Kerry and MA healthcare reform - Does anybody know where he stands?

[Mass]

I was wondering if Kerry, as both the ranking member of the SBC and a Massachusetts Senator has taken a position concerning the different healthcare reforms that have been proposed in MA (Romney, DiMasi, Travaglini(sp?), Healthcareforall http://www.hcfama.org/).

I was half disappointed by Dukakis article, though I would imagine that Kerry's position is close from that. All the reforms that have been proposed in MA start from a good move , getting as many people as possible insured and at a better price, but they all have the same problem: they were not able to think out of the box and to consider healthcare as something else than an insurance and to put the price of healthcare on the workforce rather than on profit. I just wonder how long it will take for a state to really start a real state insurance plan where people and companies will pay according to their revenue.

http://www.boston.com/news/globe/editorial_opinion/oped/articles/2006/01/10/an_unpleasant_diagnosis/

An unpleasant diagnosis

By Michael S. Dukakis | January 10, 2006

Why is the current system such a burden on Massachusetts businesses? First, because it is expensive. Second, it forces employers who do insure their employees to pay for employers who don't.

[whometense]

1. So far haven't been able to locate

any specific comments about the initiative. Did find this: http://www.boston.com/news/local/massachusetts/articles/2005/12/14/reaction_to_gov_mitt_romneys_decision_not_to_seek_re_election/

"Massachusetts families deserve a governor who will fight for them every step of the way -- creating good jobs, making our streets safe, ensuring our families have affordable health care, and protecting our environment. I hope the next election will give us the opportunity to have an open, honest conversation about putting Massachusetts families first." -- Sen. John Kerry, D-Mass.

[TayTay]

2. Not specifically, I don't know what was said last week though.

SEN. KERRY ADDRESSES AMERICAN COMPETITIVENESS

BOSTON, Sept. 26 -- Sen. John F. Kerry, D-Mass., made the following speech:
SNIP

Healthcare costs are another devastating roadblock for a competitive America. We know kids who see a doctor do better in the classroom. And the sad truth is that only because of Katrina, many children will get vaccinations for the first time and thousands of adults will see a doctor after going without a check-up for years. Illnesses lingering long before Katrina will be treated by a healthcare system that just weeks ago was indifferent, and will soon be indifferent again. For the rest of the year this nation silently tolerates the injustice of 11 million children and over 30 million adults in desperate need of healthcare. Their plight is no less tragic - no less worthy of our compassion and attention.

The stark reality for our economy is that by 2012, health care costs will account for 17.7% of our GDP and, expenditures will total $3.1 trillion. This is an incredible burden on our country - it amounts to a tax our competitors aren\'t paying. GM\'s health care costs now account for $1,400 per vehicle. Toyota recently put a major new plant in Canada, instead of the U.S because of healthcare costs.

The picture gets even bleaker for small businesses. Only 60 percent provide insurance - and that\'s a decline from 69 percent just a year before. I am working on a compromise bill with Republican Senator Olympia Snowe that will fundamentally reform the health care system for small businesses and give them access to a more affordable range of options to care for their employees. We are in the final stages of drafting our proposal and look forward to bringing it to the Senate floor in the coming months. Maybe we can get something done.

And here in Massachusetts, the healthcare community is working hard with legislative leadership to address this issue. I applaud their efforts and urge you to complete this project soon. The benefits to our economy, and the example you can set for the nation, can be enormous.

In fact, a reformed healthcare system can be a real opportunity for our economy. We should be the worldwide leader in health information technology, but we\'re not making the national investments necessary to make it happen. Health IT can save money and lives at home, and we can export our technology and expertise abroad for profit. But the president\'s budget invests just over $100 million in Health IT standards and development nationally - less funding than what one hospital system in Massachusetts spends all by itself.

When you try to figure out why Washington is moving so slowly, or even backwards on competitiveness, the reasons are not so different from what we saw in New Orleans. What\'s missing is the urgency - the roll up your sleeves leadership - the sit at the table until you get it done decision-making - the forward-looking set of priorities.

[MH1]

3. Did he and Snowe come to agreement on the bill he mentions?

The picture gets even bleaker for small businesses. Only 60 percent provide insurance - and that\'s a decline from 69 percent just a year before. I am working on a compromise bill with Republican Senator Olympia Snowe that will fundamentally reform the health care system for small businesses and give them access to a more affordable range of options to care for their employees. We are in the final stages of drafting our proposal and look forward to bringing it to the Senate floor in the coming months. Maybe we can get something done.

I have a bad feeling that is the AHP thing and I think I saw a bill with her name that he did not cosponsor. I don't think he'll support AHPs.

