AMERICANS will get their national health insurance plan whether they like it or not. That was the prevailing opinion in Washington on the eve of Thanksgiving.

Whether this prediction holds water after the turkey has vanished from their tables should become clearer over the weekend. Republican activists and stirred-up independent opponents of Big Government have promised scores of tea parties to scare the daylight out of their senators and congressmen and -women back in their districts for the holiday.

That’s American politics up close and personal. Every gimmick is in play, including pieces of American history like the Dec. 16, 1773, Boston Tea Party. Ostensibly an act of resistance against taxation without representation, the American colonials boarded three British ships tied up in Boston and dumped their cargo of tea.

The tea parties awaiting President Barack Obama’s health care reform are not in the same historical league. But if they are widespread and intimidating enough, their political impact could derail Mr. Obama’s signet project — as well as his chances for a second term in the White House.

Health care is the heart of the “Yes, we can” change he pledged to bring to Washington and if he flops, he will be politically crippled — or worse.

I don’t think I am overstating the significance of the health care struggle. A rickety economy is already hurting Mr. Obama more than he lets on. He spent trillions of dollars on Wall Street bailouts and trillions more on economic stimulus that refuses to translate into American jobs.

Repeated setbacks abroad, as in Beijing last week when Chinese leaders lectured him on the foolishness of overspending, must be cutting him down to size in the eyes of foreign governments and publics. And Iran thumbing its nose at Mr. Obama’s threats of sanctions, unless Tehran abandons its quest for nuclear weapons, is rubbing salt into his wounds.

Put public opinion polls telling him that more Americans reject national health care than support it against this grim backdrop, and the depth of Mr. Obama’s troubles becomes obvious to friend and foe alike.

But, as I said, he will pull it out because he must. An American president’s power to grant or to withhold political favours is enormous and there should be no doubt he will use it.

Canadians know the up and the downside of national health insurance. They don’t have to worry about medical bills, but must wait their turn for anything short of dire emergency.

Most Americans don’t have to wait. They are well insured and get top services without delay. The less fortunate and the 20-odd million uninsured live in fear of financial ruin and depend on emergency room care.

The national health care legislation now wending its way through Congress is supposed to end this scandal.

Who could argue with such a sensible solution? On the face of it, only heartless curmudgeons, blind politicians and those who profit from the misery of others fit the frame.

The biggest problem is the enormous cost — and that scares the voters. Can the United States afford national health insurance? Mr. Obama and most Democrats in Congress say “yes.” Americans “cannot afford not to have it,” says Mr. Obama as he assures the country that his plan would save money over time and reduce the national deficit.

Experience with Medicare — benefits that Americans who paid social security taxes for 10 years get at age 65 — says something else. When President Lyndon Johnson sent his Medicare legislation to Congress in 1965, projections for the next 25 years said the plan would cost $12 billion by 1990 — $9 billion for hospital payments and $3 billion for doctors’ services. The actual 1990 tab was $110 billion.

These figures can be found in government accounts.

For all the political noise and numbers buzzing in Washington, the nut question is: How much? And I don’t have to spell out the spin from both sides.

Mr. Obama will buy the votes he must have to salvage his eroding power and offer a chance of re-election. The bidding has already started — at $300 million for a vote — when Senator Mary Landrieu, a Democrat from Louisiana, withheld her support on make-or-break procedural votes until she got the money for her state.

Unless the tea parties fizzle and the Republicans turn out to be paper elephants, Americans will join Canada and the rest of the modern world where national health care is a given. It will cost them trillions of dollars more than Mr. Obama says it will, but who’s counting?rless processes and simplification is administrative savings and “green government.”

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Post tags: Chinese Leaders, Health Insurance Plan, Taxation Without Representation

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If you are feeling the stress of the upcoming April 15 income tax deadline, you have another option – you can file a tax extension and delay your income tax deadline to October 15.

The IRS is willing to grant you the six month income tax extension without you having to come up with an excuse to extend. In fact, the IRS doesn’t even ask why you need to extend. As long as you properly submit your extension request by providing accurate information, the IRS will grant you the six month extension automatically.

The fastest way to file an extension is to file it online through a website run by an approved IRS e-file provider like FileLater.com. FileLater.com makes the process easy. You’ll be asked for your contact information and then taken through a few simple questions to determine if you want to make a tax payment along with your extension. The whole process takes less than 10 minutes. A day later you’ll have an email back with the status of your extension. It’s that simple.

