KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Weekend Update: Congress Weighs Changes In Health Law’s Business Purchase Requirements; Young Adults Lack Coverage; Medicaid vs. Schools?

News outlets offer a variety of stories about the new federal health law and getting health coverage.

The Washington Post looks at momentum building to "modify and possibly repeal" one funding provision of the health law. "The provision, which takes effect next year, will require businesses to file 1099 tax forms reporting any purchases they make of goods or services above $600 from any individual or business, including corporations. Currently, businesses only need to file 1099s when they buy services -- and only when the vendor is an unincorporated person or business. The move -- designed to clamp down on tax evasion -- was projected to raise $17.1 billion over 10 years toward the cost of the health-care law. But the measure has prompted alarm from small businesses, who complain that it could prove exceedingly labor-intensive and expensive. Members of Congress from both parties have taken notice, and the Senate is scheduled to vote Sept. 14 on two amendments to an unrelated bill: One would eliminate the 1099 provision; the other would exempt businesses with fewer than 25 employees, raise the reporting threshold to purchases above $5,000, and exclude those made with a credit card. A 60-vote majority would be required in both cases" (Aizenman, 8/29).

The Richmond Times Dispatch  reports on insurance needs for young adults. "Adults ages 19 to 29 are the largest group of uninsured Americans, though they are cheapest to cover, according to Sara Collins, vice president of Affordable Health Insurance at the Commonwealth Fund, a private organization that focuses on health policy. According to a 2009 survey by the Commonwealth Fund, more than 75 percent of young adults surveyed were forgoing care because of the cost. Those who did seek treatment paid twice as much as people with insurance. In paying for care, 31 percent said they had postponed education or career plans to pay health-care bills, and about half asked their parents for assistance. ... Many young adults think they are healthy so they go without health insurance, [a family physician] said. This common practice winds up being expensive" (Chapman, Fung and Chopin, 8/29).

The New York Times takes a look at the use of high-deductible health insurance plans linked to tax-exempt savings accounts and points out that although the plans have been growing in use, the new federal health law may make them "less attractive, if new rules, yet to be announced, require lower deductibles and impose other restrictions."

Under such plans "[i]n exchange for picking up a larger share of their own health care costs, employees pay lower insurance premiums and are allowed to use pretax dollars to pay out-of-pocket costs. But many consumers embracing the plans have discovered there are pitfalls aplenty, including out-of-pocket expenses they cannot afford. To open a health savings account, you must be enrolled in a qualified health insurance plan with a deductible of at least $1,200 for an individual or $2,400 for a family. In return for accepting the higher deductible, you are allowed to deposit pretax dollars in the H.S.A., which are used to pay your out-of-pocket medical costs."

Employers say the plans require that workers "shoulder more of their own health care costs" and that forces them to be "wiser consumers of health care." Critics worry, however, that "high-deductible plans work only for young, relatively healthy people who do not spend a lot on health care anyway. When sick people are faced with paying high out-of-pocket costs for medical bills, they simply go without the care they need, experts note. What's more, shopping for the best health care prices is difficult for consumers - sometimes impossible, because doctors and other health care providers don't readily disclose prices" (Konrad, 8/27).

Republicans renewed their criticism of the federal health law in the party's weekly Saturday address to the country. The Hill reports that Florida Senate candidate Marco Rubio called for the repeal of the law while delivering a broad attack on Democratic policies. Rubio "urged lawmakers to 'repeal ObamaCare and replace it with a plan that will lower health insurance costs for Americans without bankrupting the nation.' He said the new system should promote competition, allow people to keep their current coverage, and give individuals the same tax breaks businesses get for insuring employees."

Rubio is "locked in a tight three-way race to represent Florida in the Senate with Democratic Congressman Kendrick Meek and incumbent Gov. Charlie Crist, who dropped out of the Republican primary to run as an independent" (Nagesh, 8/28).

