Late yesterday, Majority Leader Harry Reid (D-NV) released the Patient Protection and Affordable Care Act, the health care reform bill that will be taken under consideration by the full Senate. It is expected that the Senate will take up its first vote on the bill on Saturday; with 60 votes in support, debate would be allowed to continue on the Senate floor. If this happens, debate is expected to last 3-4 weeks.

The bill does include four of LSA’s top health care reform priority provisions: the CLASS Act, which would create a voluntary insurance program to help participants with significant functional limitations receive long term services and supports (Title VIII, page 1925); the Community First Choice Option, which would allow states through a Medicaid state plan amendment to provide community-based attendant services and supports to people with disabilities who are Medicaid eligible and require an institutional level of care (Section 2401, page 466); grants for home visitation programs, which would provide supportive services to low income families in their homes, with a focus on children’s health, parenting skills, and school readiness (Section 511, page 568); and health insurance credits for small businesses (defined as 25 or fewer employees), including non-profit organizations (Section 1421, page 307). The bill does NOT include a provision for therapeutic foster care (TFC) services that had been included in the Senate Finance Committee’s health care reform bill. LSA is joining with many other organizations in sending a letter to Senator Reid to ask that the TFC provision be included as the bill moves forward.

LSA is continuing to monitor the health care reform debate in the Senate, and will be posting updates here on our blog and on our Twitter page regularly.

Today produced three big events that relate to LSA’s public policy priorities:

-The House of Representatives released its merged health care reform bill. It clocks in at 1990 pages with an estimated cost of $894 billion over 10 years. It does include the creation of both the Community Living Assistance Services and Supports (CLASS) program (Section 2581, page 1562) and grants to states for home visitation programs (Section 1904, page 1177).

-The Department of Housing and Urban Development and the Treasury Department released a statement in support of funding for the National Housing Trust Fund It states, “Finally, we will work with Congress to identify a financing source for the Housing Trust Fund, which will help provide decent housing for families hardest hit by the current economic downturn.”

-The Subcommittee on Housing, Transportation and Community Development of the Senate Banking, Housing and Urban Affairs Committee held a hearing entitled “Modernizing Affordable Housing for Seniors and People with Disabilities.” The hearing focused on the Section 202 Affordable Housing for the Elderly Reform Act of 2009 (S. 118) and the Frank Melville Supportive Housing Act of 2009 (S. 1481), two pieces of legislation LSA has been advocating passage of. All individuals who testified as well as the Senators in attendance offered support for the bills and spoke of the overwhelming need to take measures to ensure expansion of housing for seniors and people with disabilities.

More on these developments in the days and weeks to come! Keep up with the latest on our Twitter page.

As the House and Senate each continue to merge their health care reform bills, there is still uncertainty about whether or not they will include provisions that LSA strongly supports; namely, the Community Living Assistance Services and Supports program, the Community First Choice Option, the home visitation program and employer incentives for non-profit organizations that provide health insurance to employees. We have been asking advocates to call their Senators in support of these provisions, and continue to encourage people to make calls to their members of Congress on these issues. Now is the time to make your voice heard on health care reform!

Some resources to learn more about these issues:

• CLASS program
• Community First Choice Option
• Home Visitation program
• Non-profit employer incentives

Cross-posted from the October 13 issue of LSA Washington

This afternoon, the Senate Finance Committee voted 14-9 to pass the America’s Healthy Future Act. The vote was pushed to this week so committee members would be able to receive and have time to review a preliminary financial score on the legislation from the Congressional Budget Office (CBO). The CBO report on the bill, released last Wednesday, showed the legislation would result in a net reduction in federal deficits of $81 billion over 10 years, with a cost of $829 billion over 10 years. The score is preliminary because the Chairman’s mark still needs to be put into legislative language; this is typical of how the Senate Finance Committee operates.

Behind the scenes work on merging the Senate Finance Committee health care reform legislation with the Senate Health, Education, Labor and Pensions (HELP) Committee health care reform legislation has already begun. Now that the Senate Finance Committee bill has passed out of committee, the two bills will continue to be merged with the expectation that a merged bill will be moved to the Senate floor the week of October 19 to begin debate. Debate on the floor is expected to last up to 3-4 weeks. The House is expected to begin debate on the floor on their merged tri-committee health care refom bill the week of October 26.

LSA advocates are encouraged to continue to contact their members of Congress about health care reform, especially regarding the inclusion of long term supports and services. For more information on the CLASS program and for a sample script for your call, please visit our Take Action page.

For more information on health care reform and to keep up with the action on the legislation, visit our Twitter site or contact us at advocacy@lutheranservices.org.

