FTC Alert: Scammers Out to Trick Consumers Using the Supreme Court’s Affordable Care Act Ruling

It’s enough to make you sick. No sooner had the U.S. Supreme Court ruled on the Affordable Care Act than scam artists began working the phones. They say they’re from the government and that, using the Affordable Care Act as a hook, they need to verify some information. They might have the routing number from your bank, and then use that information to get you to reveal the entire account number. Or, they’ll ask for your credit card or Social Security number, Medicare ID, or other personal information.

The Federal Trade Commission, the nation’s consumer protection agency, advises consumers not to give out personal or financial information in response to unsolicited phone calls, emails, or knocks on your door. Scam artists want your information to commit identity theft, charge your existing credit cards, debit your checking account, open new credit card, checking, or savings accounts, write fraudulent checks, or take out loans in your name.

If someone who claims to be from the government calls and asks for your personal information, hang up. It’s a scam. The government and legitimate organizations you do business with already have the information they need and will not ask you for it. Then, file a complaint at ftc.gov or call 1-877-FTC-HELP. If you think your identity’s been stolen, visit www.ftc.gov/idtheft  or call 1-877-ID-THEFT. You also can file a complaint with your state Attorney General.

For more information about the federal health care law, visit HealthCare.gov.

The Federal Trade Commission works for consumers to prevent fraudulent, deceptive, and unfair business practices and to provide information to help spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC’s online Complaint Assistant or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 2,000 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s website provides free information on a variety of consumer topics.  Like the FTC on Facebook, follow us on Twitter, and subscribe to press releases for the latest FTC news and resources.

November 4, 2011

Press Release from National Area Agencies on Aging Association (n4a) on the Older Americans Act Reauthorization

This morning, the U.S. Administration on Aging (AoA) made public a set of 11 principles related to the current reauthorization of the Older Americans Act (OAA). n4a has reviewed the document and begun the process of getting further details, where available, from AoA.

Intended to offer technical assistance to Congress as it considers OAA reauthorization, the AoA principles reflect the Administration’s response to what it heard in its 2010 OAA listening sessions and offer suggestions to lawmakers that, while specific, stop short of formal recommendations.

Several of the ideas presented in the AoA document reflect some of n4a’s reauthorization priorities, including consolidation of the Title C1 and C2 nutrition programs, advancing the capacity of the Aging Network, and promoting evidence-based health promotion and disease prevention.

n4a does not agree with every aspect of AoA’s approach to these issues, however, and will be actively working with the Administration and Congress to address any areas of concern. Specifically, we are concerned that in several instances the principles pull local dollars up to the state level—whether by allowing a carve-out of III B funds for legal services with only optional funding through AAAs or permitting states to keep III D funds from reaching every PSA.

The larger context for these AoA principles is that the Senate HELP Subcommittee on Primary Health and Aging, chaired by Senator Bernie Sanders (I-VT), is actively writing legislation to reauthorization OAA. n4a is working closely with this committee, and other Senate offices interested in reauthorization, to promote our priorities and provide the AAA and Title VI perspective on other proposals being pushed by lawmakers.

While the House has not yet taken up OAA—and we do not expect them to do so until early 2012—the Senate HELP Committee remains focused on moving a bill through committee this fall. More to come!

AoA’s Reauthorization Principles Document: http://aoa.gov/AoARoot/AoA_Programs/OAA/Reauthorization/docs/OAAreauth_summaries_stakehldrs.pdf

CLASS Repeal

This has not been a good month for the CLASS program, the long-term services and supports social insurance system passed as a part of Affordable Care Act (ACA) to help individual workers financially protect themselves from long-term care expenses. On October 14, HHS Secretary Sebelius informed Congress that the Administration, despite nearly a year of intensive work, had “not identified a way to make CLASS work at this time.”

n4a and other advocates of CLASS realize that we must keep this conversation going—despite this major set-back, the needs of millions of American workers and families have not changed, nor have the complications of financing long-term services and supports lessened in any way.

