STATE OF FLORIDA et al v. UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES et al

Filing 83

NOTICE Errata re Exhibits in support of 82 Defendants' Motion for Summary Judgment by TIMOTHY F GEITHNER, KATHLEEN SEBELIUS, HILDA L SOLIS, UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, UNITED STATES DEPARTMENT OF LABOR, UNITED STATES DEPARTMENT OF THE TREASURY (Attachments: # 1 Table of Exhibits, # 2 Exhibit 1, # 3 Exhibit 2, # 4 Exhibit 3, # 5 Exhibit 4, # 6 Exhibit 5, # 7 Exhibit 6, # 8 Exhibit 7, # 9 Exhibit 8, # 10 Exhibit 9, # 11 Exhibit 10, # 12 Exhibit 11, # 13 Exhibit 12, # 14 Exhibit 13, # 15 Exhibit 14, # 16 Exhibit 15, # 17 Exhibit 16, # 18 Exhibit 17, # 19 Exhibit 18, # 20 Exhibit 19, # 21 Exhibit 20, # 22 Exhibit 21, # 23 Exhibit 22, # 24 Exhibit 23, # 25 Exhibit 24, # 26 Exhibit 25, # 27 Exhibit 26, # 28 Exhibit 27, # 29 Exhibit 28, # 30 Exhibit 29, # 31 Exhibit 30, # 32 Exhibit 31, # 33 Exhibit 32, # 34 Exhibit 33, # 35 Exhibit 34, # 36 Exhibit 35, # 37 Exhibit 36, # 38 Exhibit 37, # 39 Exhibit 38, # 40 Exhibit 39, # 41 Exhibit 40, # 42 Exhibit 41, # 43 Exhibit 42, # 44 Exhibit 43) (BECKENHAUER, ERIC)

STATE OF FLORIDA et al v. UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES et al

Doc. 83 Att. 2

Exhibit 1

Dockets.Justia.com

111TH CONGRESS " 2d Session

HOUSE OF REPRESENTATIVES

!

REPORT 111­443

THE RECONCILIATION ACT OF 2010

REPORT
OF THE

COMMITTEE ON THE BUDGET HOUSE OF REPRESENTATIVES
TO ACCOMPANY

H.R. 4872
A BILL TO PROVIDE FOR RECONCILIATION PURSUANT TO SECTION 202 OF THE CONCURRENT RESOLUTION ON THE BUDGET FOR FISCAL YEAR 2010

together with MINORITY VIEWS

VOLUME II DIVISION II­III
MARCH 17, 2010.--Committed to the Committee of the Whole House on the State of the Union and ordered to be printed
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954 dropped from 61 percent to 38 percent.5 The number of uninsured Americans is expected to hit 61 million by 2020.6 In no uncertain terms, the U.S. health care system is in crisis and has been for some time. Reform is needed. Inaction is not an option. H.R. 3200, America's Affordable Health Choices Act, adopts the health care reform principles outlined by President Barack Obama. Specifically, the bill preserves and strengthens the employer-based health care system, includes protections for small businesses, creates a health insurance marketplace where individuals can choose between private insurance and the public health insurance option, ensures low and middle income Americans have access to affordability credits to help offset the costs of insurance and saves over $500 billion in future health outlays of Medicare and Medicaid through reforms to the system. Together, these critical reforms are fundamental to the long-term health and security of this country. II. COMMITTEE ACTION INCLUDING LEGISLATIVE HISTORY VOTES IN COMMITTEE
LEGISLATIVE HISTORY AND

For more than 70 years, Congress and Presidents have attempted to reform the nation's health care system, most recently under President Clinton in 1993­94. The election of the Democratic majority in Congress in 2006 and President Obama in 2008 have led to renewed efforts toward national health care reform. The legislative history described in this report is limited to legislative action beginning in the 110th Congress.
110TH CONGRESS (2007­2008) HEARINGS IN THE HOUSE OF REPRESENTATIVES

Committee on Education and Labor On March 15, 2007, the Subcommittee on Health, Employment, Labor and Pensions of the Committee of Education and Labor held a hearing entitled ``Examining Innovative Approaches to Covering the Uninsured Through Employer-Provided Health Benefits.'' The panel included: Joan Alker, Deputy Executive Director, Center for Children and Families; Brian England, Owner, British American Auto Repair Columbia; Andrew Webber, President and Chief Executive Officer, National Business Coalition on Health; and Linda Blumberg, Ph.D., Economist and Principal Research Associate, Urban Institute. On May 22, 2007, the Subcommittee on Health, Employment, Labor and Pensions of the Committee of Education and Labor held a hearing entitled ``Health Care Reform: Recommendations to Im5 National Small Business Association, ``2008 NSBA Small & Mid-Sized Business Survey,'' Table at 14, available at: http:www.nsba.biz/docs/2008bizsurvey.pdf. 6 The Commonwealth Fund Commission on a High Performance Health System, ``The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to Pave the Way,'' Exhibit ES­2: Trend in the Number of Uninsured, 2009­2020 Under Current Law and Path Proposal, February 2009, available at: http:www.commonwealthfund.org//media/Files/Publications/Fund%20Report/2009/Feb/ The%20Path%20to%20a%20High%20Performance%20US%20Health%20System/ 1237lCommissionlpathlhighlperformlUSlhltlsyslWEBlrevl03052009.pdf.

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955 prove Coordination of Federal and State Initiatives.'' The panel included: Congressman John Tierney (D­MA); Congressman Tom Price (R­GA); Congresswoman Tammy Baldwin (D­WI); Mila Kofman, J.D., Associate Research Professor, Health Policy Institute, Georgetown University; John Colmers, Secretary, State of Maryland Department of Health and Mental Hygiene; Steven Goldman, Commissioner, New Jersey Department of Banking and Insurance; John Morrison, Auditor and Commissioner, Montana Insurance and Securities; Amy Moore, Partner, Covington & Burling, LLP; and Kevin Covert, Board Member, American Benefits Council. On September 25, 2008, the Committee on Education and Labor held a hearing entitled ``Safeguarding Retiree Health Benefits.'' The panel included: C. William Jones, Chairman, ProtectSeniors.org; Bill Kadereit, President, National Retiree Legislative Network; David Lillie, Retiree, Raytheon Missile Systems; Scott Macey, Senior Vice President and Director of Government Affairs, Aon Consulting, Inc; Norman Stein, Douglas Arant Professor of Law, University of Alabama; and Dale Yamanoto, President and Founder, Red Quill Consulting. Committee on Energy & Commerce On September 18, 2008, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled ``America's Need for Health Reform.'' The panel included: Ronald E. Bachman, F.S.A., M.A.A.A., Senior Fellow, Center for Health Transformation; Governor Jon S. Corzine, State of New Jersey; Karen Davis, President, The Commonwealth Fund; Elizabeth Edwards, Senior Fellow, Center for American Progress; William J. Fox, F.S.A., M.A.A.A., Principal and Consulting Actuary, Milliman Inc.; E.J. ``Ned'' Holland, Jr., Senior Vice President, Human Resources and Communication, EMBARQ; Patricia Owen, President/Founder, FACES DaySpa; Stephen T. Parente, Ph.D., Director, Medical Industry Leadership Institute, and Associate Professor of Finance, Carlson School of Management, University of Minnesota; and Karen Pollitz, M.P.P., Research Professor, Health Policy Institute, Georgetown University. Committee on Ways and Means On November 17, 2007, the Subcommittee on Income Security and Family Support in the Committee on Ways and Means held a hearing entitled ``Impact of Gaps in Health Coverage on Income Security.'' The panel included: Sherena Johnson, former foster youth, Morrow, GA; Sara R. Collins, Ph.D., Assistant Vice President, Program on the Future of Health Insurance, Commonwealth Fund; Ron Pollack, Founding Executive Director, Families USA; Bruce Lesley, President, First Focus; and Brian J. Gottlob, Senior Fellow, Milton and Rose D. Friedman Foundation, Indianapolis, IN. On April 15, 2008, the Subcommittee on Health in the Committee on Ways and Means held a two-panel hearing entitled ``Instability of Health Coverage in America.'' The first panel included former Senator Dave Durenberger (R­MN). The second panel included: Diane Rowland, Sc.D., Executive Vice President, Kaiser Family Foundation; John Z. Ayanian, M.D., Professor of Medicine and Health Care Policy, Harvard Medical School; Michael O'Grady,

