Senator Carper Votes for the Health Care and Education Affordability Reconciliation Act of 2010

"This is a historic moment for our country, but just the first step of many as we continue to work to address problems in our health care system."

WASHINGTON –Today Sen. Tom Carper (D-Del.) joined a majority of his Senate colleagues in voting for the Health Care and Education Affordability Reconciliation Act of 2010 (H.R. 4872). By a vote of 56 to 43, the Senate passed the Reconciliation legislation which will make a series of targeted changes to strengthen and enhance the Patient Protection and Affordable Care Act that was signed into law by President Obama earlier this week. The combined health reform measures – the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act of 2010- would reduce the federal deficit by $1.3 trillion over 20 years, and provide health insurance to 32 million currently uninsured Americans.
“Comprehensive health reform is something that I feel passionately about and a cause that I have been working on for a very long time,” said Senator Carper. “On Tuesday President Obama signed the health reform legislation that I helped to write into law, marking a historic moment for our country after decades of struggle for reform. As significant as this step was, it was just the first step of many as we continue to work to address problems in our health care system. Today the Senate took another important step in this ongoing effort, passing this legislation that makes a series of targeted fixes designed to enhance our health reform law.  These measureswill reduce the federal deficit by $1.3 trillion dollars over the next 20 years, help more than 130,000 Delawareans get health care coverage, improve health care services, and reduce health care costs for American families and businesses. 
Part of the Health Care and Education Affordability Reconciliation Act of 2010 will make key changes to the student loan industry. This measure will save taxpayers nearly $70 billion over ten years with the savings being used to make key investments in education and paying down the federal deficit. Over the next ten years, Delaware will benefit from $53 million in Pell Grants, $8 million for Historically Black Colleges and Universities (HBCU), and $7.5 million in College Access Grants.
“While having two major pieces of reform passed in one bill wouldn’t have been the path many of us would have chosen, that is what the Senate budget rules required in order to finish our health reform bill and to pass student loan reform this year,” noted Senator Carper. “With this legislation we were able to find a way to both increase Pell grants for needy students and pay down the deficit – two priorities that I care deeply about. Some are concerned about potential job loss that may occur as a result of the student loan piece of this bill and I share similar concerns.  That is why I worked closely with Education Secretary Duncan, HELP Chairman Harkin, the other members of the HELP committee, and members of the student loan industry to try and meet the goals of increasing Pell grants, paying down the deficit and saving jobs in our country.   We were successful in mitigating job losses in Delaware, particularly in regards to Access Group, which under this legislation will be given a set number of student loans to be serviced and as a result will continue to play an important role in the student loan industry. While some banks and lenders will no longer be able to originate federal student loans, they will still be able to do what they do best – originate their own private student loans, service federal student loans and help students understand their repayment obligations upon graduation.”
Senator Carper’s Initiatives that were Included in the Health Reform Legislation Follow:
Encouraging Prevention and Wellness
Creates National Standards for Menu Labeling
·         This provision requires restaurants with 20 or more locations nationwide to disclose nutritional information about their standard menu items.
·         Chain restaurants will have to post, on the menu or menu board, the number of calories in each menu item, as well as a statement that enables the public to understand the significance of the information within the context of an average daily diet.
·         Additional nutritional information – including calories from fat, amounts of fat, saturated fat, cholesterol, sodium, total carbohydrates, complex carbohydrates, sugars, dietary fiber, and protein – would be available to customers in print form upon request.

Encourages Employer-Sponsored Wellness Programs Under the Health Insurance Portability and Accountability Act (HIPAA) by Increasing the Premium Discount that Employers can use to Reward Employees for Participating in Wellness Programs
·         This provision codifies the current regulatory framework of allowances for premium deduction under HIPAA by raising the allowed percentage reduction in premium from 20 percent to 30 percent. 
·         The Secretaries of HHS, Labor and Treasury are given the discretion to increase the percentage reduction in premium to 50% for adherence to or participation in a program of health promotion and disease prevention. 