We’ve mentioned a few times on this blog and in LSA Washington that we’ve been keeping an eye on a provision in the America’s Healthy Future Act that would provide tax credits to some non-profit organizations to provide health insurance to their employees. This is a big issue for many, if not all, of our organization; here’s the lowdown on where things stand:

When the original chairman’s mark of the America’s Healthy Future Act was introduced, a provision that addressed the issue of the cost of health insurance was not included. Before the Senate Finance Committee began their markup of the legislation, members of the committee submitted a total of 564 amendments; one of these amendments was submitted by Senator John Kerry (D-MA), Senator Olympia Snowe (R-ME), Senator Chuck Schumer (D-NY), Senator Blanche Lincoln (D-AR), and Senator Maria Cantwell (D-WA), and would extend the small business tax credits included in the chairman’s mark to eligible non-profit organizations. Senator Max Baucus (D-MT), chairman of the Senate Finance Committee, wrapped several of the 564 original amendments into a modified mark, including this amendment. The text of the provision as included in the modified mark (bottom of page 34) is this:

“The provision extends the small business tax credit to organizations exempt from tax under section 501(a) by reason of being described in section 501(c)(3) (i.e., charitable organizations) that would otherwise qualify for the small business tax credit. However, for tax exempt organizations, the applicable percentage for the credit during Phase I is limited to 25 and the applicable percentage for the credit during Phase II is limited to 35. The small business tax credit is otherwise calculated in the same manner for tax exempt organizations that are qualified small employers as the tax credit is calculated for all other qualified small employers. Charitable organizations will be eligible to apply the tax credit against the organization’s liability as an employer for payroll taxes for the taxable year to the extent of the amount of income tax withheld from its employees under section 3401(a), the amount of hospital insurance tax withheld from its employees under section 3101(b), and the amount of the hospital tax imposed on the organization under section 3111(b). However, the charitable organization will not be eligible for a credit in excess of the amount of these payroll taxes.” (italics mine)

The original language (top of page 23) regarding the small business tax credit is this:

“The Chairman‘s Mark would provide a tax credit for a qualified small employer for contributions to purchase health insurance for its employees. A qualified small employer for this purpose generally would be an employer with no more than 25 fulltime equivalent employees (FTEs) employed during the employer‘s taxable year, and whose employees have annual fulltime equivalent wages that average no more than $40,000. However, the full amount of the credit would be available only to an employer with ten or fewer FTEs and whose employees have average annual fulltime equivalent wages from the employer of less than $20,000. Under the Mark, an employer‘s FTEs would be calculated by dividing the total hours worked by all employees during the employer‘s tax year by 2080. For this purpose, the maximum amount of hours that would be counted for any single employee would be 2080. Wages would be defined the same as for purposes of FICA and the average wage would be determined by dividing the total wages paid by the small employer by the number of FTEs.” (italics mine)

The reality is that many non-profit organizations (as well as small businesses) have been struggling for years to provide affordable, decent health insurance to their employees; this challenge has expanded as state revenues for social services have decreased, as has philanthropic giving. This Non Profit Quarterly article paints a stark picture of the realities facing non-profits organizations when it comes to providing health insurance.

While this provision is good first step in allowing non-profit organizations access to the same kind of tax credits as small businesses of the same size, this provision would not benefit non-profit organizations with greater than 25 employees, with full benefits of the credit only going to organizations that employ 10 or fewer people who make an average of $20,000. Many non-profit organizations, including many if not most LSA organizations, would not see any financial relief in providing health insurance to their employees through this provision.

While we have yet to see a legislative alternative to the provision included in the Senate Finance Committee health care reform legislation (neither the House bill nor the Senate HELP Committee bill address this issue), it is important that we make sure our federal elected officials know about the financial impact on non-profit organizations as they try to provide good health insurance options to their employees. If your organization has found this to be an issue, please do two things: 1) call your Representative(s) and Senators and let them know how this issue has impacted your organization, and 2) send us your stories at advocacy@lutheranservices.org, so we at LSA can help raise awareness about this issue on Capitol Hill in these important days of decision-making about what health care reform will look like for our country.