Another benefit to using FileLater.com is that they will help you ensure the information you submit is accurate, and they’ll help you submit multiple times (for no additional fee) if you for some reason get a rejection from the IRS.

FileLater.com will also provide you with an online calculator to help you determine if you should make a payment with your tax extension. If you decide to make a payment, you’ll be able to either mail a check directly to the IRS or pay via direct debit from your bank to the IRS as part of your tax extension e-file.

It is important to note that filing a tax extension does not grant you extra time to pay the IRS if you expect to owe the IRS additional tax dollars beyond any current W2 withholdings or estimated tax payments you’ve already made for the 2007 tax year. If you owe the IRS when you file your return and don’t pay when you file your extension, you may be subject to penalties and interest payments.

So, do yourself or your tax preparer a favor and file a tax extension. The deadline to file your income tax extension with the IRS is midnight on April 15. If you are for some reason rejected, you’ll have until April 20 to correct any errors and complete your extension.

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Post tags: Extra Time, Interest Payments, Online Calculator

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Important Things to Know When Filing a Tax Extension Form 4868

Are you one of the millions of taxpayers who have not yet filed a tax return? Do you wish you had more time? The April 15th deadline is right around the corner but there is an easy way for you to get an extension of time for filing your tax return.

Filing a Tax Extension Form 4868 with the IRS will automatically give you until October 15th to file your tax return. For US citizens and alien residents abroad, you will need to file IRS Form 2350.

This is great for taxpayers who have complex tax situations or for those who are still waiting for all of their tax statements. The deadline to submit Automatic Extension Form 4868 is April 15th.

Please note, extension Form 4868 will not grant you more time to pay taxes owed. If you owe money on your tax return, the balance is still due on April 15th. The IRS will calculate penalties and interest on any outstanding balance if you do not pay in full by April 15th.  

In cases where a taxpayer does not file a past due return and does not contact the IRS, a substitute return will be prepared by the IRS based on information received from other sources. This may overstate your tax liability because this substitute return will not include any additional exemptions or expenses you may be entitled to. Bottom line: You will still need to pay any taxes owed by April 15th to avoid any penalties and interest.

Where can you go to file Form 4868? The easiest way would be to use an online tax software provider to prepare and submit the Form 4868 electronically.  There are some sites, such as www.esmarttax.com, that will allow you to e-file the Form 4868 for free.  There is a free version of the eSmartTax.com online tax software that you can use to estimate if you owe any taxes. You will also be given the option of paying any estimated taxes owed using direct debit from your bank account. The e-file method of submitting your Form 4868 and any necessary tax payment will avoid the risk of loss or theft in the mail.

Visit www.esmarttax.com or www.irs.gov to learn more about how you can easily file an Automatic Extension Form 4868.

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Government agencies of all sorts, from FEMA to the FBI at the federal level, to state and local agencies are lambasted for ponderous bureaucracy and “red tape”.  Incompetence and inefficiency in government is felt so acutely because its consequences can be so horrible.  While certainly not incompetent, no other government agency seems to be as universally loathed as the Internal Revenue Service (IRS), and no tax policy seems to be as complicated, costly, and unnecessary as the Alternative Minimum Tax (AMT).

    Introduced to the American people by virtue of the Tax Reform Act of 1969, the AMT was designed to close loopholes that allowed some high-worth households to avoid paying income taxes altogether.  There are plenty of problems with the AMT.  In the words of the Brookings Institute, it is “notoriously and pointlessly complex”.  Not only is it a hardship for taxpayers, the Internal Revenue Service has identified the AMT as one of the most difficult programs to administer.  It is, in the words of Leonard Burman, Director of the Tax Policy Center,  “the 800-pound gorilla in the room”.  Not only is the tax itself difficult and intractable, but so too is its resolution.  As we will see, there is little satisfaction with the tax as it is, yet, as we will also see, the most obvious solution, namely getting rid of it, is an equally offensive option.

    The AMT is also not indexed to inflation, meaning more households will be subjected to it, including upper-middle class households that were not part of the tax’s scope when it was created.  The Alternative Minimum Tax is unpopular, and deservedly so, and this unpopularity has led to calls for its repeal.  Organizations such as the Cato Institute and the Tax Foundation have been arguing for a repeal of the AMT.  A complete repeal of this cumbersome and difficult tax is certainly tempting, but it is not the best course of action for a nation that is literally hemorrhaging money. 

