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Transcript: Health On The Hill – Sept. 21, 2010

The Obama Administration and supporters of the new health law have planned a series of events this week to commemorate the law’s six-month anniversary and a package of consumer protections that go into effect Thursday as Republicans plan to unveil their plans Thursday to overhaul the nation’s health care system.

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LAURIE MCGINLEY: Hello. I’m Laurie McGinley with Kaiser Health News and this is Health on the Hill, our weekly discussion of health care policy news. Joining me today are Mary Agnes Carey of Kaiser Health News and Noam Levey of The Los Angeles Times and the Tribune/Washington Bureau.

Well, Mary Agnes, on Thursday, as you know, is the six month anniversary of the health care reform law, what should we expect from the administration and the other supporters of the law?

MARY AGNES CAREY: It is going to be a whole lot of events, a lot of focus on explaining these provisions to consumers and to the public with hopes that they will build even more support and interest in the public for the law. President Obama is going to meet with the state health insurance commissioners. They are critical to implementation of the health law.

Something like 200 groups all over the country that back the bill are going to sponsor events in their states and communities to talk about it. Lots of members of Congress are going to have conference calls and put out press releases and maybe have some events in their districts and states to talk about health care reform, because they really want to bring focus to, as you mentioned, the six-month anniversary and a lot of the provisions that go into effect.

LAURIE MCGINLEY: And Noam, what should we expect from the Republicans and the critics of this law?

NOAM LEVEY: Well, the Republicans are planning to roll out their agenda should they reclaim the majority on Capitol Hill [in November]. At the same time, we expect to hear a bit about health care in there as well.

We have sort of heard the kind of critiques about the problems with the bill, they have talked a lot about protecting seniors [with] Medicare Advantage [plans]. We have heard some Republicans like Paul Ryan in the House talk about even more radical changes to Medicare, so I expect that we’ll hear kind of some of the same critiques, although I expect that also they may not have to do that much work. A lot of the issues that have been in the news about rising premiums and so forth and this sort of nuts and bolts problems of implementation have sort of played right into their message without them having to do very much at all.

LAURIE MCGINLEY: Well, they have been talking a lot about trying to repeal the law or make significant changes in it, what is their strategy and do they have a chance of succeeding?

NOAM LEVEY: Well, it would be very hard for them to repeal the law, obviously. They would have to presumably have two-thirds majorities in the House and Senate which, even by the most optimistic projection for Republicans, seem unlikely, but one of the things that they certainly could do is go after provisions of the law and there has been talk about doing this by attaching provisions to funding bills – I think abortion is probably an issue that I am sure will reemerge. You can see changes to some of the implementation regulations that could be dictated through appropriations bills, should they have the majority. So, I think we will get a better sense once January comes about, about how they are [could] do it, but there are targeted things they could do.

LAURIE MCGINLEY: What are some of the other things the Republicans could do short of repealing the law?

MARY AGNES CAREY: Oversight is a big area for them. You can simply call up, have Don Berwick come up to the Hill, the head of the Center for Medicare and Medicaid Services. You could have Kathleen Sebelius, the secretary of HHS, she has certainly been on the Hill, but have her up more.

Look at the regulatory process, really focus in on those things, have some discussion about the individual mandate, for example. That might not necessarily be an oversight hearing, but Republicans could use if they have the majority the committee process to have hearings, have discussions, focus in on things about the law that they find unfavorable and even if it isn’t a repeal of it, they can have a steady drum beat of negativity, if you will, leading up to the 2012 presidential and congressional elections to make their case of why they dislike the law and what they would do differently.

LAURIE MCGINLEY: Could you tell us a little bit about the provisions that are going into effect on Thursday?

MARY AGNES CAREY: They include things such as keeping your adult child on your policy until age 26, unless they could get coverage through a job. No discrimination on coverage for children up to age 19, if they have a pre-existing medical condition. No lifetime dollar limits on the coverage that you have.

Other provisions that kick in including no deductibles or cost-sharing for some preventive services, covering immunizations at no cost, and direct access to a pediatrician or a gynecologist or obstetrician for patients. It is all a set of consumer friendly, if you will, provisions that consumers can look at and try to understand how the health law may or may not benefit them.

LAURIE MCGINLEY: Noam, there has been a bit of a flap about [some] insurance companies deciding not to sell child-only policies, could you tell us a little bit about it?

NOAM LEVEY: Well, this kind of goes to this broader dance that the insurance industry has been doing with the Administration ever since implementation. When the bill was passed, some of the senior folks in the insurance industry said we plan to implement it, we want to support it, we are going to do everything we can to figure out a way to make this successful.

One of the provisions in the bill, which Mary Agnes mentioned, which would end pre-existing exclusions for children, this is this practice which got a lot of attention during the debate in which insurance companies deny coverage to people who are sick. That is going to end for everybody in 2014, but Democrats in crafting the bill wanted to provide sort of one extra benefit early on to children, so that sick children would be able to get coverage.

Now the problem is that there is nothing in the bill that says that insurance companies have to sell child policies, it just says if they do sell child policies, they have to take sick children. Now, the insurance industry has said, and probably with some merit frankly, that if you only get patients signing up their sick children when their children get sick, you will have an adverse selection problem, where only the sick children go on the books.

That drives up costs, as we have seen in some states that have had guaranteed issue for everybody. You get people essentially buying coverage on the way to the hospital, and that has an adverse effect for people who are not sick. So, interestingly there is a debate now about: should there be an enrollment period so that you can only enroll your kids during a set number of months? If you do that, then you sort of have some control over what the risk pool looks like for sick children.

The problem is that it is not explicit in the law, whether that mechanism should work. Now this is obviously extremely arcane, but I think it goes to this issue of sort of how important the smallest little detail of how you regulate what insurance companies do, when and to whom actually works. So, we are going to allegedly get some additional clarification from the administration about this enrollment period issue which may help clarify this, but it is another hiccup in what will probably be years of hiccups of implementing this bill.

LAURIE MCGINLEY: I want to ask you one more question, as we head to the November elections, the Democrats have had a hard time getting traction in terms of using health care as an issue, do you think the events of this week will make a difference or is the problem that, despite the fact that the recession has been declared over, that people are still in such economic distress that that will overshadow the health care issue?

MARY AGNES CAREY: Well, I think the economy absolutely will be the top issue in the elections, talking about provisions in the health law certainly can’t hurt. Consumers may find this very valuable and I think the success or failure of the health law is really as individuals view it and decide whether or not it works for them, individually. This could help in the Democrats hope that people feel that way about the law, but I think when it’s all said and done, economy is issue A.

NOAM LEVEY: I think that’s right, I think as people see the benefits of the bill, certainly those people who enjoy those benefits will probably view the bill more favorably, but the problem I think is that for every person, every senior who gets a check when they hit the doughnut hole for their Medicare Part D, every parent who is able to sign up their 25-year-old kid, there probably are two or three or four Americans who are continuing to have a headache with the health care system, most prominently with cost.

People’s insurance premiums are going up and up and up. Most of that probably has nothing to do with the health care law, but from a political standpoint, I had a colleague of mine who said he was back in California last week, talking to his sister who has voted Democratic her entire life, voted for Barack Obama. Her health insurance bill went up 20 percent and she was raving mad. She said “I am not voting for a Democrat again,” so that is a problem and I think there is nothing Democrats are going to be able to do about that in the next six weeks.

LAURIE MCGINLEY: Well, thank you both for joining us.