The Department of Health and Human Services sent out this invitation for faith- and community-based organizations to learn more about what they can do during the fall flu season; you can sign up to be on the HHS mailing list by going here and clicking on the “Join our mailing list” link about halfway down the right side of the page:

“Community and Faith-based Organizations and Response to 2009 H1N1 Flu

Thursday, September 24

1:30-2:30 pm EST

Please join us for a conference call with Secretary of Health and Human Services Kathleen Sebelius, Secretary of Homeland Security Janet Napolitano, and Director of the White House Office of Faith-based and Neighborhood Partnerships Joshua DuBois, as well as HHS & CDC experts to discuss the release of a new resource “H1N1 Flu: A Guide for Community and Faith-based Organizations.” The call will focus on the important role of community and faith-based leaders and organizations as partners in 2009-2010 flu response and prevention. The new guide was developed by the HHS Center for Faith-based and Neighborhood Partnerships (HHS Partnership Center) with support from the Centers for Disease Control. Speakers will provide the latest information on H1N1 flu and vaccination plans, and an overview of the guide.

You and your organization are crucial leaders and resources in your communities, and essential partners in comprehensive state and local flu response. We want to ensure you and your communities have this resource and the most up-to-date information on H1N1 flu. The HHS Partnership Center will keep an open and dynamic channel of communication throughout the response effort. Following the completion of the call, we will send a call summary to our listserv. If you are not part of our listerv, you can join us at www.hhs.gov/partnership, click ‘Join the Mailing List’ under the ‘Newsletter’ box on the left-hand side of your screen.

At the time of the call, copies of the guide will be available for download at www.flu.gov and at our website www.hhs.gov/partnership.

Dial-In Information:

Toll Free – 1.800.369.1899

Passcode - 1696323″

The Senate Finance Committee began their markup of the America’s Healthy Future Act of 2009 this morning, with members of the committee each having the opportunity to speak for 10 minutes on the bill. Senator Max Baucus (D-MT), chairman of the Finance Committee, offered modifications to the Chairman’s Mark of the bill, which include some corrections as well as the addition of several amendments offered by various members of the committee.

In yesterday’s post, we noted a few amendments offered to this bill that we were looking at; two of them have been included in the modified version of the bill:

Kerry/Snowe/Schumer/Lincoln/Cantwell Amendment # C2:
The provision extends the small business tax credit to organizations exempt from tax under section 501(a) by reason of being described in section 501(c)(3) (i.e., charitable organizations) that would otherwise qualify for the small business tax credit. However, for tax exempt organizations, the applicable percentage for the credit during Phase I is limited to 25 and the applicable percentage for the credit during Phase II is limited to 35. The small business tax credit is otherwise calculated in the same manner for tax exempt organizations that are qualified small employers as the tax credit is calculated for all other qualified small employers. Charitable organizations will be eligible to apply the tax credit against the organization’s liability as an employer for payroll taxes for the taxable year to the extent of the amount of income tax withheld from its employees under section 3401(a), the amount of hospital insurance tax withheld from its employees under section 3101(b), and the amount of the hospital tax imposed on the organization under section 3111(b). However, the charitable organization will not be eligible for a credit in excess of the amount of these payroll taxes.

Schumer Amendment #C13:
On page 50, at the end of the Long Term Services and Supports section
Insert ―The Chairman’s Mark would establish the Community First Choice Option, which would create a state plan option under section 1915 of the Social Security Act to provide community based attendant supports and services to individuals with disabilities who are Medicaid eligible and who require an institutional level of care. These services and supports include assistance to 12
individuals with disabilities in accomplishing activities of daily living and health related tasks. States who choose the Community First Choice Option would be eligible for enhanced federal match rate of an additional six percentage points for reimbursable expenses in the program. The option would sunset after five years.
The Community First Choice Option also would require data collection to help determine how states are currently providing home and community based services, the cost of those services, and whether states are currently offering individuals with disabilities who otherwise qualify for institutional care under Medicaid the choice to instead receive home and community based services, as required by the U.S. Supreme Court in Olmstead v. L.C. (1999).
The Community First Choice Option would also modify the Money Follows the Person Rebalancing Demonstration to reduce the amount of time required for individuals to qualify for that program to 90 days.

Also included was an amendment by Senator John Rockefeller (D-WV) which would express a “sense of the Senate that this Congress should address long-term services and supports in a comprehensive way that guarantees elderly and disabled individuals the care they need. The Mark would further express the Sense of the Senate that long term services and supports should be made available in the community in addition to in institutions.”

Senator Baucus is still hopeful that the Senate Finance Committee will be able to vote on the bill by the end of the week. The markup is being shown on C-SPAN (it has been on C-SPAN 1, 2, and 3 at different times of the day today), and can also be accessed online here. Keep up with the latest here and through our Twitter page!

The long-awaited Senate Finance Committee health care reform bill (aka “the Baucus bill”) was introduced last Wednesday, without the bipartisan support that had been hoped for by Senator Max Baucus (D-MT), chairman of the Senate Finance Committee. Senators on the Finance Committee had until last Friday at 5:00 PM to submit amendments to the bill, and they did: 564 of them. A few that we’re keeping a close eye on:

#227, submitted by Senator John Kerry (D-MA) along with four other Senators; this amendment would modify the small business tax credit so “non-profit entities that meet the eligibility requirements of the small business credit would be eligible to receive the credit.”

