Washington, D.C. – As the Senate Finance Committee began consideration of its health care reform bill, U.S. Senator Mike Enzi, R-Wyo., said he would offer amendments to reduce health care costs for average Americans, scale back the total spending in the bill, and protect American workers from new taxes and costly mandates. The amendments include:
Coverage Amendments
Enzi Amendment #C1
Short Title: Lowering the cost of health care by increasing benefit flexibility.
Description of Amendment: The amendment lowers the actuarial value of the bronze plan to 60 percent and maintains the out-of-pocket limit specified in the Chairman’s mark.
Enzi Amendment #C2
Short Title: Lowering the cost of health care by increasing benefit flexibility.
Description of Amendment: The amendment ensures that Americans are not forced to purchase richer plans than those purchased by Members of Congress by allowing enrollment in a high deductible health plan to satisfy the minimum creditable coverage requirement.
Enzi Amendment #C3
Short Title: Ensure American workers are protected from lower wages and job loss.
Description of Amendment: Prior to implementing the employer assessments or fees described in Title 1, Subtitle D, the Secretary of Labor must certify that the implementation of such fees and assessments would not result in a reduction of workers’ wages or an increase in the unemployment rate.
Enzi Amendment #C4
Short Title: Ensuring Americans are protected from dramatic cost increases.
Description of Amendment: The amendment requires that prior to a State implementing the rating rules in the individual market or the rating rules in the small group market specified in the Chairman’s mark, the State Insurance Commissioner must certify the health insurance premiums in the State will not increase for a majority of residents.
Enzi Amendment #C5
Short Title: Lowering the cost of health insurance by increasing premium variability.
Description of Amendment: The amendment modifies the sections of the Chairman’s mark relating to rating rules in the individual and small group markets by allowing group health plans and health insurance issuers offering coverage in the individual and group markets to vary insurance premiums based on an individual’s participation in wellness programs.
Enzi Amendment #C6
Short Title: To provide additional choices to individuals who would otherwise be enrolled in Medicaid thru expansions in this bill.
Description of Amendment: This amendment would allow individuals who would otherwise be enrolled in Medicaid thru the expansion in this bill the right to choose to be covered by Medicaid or a qualified private health plan offered through their State exchange.
Offset: Reduce exchange subsidies as much as necessary to make this amendment budget neutral starting with subsidies awarded to individuals earning 400% of poverty.
Enzi Amendment #C7
Short Title: Congressional Enrollment in Medicaid.
Description of Amendment: Not withstanding any other provision of law, on the date of enactment of this Act, all members of Congress shall enroll in the Medicaid program under title XIX of the Social Security Act.
The term “Member of Congress” means any member of the House of Representatives or the Senate.
Enzi Amendment #C8
Short Title: To ensure that Medicaid expansions will not take effect until State Medicaid programs can guarantee that enough physicians in the State will actually accept and treat Medicaid patients.
Description of Amendment: Any federally-mandated expansion of a State’s Medicaid program shall not apply until to a State until the State’s Medicaid program certifies that at least 70% of primary care physicians and pediatricians in the State are willing to accept and treat Medicaid patients.
Enzi Amendment #C9
Short Title: To exempt any State that the State’s revenues have declined for 2 consecutive fiscal year quarters from any mandatory Medicaid expansions.
Description of Amendment: Notwithstanding any other provision of this Act, with respect to a State, any provision of this Act or an amendment made by this Act that imposes on the State a federally-mandated expansion of Medicaid shall not apply to the State if the State's revenues have declined for the 2 most recent consecutive fiscal year quarters as of the date of enactment of this Act.
Enzi Amendment #C10
Short Title: Prohibit a state from expanding its Medicaid program until it implements program integrity and quality improvement measures.
Description of Amendment: This amendment prohibits a State from expanding its Medicaid program until it implements program integrity and quality improvement measures specified in the bill and is able to certify that it has reduced its payment error rate to the lower of 3.6 percent or the most recent annual Medicare payment error rate.
Enzi Amendment #C11
Short Title: Terminates Medicaid expansions that results in increased costs for a State
Description of Amendment: Notwithstanding any other provision of this Act, with respect to a State, any provision under this Act or an amendment made by this Act, a State may terminate a federally-mandated expansion of its Medicaid program authorized under this bill if the State can demonstrate that such expansion has increased its total Medicaid costs by more than 3 percent.
Enzi Amendment #C12
Short Title: To ensure that no mandates on abortions are prohibited.
Description of Amendment: The amendment prohibits the any federal government entity from requiring that a health plan cover or provide access to abortions except in the case where the mother’s life is in danger or the pregnancy is the result of rape or incest.
The amendment strikes the language in the bill regarding the requirement to offer plans with abortions, the requirement to segregate funds, the rules regarding the tax credits and abortions, and the non discrimination language on abortions.