Last week, the House Energy and Commerce Committee held a hearing on CLASS, where Assistant Secretary for Aging Kathy Greenlee testified that “while we have had to suspend our work on implementing CLASS, we remain committed to making sure that people will be able to get the long-term care they need.”

The latest political skirmish over CLASS happened earlier this week, when Senator John Thune (R-SD) attempted to repeal CLASS on a Unanimous Consent (UC) vote in the Senate. While CLASS is not advancing administratively at this time, advocates believe it is unnecessary to repeal it, and leaving it in the law at least provides a building block for future progress.

Luckily, Senator Jay Rockefeller (D-WV) blocked the UC vote, noting that 70 percent of people over 65 will require long-term services and supports at some point in their lives and that 40 percent of people who need long-term services supports are under the age of 65.

FY 2012 Appropriations

Two weeks from now, the continuing resolution (CR) that funds the government through November 18 by keeping most programs frozen at existing levels will expire.

n4a can report that appropriations work is being advanced in the interim, with House and Senate negotiators finding modest success in passing small clusters of two or four appropriations bills merged together to form “minibus” bills. Instead of putting up to 12 of the bills together as one “omnibus,” as has been the trend in recent years, these minibuses may prove key to finishing FY 2012 appropriations bills in 2011. We also expect Congress to pass another CR, potentially even before this one expires, that would go into December and buy lawmakers more time to do their work.

The spending bill that includes OAA and other critical social supports for older adults, however, retains its reputation as being one of the hardest to pass, given its size and popularity for political battles. The Labor/HHS/Education bill is likely to be one of the last to be finalized, but n4a continues our advocacy to convince appropriators to fund OAA programs at the highest possible levels.

You are invited!

Critical Legislative Advocacy Issues Facing Seniors and People with Disabilities

Wednesday, November 2, 2011    1:00 pm – 3:00 pm

The Kirkwood Center Ballroom B & C

7725 Kirkwood Boulevard S.W.
Cedar Rapids, Iowa 52404

Free and open to the public

Target audience: older adults and people with disabilities and their advocates, providers, elected officials and their staff, and policy makers.

For questions or to RSVP email Ingrid.Wensel@kirkwood.edu or call 1.800.332.5934/1.319.398.5559

Agenda:

• The National Debt Debate  Presenter: Mike Owen, Assistant Director, Iowa Policy Project
• Affordable Care Act Update: Why the ACA is a smart use of our health care dollars?  Presenter: Judy Baker, U.S. Department of Health and Human Services Region VII Director
• Home and Community Based Services: Reducing and slowing the growth of long term care expenditures and the Olmstead Decision  Presenter: Robert Bacon, Director, Iowa University Center for Excellence on Disabilities
• National Council on Aging One Away Campaign  Presenter: Ingrid Wensel, Executive Director, Heritage Area Agency on Aging
• Networking

Presenter Organization Affiliate Information

 The Center for Disabilities and Development

The Center for Disabilities and Development (CDD) is Iowa’s University Center for Excellence in Developmental Disabilities (UCEDD). As a member of the national network of 67 UCEDDs, CDD shares the vision in which all Americans, including Americans with disabilities, participate fully in their communities. CDD partners with Iowans with disabilities, their family members, providers, state and local agencies, and many others to improve the health and full community participation of persons with disabilities and to advance the community services which are a critical to support independence.

Health and Human Services (HHS) Office of Intergovernmental External Affairs

The Office of Intergovernmental External Affairs serves the Secretary as the primary link between the U.S. Department of Health and Human Services (HHS) and state, local, and tribal governments. The mission of the Office of Intergovernmental External Affairs is to facilitate communication regarding HHS initiatives as they relate to state, local, and tribal governments. IEA serves the dual role of representing the state and tribal perspective in the federal policymaking process as well as clarifying the federal perspective to state, and tribal representatives.  The Office of Intergovernmental External Affairs hosts ten Regional Offices that directly serve state and local organizations.  Each Regional Office is led by a President-appointed Regional Director. The Secretary’s Regional Directors ensure the Department maintains close contact with state, local, and tribal partners and addresses the needs of communities and individuals served through HHS programs and policies.