    First and foremost, a repeal of the AMT would result in a substantial loss of tax revenue.  The Center on Budgetary and Policy Priorities estimates that we would lose from $800 billion to $1.5 trillion in federal revenues over a 10 year period.  With the presence of other generous tax cuts, exorbitant military spending, and lavish “rescue” plans for financial institutions, the loss of this revenue could be catastrophic.  What’s more, a repeal of the AMT would be singularly regressive.

    The Brookings Institute estimates that more than 75% of the benefits of repeal would go to households with income above $100,000.  This nation is reluctant enough to provide government assistance to households with abysmally low incomes.  We should be equally cautious of an attitude of excessive indulgence for our most prosperous taxpayers.  It would be idiotic for us to relinquish our claim to the resources of our wealthiest in these increasingly dire economic times.  It would be despicable if we were to benefit our most fortunate while enjoining those in poverty to accept responsibility for “mistakes,” for which they are not entirely responsible.  It is clear that the AMT as it stands is unsatisfactory; a complete repeal of the tax would lead to equally unsatisfactory consequences.  The best option would be to reform the AMT to minimize its substantial flaws without foregoing at least some of the appreciable tax revenue it generates.

    The most important step in reforming the AMT is to spare middle class taxpayers.  High net worth households have the resources to withstand this bleak economic period.  The middle class will be hard-pressed enough without having to worry about the AMT.  Simply indexing the AMT for inflation would eliminate the “bracket creep” of inflation pushing households into higher tax brackets for the purposes of this tax.  The AMT can also be reformed to authorize personal credits and dependent exemption deductions.  The Brookings Institute estimates that these reforms would reduce the number of AMT taxpayers in 2010 by 88%.

    The AMT demonstrates how a solution to a problem yesterday can be the source of new problems today.  This is a lesson we must keep in mind when we address this unpopular tax.  Repeal will lead to critical revenue losses, which in turn may lead to draconian tax increases in the future, while reform can protect the middle class without completely sacrificing the valuable tax revenues we will need for an uncertain future.

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Post tags: Households, Incompetence, Pound Gorilla

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The following are the taxes charged b the PA State Taxes department-

1. Personal Income Tax

Pennsylvania is the only state in the United States of America to have a flat rate of tax of about 3.07% on individual income without any personal exemptions. Taxes are collected for municipal, county and school district. In spite of all this, the people of Pennsylvania, who thrive on a very modest income, qualify for the Tax Forgiveness Credit. April 15 or the next weekend is the last date for all the returns in the PA state.

2. Sales Tax

Sales taxes, too, are as high as 6% in Pennsylvania on taxable services and goods. One percent of sales tax is collected for taxable services and goods from the states of Allegheny and Philadelphia. Items like apparels, textbooks, drugs, raw food, residential heating fuels and sales for resale are the major ones exempted from sales taxes.

3. Personal and Real Property Taxes

Usually, the state of Pennsylvania does not impose taxes on personal properties or real estates. These kinds of taxes are meant for counties, school districts and municipalities normally. These districts impose taxes on personal property and real estate so it is better to know what school district or county you live in.

Municipalities are allowed to impose taxes on the real estates which do not cross 30 mills on the stipulated value of property and without the special allowance of the court. To know more about this you must visit the Pennsylvania Department of Education website.

Qualified seniors and disabled persons are eligible for the State Property Rent/Tax rebate program. The PA department of Revenue administers this while it is helped by Pennsylvania Lottery. Taxpayers are allowed to reimburse amounts up to a $650 a year. This is for the money they had earlier paid for rent or property taxes the previous year. The employers are expected to withhold this amount of money from the employees which they get from their municipal services and emergency imposed by the school districts and municipalities.

4. Estate Taxes and inheritance

Inheritance taxes are collected by the state of Pennsylvania. These taxes have an estate taxes based on decedent’s gross estate and confined to the credit of the state death taxes which is allowed on federal tax return. However, the Keystone state’s estate taxes are not imposed on this since federal credit for all these state estate taxes have been phased out completely.

5. Few more Facts on PA State Taxes

The facility of checking the status of all the refunds oh the PA state taxes in the website is provided to all the taxpayers. The department of Pennsylvania has a list of employers with stagnating tax accounts to collect heir respective state taxes which are yet to be paid. Anything earned outside the state of Pennsylvania is not taxable with respect to active full time military pay.