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956 Senior Fellow, National Opinion Research Center, University of Chicago; Stan Brock, Founder and Volunteer Director of Operations, Remote Area Medical, Knoxville, TN; and Stephen Finan, Associate Director of Policy, American Cancer Society. On May 14, 2008, the Subcommittee on Health in the Committee on Ways and Means held a hearing entitled ``Health Savings Accounts and Consumer Driven Health Care: Cost Containment or Cost-Shift.'' The panel included: John F. Dicken, Health Care Director, U.S. Government Accountability Office (GAO); Michael E. Chernew, Ph.D., Professor of Health Care Policy, Harvard Medical School; Linda J. Blumberg, Ph.D., Principal Research Associate, Urban Institute; Judy Waxman, Vice President and Director of Health and Reproductive Rights, National Women's Law Center; and Wayne Sensor, CEO, Alegent Health. On June 10, 2008, the Subcommittee on Health in the Committee on Ways and Means held a two-panel hearing entitled ``Addressing Disparities in Health and Healthcare: Issues for Reform.'' The first panel included: Delegate Donna M. Christensen (D­ USVI); former Congresswoman Hilda L. Solis (D­CA); Delegate Madeleine Z. Bordallo (D­GU); and Congressman Jerry Moran (R­ KS). The second panel included: Marsha Little-Blanton, Dr.P.H., Senior Advisor on Race, Ethnicity and Healthcare, Kaiser Family Foundation; Mohammed Akhter, M.D., M.P.H., Executive Director, National Medical Association; Deena Jang, J.D., Policy Director, Asian and Pacific Islander American Health Forum; Anthony B. Iton, M.D., J.D., M.P.H., Director of Public Health and Health Officer, Alameda County, CA; Sally Satel, M.D., Resident Scholar, American Enterprise Institute; and Michael A. Rodriguez, M.D., M.P.H., Associate Professor and Vice Chair of Research, Department of Family Medicine, University of California, Los Angeles. On September 11, 2008, the Subcommittee on Health in the Committee on Ways and Means held a hearing entitled ``Reforming Medicare's Physician Payment System.'' The panel included: Bruce C. Vladeck, Ph.D., Senior Health Policy Advisor and Executive Director of Health Sciences, Ernst & Young, LLP; Gail Wilensky, Ph.D., Senior Fellow, Project Hope; Nancy H. Nielsen, M.D., Ph.D., President, American Medical Association; and Donald M. Crane, President and Chief Executive Officer, California Association of Physician Groups. On September 23, 2008, the Subcommittee on Health in the Committee on Ways and Means held a hearing entitled the ``Health of the Private Health Insurance Market.'' The panel included: Karen Davis, President, Commonwealth Fund; Bruce Bodaken, Chairman and Chief Executive Officer, Blue Shield of California; Roger Feldman, Ph.D., Blue Cross Professor of Health Insurance, University of Minnesota; and Mila Kofman, Superintendent of Insurance, Maine Bureau of Insurance.
HEARINGS IN THE SENATE

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Committee on Health, Education, Labor and Pension On January 10, 2007, the Senate Health, Education, Labor and Pensions (HELP) Committee held a hearing entitled ``Health Care Coverage and Access.'' The panel included: Peter Meade, Executive

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957 Vice President, Blue Cross Blue Shield of Massachusetts; John McDonough, Executive Director, Health Care for All; Karen Davis, President, Commonwealth Fund; Andy Stern, President, SEIU; Debra Ness, President, National Partnership for Women and Families; Larry Burton, Executive Vice President, Business Roundtable; Peter Harbage, New America Foundation; Joseph Antos, Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute; John Goodman, President, National Center for Policy Analysis; and Pat Vredevoogd Combs, National Association of Realtors, and owner, Coldwell-Banker-AJS Realty. On February 12, 2008, the Senate HELP Committee held a hearing entitled ``Addressing Healthcare Workforce Issues for the Future.'' The panel included: A. Bruce Steinwald, Director, Healthcare GAO; Kevin Grumbach, M.D., Director, Center for California Health Workforce Studies, University of California San Francisco, and Chair, Department of Family and Community Medicine; Roderick S. Hooker, Ph.D., P.A., Director of Research, Rheumatology Section, Medical Service Department of Veterans Affairs, Dallas VA Medical Center; Edward S. Salsberg, M.P.A., Director, Center for Workforce Studies, Association of American Medical Colleges; James Q. Swift, D.D.S., Board President, American Dental Education Association; Bruce Auerbach, M.D., President Elect, Massachusetts Medical Society, and Vice President and Chief of Emergency Medicine, Sturdy Memorial Hospital; Beth Landon, M.H.A., M.B.A., Director, Alaska Center for Rural Health, University of Alaska; Jennifer Laurent, M.S., FNP­BC, President, Vermont Nurse Practitioner Association; and John E. Maupin, Jr., D.D.S., M.B.A., President, Morehouse School of Medicine. Committee on Finance On March 14, 2007, the Senate Committee on Finance held a hearing entitled ``Course for Health Care Reform: Moving Toward Universal Coverage.'' The panel included: James J. Mongan, M.D., President and Chief Executive Officer, Partners HealthCare; Stuart H. Altman, Ph.D., Dean, Sol C. Chaikin Professor of National Health Policy, The Heller School for Social Policy and Management, Brandeis University; John Sheils, Vice President, The Lewin Group; and Richard G. Frank, Ph.D., Vice Chair, Citizens' Health Care Working Group. On May 6, 2008, the Senate Committee on Finance held a hearing entitled ``Seizing the New Opportunity for Health Reform.'' The panel included the Honorable Tommy Thompson and the Honorable Donna Shalala, both former Secretaries of Health and Human Services. On June 3, 2008, the Senate Committee on Finance held a hearing entitled ``Rising Costs, Low Quality in Health Care: The Necessity for Reform.'' The panel included: Paul B. Ginsburg, Ph.D., President, Center for Studying Health System Change; Elizabeth McGlynn, Ph.D., Associate Director, RAND Health, and Distinguished Chair in Health Quality; Arlene Holt Baker, Executive Vice President, AFL­CIO; and Felicia Fields, Group Vice President, Human Resources and Corporate Services, Ford Motor Company. On June 10, 2008, the Senate Committee on Finance held a hearing entitled ``47 Million and Counting: Why the Health Care Mar-

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958 ketplace is Broken.'' The panel included: Lisa Kelly, cancer patient; Raymond Arth, President and CEO, Phoenix Faucets; Ron Williams, Chairman and Chief Executive Officer, Aetna, Inc.; and Mark Hall, Professor of Law and Public Health, Wake Forest University School of Law and School of Medicine. On September 9, 2008, the Senate Committee on Finance held a hearing entitled ``Improving Health Care Quality: An Integral Step Toward Health Reform.'' The panel included: Peter V. Lee, J.D., Executive Director of National Health Policy, Pacific Business Group on Health; Samuel Nussbaum, M.D., Executive Vice President for Clinical Health Policy and Chief Medical Officer, WellPoint, Inc.; Gregory Schoen, M.D., Regional Medical Director, Fairview Northland Health Services; Kevin B. Weiss, M.D., President and CEO, American Board of Medical Specialties; and William L. Roper, M.D., M.P.H., Dean, School of Medicine, University of North Carolina (UNC), and Vice Chancellor for Medical Affairs and CEO, UNC Health Care System. On September 23, 2008, the Senate Committee on Finance held a hearing entitled ``Covering the Uninsured: Making Health Insurance Markets Work.'' The panel included: John Bertko, F.S.A., M.A.A.A., Adjunct Staff, The RAND Corporation, and Former Chief Actuary, Humana, Inc., Flagstaff, AZ; Andrew Dreyfuss, Executive Vice President, Health Care Services, Blue Cross Blue Shield of Massachusetts; Pam MacEwan, Executive Vice President, Public Affairs and Governance, Group Health Cooperative; and Kim Holland, State of Oklahoma Insurance Commissioner. On November 19, 2008, the Senate Committee on Finance held a hearing entitled ``Health Care Reform: An Economic Perspective.'' The panel included: Ivan G. Seidenberg, Chairman and Chief Executive Officer, Verizon Communications, Inc.; Andy Stern, President, SEIU; Uwe E. Reinhardt, Ph.D., James Madison Professor of Political Economy, Woodrow Wilson School of Public and International Affairs, Princeton University; and Amitabh Chandra, Ph.D., Assistant Professor of Public Policy, John F. Kennedy School of Government, Harvard University.
111TH CONGRESS (2009­2010) HEARINGS IN THE HOUSE OF REPRESENTATIVES

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Committee on Education and Labor On March 10, 2009, the Subcommittee on Health, Employment, Labor and Pensions of the Committee of Education and Labor held a panel entitled ``Strengthening Employer-Based Health Care.'' The panel included: Mark Derbyshire, Small Business Owner; Bruce Pyenson, Principal and Consulting Actuary, Milliman, Inc.; John Sheridan, CEO, Cooper University Hospital; Kenneth Thorpe, Chair of the Health Policy and Management Department, Emory University; E. Neil Trautwein, Vice President, Employee Benefits Counsel, National Retail Federation; and Jim Winkler, Health Management Practice Leader, Hewitt Associates. On April 23, 2009, the Subcommittee on Health, Employment, Labor and Pensions of the Committee of Education and Labor held a panel entitled ``Ways to Reduce the Cost of Health Insurance for Employers, Employees and their Families.'' The panel included:

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959 Karen Davenport, Director of Health Policy, Center for American Progress; David Himmelstein, Associate Professor of Medicine, Harvard University; Michael Langan, Principal, Towers Perrin; William Oemichan, President and CEO, Cooperative Network; Ron Pollack, Executive Director, FamiliesUSA; Janet Trautwein, Executive Vice President and CEO, National Association of Health Underwriters; and William Vaughn, Senior Health Policy Analyst, Consumers Union. On June 10, 2009, the Subcommittee on Health, Employment, Labor and Pensions of the Committee of Education and Labor held a hearing entitled ``Examining the Single Payer Health Care Option.'' The panel included: Congressman John Conyers, Jr. (D­MI); Marcia Angell, M.D., Senior Lecturer in Social Medicine, Harvard Medical School; David Gratzer, Senior Fellow, Manhattan Institute; Geri Jenkins, R.N., Co-President, California Nurses Association/ National Nurses Organizing Committee; and Walter Tsou M.D., M.P.H., National Board Advisor, Physicians for a National Health Program. Committee on Energy & Commerce On March 10, 2009, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled ``Making Health Care Work for American Families: Designing a High Performing Healthcare System.'' The panel included: Doug Elmendorf, Director, Congressional Budget Office; Glenn Hackbarth, Chairman, Medicare Payment Advisory Commission; Jack C. Ebeler, Vice Chair, Committee on Health Insurance Status and Its Consequences, Institute of Medicine; Alan Levine, Secretary, Louisiana Department of Health and Hospitals; Atul Gawande, M.D., Associate Professor of Surgery, Harvard Medical School, and Associate Professor, Department of Health Policy and Management, Harvard School of Public Health; and M. Todd Williamson, M.D., President, Medical Association of Georgia Policy Studies. On March 17, 2009, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled ``Making Health Care Work for American Families: Ensuring Affordable Coverage.'' The panel included: Uwe E. Reinhardt, Ph.D., Professor of Political Economy, Economics and Public Affairs, Princeton University; Sally C. Pipes, B.A., President and Chief Executive Officer, Pacific Research Institute; Judy Feder, Ph.D., Senior Fellow, Center for American Progress Action Fund; Mila Kofman, J.D., Superintendent of Insurance, State of Maine Bureau of Insurance; Jon Kingsdale, Ph.D., Executive Director, Commonwealth Health Insurance Connector Authority, MA; Karen Pollitz, M.P.P., Research Professor, Health Policy Institute, Georgetown University; Katherine Baicker, Ph.D., Professor of Health Economics, Harvard School of Public Health; and Edmund F. Haislmaier, B.A., Senior Research Fellow, Center for Health, Heritage Foundation. On March 24, 2009, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled ``Making Health Care Work for American Families: Improving Access to Care.'' The panel included: Brian D. Smedley, Ph.D., Vice President and Director, Health Policy Institute, Joint Center for Political and Economic Studies; Michael John Kitchell, M.D., President-Elect,

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960 Iowa Medical Society, McFarland Clinic PC; Michael A. Sitorius, M.D., Professor and Chairman, Department of Family Medicine, University of Nebraska Medical Center; Risa Lavizzo-Mourey, M.D., M.B.A., President and CEO, Robert Wood Johnson Foundation; Fitzhugh Mullan, M.D., Murdock Head Professor of Medicine and Health Policy, Professor of Pediatrics, George Washington University; Jeffrey P. Harris, M.D., F.A.C.P., President, American College of Physicians; James R. Bean, M.D., President, American Association of Neurological Surgeons; and Diane Rowland, Sc.D., Executive Director, Kaiser Commission on Medicaid and the Uninsured. On March 27, 2009, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled ``Making Health Care Work for American Families: The Role of Public Health.'' The panel included: E. Besser, M.D., Acting Director, CDC, and Acting Administrator, Agency for Toxic Substances and Disease Registry; Jonathan E. Fielding, M.D., M.P.H., Chair, Task Force on Community Preventive Services, and Director, L.A. County Department of Public Health and County Health Officer; Heather Howard, J.D., Commissioner, New Jersey Department of Health and Senior Services; David Satcher, M.D., Ph.D., Former U.S. Surgeon General, and Director, Satcher Health Leadership Institute, Morehouse School of Medicine; Barbara Spivak, M.D., President, Mt. Auburn Cambridge Independent Practice Association, Inc.; Devon Herrick, Ph.D., Senior Fellow, National Center for Policy Analysis; and Jeffrey Levi, Ph.D., Executive Director, Trust for Americas Health. On April 2, 2009, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled ``Making Health Care Work for American Families: Saving Money, Saving Lives.'' The panel included: Jonathan Skinner, Ph.D., Professor of Economics, Dartmouth Institute for Health Policy and Clinical Practice; Christine K. Cassel, M.D., President and CEO, American Board of Internal Medicine and ABIM Foundation; John Goodman, Ph.D., President and CEO, National Center for Policy Analysis; Bruce Sigsbee, M.D., M.S., President Elect, American Academy of Neurology, and Medical Director, Pen Bay Physicians and Associates; Dennis Smith, M.P.A., Senior Research Fellow in Health Care Reform, Heritage Foundation; Jerry Avorn, M.D., Professor of Medicine, Harvard Medical School; Paul Ginsburg, Ph.D., President, Center for Studying Health System Change; Regina Herzlinger, Ph.D., Professor of Business Administration, Harvard Business School; Ronald Bachman, F.S.A., M.A.A.A., Senior Fellow, Center for Health Transformation; and Diane Archer, J.D., Director, Health Care Project, Institute for America's Future. On June 16, 2009, the Subcommittee on Oversight and Investigation of the Committee on Energy and Commerce held a hearing entitled ``Termination of Individual Health Policies by Insurance Companies.'' The panel included: Don Hamm, CEO, Assurant Health; Richard Collins, CEO, Golden Rule Insurance Company, UnitedHealth Group; Brian A. Sassi, President and CEO, Consumer Business, WellPoint, Inc.; Karen Pollitz, M.P.P., Research Professor, Health Policy Institute, Georgetown University; Robin Beaton, Policyholder; Wittney Horton, Policyholder; and Peggy Raddatz, Relative of Policyholder.

