Rockefeller Reaffirms Opposition To Passing Public Option Through Reconciliation

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Sen. Jay Rockefeller (D-WV) says there’s no sense in trying at this point. The public option should be put aside for the moment, so that health care reform can pass unperturbed–particularly because the measure on offer has already been watered down to a great degree.

“I fought for a meaningful public option, both in the Senate Finance Committee and on the Senate floor,” Rockefeller says in a new statement. “My version didn’t pass out of committee and other versions were watered down. Unfortunately, there simply has not been enough support to date to pass a strong public option, despite these efforts.”

I will continue to support viable options for enacting a robust public plan. Right now, however, there is no value for the American people in diminishing a meaningful public option so substantially that it exists in name only — and that is why we must focus our attention on the many great private health insurance reform ideas on the table today.

Rockefeller took a similar position on the issue of drug reimportation–a policy he supports and which may have had enough votes to pass in the Senate, but which was met with resistance by leading Democrats seeking to preserve industry’s support for health care reform. You can read the entire statement below the fold.

“From the very beginning, I have supported a strong and meaningful public option that would lower costs for consumers and hold health insurance companies accountable. That is why I introduced the Consumers Health Care Act (S. 1278), which would have saved consumers at least $50 billion over ten years. I also supported the House’s public option approach, which would have saved consumers more than $100 billion over ten years.

“I fought for a meaningful public option, both in the Senate Finance Committee and on the Senate floor. My version didn’t pass out of committee and other versions were watered down. Unfortunately, there simply has not been enough support to date to pass a strong public option, despite these efforts.

“I will continue to support viable options for enacting a robust public plan. Right now, however, there is no value for the American people in diminishing a meaningful public option so substantially that it exists in name only — and that is why we must focus our attention on the many great private health insurance reform ideas on the table today.

“We need to continue the forward momentum on health care reform, and find ways to hold health insurance companies accountable and to lower costs for consumers. This is why I am fighting for other effective ways to achieve these health insurance reform goals, including a minimum medical loss ratio (MLR) requirement and the creation of a federal authority to review premium increases — both are included in the President’s proposal along with a number of other critical health insurance reforms.

“I do not oppose reconciliation, and have long made the case for exploring all avenues available to pass health reform.”

SENATOR ROCKEFELLER HEALTH INSURANCE REFORM INITIATIVES THAT PASSED IN THE SENATE BILL:

Requiring Health Insurance Companies to Spend 85 Percent of Consumers’ Premium Dollars on Actual Medical Care (i.e. minimum medical loss ratios). As Chairman of the Senate Commerce Committee, Rockefeller has led several investigations into health insurance industry practices and their impact on consumers. A recent series of investigations uncovered disturbing information about the percentage of consumers’ premium dollars that health insurance companies actually spend on medical care, instead of marketing and profits. Senator Rockefeller subsequently joined Senator Al Franken (D-MN) in introducing the Fairness in Health Insurance Act (S. 1730), which would require all health insurers to spend at least 90 percent of premium dollars on actual medical care. Rockefeller also pushed, unsuccessfully, for a minimum medical loss ratio requirement during the Senate Finance Committee’s health reform mark-up. After the Finance Committee mark-up, Senator Rockefeller worked with Leader Reid, the Congressional Budget Office, and the “Gang of 10” Senators to make sure that strong medical loss ratio requirements would be included in the final bill. Ultimately, the manager’s amendment requires health insurers to spend at least 85 percent of premiums (85 percent in the large group market, 80 percent in the small and individual group markets) on actual health care services, not administrative costs, marketing campaigns or profits. This provision is also applied to grandfathered health plans.

Stronger Prohibitions on Annual and Lifetime Coverage Limits. On May 21, Senator Rockefeller introduced the Annual and Lifetime Health Care Limit Elimination Act (S. 1149) to prohibit insurers from imposing annual or lifetime limits as part of any individual or group health insurance policy. The Finance Committee health reform bill included a provision to eliminate annual and lifetime limits on coverage, but only in the individual and small group markets. During the Finance health reform mark-up, Senator Rockefeller filed an amendment (C3) to strengthen the underlying language regarding annual and lifetime limits. Chairman Baucus ultimately included language prohibiting insurers in the large group market from imposing “unreasonable” annual or lifetime limits on coverage – with the term “unreasonable” undefined. Senator Rockefeller continued to push for a full prohibition on annual and lifetime limits. Ultimately, the manger’s amendment bans lifetime dollar limits on coverage and, prior to 2014, tightly restricts use of annual dollar limits on coverage to be sure individuals can access needed care. These restrictions are based on criteria developed by the Secretary of Health and Human Services. Annual dollar limits on coverage will be completely prohibited beginning in 2014, when the state health insurance exchanges are operational.