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Post tags: Education Website, State Of Pennsylvania, Taxable Services

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Women’s workout plans differ from the men as they workout for different reasons. Men workout to stay healthy and increase their efficiency in their professional life and personal life whereas women in most cases work out to keep their physique well shaped and attractive and not to mention, they love to look younger than they really are.

There are also women who have taken body building as a profession. Though the number is very low compared to the men body builders but it is increasing at a faster pace. Women have high paid jobs and their fitness matters a lot when it comes to attaining a good carrier.

Workout routines for women are different from that of men. Men count working out as their daily life essential and find out time in the early morning or late night as they remain off duty after they are done with their office. But women have to take care of their family, children and husband after they are done with their office. This makes it tough for the women to find spare time to work out. So women should have a routine that would enable them to workout in small time frames and they should do it frequently. If women are regular with their exercise, they do not need to work out intensely as men do. So workout for women is not only weight loss workouts it is more than that.

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Despite the setbacks presented by the skyrocketing prices of diesel and other petroleum products, the trucking industry is still reaping profits. Even if gas rates have pushed past the ceiling, companies and other enterprises still need trucks and rigs to get their merchandises delivered to their destinations. Joining the trucking industry at this time is quite a risky move, to say the least, but trucks and big rigs and wheelies are still very necessary for most businesses.

Creating a trucking business and obtaining trucking authority entails careful planning. Of course, there are some federal regulations like getting a US Dot Number and other regulations to comply with, including trucking insurance.

Businesses that involve vehicles for commercial purposes, when the nature of their operation includes ferrying passengers or hauling cargo in interstate business affairs and arrangements, trucking and logistics included, are required to register with the Federal Motor Carrier Safety Association (FMCSA). The application for a US Dot number is of strict adherence because of its relative importance in future dealings such as auditing, crash investigations, accidents, and inspections. The US Dot number is the vehicle’s unique identifier and in some states, the registration for such number is needed to finish a commercial vehicle registration process. The following states require registration of a US Dot number:

•    Alabama

•    Alaska

•    Arizona

•    Colorado

•    Florida

•    Georgia

•    Iowa

•    Kansas

•    Kentucky

•    Maine

•    Michigan

•    Minnesota

•    Missouri

•    New York

•    Ohio

•    Oklahoma

•    Oregon

•    South Dakota

•    Tennessee

•    Utah

•    Washington

•    West Virginia

•    Wisconsin

•    Wyoming.

All authorized for-hire Motor Carriers of non-exempt property and passengers, Brokers, and Freight Forwarders based in the U.S. or Canada must obtain Operating Authority before they can begin interstate operations in the United States.

Trucking firms may be required to apply for both US Dot Number and interstate trucking operating authority. This depends on the line of the trucking business (forwarder, shipper, and motor carrier among others) and the materials to be transported (non-hazardous materials, hazardous substance, property, and passengers). 

On top of this, trucking firms and companies still have to acquire trucking insurance as mandated by federal regulations. Transportation and trucking insurance acts like life safety nets not just for the trucks and rigs, but for the load as well. It is advised that the names of the company and owners submitted in previous trucking papers match the ones provided in their trucking insurance papers to avoid dismissal of insurance applications.

Depending on the line of their trucking business, trucking insurance requirements for passenger, property, and freight trucking and transportations vary. Companies from the said fields are instructed to file a BMC-91 or BMC-91X form, otherwise known as the Public Liability Insurance. If the vehicle to be operated has a gross vehicle weight rating (GVWR) of 10,000 pounds or more to transport non-hazardous commodities or hazardous commodities, bodily injury and property damage (public liability) insurance must be maintained.

The said insurance covers bodily injury, property damage, and environmental restoration. Trucking companies that cater to passengers are covered by as much as $5 million; $1.5 million for those that seat 15 or less passengers. Freight companies are insured from $750,000 to $5 million, depending on the cargo they are transporting.

Aside from the BMC-91 or BMC-91X form and a US Dot Number, motor carriers and freight forwarded should apply for BMC-34, otherwise known as cargo insurance. Cargo insurance covers $5,000 per vehicle for motor carriers and $10,000 per occurrence. Freight brokers, on the other hand, can either file a BMC-84 or BMC-85, known as surety bond and private trust agreement respectively, both of which can cover a trucking company for as much as $10,000.

All Motor Carriers, Brokers, Freight Forwarders must also file a Unified Carrier Registration (UCR). Hazardous Materials Carriers must file and maintain a Hazardous Materials Registration Statement.