Grants for Small Businesses to Provide Comprehensive Workplace Wellness Programs
$200 million over 5 years is authorized for grants to small businesses with less than 100 employees to provide access to comprehensive, evidence-based workplace wellness programs.
Provides cognitive and memory screenings as part of Annual wellness visits in Medicare
·         Provision ensures that cognitive and memory screening will be covered as part of Medicare patients’ annual physical. Regular screenings are useful in detecting memory and cognition loss and can be helpful in diagnosing chronic diseases such as Alzheimer’s and Dementia. Early diagnosis of these types of diseases common among Medicare patients can result in better, more cost effective treatment.

Provides Coverage for Annual wellness visits (physicals) in Medicare
·         Provision ensures that annual physicals will be coverage as part of patients’ regular Medicare benefits

Require Centers for Medicare and Medicaid to increase its public outreach and guidance to states and health care providers regarding Medicaid’s coverage of obesity-related services
·         This provision increases public awareness regarding obesity-related services by requiring CMS to increase outreach and guidance to states and health care providers regarding the types of obesity-related benefits covered by Medicaid, such as obesity screening and counseling for both children and adults. 
Reducing Health Care Costs and Making Health Care More Effective

Creates State Demonstration Programs to Evaluate Alternatives to Current Medical Tort Litigation
·         Establishes a robust grant program, with $50 million of funding, to encourage states to experiment with medical liability laws and to test alternatives to current tort litigation.
·         The program will enable states to try out new medical malpractice models that improve patient safety, reduce overall litigation, and reduce defensive medicine.
Require Centers for Medicare and Medicaid (CMS) Innovation Center to evaluate models for paying physicians in group practices and in hospitals through salary-based payments
·         Provision ensures that the list of criteria for new models that will be tested in the CMS Innovation Center includes a salary-based reimbursement model for doctors in group practices and in hospitals. 
Personalized Medicine and Access to Critical Lab Tests
·         This provision removes outdated Medicare regulations for laboratory billing that obstruct patient access to highly specialized laboratory tests and delay patients’ diagnoses and treatments.
·         The provision ensures that patients have access to timely laboratory tests that will help doctors determine which medicines are the most appropriate for their patients.
·         This will ensure that patients can take advantage of “personalized medicine,” based on the application of genomic and molecular data to improve the delivery of health care, facilitate the discovery and clinical testing of new products, and help determine a patient’s predisposition to a particular disease or condition.

Reducing Fraud, Waste and Abuse
Extend the Length of Time States Have to Repay the Federal Share of a Medicaid Overpayment
·         Under current law, states have to repay the federal share of any overpayments within 60 days of discovery; however, collections of overpayments—especially in fraud cases—seldom occur that fast. 
·         This amendment would extend the 60 days states have to repay the federal share of a Medicaid overpayment to 1 year for fraud cases. In any case due to fraud, where the State is unable to recover within the allotted time because the amount has not been finally determined through the judicial process or the final judgment is under appeal, the state must repay the federal share within 30 days after the final judgment is made.

Expand the Recovery Audit Contractor (RAC) Program to other Federal Health Programs
·         Expands the use of RACs to Medicaid and those elements of the Part C and Part D programs which lend themselves to RAC audits. 
·         This provision requires CMS to report to Congress on the amount of money recovered in the first 3 years of this expansion.