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961 Committee on Ways & Means On March 11, 2009, the Committee on Ways and Means held a hearing entitled ``Expanding Coverage, Improving Quality and Controlling Costs.'' The panel included: John Z. Ayanian, M.D., M.P.P., on behalf of the Institute of Medicine Committee on Health Insurance Status and Its Consequences; Karen Davis, President, Commonwealth Fund; and John M. Pickering, Principal, Consulting Actuary, Milliman, Inc. On March 17, 2009, the Subcommittee on Health in the Committee on Ways and Means held a hearing entitled ``MedPAC's Annual March Report to the Congress on Medicare Payment Policy.'' The panel featured Glenn M. Hackbarth, Chairman, Medicare Payment Advisory Commission. On April 1, 2009, the Committee of Ways and Means held a hearing entitled ``Reforming the Health Care Delivery System.'' The hearing consisted of two panels. The first panel included: Glenn M. Hackbarth, Chairman, Medicare Payment Advisory Commission; Elliot S. Fisher, M.D., M.P.H., Director, Population Health and Policy, Dartmouth Institute for Health Policy and Clinical Practice, and Professor of Medicine and Community and Family Medicine, Dartmouth Medical School; and Robert A. Berenson, M.D., Senior Fellow, Urban Institute. The second panel included: Glenn D. Steele, Jr., M.D., Ph.D., President and CMO, Geisinger Health System; L. Allen Dobson, Jr., M.D., F.A.A.F.P., Vice President for Clinical Practice Development, Carolinas Health System; and Brent C. James, M.D., M.Stat., Chief Quality Officer and Chief Medical Officer, Institute for Health Care Delivery Research, Intermountain Healthcare. On April 22, 2009, the Committee on Ways and Means held a hearing entitled ``Insurance Market Reforms.'' The panel included: Uwe E. Reinhardt, Ph.D., James Madison Professor of Political Economy and Professor of Economics and Public Affairs, Princeton University; William Vaughn, Senior Policy Analyst, Consumers Union; William D. Hobson, Jr., M.S., President and CEO, Watts Healthcare Corporation; David Borris, Owner, Hel's Kitchen Catering, Northbrook, Ill.; Kenneth L. Sperling, Global Health Management Leader, Hewitt Associates, on behalf of National Coalition on Benefits; and Linda Blumberg, Ph.D., Principal Research Associate, Urban Institute. On April 29, 2009, the Committee on Ways and Means held a hearing entitled ``Employer Sponsored Insurance.'' The panel included: Elise Gould, Ph.D., M.P.Aff., Director of Health Policy Research, Economic Policy Institute; J. Randal MacDonald, Senior Vice President for Human Resources, IBM Corporation; Kelly Conklin, Owner, Foley-Waite Associates; Denny Dennis, Senior Research Fellow, NFIB Research Foundation; John Shells, Senior Vice President, Lewin Group; and Gerald Shea, Special Assistant to the President, AFL­CIO. On May 6, 2009, the Committee on Ways and Means held a hearing on ``Health Care Reform'' with Kathleen Sebelius, the Secretary for Health and Human Services.

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962
HEARINGS IN THE SENATE

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Committee on Health, Education, Labor and Pensions On January 29, 2009, the Senate HELP Committee held a hearing entitled ``Crossing the Quality Chasm in Health Reform.'' The panel included: Nancy Davenport-Ennis, CEO, National Patient Advocate Foundation; Karen Davis, President, Commonwealth Fund; Rhonda Robinson-Beale, M.D., Chief Medical Officer, Optum Health Behavioral Solutions, Golden Valley, MN; Elizabeth Teisberg, Ph.D., Associate Professor, University of Virginia's Darden School of Business; and Christine K. Cassel, M.D., President, American Board of Internal Medicine. On February 23, 2009, the Senate HELP Committee held a hearing entitled ``Principles of Integrative Health: A Path to Health Care Reform.'' The panel included: Cathy Baase, M.D., Global Director Health Services, Dow Chemical Company; Robert M. Duggan, M.A., M.Ac., President, Tai Sophia Institute; James S. Gordon, M.D., Founder and Director, Center for Mind-Body Medicine; Wayne B. Jonas, M.D., President, Samueli Institute; Sister Charlotte Rose Kerr, R.S.M., R.N., B.S.N., M.P.H., M.Ac., Practitioner and Professor Emeritus, Tai Sophia Institute; Mary Jo Kreitzer, Ph.D., R.N., Founder and Director, University of Minnesota Center for Spirituality & Healing; Herbert Benson, M.D., Director Emeritus, Benson-Henry Institute for Mind Body Medicine, Massachusetts General Hospital; Brian M. Berman, M.D., Director, Center for Integrative Medicine, University of Maryland School of Medicine; Susan Hartnoll Berman, Executive Director, Institute for Integrative Health; Ron Z. Goetzel, Ph.D., Research Professor and Director, Institute for Health and Productivity Studies, Rollins School of Public Health, Emory University; Kathi J. Kemper, M.D., M.P.H., F.A.A.P., Caryl J. Guth Chair for Complementary and Integrative Medicine, Division of Health Sciences, Wake Forest University; and Simon Mills, Project Lead, United Kingdom Department of Health project: Integrated Self Care in Family Practice. On February 24, 2009, the Senate HELP Committee held a hearing entitled ``Addressing Underinsurance in National Health Reform.'' The panel included: Cathy Schoen, M.S., Senior Vice President, Commonwealth Fund; Gail Shearer, M.S., Director of Health Policy Analysis, Consumers Union; Diane Rowland, D.Sc., Executive Vice President, Henry J. Kaiser Family Foundation, and Executive Director, Kaiser Commission on Medicaid and the Uninsured; and Grace-Marie Turner, President, Galen Institute. On March 24, 2009, the Senate HELP Committee held a hearing entitled ``Addressing Insurance Market Reform in National Health Reform.'' The panel included: Janet Trautwein, Executive Vice President and CEO, National Association of Health Underwriters; Ronald A. Williams, M.S., Chairman and Chief Executive Officer, Aetna, Inc.; Karen Pollitz, M.P.P., Research Professor, Health Policy Institute, Georgetown University; Karen Ignagni, M.B.A., President and CEO, America's Health Insurance Plans; Len Nichols, Ph.D., Director, Health Policy Program, New America Foundation; Katherine Baicker, Ph.D., Professor of Health Economics, Department of Health Policy and Management, Harvard School of Public

