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Good News and Incomplete News

There is an old saying that there are two things one should never see being made -- sausage and laws. I've seen both and they aren't pretty.

The Senate Finance Committee passed out its version of health care reform yesterday - good news and incomplete news! The good news is there are various great insurance reforms.

The bad news is that there is no language regarding access to IVIG for Medicare patients with primary immunodeficiency diseases (PIDD).

Five Congressional committees now have reported out versions of health care reform legislation. The Senate Finance Committee bill and the Senate Health, Education, Labor & Pensions (HELP) Committee bill will be combined in some fashion by Majority Leader Harry Reid (D-NV) and sent to the floor for debate, amendments and final passage or defeat by the whole Senate. The same process will occur in the House of Representatives with their three bills.

The good news for patients with PIDD, as well as for everyone else, is that all 5 of the bills contain provisions that eliminate the pre-existing exclusions that most current health insurance policies contain. All of the plans will be guaranteed access and renewable. In other words, no one can be turned down due to health status.

All of the bills also eliminate lifetime and annual caps on benefits. And all of the bills provide annual out-of-pocket (OOP) cost protections. The House Energy & Commerce Committee capped annual OOP costs at $5,000 per individual and $10,000 per family. The Senate Finance committee capped OOP costs to conform with the current law level for Health Savings Accounts (HSA), which is approximately $6,000 per individual and $12,000 per Family.

All of the bills move toward community rating. That is, they reduce the amount of premium discrimination that is allowed. For example, the Senate HELP bill allows that the most expensive premium that can be charged in a plan can only be twice the amount of the least expensive premium, or a 2 to 1 ratio. On the other hand, the Senate Finance committee allows the most expensive premium to be 6 times as much as the least expensive premium or a 6 to 1 ratio.

These are all good things that will benefit our patient community. However, our premier issue regarding Medicare patient IVIG access, especially in the home setting, still has not been resolved. In the House, Congresswoman Matsui received a commitment from Energy & Commerce Committee Chairman Waxman to continue to work to fix this problem. Senator Kerry got a similar commitment in the Senate. IDF is working closely with the staff of Senator Kerry and Congresswoman Matsui. Hopefully, there will be an IVIG provision in both bills.

The expectation is that in the coming weeks, both chambers of Congress will vote on their respective bills. Then there still is another step to go before legislation can go to the President for signature – Conference Committee. It is quite probable and normal that the bills from the House and Senate will be similar but not the same as one another. A Conference Committee of House and Senate leaders will meet to iron out the differences between the bills and present exactly the same bills to be voted on a final time by both chambers. Only then can a bill be sent to President Obama.

There is a lot more time for sausage making!

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