Key Consumer Protections in the Comprehensive Health Reform Bill Will:
 – Eliminate pre-existing conditions for children immediately and for adults in 2014.
 – Guarantee 75% percent price discounts on brand name drugs for Medicare seniors who reach the prescription drug coverage gap.
 -Small businesses get a 35% tax credit so they can afford insurance for their employee
 – Require insurers to permit children to stay on family policies until age 26.
 – Prohibit annual or lifetime limits by health insurers.
 – Require health insurers to spend more of their premium revenues on medical services, with less going to administrative costs and profits—or else pay rebates to their policy holders.
 Key Benefits for Delaware:
·         Provide tax credits for up to 10,500 Delaware small businesses to help make coverage more affordable. [, accessed 3/20/10]
·         Prohibit insurance companies from excluding coverage of pre-existing conditions for the 206,993 children in Delaware, starting this year. [U.S. Census Bureau, 1/7/10]
·         Close the ‘donut hole’ and improve other Medicare benefits for 140,000 Delaware seniors. [, accessed 3/20/10]
·         Reduce Medicare premiums for the 135,000 Delaware seniors who are not enrolled in Medicare Advantage and will no longer subsidize these private insurance plans. [Senate Finance Committee]
·         Ensure affordable coverage options for 109,000 Delawareans who are uninsured and 29,000 Delawareans who purchase health insurance through the individual market. [, accessed 3/20/10]
·         Ensure immediate access to affordable insurance options for as many as 11,006 uninsured Delawareans who have a pre-existing condition. [staff estimate using Agency for Healthcare Research and Quality (AHRQ), 4/09 and, accessed 3/20/10]
·         Provide tax credits for up to 69,400 Delawareans to help make health insurance more affordable, bringing $1.12 billion in premium and cost-sharing tax credits into Delaware during the first five years of the health insurance Exchange. [, accessed 3/20/10; Senate Finance Committee]
·         Reduce family health insurance premiums by $1,720 – $2,450 for the same benefits, as compared to what they would be without health reform by 2016. [Senate Finance Committee estimate based on CBO, 11/30/09]
·         Provide access to Medicaid for 7,989 newly-eligible Delawareans, and provide $395 million in federal funding for the cost of their coverage. [Urban Institute, 1/25/10; Senate Finance Committee]
·         Create 900 – 1,400 jobs by reducing health care costs for employers. [U.S. Public Interest Research Group, 1/20/10]
·         Allow 83,010 young adults to stay on their parents? insurance plans. [U.S. Census Bureau, 1/7/10]
·         Provide more federal funding for 12 Community Health Centers in Delaware. [National Association of Community Health Centers, 2009]
Affordable Coverage Options for Delaware Small Businesses

·         Small businesses make up 69.3 percent of all Delaware businesses, yet just 47.7 percent of these small businesses are able to offer health insurance to their employees. [AHRQ, accessed 3/20/10; AHRQ, accessed 3/20/10]

·         Starting this year, up to 10,500 Delaware small businesses will be eligible for tax credits for a percentage of their contribution to their employees? health insurance. [, accessed 3/20/10] Small businesses of the size that qualify for these tax credits employ 50,815 Delawareans. [AHRQ, accessed 3/20/10]

Protecting Children
·         Recognizing the special vulnerability of children, health reform prohibits insurance companies from excluding coverage of pre-existing conditions for the 206,993 children in Delaware. This takes effect six months after enactment and applies to all new plans. [U.S. Census Bureau, 1/7/10]
Strengthening Medicare for Delaware Seniors
·         Health reform improves Medicare benefits for the 140,000 Medicare beneficiaries in Delaware. [, accessed 3/20/10] Each year, 24,800 Delaware seniors hit the Medicare Part D ‘donut hole.’ [, accessed 3/20/10] Starting this year, seniors who hit this gap in their prescription drug coverage will receive a $250 check, and the ‘donut holewill be completely closed by 2020.

·         The 140,000 Medicare beneficiaries in Delaware will see other improvements to the program, including a free, annual wellness visit and no cost-sharing for prevention services. Finally, by gradually moving to a more fair payment system for private insurance companies who participate in Medicare Advantage, health reform will lower Medicare costs for the 135,000 Delaware seniors not enrolled in Medicare Advantage, by as much as $45 in premium costs each year. [Senate Finance Committee]

Affordable Coverage Options for Delawareans

·         Health reform will provide immediate access to quality, affordable health insurance for as many as 11,006 uninsured Delawareans who are unable to obtain health insurance because of a pre-existing condition. [staff estimate using AHRQ, 4/09 and, accessed 3/20/10] This new $5 billion program will take effect 90 days after enactment of health reform.

·         Health reform will ensure that the 109,000 uninsured Delawareans and 29,000 Delawareans who purchase health insurance through the individual market have access to health insurance.
More Details on the Comprehensive Health Reform Bill can be Found at: