This week the Senate and House passed the final version of S. 1793, the Ryan White HIV/AIDS Treatment Extension Act of 2009 and the measure is now headed to the President Obama’s desk for signature.
On
October 13, the Senate Finance Committee voted 14-9 to pass the America’s
Healthy Future Act, with the support of one Republican, Senator Olympia Snowe
(ME). The Committee has completed
writing the bill and it will now be merged with the Senate Health, Education,
Labor and Pension Committee’s version of the bill.
As
the House and Senate continue to gear up for floor action on health reform in
the coming weeks, the behind the scenes jockeying between the moderate and
progressive wings of the Democratic Party continues. Leadership in both the House and Senate are
working to garner enough votes within the Democratic Caucus to pass a bill
during the month of November and avoid procedural hurdles such as a filibuster
by the Republican Party in the Senate.
One
central point of debate continues to be whether or not to include a “public
option,” a plan that is provided by the federal government. Supporters of a public option maintain that
this would bolster competition with private plans and therefore drive down the
cost of the private plans that are offered.
Those opposed to a public option have numerous concerns, including the
cost of offering a public option, cost-shifting and provider reimbursement
rates, among others. This week, the
Congressional Budget Office (CBO) released its score of a “robust” public
option in the House of $871 billion over the next 10 years, meeting President
Obama’s target of $900 billion. The
robust plan would coverage to approximately 96% of uninsured U.S. residents
who qualify. Additional cost estimates will be released in the coming days.
The CBO estimated that
Senate Finance Committee’s version of the bill is projected
to cost more than the original bill ($779 billion) but it came in lower than
they anticipated. The projected score of the amended bill is $829 billion
and CBO estimates it will reduce the deficit by $80 billion over 10
years. The Committee's bill also would expand health coverage to 29
million more people (94% of non-elderly U.S.
residents) by 2019, up from 83% of nonelderly U.S. residents currently. The
report noted that 25 million residents would remain uninsured under the
legislation, about one-third of whom would be undocumented immigrants.
This
week the Senate and House passed the final version of S. 1793, the Ryan White
HIV/AIDS Treatment Extension Act of 2009 and the measure is now headed to the
President Obama’s desk for signature. The first responder notification
provision that was dropped in the 2006 law has been reinstated. However,
there have been some changes. Concerns were raised by health departments and
hospitals that notification during a public health emergency would overwhelm
staff of hospitals and health departments with paperwork when they should be
focusing on patient care.
Staff
was somewhat sympathetic to their concerns and after many days of negotiations
the final language states that the Secretary may wholly or partially waive the
first responder notification provisions during a federally declared public
health emergency. Advocates Board members, the fire community and other groups will
request meetings with Administration officials at HHS to discuss the changes
made in the language and deliver the message that the first responder community
can accept waiving the rule that requires a first responder be notified 48
hours after an inquiry is made about the possibility of an exposure. However, waiver of the notification provision
in its entirety puts first responders’ health at risk.
At
the end of September, Congress passed a Continuing Resolution that funds
federal agencies at the FY 09 level through the end of October. To date, Congress has passed four of the 12
fiscal 2010 spending bills. Three others, Defense, Interior-Environment and
Transportation-Housing and Urban Development are in House-Senate negotiations.
One of the remaining bills will likely be used as the vehicle to move those
bills that have not been considered on the Senate floor. This “mini-bus” will include the Labor,
Health and Human Services and Education appropriations bill. At this time,
passage of a “mini-bus” is anticipated to occur in early December.