Senators Bingaman & Udall Discuss Health Reform Bill with NM Media

This morning I participated in a joint conference call for New Mexico reporters with Sen. Jeff Bingaman and Sen. Tom Udall about the pending passage of the Patient Protection and Affordable Care Act in the Senate. Naturally, both of our Senators expressed pride in what they termed an "historic" vote on a bill that was "a generation in the making."

Sen. Udall said the bill would cover 31 million additional Americans nationwide, and that about 91% of New Mexicans would have coverage when the legislation is fully implemented. He praised the inclusion of a national nonprofit plan that would provide an alternative to coverage from for-profit insurers, as well as the bill's provisions for increased preventive care and additional primary care physicians.

Rural Health Care
Sen. Udall also explained that there will be more health care options for rural New Mexicans, including a pilot program that would expand and analyze the effectiveness of tele-health care, especially in regard to monitoring and dealing with chronic diseases like diabetes. There are additional rural health care improvements in the bill as a result of reforms proposed by the Senate's freshman class, of which he is a member, that would encourage innovation and lower costs for consumers.

Indian Health Care
Sen. Udall was particular enthusiastic about the Indian Health Care Improvement Act provisions in the Senate bill that grant permanent reauthorization for the IHS so it can fulfill the nation's treaty obligations to provide health care to more than 1.9 million members of tribes nationwide.

"Enormous Reforms"
Sen. Bingaman explained that although he believed Democrats in the Senate provided many opportunities for Republicans to participate in the development of the bill, they were unsuccessful. He said the Senate bill includes "enormous reforms" that would expand Medicaid in New Mexico to cover more than 125,000 additional people and provide eligibility credits to about 230,000 New Mexicans. If Medicare coverage is included, about 95% of New Mexicans would be insured when the legislation is fully implemented -- and 98% nationally.

Sen. Bingaman praised provisions of the bill that include prohibiting recission, extending dependent coverage for children until 26 years of age, preventive measures that will start up in 2010 for all new policies and stopping insurers from refusing coverage due to pre-existing conditions -- for children in 2010 and for others in 2014.

Senate Negotiations
In response to some rather pointed questions about the deals negotiated with certain Senators to gain their votes for passage, both Senators said they weren't pleased with the trade-offs and preferred that they not be offered, but that they were not consulted about them and thus had no power in the process.

Only a Start
Both Senators stressed repeatedly that this legislation is a first step, and not the end of the story. Sen. Udall talked up the merits of the experimental nature of many elements of the bill, which will be studied as we go forward so provisions can be improved and fine-tuned in legislation down the road. Sen. Bingaman said, "Nothing is chiseled in stone."

Reproductive Health Coverage
Asked about Sen. Ben Nelson's amendment related to abortion coverage, both Senators said they believed the bill met the requirements of the Hyde Amendment that no public funds be used on abortions -- which they support -- without the amendment. Sen. Bingaman said he would prefer that the Nelson amendment not be included, but that he was encouraged that several women Senators who strongly support a woman's right to choose thought the compromise was acceptable.

My Question: Excise Tax vs. Income Surtax
I got a chance to ask a question and I encouraged the Senators to discuss whether they support the Senate excise tax on so-called high-end health insurance coverage versus the House surtax on our wealthiest individuals to help pay for reform. The Senate excise tax would impose a 40% tax on some benefits, including those gained by a number of unions in lieu of pay increases during union negotiations.

Sen. Bingaman said the excise tax would affect only very high-end, very generous top-of-the-line benefits, and that very few of those existed in New Mexico. He said the tax was designed to discourage the addition of more and more benefits to policies, thus driving up health care costs generally. He said the primary aim of the tax is to reduce health care costs. Senator Bingaman offered that unions would have to return to negotiating for pay increases instead of increased benefits, and that the salary increases would produce additional tax revenues for the government.

As to the House surtax, Sen. Bingaman said he didn't support it because the Bush tax cuts will sunset in late 2010 and there was a need to preserve as much "flexibility" as possible in dealing with our tax structure at that point. Sen. Udall didn't get a chance to offer any comments on the tax issue.

Primary Care
When asked about the need for more primary care doctors and facilities, the Senators discussed a 10% bonus for primary care physicians that would start up in 2011. They also described funding for additional primary care training in medical schools and a provision that would encourage primary care medical students to serve their residencies in community health centers and rural hospitals.

Pre-Existing Conditions
In response to a question about coverage for those with pre-existing conditions, Sen. Bingaman said within six months $5 billion in state-based funding would be available for high-risk group coverage available to those who can't get coverage on their own. In 2014, when the exchanges kick in, pre-existing condition premiums would be part of the "community rating" system. Insurers would be able to boost premiums on a 3-1 ratio basis for those who are older and sicker.

Note: I've paraphrased the statements of Senators Bingaman and Udall based on my notes during the call, so keep that in mind when reading their answers. As I've said many times, I'm not a trained reporter but I wanted to give you the flavor of this morning's call.