Heritage Area Agency on Aging

With 40 years of experience, The Heritage Agency is the leader in planning, coordinating, advocating for, and funding programs that serve the more than 70,000 older adults in Benton, Cedar, Iowa, Jones, Johnson, Linn and Washington counties in Iowa.  Part of a national network of Area Agencies on a Aging,  The Heritage Agency is funded through many sources including the Federal Older Americans Act, the Iowa Department on Aging, grants, and private donations. 

 Iowa Policy Project

The mission of the Iowa Policy Project is to promote public policy that fosters economic opportunity while safeguarding the health and well-being of Iowa’s people and the environment. The Iowa Policy Project (IPP) is a nonprofit, non-partisan organization founded in 2001 to produce research and analysis to engage Iowans in state policy decisions. IPP focuses on tax and budget issues, the Iowa economy, and energy and environmental policy. By providing a foundation of fact-based, objective research and engaging the public in an informed discussion of policy alternatives, IPP advances effective, accountable and fair government.

Health Reform Hits Main Street, a new animated short video from the Kaiser Family Foundation, features the YouToons explaining health reform.

This movie explains problems in the current health care system, short-term changes that will take place between now and 2014, and major provisions that will take effect in 2014. Watch.

Thanks to recent changes enacted by Congress, Iowans on Medicare will have enhanced preventive benefits starting in 2011.  “This is exciting news for people on Medicare because the changes make preventive services more affordable and accessible,” says Kris Gross from the State of Iowa’s Senior Health Insurance Information Program (SHIIP).

     Next year, for the first time, Medicare beneficiaries can receive an annual wellness visit. This includes a basic health risk assessment and provides personalized prevention plan services.  If you are enrolled in Medicare Part B, one wellness visit will be covered at no cost every 12 months.  You must be enrolled in Medicare for more than 12 months to receive this benefit. If you had a “Welcome to Medicare Physical Exam” when you first went on Medicare, the wellness visit has to come at least 12 months after that exam.

     Another important change coming in 2011 removes deductibles and co-payments for many of Medicare’s preventive services.  The following preventive benefits will be provided at no cost to individuals who are enrolled in Medicare Part B: “Welcome to Medicare” physical exam, bone mass measurement, mammograms, pap test and pelvic exam, colorectal cancer screening (including a colonoscopy for high risk individuals and flexible sigmoidoscopy) and medical nutrition therapy for individuals with diabetes and kidney disease.

     One of the best ways to keep up with the preventive services you are eligible to receive is registering with the My Medicare website (https://mymedicare.gov/).  This is your personal Medicare website for tracking your Medicare services.  It will send you e-mail reminders when you are eligible for Medicare coverage of preventive services.   

     For more information about all of Medicare’s preventive benefits visit the SHIIP website at http://www.therightcalliowa.gov/ and go to the “Medicare” section of the website.  The “Manage Your Health” section of the Medicare website (http://www.medicare.gov/) also provides preventive services information.  You can also call SHIIP at 1-800-351-4664 (TTY 800-735-2942) with your questions.  SHIIP counselors are available statewide to discuss your Medicare questions.  SHIIP is a free, confidential and objective service and does not sell, endorse or promote any insurance products.

Frequently asked questions:

Q. Did the health reform legislation do anything to improve Medicare preventive benefits?
A. Yes, thanks to recent changes enacted by Congress, Iowans on Medicare will have enhanced preventive benefits starting in 2011. This is exciting news for people on Medicare because the changes make preventive services more affordable and accessible.

Q. What’s changing?
A. Next year, for the first time, Medicare beneficiaries can receive an annual wellness visit. This includes a basic health risk assessment and provides personalized prevention plan services. If you are enrolled in Medicare Part B, one wellness visit will be covered at no cost every 12 months. You must be enrolled in Medicare for more than 12 months to receive this benefit. If you had a “Welcome to Medicare Physical Exam” when you first went on Medicare, the wellness visit has to come at least 12 months after that exam.

