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House Passes Bill With COBRA Provision

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House members today voted 244-188 to pass H.R. 1, a bill that could provide $30 billion in funding to help laid-off workers continue group health coverage.

The bill includes provisions that would provide subsidies both for laid-off workers and their former employers, to encourage workers to use the continuation health benefits available under the Consolidated Omnibus Reconciliation Act, or COBRA.

The bill also includes a provision that supporters say would jump start computerization of health records.

House members voted for H.R. 1, the American Recovery and Reinvestment Act, largely along party lines, with all Republicans voting against it and only 11 Democrats voting against it.

The health finance-related provisions in the House bill are similar to the health finance-related provisions in the Senate version, which is still being debated in Senate committees.

In a letter to Congress, Karen Ignagni, president of America’s Health Insurance Plans, Washington, expressed strong support for the COBRA subsidies for laid-off workers.

“At a time when unemployment is rising across the nation, this assistance will help ensure continuity of coverage and serve as an important lifeline for many workers who do not qualify for Medicaid, but still need help paying their health insurance premiums,” Ignagni writes in the letter.

The Obama administration and Democrats in Congress hope to have H.R. 1 enacted by President’s Day weekend.

The House bill would provide $20 billion to computerize medical records.

The Senate version was modified in committee Tuesday to ensure that long term care facilities would be eligible for funding. That change was made at the request of Sen. Herb Kohl, chairman of the Senate Special Committee on Aging.

Kohl won an expansion of the general definition of “health care provider” to include nursing facilities and other long term care facilities, in addition to skilled nursing facilities and home health entities.

The health information technology provision is supported by the insurance industry, but AHIP and the National Association of Health Underwriters, Arlington, Va., have raised questions about privacy provisions.

AHIP says the House and Senate bills call for federal regulators to issue regulations that could restrict the information that could be exchanged for health promotion, disease management, and care coordination programs.

“By preventing health care providers and health plans from using or sharing information electronically, such regulations could undermine existing quality improvement initiatives,” AHIP says in letters sent to members of the House and the Senate.

Both AHIP and NAHU are expressing concern about bill provisions that would authorize state attorneys general to enforce federal privacy standards.

“This will create a ’50 state’ approach to federal regulatory enforcement that is neither uniform, clear, nor cost effective,” AHIP writes in its letter.

John Greene, vice president of congressional affairs at NAHU, says, “Allowing state AGs to get involved will create a patchwork of rules that will undo the uniformity we are seeking that will reduce costs and provide improved health outcomes for the American people.”

The current provision was added because the Office of Civil Rights at the U.S. Department of Health and Human Services, which is responsible for enforcing Health Insurance Portability and Accountability Act of 1996 privacy provisions, had been criticized for lax enforcement of the law, Greene says.

He says he understands the reason for the decision to add the provision.

But “this new administration is well poised to direct OCR to perform the enforcement as they see fit,” Greene says.

Under the health assistance provision for unemployed workers, the House bill calls for subsidizing the cost of continuing group health coverage for laid-off workers and cutting workers’ share of the premiums. The cost of the COBRA expansion is set at about $30 billion.

Under current law, employers with 20 or more employees that provide group health benefits must provide access to continuation benefits for 18 months.

Employers and health insurers can charge the workers who take up the COBRA coverage 102% of the usual premium.

Under the House stimulus bill, laid-off workers could continue health benefits for 12 months by paying just 35% of the premiums.

The government would pay the remaining 65% of the premiums.

Group health plan members laid off without cause could keep subsidized continuation benefits for 12 months, or until they received new major medical coverage.

The bill also would require employers to permit involuntarily terminated individuals ages 55 and older to continue group health benefits until they become eligible for Medicare or employers discontinued health plans subject to coverage continuation requirements.

Similarly, any involuntarily terminated worker in an affected group health plan for more than 10 years could keep COBRA coverage until becoming eligible for Medicare.

The American Benefits Council, Washington, and other employer groups have argued that COBRA expansion for older workers and workers with many years of experience would lead to big increases in benefits costs for affected workers.

NAHU had proposed a less expensive approach to encouraging use of continuation benefits, with COBRA amended to allow former employees to choose a less expensive coverage option offered through their employers within a reasonable amount of time.

NAHU officials said in presenting their proposal to Congress that, under current law, employees have to stay with the plan they selected until the next open enrollment, which is usually held on an annual basis.

“With broader options available, employees would have an opportunity to choose a plan that has lower premiums and may be more affordable to them during these rough economic times,” NAHU argued.

NAHU said it does not support extending the duration of COBRA benefits. “In our view, any subsidies for COBRA premiums should be temporary in nature,” the group said.