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Transcript: Health On The Hill – October 11, 2010

The Department of Health and Human Services has granted approximately 30 waivers to employers, insurers and unions that will allow them to offer limited benefit, or “mini-med,” health insurance plans. Additionally, a federal judge in Michigan ruled that Congress does have the power under the Constitution to require that individuals purchase health insurance – known as the “individual mandate” – but legal challenges to the law are ongoing and the debate is expected to land at the Supreme Court.

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JACKIE JUDD: Good day. This is Health on the Hill and I’m Jackie Judd. The candidates and the courts are weighing in on health care reform, and the Obama administration is conceding some ground in terms of implementing some parts of the law. Here to discuss all of this and more is Mary Agnes Carey, senior correspondent for Kaiser Health News. Welcome back, as always.

The administration has given waivers to a certain number of unions, retailers, other organizations because they complained that some aspects of the law were too onorous, too burdensome. What was the administration’s thinking?

MARY AGNES CAREY: We are talking here about these limited benefit plans, also known as mini meds, and in their appeals these groups to HHS said if we don’t get waivers in two key areas – one is the elimination of lifetime benefits, and the other are the increase and eventual elimination of annual benefits – that two things could possibly happen.

One is that the employers could not provide, could not afford to give health coverage to workers or that that coverage would be too expensive and workers themselves couldn’t afford the premiums. And so HHS has taken these items into consideration.

As you have noted, they have given waivers to about 30 insurers, union groups, employers, and there are more in the pipeline waiting to get these waivers. I think their thinking is they don’t want people to lose their health care coverage leading up to 2014 when a lot of the provisions of the law will be implemented that could help these folks afford coverage.

JACKIE JUDD: But you touched on this issue of precedence. There are many more companies and other organizations in the pipeline prepared to ask for concessions, waivers, whatever words you want to use. Does the administration worry about where it sets the bar?

MARY AGNES CAREY: I think that implementation of this law was never going to be easy and it wasn’t going to be pretty and this is neither easy nor pretty. It is a tough thing. They had to take so many tough votes to get this law into place and now as you implement it the rubber hits the road. It may not go exactly the way you intended.

Also, progressives will be pushing against the administration perhaps to not be so generous with waivers, but this is the balancing act, if you will, the administration has to perform. Do they give a waiver and keep folks covered? Do they not give a waiver and see what happens to people? If they lose their coverage, they have to buy it in the marketplace. These major tools going into effect in 2014 aren’t quite there yet. What risk do they want to take?

JACKIE JUDD: And three weeks out from the midterm elections, the administration certainly could not be looking forward to any headlines that could have touted, you know, a certain number of people will be losing their health insurance because of the reform law. Since we last spoke, what is new in the congressional elections?

MARY AGNES CAREY: Well, of course we are getting closer to the election, the momentum is building. We have talked about a few Democrats that have been out front and center talking about the health care law.

One is Russ Feingold, a Democrat in Wisconsin who is in the fight of his life to keep his Senate seat. His opponent, Ron Johnson, has hit him straight on for his vote for the health care bill, but Russ Feingold has come out and said no, this is a good vote. I’m proud of this vote. I wanted to stand up to insurers. I will continue to stand up to the insurers.

He cites some of the new benefits of the law, keeping children on your plan up to age 26, your adult children, no rescissions, no canceling of coverage once you get sick. He has come out front and center to say I believe in the health law and I believe in my vote, and not a lot of Democrats have done that this election cycle, so I think this will be a heavily watched contest to see how health care plays out.

JACKIE JUDD: Do strategists believe that health care reform will be a real game changer in some of these elections or is it part of the larger discontent that so many voters feel towards Washington?

MARY AGNES CAREY: I think the latter is the more accurate explanation. A lot of people feel Washington doesn’t work and so if a candidate who voted for the health care bill who is an incumbent and loses their job, it might be more out of dissatisfaction with the way Washington is working or not working over their vote on the health care bill.

JACKIE JUDD: One last area to discuss, Mary Agnes, is the court ruling last week dealing with the constitutionality of part of the reform law, what happened?

MARY AGNES CAREY: A Michigan judge said that the commerce clause of the Constitution does give Congress the power to require individuals to purchase health insurance, also known as the individual mandate. This is a key dispute in lawsuits against the health law all over the country. That was one ruling. The plaintiffs who disliked the ruling said they are going to appeal it, but we are going to see this debated over and over again.

There is a court date set for later this month on the Virginia case which also challenges the individual mandate. In December, we are going to have a court hearing on the Florida case where 20 suits have joined, opposing that and other provisions. So, it is one of those test cases on the health care bill that we are going to see go all the way to the Supreme Court.

JACKIE JUDD: Exactly. The expectation is this constitutional question will go to the Supreme Court and we all know the Supreme Court does not act that quickly so it could be another year or two or more before this question is settled.

MARY AGNES CAREY: I think you are absolutely right, but one thing I find very interesting in watching and tracking the health care implementation is you have several ongoing forces, if you will. You have the regulatory implementation game that is happening here in Washington. Obviously you have got the election debate, which we have just talked about. You have got the court challenges, but at the state level you have a lot of state officials that are saying we don’t have time to wait to see how these things play out. I have got to build a Medicaid expansion, how am I going to do that?

JACKIE JUDD: Implement the law that now stands.

MARY AGNES CAREY: Implement the law, exactly. Set up a system that when people come to apply, will they go in the exchange, will they go into Medicaid? State insurance commissioners and legislators are looking at their provisions on regulating insurance rates, how will those play out? And those are just two of the many responsibilities states have and they are working ahead and they can’t really wait to see how these things shape out.

JACKIE JUDD: And as you said, nobody said it would be pretty or smooth.

MARY AGNES CAREY: That is right.

JACKIE JUDD: Thank you so much, Mary Agnes Carey of Kaiser Health News.