Q. What was done to make preventive benefits more affordable?
A. Starting in 2011 you will no longer pay deductibles and co-payments for many of Medicare’s preventive services. The following preventive benefits will be provided at no cost to individuals who are enrolled in Medicare Part B: “Welcome to Medicare” physical exam, bone mass measurement, mammograms, pap test and pelvic exam, colorectal cancer screening (including a colonoscopy for high risk individuals and flexible sigmoidoscopy) and medical nutrition therapy for individuals with diabetes and kidney disease.

Q. What information is available to help me best take advantage of Medicare preventive services?
A. One of the best ways to keep up with the preventive services you are eligible to receive is registering with the My Medicare website (https://mymedicare.gov). This is your personal Medicare website for tracking your Medicare services. It will send you e-mail reminders when you are eligible for Medicare coverage of preventive services.
For more information about all of Medicare’s preventive benefits visit the SHIIP website at www.therightcalliowa.gov and go to the “Medicare” section of the website. The “Manage Your Health” section of the Medicare website (www.medicare.gov) also provides preventive services information. You can also call SHIIP at 1-800-351-4664 (TTY 800-735-2942) with your questions. SHIIP counselors are available statewide to discuss your Medicare questions. SHIIP is a free, confidential and objective service and does not sell, endorse or promote any insurance products.

For more information contact: SHIIP Iowa Insurance Division at 515-281-5705.

With health care reform legislation now law, what comes next? Implementation of this massive and complicated new law is now the new challenge for policymakers and advocates alike. n4a will be working in the months and years ahead to advocate on regulations and other implementation issues, as well as looking for opportunities to assist AAAs and Title VI programs help consumers make sense of it all. Read on for some of the key provisions that n4a advocated for in the legislation-many of which will need continued attention as they are implemented by HHS and the states. n4a belives that Congress has realized a historic goal in providing health insurance coverage to nearly all Americans.

We also commend Congress for taking positive steps to increase the availability of home and community-based services and long-term services and supports for older Americans. In particular, the establishment of the new CLASS program is a very welcome sign, and we look forward to working with the Administration and other stakeholder groups as this program is implemented.

Finally, we are appreciative of other key provisions that were included in the bill for which n4a advocated including: resources for ADRCs; additional Medicare Part D funds to support efforts by the Aging Network; prevention and wellness provisions; and the Elder Justice Act provisions, just to name a few.

Key Provisions in Health Care Reform

CLASS Program

This new, voluntary long-term care insurance program represents a significant step forward in how future older adults and people with disabilities will be able to afford and access home and community-based services. According to the Congressional Budget Office, the CLASS plan will reduce Medicaid spending and will be solvent and sustainable for the long term. And it will help individuals and families struggling to maintain their independence and financial stability by providing a much-needed daily benefit to help purchase the care they need to stay healthy and at home.

Aging and Disability Resource Centers

The bill provides $10 million a year over five years (FY 2010-2014) for the continuation of Aging and Disability Resource Centers (ADRCs) through the demonstrations developed by the Administration on Aging and the Centers for Medicare and Medicaid Services.

Medicare Part D Improvements

The bill makes improvements to the annual enrollment process for beneficiaries; in particular, changes the timing of the Part C and D enrollment period to begin on October 15 and end December 7, starting in 2012. Includes an annual 45-day period of disenrollment from Medicare Advantage plans to allow beneficiaries to change their election to the original Medicare fee-for-services program under Part A and B, beginning in 2011.

Additional Outreach and Assistance Funds for Part D

The bill provides additional funding to support outreach and assistance for Part D and low-income prescription drug programs by State Health Insurance Assistance Programs (SHIPs), AAAs, ADRCs, and the National Center for Benefits and Outreach Enrollment, providing a total of $45 million to these entities between FY 2010 and 2012. In addition to these efforts, funds may be used for outreach activities aimed at preventing disease and promoting wellness.

Prevention and Wellness

It expands coverage of preventive health services under the Medicare and Medicaid programs. The provisions will implement a national strategy and grant programs to support community-based prevention and wellness programs including a “Healthy Aging, Living Well” program that will provide more preventive health services and help achieve the goal of reducing chronic diseases and addressing health disparities.