Enzi Amendment #C13
Short Title: To ensure that abortions are not paid for with federal funds and for the purchase of supplemental abortion coverage without federal funds.
Description of Amendment: The amendment prohibits federal funds to be used to pay for any abortion or cover any part of the cost of any health plan that includes coverage of abortion, except in the case where the mother’s life is in danger or the pregnancy is the result of rape or incest. The amendment allows individuals to purchase supplemental abortion coverage with non-federal funds.
It strikes the language in the bill regarding the requirement to offer plans with abortions, the requirement to segregate funds, the rules regarding the tax credits and abortions, and the non discrimination language on abortions.
Enzi Amendment #C14
Short Title: To ensure state abortion laws and regulations are not preempted by provisions in the underlying bill.
Description of Amendment: The amendment prohibits any provision in the bill from overturning or preempting constitutionally permissible laws or regulations of a State, that place limitations or procedural requirements on abortions, including any state law requiring parental notification or consent for the performance of an abortion on a minor.
It strikes the language in the bill regarding the requirement to offer plans with abortions, the requirement to segregate funds, the rules regarding the tax credits and abortions, and the non discrimination language on abortions.
Enzi Amendment #C15
Short Title: To ensure that conscience protections are applied.
Description of Amendment: The amendment prohibits the federal government, any state or local government, health care provider or health plan that receives federal financial assistance from discriminating against an individual or institutional health care entity on the basis that the individual or entity does not perform or participate in specific surgical or medical procedures or prescribe certain pharmaceuticals in violation of the moral, ethical, or religious beliefs of the individual or entity.
It strikes the language in the bill regarding the requirement to offer plans with abortions, the requirement to segregate funds, the rules regarding the tax credits and abortions, and the non discrimination language on abortions.
Delivery Amendments
Enzi Amendment #D1
Short Title: Fair and Reliable Medical Justice Reform
Description of Amendment: Authorize grants to states under the Social Security Act for the development, implementation, and evaluation of alternatives to resolve medical disputes. The alternatives must make the medical liability system more reliable and accessible, promote a reduction in health care errors and encourage early disclosure of errors, allow for collection and analysis of patient safety data related to disputes, and provide for an appeals process and access to civil litigation system. Every state would be eligible for grants to implement new alternatives.
Alternatives may include: Certificate of merit, early disclosure and compensation, administrative determination of compensation, health courts, physician safe harbors for following guidelines, or other options states develop and the Secretary approves as consistent with goals of the demonstration program.
Each State receiving a grant under this subsection shall submit to the Secretary an annual report evaluating the effectiveness of activities funded with grants awarded under such subsection. Such report shall, at a minimum, include the impact of the activities funded on patient safety and on the availability and price of medical liability insurance.
Grants under this amendment shall equal $1,000,000,000 in mandatory spending.
OFFSET: Reduce startup funding for health care cooperatives by $1,000,000,000.
Enzi Amendment #D2
Short Title: Incentives for states to enact medical justice reform
Description of Amendment: Provide incentives through temporary increases in federal Medicaid match rates to states that adopt caps on non-economic damages for medical malpractice cases. The amount for incentives is $10,000,000,000.
OFFSET: Reduce the subsidies as much as necessary to make this amendment budget neutral starting with subsidies awarded to individuals earning 400% of poverty.
Financing Amendments
Enzi Amendment #F1
Short Title: Preserving access to Flexible Spending Accounts.
Description of Amendment: Change the cap on Flexible Spending Accounts in Title VI to $3,000; index its growth to CPI; and create a cash-out provision. The cash-out provision would allow individuals to withdraw the funds from their FSA and pay income tax on the amount withdrawn. The provision would take effect in 2011.
Offset: reduce the subsidies as much as necessary to make this amendment budget neutral starting with subsidies awarded to individuals earning 400% of poverty.
Enzi Amendment #F2
Short Title: Protecting patient access to life saving medical devices.
Description of Amendment: Exempt the following medical devices from the application of the new excise tax on medical devices:
Products used in a neo-natal intensive care unit
Products used to treat pediatric cancers
Products currently on the market through a humanitarian device exemption
All diagnostic tests and supplies associated with the prevention and treatment of HIV/AIDS
All diagnostic tests and supplies associated with the treatment and prevention of H1N1.
Offset: reduce the subsidies as much as necessary to make this amendment budget neutral starting with subsidies awarded to individuals earning 400% of poverty.
Enzi Amendment #F3
Short Title: Protecting veterans’ and Medicare beneficiaries’ access to life saving medical devices.
Description of Amendment: Exempt products sold to Medicare beneficiaries and veterans from the application of the new excise tax on medical devices.
Offset: reduce the subsidies as much as necessary to make this amendment budget neutral starting with subsidies awarded to individuals earning 400% of poverty.