[TayTay]

4. That is for a good reason.

I remember some of the SBA hearing from this year on AHP's. (*geek alert* Wonky stuff ahead, be advised) It is not that easy to get through.

April 20, 2005
Hearing:
"Solving the Small Business Health Care Crisis: Lowering Costs and Covering the Uninsured"
Participant List and Testimony
Chair Snowe's Opening Statement http://sbc.senate.gov/hearings/109hrgs.html
View Hearing **** Remember, these SBA hearings are small gems. *********

Ahm, I fear that the AHP plan endorsed by the Bushies is a bait and switch thing. (Hey, remember the Healthy Forests Initiative and the No Child Left Behind Law? Yeah, they are false advertising and a clear bait and switch thing, right? Okay. Same thing, only different.)

READ ME: Brief recap. http://www.humana.com/GovernmentRelations/CapitolUpdate/CapUp050502AHPUS.asp

Senator John Kerry (D-MA)
Sen. Kerry argued that AHPs would:

Cause premiums to rise for many small businesses and their employees
Offer no help to the uninsured
Erode important benefits and consumer protections that currently exist in the regulation of insurance products
Expose consumers and small employers to risk for unpaid claims as the result of plan failures, insolvency, and potential fraud.
Sen. Kerry also expressed concerns over how AHPs would affect state risk ratings and external review rights. This legislation offers no federal premium or patient protections.

This comes from that April 20th SBA hearing. It is also deceptive. Sen. Kerry favors AHPs, just not as written by the Bushies, cuz they will erode the protections that are in current law. There is a standoff on this. (See hearing.)

I will review the transcript tomorrow, if someone asks me nicely and offers me cookies. (Hey, this is wonky stuff. I need a reward.)

[MH1]

5. Hmmm... I didn't mean to imply that JK should support AHPs.

On the contrary, everything I've seen about them from sources I trust, say bad things, like JK said in the excerpt in your post.

I am not sure there is any variation on AHPs that the orgs I'm familiar with would support. It is possible that the label "AHP" has now been so tainted by the Bushite version that they would need to be called something else to garner support. So, not sure I like the statement "Sen. Kerry favors AHPs". Too easy to be misunderstood. I do understand that he supports some form of creative solution to help mitigate health care costs for small biz.

Okay, I'm off to bake cookies. I'd love to see more on this tomorrow. My inner wonk is smiling in anticipation.

[TayTay]

6. No, he did say that AHPs are a good idea

but this form of it is bad. That is doubly so with this Admin which will take a seemingly good idea and load it up with things that are bad and then try and ram it down the throat of Congress. (It could be that AHP is now a bad word, I haven't heard it much lately.)

BTW, for the benefit of any newbies, here is a very good and short summary of the Kids' Come First ACt:

7. Sponsored in the 109th Congress by Senator John Kerry (D-Mass.), the Kids Come First Act of 2005 (S. 114) would offer states fiscal relief in exchange for expansion of SCHIP coverage to more children (Library of Congress 2005). The bill would have the federal government pay for all Medicaid outreach and coverage costs for children under age 21 with incomes at or below poverty level ($15,670 annual income for a family of three). In exchange, each state would agree to pay its share of a SCHIP or a Medicaid coverage expansion to children under age 21 with incomes at or below 300 percent of poverty ($47,010 annual income for a family of three). By raising the age of eligible children to include young adults under age 21, the proposal would cover an estimated 11 million uninsured children in addition to the 20 million children enrolled in Medicaid today. The federal government would continue to pay the enhanced matching rate for SCHIP expansions.

[TayTay]

7. ARticle about that April SBA meeting on AHPs

Health Biz: Divide still wide on AHPs
United Press By ELLEN BECK

WASHINGTON, Apr 21, 2005 --Banter at the Senate Small Business and Entrepreneurship Committee was collegial this week and lawmakers' promises of bipartisan cooperation numerous, but when it came down to the details, Democrats dug in their heels and opposed Republican legislation allowing association health plans.

The Bush administration has proposed AHP legislation several times. It would allow industry associations to offer health plans to their members as a way to help small businesses afford insurance for their employees. The idea adapts the tactics of big businesses and labor unions, which capitalize on their huge numbers to negotiate better premium rates.

The most recent AHP legislation passed the House, but went nowhere in the Senate. Wednesday's hearing suggested not much has changed.

"We have strong evidence that AHPs just don't live up to their billing," said ranking minority member Sen. John Kerry, D-Mass., who wants to look at other options.

Kerry suggested one alternative is his presidential campaign platform component, which called for setting up a risk pool for small businesses and individuals in a program similar to the Federal Employee Health Benefits Program. Committee Republicans strongly backed AHPs.