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963 Health; and Sandy Praeger, Health Insurance Commissioner, State of Kansas. On April 28, 2009, the Senate HELP Committee held a hearing entitled ``Learning from the States: Individual State Experiences with Health Care Reform Coverage Initiatives in the Context of National Reform.'' The panel included: Jon Kingsdale, Ph.D., Executive Director, Commonwealth Health Insurance Connector Authority, MA; Susan Besio, Director, Office of Vermont Health Access, State of Vermont Human Services Agency; Harry Chen, M.D., Emergency Room Physician and Board Member, Vermont Program for Quality in Health Care; Brent James, Executive Director, IHC Institute for Health Care Delivery Research, Intermountain Health Care, Inc.; Honorable David Clark (R), Majority Leader, Utah House of Representatives; Ruth Liu, Senior Director for Health Policy, Legal and Government Relations, Kaiser Permanente; and Eileen McAnneny, Senior Vice-President of Government Affairs and Associate General Counsel, Associated Industries of Massachusetts. On April 30, 2009, the Senate HELP Committee held a hearing entitled ``Primary Health Care Access Reform: Community Health Centers and the National Health Service Corps.'' The panel included: Cynthia Bascetta, Director of Health Care, GAO; Dan Hawkins, Senior Vice President, National Association of Community Health Centers; Fitzhugh Mullan, M.D., Murdock Head Professor of Medicine and Health Policy, George Washington University School of Public Health; Caswell A. Evans, Jr., D.D.S, M.P.H., Associate Dean for Prevention and Public Health Sciences, University of Illinois at Chicago College of Dentistry; Yvonne Davis, Board Member, Community Health Center; John Matthew, M.D., Health Center, Plainfield, VT; and Lisa Nichols, Executive Director, Midtown Community Center, Ogden, UT. On June 11, 2009, the Senate HELP Committee held a two-panel hearing entitled ``Health Care Reform.'' The first panel included: Margaret Flowers, M.D., Maryland Co-Chair, Physicians for a National Health Program; Ron Williams, CEO, Aetna, Inc; Randel Johnson, Vice President for Labor, Immigration, and Employee Benefits, U.S. Chamber of Commerce; William Dennis, Senior Research Fellow, National Federation of Independent Business; Mary Andrus, Co-Chair of the Health Care Taskforce, Consortium for Citizens with Disabilities; Samantha Rosman, M.D., Board of Trustees, American Medical Association; Ray Scheppach, Ph.D., Executive Director, National Governors' Association; Gerald Shea, Special Assistant to the President, AFL­CIO; Dennis Rivera, Chair, SEIU Healthcare; Katherine Baicker, Ph.D., Professor of Health Economics, Harvard School of Public Health; Jonathan Gruber, Ph.D., Associate Head, MIT Department of Economics; Janet Trautwein, Executive Vice-President and CEO, National Association of Health Underwriters; Sandy Praeger, Kansas Insurance Commissioner; Scott Gottlieb, M.D., Resident Fellow, American Enterprise Institute; and Steve Burd, President and CEO, Safeway, Inc. The second panel included: Gary Raskob, Ph.D., Dean, University of Oklahoma College of Public Health; Jeffrey Levi, Ph.D., Executive Director, Trust for America's Health; Fay Raines, Ph.D., President, American Association of Colleges of Nursing; Wayne Jonas, M.D., President and CEO, Samueli Institute;

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964 Delos Cosgrove, M.D., CEO, Cleveland Clinic; Brent James, M.D., M.Stat., Executive Director, Institute for Health Care Delivery Research, Intermountain Health Care, Inc.; Charles Kahn, M.P.H., President, Federation of American Hospitals; John Rother, J.D., Executive Vice President for Policy and Strategy, AARP; and Judith Palfrey, M.D., President-Elect, American Academy of Pediatric. Committee on Finance On February 25, 2009, the Senate Committee on Finance held a hearing entitled ``Scoring Health Care Reform: CBO's Budget Options'' with Douglas Elmendorf, Ph.D., Director of the Congressional Budget Office. On March 12, 2009, the Senate Committee on Finance held a hearing entitled ``Workforce Issues in Health Care Reform: Assessing the Present and Preparing for the Future.'' The panel included: David C. Goodman, M.D., M.S., Director of the Center for Health Policy Research, Dartmouth College; Allan H. Goroll, M.D., M.A.C.P., Professor of Medicine, Harvard Medical School; Fitzhugh Mullan, M.D., Murdock Head Professor of Medicine and Health Policy, George Washington University; and Steven A. Wartman, M.D., Ph.D., M.A.C.P., President and CEO, Association of Academic Health Centers. On March 25, 2009, the Senate Committee on Finance held a hearing entitled ``The Role of Long-Term Care in Health Reform.'' The panel included: Judy Feder, Ph.D., Senior Fellow, Center for American Progress Action Fund; Raymond C. Scheppach, Ph.D., Executive Director, National Governors Association; Dennis G. Smith, Senior Research Fellow in Health Care Reform, Heritage Foundation; and Joshua M. Wiener, Ph.D., Senior Fellow, RTI International. On April 21, 2009, the Senate Committee on Finance held a hearing entitled ``Reforming America's Health Care Delivery System.'' The panel included: Allan M. Korn, M.D., Senior Vice President, Chief Medical Officer, Office of Clinical Affairs, Blue Cross Blue Shield Association; Glenn M. Hackbarth, J.D., Chairman, Medicare Payment Advisory Commission; Peter V. Lee, J.D., Executive Director of National Health Policy, Pacific Business Group on Health; Mark B. McClellan, M.D., Director, Engelberg Center for Health Care Reform, Brookings Institute; Lewis Morris, J.D., Chief Counsel to the Inspector General, Office of Counsel to the Inspector General; Mary D. Naylor, Ph.D., F.A.A.N., R.N., Marian S. Ware Professor in Gerontology, University of Pennsylvania School of Nursing; Debra Ness, President, National Partnership for Women and Families; Frank G. Opelka, M.D., F.A.C.S., Vice Chancellor for Clinical Affairs and Professor of Surgery, Office of the Chancellor, Louisiana State University Health Science Center; Glenn Steele, Jr., M.D., Ph.D., President, Geisinger Health System; John Tooker, M.D., M.B.A., F.A.C.P., Executive Vice President and Chief Executive Officer, American College of Physicians; Richard J. Umbdenstock, F.A.C.H.E., President and CEO, American Hospital Association; Ron Williams, Chairman and CEO, Aetna, Inc.; and Paul J. Diaz, J.D., President and CEO, Kindred Healthcare, Inc.

