December 15, 2009 Legislation




The Senate Health "Reform" debate has begun.  Prior to the debate the CBO announced an analysis of health insurance premiums for patients under the Senate bill.  It looked at 2016 premiums.  The numbers represent per person (covered life).  For those individuals purchasing insurance via the proposed exchange unsubsidized premiums would be between 10% to 13% higher than the premiums would be without any "reform".  For those individuals with incomes between 133% and 400% of the poverty level would get a government subsidy that would bring the payment to about 56% less than if there would be no bill passed.  Those under 133% would be eligible for Medicaid.  The reason for the higher premiums is that there are mandated coverage for things not currently covered.  Those who are covered by employers would see their premiums be about the same as if there was no plan in place.  This does not take into account any tax on "Cadillac" plans which would raise the premiums above the status quo.  If the employees dropped their high cost plans they would save between 9% and 12% over the status quo.  

The first Senate votes showed some Democratic solidarity.  The Senate voted down McCain's Bill to strip the Medicare reductions from the bill.  The Senate bill removes over $450 Billion in Medicare payments over the next decade.  After this amendment was defeated another amendment stating that basic Medicare benefits would not be affected by the cuts passed unanimously.  

Another vote on reversing the terrible mammogram recommendations passed the Senate 100-0.  The bill will incorporate into the Senate version of "Reform" that mammograms will be cost free to women and that screening will start at age 40.  I do not know how this will affect insurance premiums but don't look for a downward trend.   

California is following the guidelines on breast cancer for state breast screening exams.  They are now screening every two years and only after 50 years of age.  The guidelines gave them some cover since they are also broke.

Obama continues to go to the Hill to badger the Senators and the Senate continues to add amendments to the "reform" bill.  The Senate voted down 53-41 an amendment by Republicans that would have blocked cutbacks in payments to home health agencies for Medicare patients.  This means a 13% reduction in home care over ten years.  The Senate also voted down an amendment to preserve over $120 Billion in cuts to the Medicare Advantage program.  The vote was 57-41. This was after a vote passed 97-1 that nothing in the "reform" legislation would reduce benefits already guaranteed in Medicare Advantage.  The other amendment to not make it was to take out provisions to establish the Class Act which will have workers pay a premium for the promise of about $50 per day for visiting nurses, medical equipment and home renovation for long term care.  This is a  much cheaper version of a similar House bill.  I am not sure how much good the $50 will do but it is symbolic.  This came immediately after a 96-0 vote to protect Medicare home healthcare benefits.  The Senate attempted but failed to cap the pay of insurance execs to $400,000.  They also failed to pass a cap on fees to plaintiff attorneys in med mal cases. 

They (the amendments) keep on coming.  The vote on not allowing fed money to be used for abortion was defeated by the Senate in a 54-45 vote.  This may cost the Democrats the votes of the anti-abortion group and scuttle the entire bill.  It is interesting currently and for many years elective abortion has not been allowed to be paid for by fed money.


CMS has announced more time for physicians to sign up for Provide Enrollment, Chain and Ownership System (PECOS).  If a physician enrolled in Medicare prior to 2003 he or she must reenroll by April 5, 2010 in order to continue to bill Medicare.  About 30% of physicians are not enrolled in PECOS and will have their Medicare payments cut off and will not be able to rebill after the above date.

In a new one on me, the IRS is planning to withhold 3% of all monies due all Medicare providers starting in 2012.  This is to make sure that the providers are paying their taxes.  If the taxes are paid then the money will be sent to the providers.          Top


DISCLAIMER: Although this article is updated periodically, it reflects the author's point of view at the time of publication. Nothing in this article constitutes legal advice. Readers should consult with their own legal counsel before acting on any of the information presented.