In the absence of a comprehensive health insurance reform plan from Senate Republicans, an understanding of Republicans’ priorities for reform can be gained by examining their amendments to health insurance reform plans considered in Senate committees. As the Senate Finance Committee conducted its markup of the America’s Healthy Future Act, amendments filed by the Committee’s Republican members provide a clear indication that Republicans prioritize insurance company interests over enacting meaningful reform that will fix our broken health care system.
An analysis of the 294 Republican amendments filed to the Chairman’s Mark of the America’s Healthy Future Act found at least 48 that directly deliver for health insurance companies. [Center for American Progress, 9/28/2009] By comparing a recent letter from America’s Health Insurance Plans (AHIP) to Senator Baucus and the Republican amendments filed to the Chairman’s Mark, the Center for American Progress identified 48 amendments that directly address concerns that the health insurance industry organization raised about the legislation. [AHIP, 9/21/2009]
Eliminating Shared Responsibility of Health Insurance Companies
Health insurance reform is built on the belief that we all have a shared responsibility to ensure all Americans have access to quality, affordable health care – this includes individuals, employers, governments, health care providers, and insurance companies. As a partial means of financing tax credits to help low-income Americans purchase health insurance, as nearly all Americans will have the responsibility to do upon enactment of health insurance reform, the Chairman’s Mark of the America’s Healthy Future Act imposes a fee on health insurance providers. After all, insurance companies will be gaining millions of new customers, which will increase their already substantial profits. [Health Care for America Now, 5/2009]
In its letter, AHIP stated its opposition to new fees and concluded, “…we strongly urge the committee to strike these provisions.” [AHIP, 9/21/2009] Republicans responded, filing eight amendments to eliminate or substantially reduce the shared responsibility of insurance companies to contribute to health insurance reform. [Center for American Progress, 9/28/2009; Senate Finance Committee list of amendments, 9/19/2009] For example, Senator Kyl proposed two amendments, Kyl F1 and Kyl F4, to eliminate fees on all industries and to eliminate the health insurance providers’ fee, respectively. [Senate Finance Committee list of amendments, 9/19/2009] These Republican amendments required offsets, as they would reduce the revenue available for financing comprehensive health insurance reform. Senator Kyl chose to pay for both amendments by reducing the tax credits available to help low-income families purchase health insurance.
The insurance industry was also concerned that the new fees would not be tax deductible. [AHIP, 9/21/2009] Senator Hatch filed an amendment, Hatch F15, to make all industry fees deductible for income tax purposes. [Senate Finance Committee list of amendments, 9/19/2009] The Hatch amendment offset lost revenue through a proportionate reduction in spending in the Chairman’s Mark, which would include tax credits to help low-income Americans purchase health insurance.
None of these Republican amendments to protect insurance industry interests were subject to a vote in the markup, and are not included in the Chairman’s Mark.
Eliminating Market-Based Payment Reforms to Medicare Advantage
The Chairman’s Mark creates a fair market for seniors’ business, using competitive bidding to reduce subsidies to private insurance companies and allow the market to set Medicare Advantage payment rates, with bonuses for insurance plans that provide real benefits to enrollees. Reducing these overpayments saves all Medicare beneficiaries and all taxpayers money, while still allowing Medicare Advantage enrollment to grow and plans to stay where they are. In its letter, the insurance industry mischaracterized these changes to the Medicare Advantage program, stating, “We have strong concerns about the proposed funding cuts to Medicare Advantage.” [AHIP, 9/21/2009]
In response, Republican Senators offered ten amendments to prohibit the market from setting Medicare Advantage payment rates and to ensure that private insurance companies continued to receive subsidies, paid for by all Medicare beneficiaries and all taxpayers. [Center for American Progress, 9/28/2009; Senate Finance Committee list of amendments, 9/19/2009] For example, Senator Kyl offered an amendment, Kyl D1, to strike all the Medicare Advantage payment reforms in the Chairman’s Mark. Senate Kyl’s amendment would have removed all of Title III of the Mark, which contained not only provisions related to Medicare Advantage, but also improvements to the nation’s health care quality infrastructure, provisions to strengthen the primary care workforce, and a provision to eliminate the 21 percent reduction in Medicare payments physicians are scheduled to receive in 2010 under the Sustainable Growth Rate (SGR).
Senator Baucus ruled Senator Kyl’s amendment non-germane, and every Democrat present supported the Chairman in voting against the Kyl amendment to protect insurance industry interests by eliminating market-based payment reform to Medicare Advantage.
Reducing Benefit Standards
The Chairman’s Mark establishes standard benefits that health insurance policies would be required to cover, ensuring that Americans have access to meaningful coverage that offers them real security through things like preventive care when they are healthy, maternity and newborn care for when their family grows, and real coverage of medical services they might need in the event of a serious illness or accident. In its letter, the health insurance industry stated its concern about these standards, which the industry feels “…would impose higher costs on consumers…” [AHIP, 9/21/2009]
Consistent with their support for insurance industry interests over other issues, Republican Senators offered four amendments to eliminate or reduce the benefit standards established in the Chairman’s Mark. [Center for American Progress, 9/28/2009; Senate Finance Committee list of amendments, 9/19/2009] For example, Senator Kyl offered an amendment, Kyl C10, “…to prohibit the federal government from limiting consumer choice by defining the health care benefits offered through private insurance.” [Senate Finance Committee list of amendments, 9/19/2009] During debate on this amendment, Senator Kyl said, “Well, first of all, I don’t need maternity care, and so requiring that to be in my insurance policy is something that I don’t need and it’ll make the policy more expensive.” [Congressional Quarterly transcript, 9/25/2009] Senator Stabenow responded, “…I think your mom probably did…” Fortunately, Senator Kyl’s amendment to eliminate benefit standards, and to make health insurance policies more expensive for women due to the fact that they may need maternity coverage, was defeated.
Every Democrat on the Finance committee voted against Senator Kyl’s amendment to protect insurance industry interests by reducing benefit standards.
Allowing Insurance Companies to Mislead Seniors
The Medicare Advantage program allows private insurance companies to participate in Medicare and receive substantial subsidies for providing health benefits to seniors. Earlier this year, Humana, which participates in the Medicare Advantage program, sent letters to enrollees, asserting that under “Leading health reform proposals being considered in Washington, D.C., this summer…millions of seniors and disabled individuals could lose many of the important benefits and services that make Medicare Advantage health plans so valuable.” [Humana letter, accessed 10/6/2009] Upon investigation, the Centers for Medicare and Medicaid Services (CMS) instructed Humana to “end immediately all such mailings.” [CMS letter to Humana, 9/18/2009] The letter stated, “CMS is concerned that, among other things, this information is misleading and confusing to beneficiaries, represents information to beneficiaries as official communications about the Medicare Advantage program, and is potentially contrary to federal regulations…”
In proposing his amendment (Kyl D6, cosponsored by Senators Enzi, Roberts, Crapo, Bunning, Cornyn, Hatch and Ensign) to protect the insurance industry’s interests, Senator Kyl argued that the insurance companies “have the right to be wrong” in expressing their opinions to seniors enrolled in their plans. [Congressional Quarterly transcript, 9/23/2009] Senator Baucus responded that, “There is no First Amendment right to lie. There is no First Amendment right to mislead,” and Senator Bingaman pointed out that Medicare Advantage plans are “government contractors that have been hired by the government to stand in the place of the government in providing services to seniors who are entitled to services under Medicare.”
Every Democrat on the Finance Committee voted against Senator Kyl’s amendment to protect insurance industry interests by allowing insurance companies to mislead seniors.