Other documents required by the FMCSA for trucking authority and legitimization of transport and trucking operations include an excellent line of arbitration and safety audits from the FMCSA’s official auditors for new trucking firms that will be conducted within the firm’s first 18 months of operations, which includes the following:

•    Driver Qualifications;

•    Driver Duty Status;

•    Vehicle Maintenance;

•    Accident Register; and

•    Controlled Substances and Alcohol use and testing requirements.

Non-compliance of the registration requirements and other regulations of the FMCSA may lead to the cancellation of a trucking company’s registration for trucking authority and legitimization. In some instances, FMCSA deems a non-adhering trucking company as ‘inactive’ or ‘out of service.’

Trucking companies whose status are marked as ‘inactive’ or ‘out of service’ and continue to maintain operations are violating federal regulations. Aside from legal detention, company owners and truck drivers who go beyond the premise of FMCSA’s regulations are also subject to suspensions, detention, and monetary penalties. Other repercussions include civil and criminal charges for those who continue their trucking operations despite a suspended or cancelled license or trucking authority.

Incoming search terms for the article:

• cheap Freight Broker BMC-84 Bond

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Post tags: Petroleum Products, Risky Move, Trucking Logistics

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Remember when health care reform was supposed to make life better for Coloradans? Well, reform efforts have taken an unexpected, and unfortunate, turn in recent weeks.

As two studies recently released by noted international consultants PricewaterhouseCoopers, and Oliver Wyman, Inc., show, major provisions in the current legislative proposals will cause health care costs to increase far faster and higher than they would even under the current system. Anthem Blue Cross and Blue Shield followed with another actuarial study that looked at what legislation would do to Coloradan’s premiums, and found much the same.

Many elected officials are expressing outrage and indignation that the studies dared be published and have vociferously questioned their veracity. But, the truth is, consumers would be well-served by taking a more reasoned and less political approach to this new information by familiarizing themselves with the findings and then deciding if they ring true.

All of these studies identify a major flaw in the recently passed Senate and House bills around the issue of guaranteed coverage for everyone – regardless of whether or not people have preexisting medical conditions.

To set the record straight, it was the insurance industry that came to the table back in November 2008, offering to sell insurance to any individual who requested coverage, regardless of any pre-existing medical condition – with the caveat that these insurance reforms be coupled with an effective mandate that all Americans purchase insurance. The mandate is essentially the linchpin between expanding coverage and premium affordability.

Instead of creating an enforceable individual mandate, however, both the House and Senate bills establish a clear disincentive for healthy people to secure or maintain coverage. As a result, people will buy coverage only when they get sick and cancel it when they don’t need to pay medical bills. This would be the same as allowing people to obtain auto insurance after they have had an accident or secure homeowner’s insurance after their house has burned down.

The studies findings in this area have played out in real life. For example, in New York and Vermont, where guaranteed issue was adopted in the individual market without a mandate, average premiums are approximately 60 percent higher than the national average. In New Jersey and Maine, thousands dropped coverage after state health care reform was enacted, resulting in individual markets that were slashed by more than half in both states-markets in which it is now very costly to obtain coverage.

The PricewaterhouseCoopers study showed that a weak individual coverage requirement coupled with a guarantee issue requirements, no pre-existing condition limits, and no rating adjustments based on health status would result in an increase of premiums by 41-54 percent for the average individual premium.

The Oliver Wyman study illustrated that the watering down of individual coverage mandates could result in the ultimate failure of reform by causing premiums to spiral out of control for all those who responsibly purchase coverage.

And, Anthem’s study showed that health insurance costs would rise dramatically in Colorado if current federal reform proposals become law. For example, a healthy 25-year-old man in Denver would face an increase of 140 percent.

Are these biased studies commissioned by the insurance industry, that say only what the industry wants you to hear? Read the reports and judge for yourself.

It is critically important that we hold our elected officials to the highest standard and ask that their efforts to reform health care are more than just political theatre. Reform needs to incorporate the very best thinking on these complex issues in order that the final legislation serves to lower the cost of health insurance, improve the quality of health care and increase access to all Americans. Passing health care reform is an enormously difficult political challenge, getting it right is the only point of doing it

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Post tags: Indignation, International Consultants, Veracity

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President Obama and Democratic leaders in Congress claim that government-run health care will remedy skyrocketing medical costs and improve access to quality health care coverage.