Independent Federal Data Center to Provide Objective Medical Charge Information to Consumers and Providers. For many years, the commercial health insurance industry has collected medical charge information and used this data to calculate reimbursement rates for health care services delivered outside their networks. The private entity that collected this data and calculated payment rates was a health services company called Ingenix, a subsidiary of United Healthcare. Recent investigations by the New York Attorney General and the Senate Commerce Committee exposed the flaws of the Ingenix system – its calculations systematically underestimated the actual market costs of health care, which meant that consumers paid more for out-of-network services than they should have under the terms of their health care coverage. As part of the settlement they reached with the New York Attorney General, United Healthcare and other New York-based insurers who used the Ingenix data agreed to contribute money to start up a non-profit entity that would provide accurate, independent cost data to insurance companies, providers, and consumers. The manager’s amendment includes a provision to create an independent federal data center to collect medical charge information from private insurance payers, analyze and organize this information, and then make it available to consumers, health insurance payers, providers, researchers, and policy makers.

Additional Insurance Transparency and Reporting Requirements. On May 14, Senator Rockefeller introduced the Informed Consumer Choices in Health Care Act (S. 1050), legislation to help consumers obtain the information they need to make informed choices about health insurance coverage. He subsequently held a Commerce Committee hearing on Consumer Choices and Transparency in the Health Insurance Industry on June 24. Wendell Potter and others testified that health insurance industry makes it as hard as possible for consumers to understand the terms and benefits of policies. While both the Senate HELP and Finance Committee health reform bills included some provisions from S. 1050, Senator Rockefeller redoubled his efforts to improve transparency after hearing details of the insurance industry’s efforts to intentionally consumer consumers. He filed an amendment (C12) during the Finance Committee’s health reform mark-up to strengthen the transparency provisions. While his amendment was not adopted during the Finance mark-up, Leader Reid strengthened the transparency and reporting provisions as part of the merged Senate bill. Additionally, Senator Rockefeller successfully secured language in the manager’s amendment requiring insurers (including grandfathered plans) to publicly report on a number of indicators that show how well they treat both consumers and providers within their network. These provisions will help consumers make informed choices of the health coverage they buy.

Federal Studies of the Large Group Market (including the Self-Insured Market). Senator Rockefeller has fought consistently to apply the health insurance market reforms and consumer protections to health insurance in every single market, including the large group market.

In an effort to protect consumers in the self-insured market, Senator Rockefeller filed an amendment (C1) to the Senate Finance Committee health reform mark that would have applied all of the health insurance market reforms to the self-insured market. While he was able to successfully extend the prohibitions on annual and lifetime limits to the self-insured market as part of the Finance-passed bill, he was not able to secure the application of the remaining reforms to the self-insured market. At Senator Rockefeller’s urging, Leader Reid included several of the provisions from the HELP-passed bill which applied many of the insurance reforms to the self-insured market – including no pre-existing condition exclusions, no rescissions, dependent coverage up to age 26, and a mandatory internal and external appeals process – as part of the merged Senate bill. However, other critical reforms – such as minimum medical loss ratio, minimum creditable coverage, and a prohibition of discrimination based on salary – still do not apply to the self-insured market. Ultimately, Senator Rockefeller was able to secure two comprehensive studies of the large-group market in the manager’s amendment to help inform reform of this market in the future.

Immediate Elimination of Pre-existing Condition Exclusions for Children. The manager’s amendment would immediately eliminate all pre- existing condition exclusions for children under age 19. Senator Rockefeller secured inclusion of this key insurance reform for children as part of the “Gang of 10” negotiations between moderate and progressive Democrats. This provision is based on legislation he reintroduced earlier this year – the Pre-existing Conditions Patient Protection Act (S. 623). Senator Rockefeller also filed an amendment (C2) to the Finance Committee health reform mark to immediately eliminate all pre-existing condition exclusions for children.

ABOUT THE AUTHOR

Brian Beutler is TPM's senior congressional reporter. Since 2009, he's led coverage of health care reform, Wall Street reform, taxes, the GOP budget, the government shutdown fight and the debt limit fight. He can be reached at brian@talkingpointsmemo.com
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