Elder Justice Act

The bill includes the Elder Justice Act provisions that would implement a comprehensive national strategy to address elder abuse, neglect and exploitation. These provisions would enhance the training, recruitment and staffing in long-term care systems and enhance state adult protective service systems, long-term care ombudsman programs, and law enforcement practices. The bill also provides for new nursing home transparency and criminal background checks requirements.

Empowered at Home

Empowered at Home provisions will remove certain barriers to providing Medicaid HCBS by offering states more flexibility in state plan amendments for HCBS and modify the spousal impoverishment statute to mandate that states include the spousal impoverishment protections in their waiver programs.

Community First Choice

The bill includes a new option which offers states a financial incentive to further rebalance the provision of LTSS in Medicaid. Individuals in participating states would gain guaranteed access to community based attendant services-currently, only institutional care is guaranteed.

Money Follows the Person

Reauthorizes the MFP program, originally authorized under the Deficit Reduction Act of 2005, and continues federal support through 2016 for grants to states to transition Medicaid-enrolled nursing facility residents to their homes or other community settings, while making some positive changes to the minimum residency requirement (from six months to 90 days).

Dr. Peter Damiano, Director of the Public Policy Center at the University of Iowa, will address the “Implications of Health Care Reform for Seniors,” at a forum to be held May 10 at 2:00 p.m. at the Coralville Public Library.

Parking is available on the lower level of the library parking lot with easy access to Schwab Auditorium.

This presentation, sponsored jointly by the Johnson County Task Force on Aging (The Heritage Area Agency on Aging) and Johnson County Livable Community, will seek to present the facts addressing the many concerns that seniors have about the health care legislation recently passed by Congress, as well as to outline the timeline that is projected for implementation.

Dr. Damiano was selected to make this presentation because the sponsors wished to have a public policy presentation rather than a Democratic or Republican statement. Hopefully this will be a delightful alternative to the rhetoric that has filled the airways. There will be an opportunity for those attending to ask questions about the legislation, since most persons have not read the entire bill.

This event is presented as a community service, with the hope that it will be of benefit not only to seniors but to those whose parents are advancing in years. For information call Bob Welsh, 319-354-4618.

It is hoped that those who manage facilities for seniors will arrange to bring a bus load of persons. (If you need special accommodations let Bob Welsh know.) It is hoped that those who work closely with seniors will attend this event so they will have the correct information to share with their clients. Hopefully service providers will share information about this event with their clients and their family members who are concerned about how the legislation will impact their lives.

Follow this link to access the AARP web site to help older Americans with questions about the health care reform law: www.aarp.org/getthefacts.

National Area Agencies on Aging (n4a) legislative update March 22, 2010

The House of Representatives approved the Senate health reform bill (H.R. 3590) Sunday night by a vote of 219 to 212, sending the legislation to President Barack Obama for his signature. The vote marks the climactic finale to a year-long attempt by Democrats to enact Obama’s signature legislative goal: expanding health insurance to nearly all Americans, a goal that eluded the party for decades. No Republicans voted yes and 34 Democrats voted against the bill.

Following consideration of the health reform bill, the House passed, 220-211, a reconciliation measure (H.R. 4872) that would modify provisions of H.R. 3590 based on negotiated changes between the House, Senate and White House. Some of those changes would increase federal subsidies to help low and moderate-income families purchase medical coverage through health insurance exchanges, provide a $250 rebate beginning in 2010 to seniors who reach the gap in Medicare prescription drug coverage (i.e., “the doughnut hole”) and phase out the doughnut hole and close it by 2020.

The reconciliation bill, which increases the number of people insured by the health care bill by about a million and reduces the deficit by about $143 billion over 10 years—about $25 billion more than the Senate health care bill—now goes to the Senate for consideration. Under budget reconciliation rules, the measure will require only a simple majority of 51 votes as opposed to the usual 60 votes required to surmount a filibuster in the Senate.

The timing of a final vote on the bill in the Senate is unclear at this point. Republicans are expected to attempt to block the legislation on procedural grounds and offer a series of amendments which could extend consideration of the bill. However at the same time, Democratic Senators will be anxious to complete work on the bill prior to the upcoming two-week spring recess, which begins March 26.