After drafting a bill behind closed doors without input from the public, the Senate majority produced a bill that raises taxes, drastically cuts Medicare, and increases premiums to create a new government program: the so-called public option. On Nov. 21, the Senate voted 60-39 to proceed to consideration of this legislation. I opposed this measure because I believe the public option is simply socialized medicine and expanded government disguised as greater choice.

I believe that we have the best health care system in the world — the finest doctors, first-rate treatments, cutting-edge innovation, and low wait times. Our current system is not perfect, but we must seek to build upon rather than tear down these strengths.

I do not believe the American people desire or deserve higher taxes and rationed care, which would result from government-run health care. As the Senate resumes consideration of health care legislation this week, I will continue to support steps that will decrease costs without diminishing quality.

The non-partisan Congressional Budget Office estimates that Senate Democrats’ proposal will cost $849 billion over 10 years. While Americans will be hit immediately with new taxes and government mandates, the actual services and coverage promised will not be implemented until 2014.

The Senate Budget Committee estimates the true 10-year cost of the proposal to be $2.5 trillion once fully implemented. Even the authors of this legislation concede that approximately 20.4 million people will lose insurance while waiting for new programs to take effect. Moreover, according to the CBO, once fully implemented, 24 million people will still remain without health insurance.

To pay for this massive yet ineffective expansion of government control, the bill includes more than $493 billion in new tax increases and another $464 billion in Medicare cuts, thereby placing the burden of reform squarely on the shoulders of the middle class, small businesses and the elderly.Nearly half a trillion dollars in Medicare reductions will result in cutting seniors’ care through hospitals, nursing homes, hospice and home health care, and Medicare Advantage programs. The bill imposes $28 billion in new taxes on employers who do not provide government approved health plans, and it charges a penalty of $750 per uninsured individual — a form of double taxation.I do not believe massive tax increases and a reduction in coverage are what the American people have in mind as a way to improve access and create affordable, quality health care.

Medical rationing is inevitable under government-run health care. Supporters of government-run medicine often cite Canada or Great Britain as models for the U.S. Yet these countries are forced to ration care or have long waiting lists for medical treatment. More than 750,000 Britons are currently awaiting admission to the National Health Service hospitals. Last year, more than half of Britons waited more than 18 weeks for care.

The Fraser Institute, an independent Canadian research organization, reported in 2008 that the average wait time for a Canadian awaiting surgery or other medical treatment was 17.3 weeks, an increase of 86 percent since 1983. Access to a waiting list is not access to health care. Simply put, government financing means government control, and government control means less personal freedom.

While we need to enact reforms to our health care system that will reduce costs and improve access, our nation cannot withstand the deep deficits this colossal health care entitlement program would create. Instead, we need a system that restores the patients and doctors as the center of every health care decision rather than the government and insurance companies.

By making insurance portable, expanding health savings accounts, reducing frivolous lawsuits that provide only marginal assistance to injured patients and drive up our health care costs, emphasizing preventive care, reducing administrative costs, and making insurance more affordable to small business and individuals, we can efficiently decrease the costs that currently burden Americans while expanding coverage — thus improving quality and making health care more affordable.

Allowing the government to have a heavy hand in how we manage our health care will lead to a decrease in flexibility and options for both patients and doctors. As Congress works to improve our health care system, it is important to remember that there is a difference between government-run health care coverage and actual access to medical care. The goal of rational health care reform should be to decrease costs and increase access. The bill before the Senate does exactly the opposite.

This is not reform. This bill is simply bad medicine.

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Post tags: Democratic Leaders, Health Care Legislation, Senate Budget Committee

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Week of December 7, 2009

The Senate began to slog its way through amendments (see below) last week in a process that promises to get harder, not easier. In the meantime, the debate continues as to whether the Senate bill would do anything significant to slow rising health care costs, and a Bloomberg story points out that a number of economists and analysts are doubtful that it will. The White House defends the bill’s ability to slow costs, but some analysts predict that Congress will need to make many more tough decisions to have a real impact. According to Bloomberg, a group of Senators that includes Joe Lieberman (I-CT) and Susan Collins (R-ME) is taking aim at rising costs with an amendment that would include new requirements on providers to try to wring more costs out of the system. Anyone concerned about the rising cost of health care should be engaged in the process by reaching out to their Senators to urge a greater focus on bending the cost curve.

