The HELP Bill

During markup (amendment by committee) in the Senate Health, Education, Labor and Pensions Committee, a number of significant anti-rationing amendments were added to the HELP bill, (see “Anti-Rationing Amendments Adopted” below . However, one crucial amendment to the section on comparative effectiveness was voted down 12 to 10. See www.nrlc.org/press_releases_new/Release062209.html (To further understand how comparative effectiveness research could be used to ration treatment based on disability, see http://www.nrlc.org/HealthCareRationing/CompEff.pdf.)

Moreover, Section 3101(p)(1) provides, “Beginning on January 1, 2012 a qualified health plan may contract with –
. . . .(B) a health care provider if such provider implements such mechanisms to improve health care quality as the Secretary may by regulation require.”

Under this provision, the Secretary of Health and Human Services is given authority to impose on doctors and other health care providers any and all regulations she considers meet the vague objective of “improv[ing] health care quality” on penalty of being unable of being part of the providers for any qualified health care plan. These could easily include regulations prohibiting “ineffective” health care, which could be deemed to be a way of improving health care quality. Particularly in light of the defeat of the Enzi amendment to the comparative effectiveness element of the bill, health care judged to inadequately serve the “quality of life,” based on the use of some such measurement as “quality-adjusted life years” could be deemed ineffective and thus prohibited by the Secretary under this provision.

In addition, Amendment 228 offered by pro-life Senator Orrin Hatch (R-UT), and the similar Amendment 229 offered by pro-life Senator Tom Coburn (R-OK), to ensure that taxpayers are not forced to fund assisted suicide were not adopted.

FUTURE OF THE HELP BILL

The originally expressed intent of the Senate Democratic leadership was to meld the HELP Bill as reported out of the Senate Health, Education, Labor and Pensions Committee with whatever bill might be reported out of the Senate Finance Committee  and to bring the product to the Senate floor for amendments and a final vote. Since there is an informal deadline of September 15, 2009 for completion of negotiations on the Senate Finance bill, which would subsequently have to go through committee markup, this would probably not occur until October. On the other hand, if there is no agreement (or no timely agreement) in the Senate Finance Committee, then the Senate Democratic leadership has suggested that it may either bring the HELP bill or some modified version of it directly to the Senate floor.

To see the HELP bill as reported out of committee click here.

ANTI-RATIONING AMENDMENTS ADOPTED

During markup in the Senate Health, Education, Labor and Pensions Committee, the following amendments offered by pro-life Senator Mike Enzi (R-WY), the ranking minority member, (and similar amendments offered by pro-life Senator Pat Roberts (R-KS) were adopted:

To Section 2707 (a)(2) of the HELP bill, which provides that “a group health plan and a health insurance issuer offering group or individual health insurance coverage shall develop and implement a reimbursement structure for making payments to health care providers that provides incentives for –
. . . .(2) payment policies that substantially reflects [sic] the payment policy of the Medicare program under title XVIII of the Social Security Act and the Children’s Health Insurance Program under title XXI of such Act with respect to any generally implemented incentive policy to promote high quality health care.”

Enzi Amendment 280 inserted following “health care”:

“; provided, in order that no health plan or health insurance issuer shall be forced to deny patients medical care needed to prevent their deaths or preserve or restore their health, no plan or issuer shall be prohibited from providing a treatment or diagnostic procedure it chooses to cover, unless such treatment or procedure has been determined to be unsafe, dangerous, or capable neither of preventing the patient’s death nor of preserving or restoring the patient’s health.”

To Section 3101(d) of the HELP bill, which provides “A Gateway may certify a health plan if –
. . . .(2) the Gateway determines that making available such health plan through such Gateway is in the interests of qualified individuals and qualified employers in the State or States in which such Gateway operates.”

Enzi Amendment 274 added “; provided, that the Gateway may not exclude a health plan:

(A) on the basis that the plan is a fee-for-service plan;
(B) through the imposition of premium price controls; or
(C) on the basis that the plan provides treatments necessary to prevent patients’ deaths in circumstances the Gateway deems inappropriate or too costly.”

In addition, Enzi Amendment 278 added;

“(3) the Gateway determines that the plan has not established a pattern or practice under which benefits covered by the plan are denied to covered individuals on the basis of the individuals’ age or expected length of life or of the individuals’ present or predicted disability, degree of medical dependency, or quality of life.”

To Section 3101(c)(1) of the HELP bill, which provides, “In establishing the essential health benefits under section (c)(1)(A), the Secretary shall–“ , Enzi Amendment 285 added:

“(C) not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life.”

Enzi Amendment 272 added:

“(E) ensure that health benefits established as essential not be subject to denial to patients against their wishes on the basis of patients’ age or expected length of life or of patients’ present or predicted disability, degree of medical dependency, or quality of life.”