Key Provisions in H.R. 3590

CLASS Program

This new, voluntary long-term care insurance program represents a significant step forward in how future older adults and people with disabilities will be able to afford and access home and community-based services. According to the Congressional Budget Office, the CLASS plan will reduce Medicaid spending and will be solvent and sustainable for the long term. And it will help individuals and families struggling to maintain their independence and financial stability by providing a much-needed daily benefit to help purchase the care they need to stay healthy and at home.

Aging and Disability Resource Centers

The bill provides $10 million a year over five years (FY 2010-2014) for the continuation of Aging and Disability Resource Centers (ADRCs) through the demonstrations developed by the Administration on Aging and the Centers for Medicare and Medicaid Services.

Medicare Part D Improvements

The bill makes improvements to the annual enrollment process for beneficiaries; in particular, changes the timing of the Part C and D enrollment period to begin on October 15 and end December 7, starting in 2012. Includes an annual 45-day period of dis-enrollment from Medicare Advantage plans to allow beneficiaries to change their election to the original Medicare fee-for-services program under Part A and B, beginning in 2011.

Additional Outreach and Assistance Funds for Part D

The bill provides additional funding to support outreach and assistance for Part D and low-income prescription drug programs by State Health Insurance Assistance Programs (SHIPs), AAAs, ADRCs, and the National Center for Benefits and Outreach Enrollment including a total of $45 million to these entities between FY 2010 and 2012. In addition to these efforts, the funded entities would support outreach activities aimed at preventing disease and promoting wellness.

Prevention and Wellness

It expands coverage of preventive health services under the Medicare and Medicaid programs. The provisions will implement a national strategy and grant programs to support community-based prevention and wellness programs including a “Healthy Aging, Living Well” program that will provide more preventive health services and help to achieve the goal of reducing chronic diseases and addressing health disparities.

Elder Justice Act

The bill includes the Elder Justice Act provisions that would implement a comprehensive national strategy to address elder abuse, neglect and exploitation. These provisions would enhance the training, recruitment and staffing in long-term care and enhance state adult protective service systems, long-term care ombudsman programs, and law enforcement practices. The bill also provides for new nursing home transparency and criminal background checks requirements.

Empowered at Home

Empowered at Home provisions will remove certain barriers to providing Medicaid HCBS by offering states more flexibility in state plan amendments for HCBS and modify the spousal impoverishment statute to mandate that states include the spousal impoverishment protections in their waiver programs.

Community First Choice

The bill includes a new option which offers states a financial incentive to further re-balance the provision of LTSS in Medicaid. Individuals in participating states would gain guaranteed access to community-based attendant services—currently, only institutional care is guaranteed.

Money Follows the Person

Reauthorizes the MFP program, originally authorized under the Deficit Reduction Act of 2005, and continues federal support through 2016 for grants to states to transition Medicaid-enrolled nursing facility residents to their homes or other community settings, while making some positive changes to the minimum residency requirement (from six months to 90 days).

If you have questions about this Legislative Update, please contact n4a’s Public Policy and Legislative Affairs staff, Amy Gotwals and K.J. Hertz, at 202-872-0888 or agotwals@n4a.org, khertz@n4a.org.

Late Saturday, the House of Representatives passed the first major health care reform bill (H.R. 3962, the Affordable Health Care for America Act) in 40 years, by a vote of 220-215. The razor-thin margin of only two votes beyond a majority of 218 was only possible after Democratic leaders negotiated with anti-abortion rights members of their party to amend the bill to restrict women from purchasing coverage for abortion care with their own funds in the health insurance exchanges and public plan that the legislation created.

With one lone exception, House Republicans opposed the health care bill and were joined by 39 Democrats who also voted against it. (To find out how your Representative voted on the bill, visit: THOMAS.) The rule setting the parameters for the debate allowed for just two amendments, a Republican alternative measure and the previously mentioned abortion-related amendment. As a result, Members of both parties were unable to offer floor amendments to the bill to add or change specific provisions.

n4a signed on to a number of coalition letters in support of specific provisions in the bill that would benefit older adults. The provisions of Project 2020 were not included in the House bill that went to the floor, and Rep. Bruce Braley (D-IA), the House sponsor of Project 2020, was unable to offer a planned floor amendment to add its provisions due to the “closed” rule process. Although n4a was glad to see that a robust CLASS Act insurance plan was included in the House bill.