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965 On May 5, 2009, the Senate Committee on Finance held a hearing entitled ``Expanding Health Care Coverage.'' The panel included: Stuart M. Butler, Ph.D., Vice President, Domestic and Economic Policy Studies, Heritage Foundation; John Castellani, President, Business Roundtable; Gary Claxton, Vice President and Director, Health Care Marketplace Project, Henry J. Kaiser Family Foundation; Donald A. Danner, President and CEO, National Federation of Independent Business; Jennie Chin Hansen, R.N., M.S., F.A.A.N., President, AARP; Karen Ignagni, President and CEO, America's Health Insurance Plan; R. Bruce Josten, Executive Vice President, Government Affairs, U.S. Chamber of Commerce; Len Nichols, Ph.D., Director, Health Policy Program, New America Foundation; Ron Pollack, J.D., Executive Director, Families USA; Sandy Praeger, Chair, Health Insurance and Managed Care Committee, National Association of Insurance Commissioners; Sara Rosenbaum, J.D., Chair, Department of Health Policy, George Washington School of Public Health and Health Services; Diane Rowland, Sc.D., Executive Vice President, Henry J. Kaiser Family Foundation; Raymond C. Scheppach, Ph.D., Executive Director, National Governors Association; Scott Serota, President and Chief Executive Officer, Blue Cross and Blue Shield Association; and Andy Stern, President, SEIU. On May 12, 2009, the Senate Committee on Finance held a hearing entitled ``Financing Comprehensive Health Care Reform.'' The panel included: Stuart H. Altman, Ph.D., Sol C. Chaikin Professor of National Health Policy, Heller School for Social Policy and Management, Brandeis University; Joseph R. Antos, Ph.D., Wilson H. Taylor Scholar in Health Care and Retirement Policy, American Enterprise Institute; Katherine Baicker, Ph.D., Professor of Health Economics, Harvard School of Public Health; Leonard Burman, Ph.D., Director, Tax Policy Center, Urban Institute; Robert Greenstein, Ph.D., Executive Director, Center on Budget and Policy Priorities; Jonathan Gruber, Ph.D., Professor of Economics, Massachusetts Institute of Technology; Michael F. Jacobson, Ph.D., Executive Director, Center for Science in the Public Interest; James A. Klein, President, American Benefits Council; Edward Kleinbard, Chief of Staff, Joint Committee on Taxation; Gerald M. Shea, Special Assistant to the President, AFL­CIO; John Sheils, Senior Vice President, Lewin Group; Gail Wilensky, Ph.D., Senior Fellow, Project HOPE; and Steven Wojcik, Vice President of Public Policy, National Business Group on Health.
INTRODUCTION AND CONSIDERATION OF AMERICA'S AFFORDABLE HEALTH CHOICES ACT, H.R. 3200

On June 19, 2009, Congressman George Miller (D-CA), along with Congressmen Henry Waxman (D­CA), Charles Rangel (D­NY) and John Dingell (D­MI) released the Tri-Committee draft proposal for health care reform. Committee on Education & Labor Consideration of the Tri-Committee Draft Proposal for Health Care Reform On June 23, 2009, the House Education and Labor Committee held a hearing to discuss the draft proposal for health care reform that was jointly developed by the House Ways and Means, Energy

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966 and Commerce, and Education and Labor Committees. The draft was designed to achieve President Obama's goals of controlling health care cost, preserving health care choices, and ensuring quality, affordable health care for all Americans. The hearing entitled ``The Tri-Committee Draft Proposal for Health Care Reform'' consisted of three panels. The first panel included: Christina Romer, Ph.D., Chair, Council of Economic Advisers, Office of the President; Ron Pollack, Founding Executive Director, Families USA; Gerald Shea, Special Assistant to the President, AFL­CIO; Paul J. Speranza, Senior Vice President, General Counsel and Secretary, Wegmans Food Markets, Inc.; Jacob Hacker, Ph.D., Professor and Co-Director, Berkeley Center on Health, Economic, and Family Security, University of California Berkeley; Michael J. Stapley, President and Chief Executive Officer, Deseret Mutual; John Arensmeyer, Chief Executive Officer, Small Business Majority; and Fran Visco, President, National Breast Cancer Coalition. The second panel included: Karen Pollitz, Research Professor and Project Director, Health Policy Institute, Georgetown University; Celia Wcislo, Assistant Division Director, SEIU; James A. Klein, President, American Benefits Council; William Vaughan, Senior Health Policy Analyst, Consumers Union; Robert E. Moffit, Ph.D., Director, Center for Health Policy Studies, Heritage Foundation; ReShonda Young, Small Business Owner, Alpha Express, Inc. on behalf of the Main Street Alliance; and Fitzhugh Mullan, M.D., Murdock Head Professor of Medicine and Health Policy, George Washington University. Committee on Energy & Commerce Consideration of the Tri-Committee Draft Proposal for Health Care Reform On June 23, 2009, the Subcommittee on Health of the Committee on Energy and Commerce held a hearing entitled ``Comprehensive Health Reform Discussion, Day 1.'' The panel included: Richard Kirsch, National Campaign Manager, Health Care for America Now; Ralph G. Neas, Chief Executive Officer, National Coalition on Health Care; Stephen T. Parente, Ph.D., Director, Medical Industry Leadership Institute; Marian Wright Edelman, President, Children's Defense Fund; Jennie Chin Hansen, President, AARP; David L. Shern, Ph.D., President and Chief Executive Officer, Mental Health America; Erik Novak, M.D., Orthopedic Surgeon, Patients United Now; Shona Robertson-Holmes, Patient at Mayo Clinic; Jeffrey Levi, Ph.D., Executive Director, Trust for America's Health; Brian D. Smedley, Ph.D., Vice President and Director, Health Policy Institute, Joint Center for Political and Economic Studies; and Mark Kestner, M.D., Chief Medical Officer, Alegent Health. On June 24, 2009, the Subcommittee on Health of the Committee on Energy and Commerce held a three-panel hearing entitled ``Comprehensive Health Reform Discussion, Day 2.'' The first panel on single-payer health care included: Sidney M. Wolfe, M.D., Director, Health Research Group at Public Citizen; Steffie Woolhandler, M.D., Associate Professor of Medicine, Harvard Medical School, and Co-Founder, Physicians for a National Health Program; and John C. Goodman, Ph.D., President and CEO, National Center for Policy Analysis. The second panel on state, local and tribal views included: the Honorable Michael O. Leavitt, Former Secretary, U.S.

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967 Department of Health and Human Services; the Honorable Joseph Vitale (D), Chairman, Committee on Health, Human Services, and Senior Citizens, New Jersey State Senate; W. Ron Allen, Chairman, Jamestown S'Klallam Tribe; the Honorable Jay Webber (R), New Jersey State Assembly; Raymond C. Scheppach, Ph.D., Executive Director, National Governors Association; Robert S. Freeman, Deputy Executive Director, CenCal Health, California Association of Health Insuring Organizations; and Ron Pollack, Executive Director, Families USA. The third panel on drug and device manufacturer views included: Thomas Miller, CEO, Workflow and Solutions Division, Siemens Medical Solutions, USA; Kathleen Buto, Vice President for Health Policy, Johnson & Johnson; William Vaughan, Senior Health Policy Analyst, Consumers Union; Scott Gottlieb, M.D., Resident Fellow, American Enterprise Institute; and A. Kelly, Senior Vice President, Government Affairs and Public Policy, National Association of Chain Drug Stores. On June 25, 2009, the Subcommittee on Health of the Committee on Energy and Commerce held a four-panel hearing entitled ``Comprehensive Health Reform Discussion, Day 3.'' The first panel on Medicare payment included Glenn M. Hackbarth, Chair of the Medicare Payment Advisory Commission, and the Honorable Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services. The second panel on doctor, nurse, hospital, and other provider views included: Ted D. Epperly, M.D., President, American Academy of Family Physicians; M. Todd Williamson, M.D., President, Medical Association of Georgia; Karl J. Ulrich, M.D., Clinic President and CEO, Marshfield Clinic; Janet Wright, M.D., Vice President, Science and Quality, American College of Cardiology; Kathleen M. White, Ph.D., Chair, Congress on Nursing Practice and Economics, American Nurses Association; Patricia Gabow, M.D., Chief Executive Officer, Denver Health and Hospital Authority, National Association of Public Hospitals; Dan Hawkins, Senior Vice President, Public Policy and Research, National Association of Community Health Centers; Bruce T. Roberts, R.Ph., Executive Vice President and CEO, National Community Pharmacists Association; Bruce Yarwood, President and CEO, American Health Care Association; and Alissa Fox, Senior Vice President, Office of Policy and Representation, Blue Cross Blue Shield Association. The third panel on employer and employee views included: Kelly Conklin, Owner, Foley-Waite Custom Woodworking, Main Street Alliance; John Arensmeyer, Founder and CEO, Small Business Majority; Gerald M. Shea, Special Assistant to the President, AFL­CIO; Dennis Rivera, Health Care Chair, SEIU; John Castellani, President, Business Roundtable Institute for Corporate Ethics; John Sheils, Senior Vice President, Lewin Group; and Martin Reiser, Manager of Government Policy, Xerox Corporation, National Coalition on Benefits. The fourth panel on insurers' views included: Howard A. Kahn, Chief Executive Officer, L.A. Care Health Plan; Karen Pollitz, M.P.P., Research Professor, Health Policy Institute, Georgetown University; Karen Ignagni, President and CEO, America's Health Insurance Plans; and Janet Trautwein, Executive Vice President and CEO, National Association of Health Underwriters.