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Federal

The Senate debate on health care reform actually consists of three simultaneous debates. The first is public on C-SPAN, and it’s going slowly as Republicans are pressing for 60 votes as often as they can while Democrats try to speed things up. Nothing of any great moment has been passed or decided. The second debate is the one Majority Leader Harry Reid is conducting behind closed doors as he tries to garner 60 Democratic votes for some acceptable form of a public option. Once this is accomplished, most observers believe Reid will immediately file cloture to cut off debate on the bill itself. If successful at getting 60 votes, he will go straight to final passage, which would require 51 votes. This could happen before Christmas. The third debate is the one Reid is having with House Speaker Nancy Pelosi over whether to have a conference at all. If the Senate can pass a bill the House can accept “as is,” then there will be no need for a time-consuming conference that could unravel the bill. Thus, Reid is checking in with Pelosi frequently to see what he needs to be able to pass a bill and avoid a conference.

Since returning from its Thanksgiving break last week, the Senate has slowly been making its way through a number of amendments. Key votes so far include: approved an amendment that would require first-dollar coverage (no cost sharing) for certain preventive services; approved an amendment stating that nothing in the bill reduce guaranteed benefits under Medicare; defeated a motion that would have sent the bill back to the Finance Committee for the purpose of removing proposed cuts to Medicare; defeated an amendment that would have removed the CLASS Act provisions from the bill; defeated a motion that would have sent the bill back to the Finance Committee to eliminate the proposed Medicare Advantage funding cuts; approved an amendment requiring that nothing in the bill shall eliminate benefits “guaranteed by law” to Medicare Advantage enrollees (protects only benefits also covered by traditional Medicare and does not protect extra benefits and services provided by MA plans); and defeated an amendment that would have placed limits on how much attorneys can earn from medical malpractice lawsuits.

States

ALL STATES: The National Governors Association (NGA) has announced an initiative outlining preparations for federal health care reform. Titled “Rx for Health Reform – Affordable, Accessible, Accountable,” the 2009-2010 initiative is led by Vermont Governor and NGA Chair James Douglas. It will focus on: providing governors with the information needed to transition to a new health care system; developing state-based system improvements and cost containment measures, including tools necessary to develop delivery system enhancements, looking at what is required under federal legislation, and highlighting other reforms the states could undertake to create a more efficient and effective health care system; and preparing states for implementing insurance market reforms, state-based exchanges, new mechanisms to support delivery system reform, and other national health reforms. The NGA’s Health Care Task Force includes Governor Douglas and West Virginia Governor Joe Manchin, both serving as co-chairs, as well as Indiana Governor Mitch Daniels, Mississippi Governor Haley Barbour, New Hampshire Governor John Lynch, and Oregon Governor Ted Kulongoski.

CALIFORNIA: The California Medical Association (CMA), the second largest medical association after Texas, has announced its opposition to the “Patient Protection and Affordable Care Act,” the health care reform bill being debated in the Senate. The CMA also opposed Governor Arnold Schwarzenegger’s comprehensive health care reform proposal in 2007. In other news, Republican Governor Schwarzenegger has appointed State Senator Abel Maldonado to serve as Lieutenant Governor, but Democrats in the legislature have vowed not to confirm the Republican Senator because they view him as a viable state-wide candidate who could be elected easily to the position. Maldonado still must be confirmed by the legislature, which has 90 days to act.

COLORADO: The Colorado Medical Society (CMS) continues to seek support for a bill that would define the practice of medicine as including medical necessity determinations and utilization reviews performed by health plan medical directors. As currently drafted, the proposal would potentially expose medical directors to disciplinary action by the state Board of Medicine when medical necessity or utilization review decisions are challenged. Several discussions have been held with the executive director of CMS to ascertain the nature of the problem the association is trying to address, particularly since the organization as a whole may not be supporting the bill.

ILLINOIS: Illinois’ fiscal situation is “grim and getting worse.” Illinois has a reported $12 billion structural budget deficit. Comptroller Hynes said Illinois had nearly $4.6 billion in unpaid bills at the end of September, a record development for the first quarter of any fiscal year. This, despite the state having borrowed $2.25 billion in short-term loans, which must be repaid before the end of FY2010. Hynes identified two factors that have had a major impact on the deteriorating fiscal position: the steep decline in economy-driven revenues, such as personal and corporate income taxes and sales taxes, and record lapse-period spending. Hynes predicted fiscal pressures would continue well into FY2011 and warned of record and prolonged payment delays for most categories of state programs and operations, including health care and social services. There will be increasing pressure on health care programs as the economic stimulus funds expire and the amount of money demanded by utilization increases continue to be realized. There are already significant payment cycle delays on portions of the State employee health plan. The budget situation will dominate discussions in the General Assembly, which reconvenes in January.