We are hopeful that the House bill will be improved in the area of long-term services and supports during conference with the Senate as the process continues. We are interested in hearing what you think about the House bill as we continue to push for our priorities focusing on the core elements of the Project 2020 bill in health reform legislation. To share your feedback, visit n4a’s Advocacy Feedback web page.

Key Provisions of the House Bill

• The bill would require most individuals to buy health insurance if they do not get it through their jobs, beginning in 2013. Families with incomes up to 400 percent of the federal poverty level could qualify for financial assistance.

• Employers with annual payrolls over $500,000 would be required to provide coverage or contribute to a fund for such coverage. It would create an “exchange” in each state where individuals and certain small businesses could shop for insurance policies, and it would create a public insurance plan to compete with offerings from private companies.

• Insurance companies could no longer refuse to cover customers with pre-existing medical conditions, impose annual or lifetime benefit limits or cancel a policy when someone files expensive claims.

• The measure also would expand eligibility for Medicaid to individuals and families with incomes up to 150 percent of the poverty level.

• Payments under the Medicare Advantage program would be reduced and the Medicare prescription drug program would be enhanced by phasing out the gap in coverage or “doughnut hole.”

• The bill contains the provisions of the Community Living Assistance Supports and Services (CLASS) Act to establish a voluntary national long-term care insurance program to help adults who have or develop functional impairments to remain independent, employed, and stay a part of their community.

• The bill would impose a tax surcharge of 5.4 percent on couples with gross incomes of more than $1 million and individuals with incomes of more than $500,000, and a 2.5 percent excise tax on the sale or lease of medical devices.

• The Congressional Budget Office estimates that the gross cost of the bill would be almost $1.1 trillion through fiscal 2019, but the net cost, after taxes, fees and penalties are taken into account, would be $894 billion. CBO estimates the bill would actually reduce the deficit by $104 billion, as a result of tax provisions and spending reductions.

The House rule adopted for health care reform also sets up an upcoming debate on a separate measure to change the way Medicare reimburses physicians. The physicians’ pay bill would block a 21 percent reduction in the Medicare payment rates for physician services scheduled for January 2010, and would instead provide for an increase in those payments based on the Medicare economic index. The measure is expected to be considered on the House floor starting next week.

Next Step, the Senate

Action now turns to the Senate, which has been in a bit of a holding pattern on its version of health care reform. Behind the scenes, Democratic leaders are combining the bills passed earlier this year by the Senate Health, Education, Labor and Pensions (HELP) Committee (S. 1679) and the Senate Finance Committee (S. 1796).

While the committees have different jurisdictions, there are points of overlap that will require negotiation before being merged into one Senate bill. Also holding up the process is the wait for the “score” by the Congressional Budget Office (CBO). Senate Majority Leader Harry Reid (D-NV) requested a score from CBO in late October, but has not yet received those cost estimates.

The process for Senate passage will differ markedly from the House. Unlike the House’s tightly managed vote with virtually no ability to amend the bill on the floor, the Senate is expected to consider dozens of floor amendments. n4a is working to develop amendments to improve the bill’s prevention and wellness language, as well as incorporate S. 1257, Senator Cantwell’s Project 2020 bill. We will keep you posted as advocacy opportunities arise.

While timing predictions are very difficult to make, it seems that the Senate bill may come to the floor as early as next week, but it is just as likely that it will be early December before debate begins. The White House would like to keep up the momentum and have Congress pass a final bill before the end of the calendar year, but a more reasonable timeline would have a House-Senate compromise brokered over the holidays in order to send a bill to President Obama before his State of the Union address in late January.

If you have questions or concerns, please contact n4a’s public policy and legislative affairs staff, Amy Gotwals and K.J. Hertz, at 202-872-0888 or by e-mail to: agotwals@n4a.org, or khertz@n4a.org.