On November 7, House Democrats approved their version of comprehensive health reform legislation by a 220-215 vote. 39 Democrats—primarily freshmen and members from Southern states—voted against the bill while all but one Republican opposed the measure. The tipping point came at the eleventh hour when a pro-life amendment authored by Rep. Bart Stupak (D-MI) was agreed to by a wide margin after the U.S. Conference of Catholic Bishops gave its blessing, swaying as many as 40 Democrats who were holdouts on the issue.
Due to the number of concerns RILA has with the House-passed health care bill, we were in the unfortunate position of having to oppose the measure. Specifically, in a letter to House Speaker Nancy Pelosi (D-CA), we noted that the Affordable Health Care for America Act (H.R. 3962) could actually increase costs beyond the status quo while erecting barriers to the hiring and maintenance of a healthy and productive workforce. Further, we believe that H.R. 3692 would make health insurance more expensive and drive many Americans out of the plans that they now favor.
In the Senate, the most recent action was a November 21 party-line 60-39 vote to begin debate on the Patient Protection and Affordable Care Act, which was unveiled only a few days before the vote. The legislation to be considered by the Senate is a result of weeks of closed-door deliberations between Senate Majority Leader Harry Reid (D-NV), Senate Finance Committee Chairman Max Baucus (D-MT), Senate Health, Education, Labor and Pensions Committee member Chris Dodd (D-CT) and senior White House officials.
Despite the fact that he held his caucus together for a procedural motion to proceed to debate, the path to final passage is far from clear and Sen. Reid has the unenviable job of rallying together a Democratic caucus known for its wide array of conservative and progressive members and the deals necessary to strike a careful balance between these competing factions. Undoubtedly, some of the issues most hotly contested in the House such as immigration, abortion, and a public option could also divide the Senate and Republican Leader Mitch McConnell has pledged to do his part to see to it that these divisions are exploited to keep the bill from passing. In particular, all eyes will be on a handful of centrist and conservative Democrats who continue to express ongoing concerns with the bill. Those key Democrats are Sens. Ben Nelson (D-NE), Mary Landrieu (D-LA), Blanche Lincoln (D-AR), Evan Bayh (D-IN) and Joe Lieberman (ID-CT).
Even if the Senate is able to complete their bill by the end of the year, experts agree that Congress will need time in the New Year for both chambers to merge their bills together and issue a Conference Report for a final up-or-down vote. Therefore, President Obama is unlikely to sign a health reform measure into law before January 2010.
At the outset of the health care reform debate, RILA member companies identified several core areas of importance to the industry in an effort to place targeted emphasis on issues that could have the greatest impact upon our ability to continue offering quality, affordable health benefits to our employees. Among these issues is preservation of the Employee Retirement and Income Security Act (ERISA), ensuring plan affordability for both employers and employees, opposition to a government-run “public option” health plan, and recognition of our industry’s unique workforce challenges.
Preserve ERISA. A requirement that all health insurance plans offer a minimum level of benefits undermines the fundamental premise of ERISA, which is to allow employers the opportunity to tailor health plans which meet the specific needs of their individual workforces. Because of ERISA, 170 million Americans retain health insurance coverage through an employer and therefore must be preserved.
Ensure Affordability. If the cost burden becomes too onerous for companies to continue offering health benefits, they will drop coverage, forcing employees to leave the plans that they now have and like. Establishing arbitrary thresholds for how much a plan must be subsidized or how a benefit is valued against other plans risks not only increasing costs for many employers but also decreases the plan innovation, flexibility and design that ultimately benefits our employees. A subsequent penalty assessment for falling even slightly below these standards could serve as a further disincentive for employers to continue offering health coverage.
Oppose a Public Plan. A public plan, particularly when combined with Medicare, Medicaid and other government plans, would be highly disruptive and destabilizing to the private health care marketplace. Under a public plan option, the government would soon become the largest health care purchaser in the under-65 health care market, as it already is for seniors. Soon there would be tremendous pressure for the new public plan to pay below-market rates, just as we have seen in Medicare and Medicaid, even if initially the public plan is directed to pay negotiated rates. This would result in enormous cost-shifts to private payers, undercut market-based insurance reforms, and reduce innovation in our health care system.
Exclude Part-Time, Temporary and Seasonal Hires. In service sector industries, it is commonplace for employees to be hired for part-time and/or seasonal work, or to leave a full-time job after a just few weeks. Clarifying that full-time employment is 390 hours in a quarter (or 30 hours per week for 13 weeks) and allowing employers in high-turnover industries a 90-day waiting period before automatic enrollment into health benefit plans will eliminate ambiguity about who is considered full-time and who is committed to making a career with the company. Without these safeguards, health benefit costs will either increase for those who do choose to stay or, worse, discourage job growth and creation.