Crist also spoke out on the health law, but he quickly sought to change his quote. According to The Miami Herald, "Crist said Friday he would have voted for President Barack Obama's healthcare bill -- only to retract his statement two hours later. ... In a noon interview at an Orlando television station, the anchor asked: 'Healthcare bill, how would you have voted on that?' The now-independent Crist responded: 'I would have voted for it, but I think it can be done better. I really do.' At 2 p.m., campaign spokesman Danny Kanner attempted to clarify Crist's remarks. 'Apparently . . . there may be some confusion regarding my position on healthcare,' Crist said in the statement. 'If I misspoke, I want to be abundantly clear: the healthcare bill was too big, too expensive and expanded the role of government far too much. Had I been in the United States Senate at the time,' Crist continued, 'I would have voted against the bill because of unacceptable provisions like the cuts to the Medicare Advantage program.'" His two opponents assailed the statements (Frank, 8/27).

Also raising controversy was a letter sent by the Nebraska governor to education groups urging them to work for the health law repeal.

The Associated Press/BusinessWeek report: "Nebraska Gov. Dave Heineman is urging the state's top education groups to support the repeal of federal health care reform or he will assume they tacitly support a likely reduction in education funding. 'Increased funding for Medicaid is likely to result in less funding for education,' Heineman says in the letter sent Wednesday to associations representing teachers, school boards and school administrators. 'Don't sit on the sidelines,' it says later. 'I strongly urge you to support the repeal of the recently enacted federal health care law.' The letter follows the release of a state-commissioned study last week that says health care reform will increase Nebraska's Medicaid costs by $526 million to $766 million over the next decade. In May, a state-by-state report commissioned by the Kaiser Commission on Medicaid and the Uninsured estimated a much lower cost of between $106 million and $155 million (Jenkins, 8/27).

Lincoln (Neb.) Journal Star: "Representatives of the three groups -- the Nebraska State Education Association, Nebraska Council of School Administrators, and Nebraska Association of School Boards -- said their boards will discuss the letter. Supporters of health care reform said good education and good health care are both important for children. 'It is completely unnecessary to pit education and Medicaid against each other,' said Jennifer Carter with the Nebraska Appleseed Center. 'You can't teach kids unless they are healthy. The responsible thing to do is to decide what the priorities of the state are and the budget should reflect those priorities'" (Hicks, 8/27).

Omaha Herald World: "The Omaha Public Schools superintendent and at least one state senator are crying foul. ... OPS Superintendent John Mackiel expressed dismay, saying he had never seen such threats from former Govs. Mike Johanns and Ben Nelson. 'These divisive politics are not necessary and are not the Nebraska way,' Mackiel said. 'No parent should have to choose between their children's education or their child's health. That's not the Nebraska way.' State Sen. Jeremy Nordquist of Omaha, who supports the federal health care law, said the governor is presenting a 'false choice' to state education groups" (Hammel, 8/28).

Health law opponents also scored a victory in Colorado this week. BusinessWeek reports: "Coloradans will get to weigh in on the health care overhaul this fall with a ballot measure that would try to block provisions of the federal health reform law. Colorado Secretary of State Bernie Buescher said Thursday that backers collected the required number of signatures to put the proposed state constitutional amendment on the November ballot. ... The amendment would prohibit the state from forcing residents to buy public or private health insurance, said [Jon] Caldara, head of Health Care Choice for Colorado. It would also protect fee-for-service health care by ensuring Coloradans can choose to pay out of pocket for health care services and products, he added." (8/27).

Denver Post: "Amendment 63 is an attempt to blunt federal health care reforms requiring Americans to purchase health insurance, although a November victory may be largely symbolic since federal law supersedes state law. Institute leader Jon Caldara said passing the amendment would mean the state would play no part in enforcing the federal rules. ... [But] Dede de Percin, executive director of the Colorado Consumer Health Initiative, said that because the measure would change the state Constitution, it could pose a stronger challenge to the federal mandate than similar voter-approved laws in other states. If Amendment 63 triumphs over the federal health care reforms, it would cost consumers, she said, as the cost of providing expensive care to the uninsured in emergency rooms is shifted to people who pay insurance. (Fender, 8/27)

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