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968 Committee on Ways & Means Consideration of the Tri-Committee Draft Proposal for Health Care Reform On June 24, 2009, the Committee on Ways and Means had a hearing entitled ``Health Reform in the 21st Century: Proposals to Reform the Health System.'' The hearing consisted of three panels. The first panel included: Karen Pollitz, Policy Director, Health Policy Institute, Georgetown Public Policy Institute; John F. Holahan, Ph.D., Director, Health Policy Research Center, Urban Institute; and David Gratzer, M.D., Senior Fellow, Manhattan Institute for Policy Research. The second panel included: Richard Kirsch, National Campaign Manager, Health Care for America NOW; Mike Draper, Owner, SMASH; Peter V. Lee, Executive Director for National Health Policy, Pacific Business Group on Health; Gerald Shea, Special Assistant to the President, AFL-CIO; Jennie Chin Hansen, President, AARP; and Randel K. Johnson, Senior Vice President, Labor, Immigration and Employee Benefits, U.S. Chamber of Commerce. The third panel included: Dan Baxter, Medical Director, William F. Ryan Community Health Network, NY; Ted Epperly, M.D., President, American Academy of Family Physicians; Donna Policastro, Executive Director, Rhode Island State Nurses Association on behalf of the American Nurses Association; Chip Kahn, President, Federation of American Hospitals; Larry Minnix, President and CEO, American Association of Homes and Services for the Aging; Ronald Williams, Chairman and CEO, Aetna, Inc.; and Richard Warner, M.D., Member, Kansas Medical Society House of Delegates, AMA Alternate Delegate, and past President, Kansas Medical Society. Introduction of America's Affordable Health Choices Act, H.R. 3200 On July 15, 2009, after taking into consideration comments on the discussion draft from a very wide range of voices, Chairmen George Miller, Henry Waxman, Charles Rangel, and Congressman John Dingell introduced America's Affordable Health Choices Act, H.R. 3200. The bill seeks to control rising health care costs, strengthen the employer-based health care system, and ensure that all Americans have access to quality and affordable health care coverage. Committee on Education & Labor Mark-up of H.R. 3200 The Full Committee met on July 15­17, 2009 to mark up H.R. 3200. The Committee passed by voice vote an amendment in the nature of a substitute offered by Chairman George Miller (D­CA). There were 42 other amendments offered and debated. Of the amendments offered, 20 passed, 17 failed, 4 were withdrawn, and one was ruled not germane. America's Affordable Health Choices Act of 2009 H.R. 3200 was reported favorably to the House with an amendment in the nature of a substitute. By a vote of 26­22, the Committee authorized the Chairman to transmit the bill, with an amendment in the nature of a substitute, to the Committee on the Budget in compliance with section 310 of the Congressional Budget Act of 1974 as the first part of the Committee's recommendations, pursuant to the reconciliation instruction in S. Con Res. 13.

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975 The amendment offered by Representative McKeon (R­CA) would have created a new title at the end of Division A titled Title IV--Small Business Health Fairness. This title would include rules governing association health plans; clarification of treatment of single employer arrangements; enforcement provisions related to association health plans; and other provisions related to association health plans. The amendment was defeated by a roll call vote of 21­27. The amendment offered by Representative Castle (R­DE) would have allowed variation in cost-sharing and premiums charged by the qualified health benefits plans dependent upon participant participation in employer prevention and wellness programs. The amendment was withdrawn and no further action was taken on it. The second amendment offered by Representative Wilson (R­SC) would add to H.R. 3200 a Sense of the House of Representatives that any members who vote in support of the public health insurance option are urged to forgo their right to participate in the FEHBP and enroll under the public option. The amendment was passed by voice vote. The third amendment offered by Representative Price (R­GA) would have established provisions for defined contribution health plans. The amendment was defeated by a roll call vote of 19­29. The fourth amendment offered by Representative Price (R­GA) would have struck the physician billing language in Section 225(c). The amendment was defeated by a roll call vote of 19­29. The second amendment offered by Representative McMorris Rodgers (R­WA) would have exempted plans established and maintained by Indian tribal governments. The amendment was defeated by voice vote. Committee on Ways & Means Mark-up of H.R. 3200 On July 16, 2009, the Committee on Ways and Means met to mark-up H.R. 3200, America's Affordable Health Choices Act and reported the bill as amended by a vote of 23­18. Committee on Energy & Commerce Mark-up of H.R. 3200 Beginning on July 16, 2009, the Committee on Energy and Commerce met to mark-up H.R. 3200, America's Affordable Health Choices Act. In addition to July 16, 2009, the Committee considered H.R. 3200 on July 17, 20, 30 and 31. The Committee reported the bill as amended by a vote of 31­28.
SENATE CONSIDERATION OF THE AFFORDABLE HEALTH CHOICES ACT

Beginning on June 17, 2009 the HELP Committee met to markup the Affordable Health Choices Act. The Committee reported the bill as amended on July 15, 2009 by a vote of 13­10. III. SUMMARY
OF THE

BILL

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America's Affordable Health Choices Act makes critical reforms to this nation's broken health care system. It will lower costs, preserve choice, and expand access to quality, affordable care. To protect families struggling with health care costs and inadequate coverage, the bill ensures that health insurance companies can no

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976 longer compete based on risk selection. By prohibiting rate increases based on pre-existing conditions, gender and occupation, the bill requires that insurance companies instead compete based on quality and efficiency. In addition, H.R. 3200 will lower the cost of health care by eliminating co-pays and deductibles for preventive care, capping annual out-of-pocket expenses, prohibiting lifetime limits, and allowing the uninsured, part-time workers, and employees of some small businesses to obtain group rates by purchasing health care through the HIE. H.R. 3200 will expand choice of health insurance, especially in many parts of the country where families have very limited choices because of the nature of the insurance market. The HIE will serve as an organized and transparent ``marketplace for the purchase of health insurance'' 7 where individuals and employees (phased-in over time) can shop and compare health insurance options. To participate in the HIE, insurers will be required to meet the insurance market reforms and consumer protections and offer the essential benefits package established by the new independent benefits advisory committee. Individuals and families under 400 percent of poverty who qualify for affordability credits will be able to use that money in the HIE to help offset the costs of their health care coverage. One health insurance choice within the HIE will be the public health insurance option. The public option will be required to operate on the same level as private insurance companies, adhering to the same market reforms and consumer protections, and it will be required to be financed from its premiums. Rates will vary geographically just as private insurers do. The public plan option will be able to utilize payment rates similar to Medicare with provider rates at Medicare plus 5 percent. However, beginning in Y4 the Secretary will have the authority to use an administrative process to set rates (at levels that do not increase costs) in order to promote payment accuracy and the delivery of affordable and efficient care. The inclusion of a public option in the HIE will help to rein in the costs of health insurance while preserving access. At all times, the Secretary retains the authority to utilize innovative payment mechanisms and policies to improve health outcomes, reduce health disparities, and promote quality and integrated care. Furthermore, the public option will represent choice in many communities where one insurer dominates the market. Consequently, the public health insurance option has the ability to increase competition and control costs. However, no one, including employers who put their employees into the HIE, can place or force anyone into the public option. The decision to enroll in a private plan or the public option is always left to individuals and families to decide for themselves. H.R. 3200 is built upon the premise of shared responsibility among individuals, employers and the government, so that everyone contributes and has access to affordable, quality health care. America's Affordable Health Choices Act gives employers the choice
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7 Linda Blumberg and Karen Pollitz, Health Insurance Exchanges: Organizing Health Insurance Marketplaces to Promote Health Reform Goals, the Urban Institute & Robert Wood Johnson Foundation (April 2009).

