Healthcare Reform

With the MA Senate seat going to a Republican, the Senate no longer has a 60 seat super majority. However, there are several other options being discussed to continue to push the health care reform legislation forward. It is uncertain at this time what the next steps will be but here are some of the options:

1) Have the House pass the Senate version of the bill

House leader Nancy Pelosi has come out and said that the Democrats do not have enough support in the House to pass the Senate version of the bill making this an extremely unlikely option.

2) Move a stripped down version of the bill through the Senate using a reconciliation vote which only requires 51 votes.

This is also know as the "two bill solution". The most contentious parts of a reform bill would be passed via the reconciliation vote (aka the nuclear option) and then the bipartisan consensus items would be passed in a separate bill. This is one of the more likely options.

3) Seek one Senate Republican to caucus with the Democrats in passing the final bill

Democrats are still attempting to try to win over Maine's Olympia Snowe to get the one additional vote in the Senate. It is unknown at this time the likelihood of this option, however Mrs. Snowe has publically stated that she is active speaking with the Democratic leadership about the bill.

4) Give up on healthcare and focus on the economy and jobs

In an election year with public support wavering and an unclear path on health care reform, the administration might use the State of the Union address to refocus priorities on jobs and the economy and give up the attempt to try to pass health care reform at this time.

State Health Care Reform - California

Last week, after the MA election results were finalized, a third attempt at a California single payer health plan made it out of the Senate Appropriations Committee. Two other versions were passed previously by the legislature only to have them vetoed by Governor Arnold Schwarzenegger.

Many states had put their attempts at their own versions of health care reform on hold while Congress debated its plan. By moving forward with this, the California state legislature is signaling its lack of confidence in the federal process.

California HMO Changes

California is implementing new limits on doctor wait times for HMO members. The new limits go in to effect in 2011 and limit wait times to: 10 business days for a primary care appointment, 15 days for specialists, 48 hours for urgent care, and 10 minutes to speak with customer service.

Legal Rulings

FSA Eligible Reimbursements

The 1st circuit ruled that expenses incurred for infertility treatment were not deductible when the expenses are not incurred primarily for the prevention or alleviation of a physical or mental illness or affect a structure or function of the individual’s body. i.e. - IVF is not considered a covered expense if there is no underlying medical condition.

Reference: Magdalin v. Comm'r, No. 09-1153 (1st Cir. Dec. 17, 2009)

Notable Research

In a recent article in Health Affairs, a Harvard research meta-analysis recently found that medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.

Biometric screening of children which includes: BMI, blood pressure, race, family history, blood sugar, and cholesterol levels can be used to predict with a high level of accuracy, the odds of having diabetes by the age of 39.

Dr. Dana King of the Medical University of South Carolina found that between 1988 and 2006:

• The prevalence of obesity increased from 28% to 36%.


• The percentage of people getting minimal amounts of exercise fell from 53% to 43%.


• Smoking remained unchanged at about 26% of the population.
  The percentage of people eating at least five or more fruits and vegetables per day fell from 46% to only 26%.


• Moderate alcohol consumption increased from 40% to 51% of adults.


• Only about 8% of the 15,000 research study participants met all 5 criteria for practicing a healthy lifestyle.