.quinnipiac.edu/x1295.xml?ReleaseID=1357 CNN/Opinion Research – July 31-August 3: 3 in 10 of all Americans think the president's health care proposals will help their families 44 percent feel they won't benefit but that other families will be helped by the president's plans, and one in five say no one will be helped. 83% of people are satisfied with their own health care 74% are satisfied with their personal health insurance coverage http://i.cdn.turner.com/cnn/2009/images/08/04/rel11b.pdf Public Opinion Matters

15. “I think the best way we’re going to get single payer, the only way, is to have a public option and demonstrate the strength of its power.” Rep. Barney Frank, D-MA “The public option is not a compromise, but a strategic step toward the single-payer system and the elimination of the private insurance industry.” Rep. Jan Schakowsky, D-IL “About 88.1 million workers would shift from private employer insurance to the public plan.” Lewin Group Independent Analysis of H.R. 3200, July 28, 2009 Government-Run Public Plan

16. Key Issues • Government-Run Public Plan • Employer Mandate • Will you really be able to keep the coverage you have? • Structure of the “Exchange” or “Gateway” • Is the individual mandate enforceable? • Are the market reforms workable? • Does this bill really contain health care costs? • Can the American People afford this plan?

17. Action/Fact of the Day Town Halls/In-District Meetings HUPAC Distributions In-District Phone calls, letters, emails and Faxes Consumer/Employer Outreach Dedicated Website Social Media Op-Eds and Letters to the Editor Media Outreach Radio Advertisements and PSAs August Recess Plan of Attack

18. National Association of Health Underwriters (703) 276-0220 www.nahu.org For More Information