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977 to either offer health insurance or pay a percentage of payroll for their employees to go into the HIE. Beginning in 2013, employers ``playing'' will be required to offer health coverage to all of their full-time employees and contribute 72.5 percent of the premium for an individual and 65 percent for a family premium. For part-time workers, employers will have the choice to either offer health coverage on a pro rata basis or pay the required penalty. There will be no minimum benefit requirement for existing employer-sponsored health plans until the end of 2018. At that time, employers who ``play'' will be required to offer coverage that is no less than the minimum benefit level within the Exchange and must include the insurance market reforms. Employers may also choose to ``pay'' instead of play. A ``pay'' employer would be required to make a contribution equal to 8 percent of their payroll to the HIE. However, recognizing the difficulties small businesses face, the bill includes a number of provisions to help small employers. For example, H.R. 3200 exempts employers with payrolls of $250,000 or less from the pay or play requirements. For employers with payroll between $250,000 and $400,000 the contribution amount phases-up from 2 to 8 percent so that only employers with payrolls greater than $400,000 will pay the full 8 percent. Whether obtaining coverage through an employer, a spouse or the HIE, H.R. 3200 requires that individuals either enroll in health care coverage or pay 2.5 percent of their adjusted gross income capped at the total cost of the average cost premium offered in the HIE. Recognizing that high health care costs prevent many Americans from securing health care coverage, H.R. 3200 provides for affordability credits to help eligible low- and middle-income individuals and families purchase coverage in the HIE. In addition, for those who can demonstrate that they are unable to afford health insurance, the Health Choices Commissioner (Commissioner) retains the authority to develop and grant hardship waivers. The affordability credits provided for under the bill will be available to individuals and families with incomes between 133 to 400 percent of the federal poverty level. Medicaid will be expanded so that anyone below 133 percent of poverty will be Medicaid eligible and that expansion will be fully federally financed. Employees who are offered health insurance through an employer will be unable to go into the HIE and receive affordability credits unless that employer coverage is deemed unaffordable. An unaffordable employer offer is one where the employees' share of the premium and cost sharing are more than 11 percent of family income. Finally, as millions of Americans gain coverage, investments in the health care workforce are critical to ensuring all Americans have access to needed care. H.R. 3200 includes significant investments to help train more primary care and public health physicians as well as nurses. It puts into place incentives to encourage more people to become doctors and nurses (particularly in rural areas). Some of the workforce provisions include: (1) increased funding for the National Health Service Corp.; (2) expanded scholarships and loans for health professionals who work in shortage professions and areas; (3) steps to increase physician training outside of the hospital and redistribute unfilled graduate medical edu-

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978 cation residency slots so that more primary care physicians can be trained; and (4) grants through the Department of Labor to help train and retain nurses. IV. COMMITTEE VIEWS The Committee on Education and Labor of the 111th Congress is committed to containing the cost of health care and ensuring that every American has access to affordable, quality health care coverage. H.R. 3200 includes critical reforms to the health care system that are needed to reduce surging premium and health care costs that families, businesses and governments are struggling to afford. The bill cuts over a half trillion dollars from the health care system, ensures that no one is ever one illness away from bankruptcy and creates a system where 97 percent of Americans will have health care coverage by 2015. OVERVIEW Health care reform is a critical issue in this country. There are 47 million people in the United States without health care coverage and almost nine million of them are children.8 Meanwhile, health care costs are rising for nearly everyone. The United States spends over $2.4 trillion--more than 18 percent of GDP--on health care services and products--far more than other industrialized countries.9 In addition, health care costs continue to grow faster than the economy as a whole, and individuals and families are burdened by the weight of these escalating expenses. Yet, for all this spending, the United States' scores are average or worse on many key indicators of health care quality. Health care reform is critical to restoring prosperity for our nation's families and H.R. 3200 will ensure that coverage is truly affordable and dependable for hardworking Americans. The Uninsured The number of uninsured persons in the United States continues to grow, from 44.8 million in 2005 to 47.0 million in 2006. The percentage of uninsured is also rising, from 15.3 percent of the total population in 2005 to 15.8 percent in 2006.10 More than two-thirds of the uninsured live in a household with one full-time worker. These increasing numbers can be attributed to the rising cost of health care, a decline in manufacturing jobs and an increase in workers employed in the service industries and small businesses, which are less likely to provide insurance.11 Roughly two-thirds of Americans without health insurance have incomes 200 percent below the federal poverty level--or approximately $44,000 for a family of four.12 Not surprisingly, those in households with annual incomes below $25,000 are even less likely
note 2. 9 National Coalition on Health Care, ``Facts on the Cost of Health Insurance and Health Care,'' (2007), available at: http:www.nchc.org/facts/cost.shtml 10 U.S. Census Bureau, ``Health Insurance Coverage: 2006--Highlights.'' (Aug. 27, 2007), available at: http:www.census.gov/hhes/www/hlthins/hlthin06/hlth06asc.html 11 Robert Pear. ``Without Health Benefits, a Good Life Turns Fragile,'' N.Y. Times (Mar. 5, 2007). 12 Kaiser Family Foundation, ``The Uninsured: A Primer,'' (Oct. 2008). http:www.kff.org/uninsured/upload/7451­04.pdf.
8 Supra

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979 to be insured. In 2006, twenty-five percent of these Americans were uninsured in comparison to 16 percent of the total population.13 Approximately 162 million non-elderly workers and their dependents received health coverage through their employment-based health plans.14 However, millions of other working Americans are unable to participate in an employer-sponsored plan, either because the employer does not offer coverage or the employee is not eligible under the plan. In 2005, 20 percent of ``wage and salary'' workers had an employer that did not offer any coverage to their workers. And 18 percent were not eligible for the health plan that was offered by their employer.15 For example, some firms do not offer coverage to part-time employees and some do not offer coverage to workers who have been employed for less than a specific amount of time. While employer-sponsored plans still remain the dominant source of health coverage for most Americans, the percentage of people obtaining health coverage through these plans has been steadily shrinking. For example, 60 percent of employers offered benefits in 2007, compared with 69 percent in 2000. Most of this decline can be attributed to the decline in small businesses (less than 200 workers) offering coverage.16 Among firms with less than 10 workers, the offer rate dropped from 57 percent in 2000 to 45 percent in 2007.17 For employers who have stopped offering coverage, almost three out of four say that premiums are too expensive.18 Unaffordable Health Care Coverage Employers and workers alike are increasingly concerned