KANSAS: At the request of Kansas Congresswoman Lynn Jenkins, the Kansas Health Policy Authority recently announced that it estimates the health reform bill passed by the U.S. House would provide health insurance for 240,000 Kansans without coverage and possibly save the state treasury up to $25 million a year. It estimated the U.S. Senate Finance Committee bill would insure an estimated 190,000 Kansans and reduce state costs by $25 million to $50 million a year. The Authority also concluded that the House bill would provide more federal matching dollars for Medicaid and likely would allow a reduced package of benefits for Medicaid beneficiaries added to the state rolls as a result of health reform. Current Kansas Medicaid eligibility is among the strictest in the nation, with benefits generally available only to the oldest and youngest of the state’s poor. Childless adults of working age are not eligible and parents are enrolled only if they earn less than about 27 percent of poverty guidelines. Exceptions are made for pregnant women.

MICHIGAN: State House Democrats announced a plan last week to cut auto insurance rates through tighter restrictions on auto insurance companies and the medical portion of those claims, affecting subrogation and coordination of benefits for Aetna and Cofinity®. Generally, the proposal requires auto insurance companies to offer low-cost auto insurance to low-income drivers with good driving records. The bill also would: allow the state insurance commissioner to deny rate changes by auto insurance companies before they take effect; prohibit auto insurance rate increases for those with good driving records; prohibit auto insurers from using certain types of rating factors; and limit fees paid to doctors and hospitals for treating auto accident injuries. Michigan is the only state that requires all auto insurance policies to give unlimited medical coverage for injuries suffered in auto accidents. The proposal would change that requirement and allow motorists to buy maximum medical coverage as low as $50,000. This means that rate-regulated provider groups would likely have group policies pay auto claims rather than wait for adjudication of the claim in court, as they would not want their fees limited. In addition, the allowance of low medical coverage on auto claims would affect Aetna’s subrogation and coordination of benefit activities with both auto carriers and Aetna enrollees.

MISSOURI: The Department of Insurance recently released its 2008 HMO Annual Report showing that the entire managed care market is declining. The report shows that the number of people enrolled in either an HMO or a major medical health insurance plan decreased 15 percent since 2006. PPO plans are gaining the most enrollment, and POS plans remain more popular in certain areas than HMO plans. Total premiums for managed care coverage continue to rise with the industry reporting a 7.5 percent increase from 2004 to 2008. The medical cost ratio for all HMOs operating in Missouri, covering only Missouri business, was 82 percent in 2008, compared to the nationwide industry number of 83.6 percent.

NEW JERSEY: The legislature returned from its extended recess and took action on legislation to establish a medical home demonstration project for the Medicaid population. Upon federal approval, the state Medicaid program would set out a three-year demonstration project with an annual evaluation and reporting requirement by the Division of Medicaid Assistance Services to the Governor and legislature. On the Senate side, Aetna offered support for legislation requiring chain restaurants to provide nutritional information for food and beverages on their menus. Similar legislation is currently making its way through the Assembly and will likely receive a full vote in both chambers prior to the end of the session.

NEW YORK: The legislature passed another deficit reduction plan, trimming spending and using unspent funds to plug a $2.7 billion dollar budget deficit. A large percentage of the revenue used to fill the gap came from federal stimulus money that was originally designated for the 2010 budget and cuts to the Medicaid trend factor. After intense lobbying and coalition efforts, the legislature did not pass the Governor’s proposed 0.25 percent increase to the patient services assessment or “sick tax”. In addition, the Senate did not pass the Marriage Equality Act, effectively defeating the bill for the year. The legislature will return to face a multi-billion dollar deficit again in January, and it is likely that increases to health insurance taxes will be back on the table.

UTAH: The Department of Insurance remains committed to pursuing legislation to expand the Utah Health Exchange Network Portal to include a master patient index that providers could access to obtain coverage eligibility information. The bill contains a number of troubling provisions, including a monthly batch reporting requirement on health plans. The proposal also includes a July 1, 2010 effective date allowing no time to update and test affected internal systems.

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Post tags: Insurance, Joe Lieberman, Rising Cost Of Health Care

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