"I strongly believe association health plans can play a major role in addressing this country's healthcare crisis," said committee Chairwoman Sen. Olympia Snowe, R-Maine. "AHPs will bring necessary reform to insurance markets that have long trapped small business and their employees in a vicious cycle of rising costs."

Snowe authored S. 406, the Small Business Health Fairness Act of 2005. Its companion bill in the House, H.R. 525, was introduced by Rep. Sam Johnson, R-Texas, and it passed the House Education and Workforce Committee in March.

Democrats agree small business needs help and Kerry noted insurance premiums in some cases have risen 70 percent. About 63 percent of small businesses offered the benefit in 2004, down from 68 percent in years prior.

Democrats do not like key parts of the AHP legislation and are joined in that cause by the National Small Business Association, as well as the lobby groups America's Health Insurance Plans and the Blue Cross Blue Shield Association. The National Federation of Independent Business, on the other hand, supports S. 406.

The most vexing detail for opponents is jurisdiction. Instead of placing AHPs under state regulation, the legislation would bring them under the federal umbrella of the Department of Labor, which regulates large businesses and labor unions that self-insure their workers under the Employee Retirement Income Security Act or ERISA.

Alissa Fox, BCBS's executive director for policy, told UPI's Health Biz that comparing state regulations with federal regulations on insurance is "night and day."

Fox said states have enacted consumer-protection laws that ensure health plans have the money and pay health claims when they are submitted by healthcare providers.

"What they (supporters) are saying is the way we regulate a single employer (under federal ERISA laws) paying health benefits for their own employees -- and is on the hook to pay those benefits -- is the way we're going to regulate an AHP, which is going to do everything an insurance company does."

The Labor Department, she said, tends to look at problems only when a pattern of activity emerges, but in insurance, by that time, people are left with unpaid claims.

Labor Secretary Elaine Chao appeared before the Small Business committee to defend her department's ability to oversee AHPs. She said the legislation provides a "level playing field for small business," which would see a 13 percent to 25 percent reduction in the cost of providing health benefits for workers.

She also said the Labor Department has extensive experience and capability in governing group insurance that covers millions of Americans under ERISA.

"We feel very confident about our ability to regulate (AHPs)," Chao said, and described how Labor would ensure solvency of AHPs and strengthen protections against unscrupulous groups that might try to game the system.

Hector Barreto, head of the Small Business Administration, said small businesses, which make up the backbone of the U.S. economic structure, are struggling to offer benefits and losing the battle.

"It's a terrible way to treat people who are keeping our businesses afloat," he said.

The NSBA, however, has a detailed paper on AHP's mechanical problems. It said states regulate health-insurance rates in the small-group market either through rate bands with a range of costs, or through community rating, which sets a premium for all participants in that area. The legislation would require AHPs to adhere to rate bands in the state where they are headquartered -- allowing them to apply that rate to all other states in which they operate.

According to the NSBA, a plan with either a wide rate band or no band, and selling in a state that uses community rating, would mean significantly lower rates for younger, healthier people than for older, sicker groups. That would lead to those younger, healthier folks going into AHPs, leaving the traditional pools with the older and sicker employees. That would drive traditional insurance pool rates up, which ends with the so-called death spiral as the plan becomes financially unviable and self-destructs.

Testifying Thursday before the Senate Health, Education, Labor and Pensions Committee, Karen Ignagni, president of America's Health Insurance Plans, noted the Congressional Budget Office has estimated 82 percent of small business workers would pay higher premiums under AHPs.

CBO also found most AHP participants would be people switching from traditional health plans rather than employees who did not have insurance previously. So as AHPs increase, traditional insurance enrollment decreases or has substantially higher rates, resulting in an increase in the number of uninsured, rather than a decrease, as proponents have claimed.

The legislation answers the so-called cherry picking issue, Republicans contend, by requiring AHPs be offered to all employees -- young, old, sick, healthy. Kerry said, however, AHPs could legally cherry pick by not allowing all businesses into the association.

Sen. Jim Talent, R-Mo., said AHPs are not "revolutionary change on an ideological level" but simply allow small business to do what big business does ... "because there are economies of scale to insuring big pools."

"I'm for people banding together. I'm for economies of scale," Kerry said. "The problem is that's not all that it does."

Ignagni testified insures negotiate discounts from doctors and hospitals based on their entire block of business, large and small groups.

"Because AHPs would represent small businesses only, it is unlikely that they could negotiate physician and hospital discounts that match or exceed those provided by health insurance plans covering both large and small employers," she testified.

Sen. Conrad Burns, R-Mont., said when he goes home and talks to small business owners, "it seems like it goes from conversational chatter to screaming about doing something about the affordability and access of healthcare."

Burns said he has reservations about the bill but the small business community cannot wait for perfection so he'll support it.