#241, also submitted by Senator John Kerry; this amendment would include provisions from the Empowered at Home Act (S. 434) which expand access to home and community based services under Medicaid.

#272, submitted by Senator Charles Schumer (D-NY); this amendment would establish the Community First Choice Option, which “would create a state plan option under Section 1915 of the Social Security Act to provide community based attendant supports and services to individuals with disabilities who are Medicaid eligible and who require an institutional level of care.”

#278, submitted by Senator Debbie Stabenow; this amendment would “provide a statutory definition for therapeutic foster care and would protect Medicaid reimbursement for the treatment contained in therapeutic foster care (TFC) programs. Therapeutic Foster Care (TFC) provides vital services in a community-based environment for children with severe mental and behavioral health needs” (from our friends at the Alliance for Children and Families).

There are many other amendments of interest to LSA, including several dealing with the CHIP program and ensuring coverage for children in low-income families, some which address the increase in state funding that would be required in the expansion of Medicaid, and those which address the affordability of health insurance for individuals and families, among others.

Senator Baucus announced this afternoon that he has made some changes to the legislation which will be unveiled tomorrow as the Senate Finance Committee begins its markup of the bill. The changes largely revolve around a bipartisan concern about the potential cost for middle class families. There is also some concern that employer requirements may not bode well for low-income workers whose health care costs might be higher than a higher-income colleague.

The future of the Senate Finance Committee bill remains in limbo; currently no Republican members of the committee have come out in favor of the bill, while one Democratic member of the committee, Senator John Rockefeller (D-WV) has stated that he will not support the bill if it does not contain a public option (the bill was introduced with no public option; amendments have been submitted that would add a public option). Senator Robert Menendez (D-NJ) has also indicated he may not vote for the legislation in committee if his reservations about provisions that impact legal and illegal immigrants are not addressed. Some Republicans on the committee have indicated they thought the bill as introduced was a good first step, but none have committed to voting for the bill in committee. Many Democrats and Republicans on the committee have indicated reservations about the bill as it was introduced, which indicates the future of the bill may lie in what happens with the 564 amendments over the course of the markup. The Senate Finance Committee consists of 13 Democrats and 10 Republicans.

Do you have a Senator on the Senate Finance Committee? You can click here to find out; if so, this is a great week to contact them to let them know what you think should be included in health care reform legislation. If you haven’t yet, we encourage you to read and send to your senators LSA’s health care reform principles document, “Health Care Reform: Responsibility for All”. We’ll keep you updated through out the week on this blog and through our Twitter updates about what’s happening on the Hill…please let us know if you have questions!

Members of Congress headed back to Capitol Hill for their first week back in DC after the August work period. Health care reform legislation is the hot topic of the month, with the bipartisan Senate Finance Committee “Gang of Six” meeting Tuesday and Wednesday afternoons to discuss a framework put forward by Chairman Max Baucus (D-MT). Senator Baucus has indicated he still anticipates moving a bipartisan agreement forward, but will begin markups in the Senate Finance Committee on health care reform bill the week of September 20 with or without bipartisan support of the bill.

Late last week, the Senate HELP Committee reported out its bill with amendments, which was passed in mid-July. President Obama will be addressing both houses of Congress Wednesday evening regarding health care reform legislation, which many believe will set the tone for continued negotiations on Capitol Hill. The House has yet to vote on their health care reform bill, and it is uncertain when they might do that.

At LSA, we’re continuing to focus on our principles of health care reform as outlined in “Health Care Reform: Responsibility for All” as we’re evaluating health care reform legislation from the House and the Senate:

1. Participation for all people and comprehensive, individualized care, coverage and payment
2. Mutual responsibility, affordability and sustainability
3. Adequate, coordinated and well-trained provider capacity, and adequate and appropriate infrastructure
4. Quality and availability for all people.

We are also keeping a close eye on a few key policy aspects of health care reform legislation that are critical to many LSA organizations; namely, inclusion of provisions regarding home visitation programs and long term supports and services. The framework being considered by the “Gang of Six” does include funding for home visitation programs, as does the tri-committee legislation in the House; the Senate HELP committee bill and the House tri-committee bill do include the CLASS long term supports and services provision, but none of the health care reform bills so far include the provisions of the Community Choice Act.

We are still keeping tabs on LSA’s other priority issues that are expected to see action on Capitol Hill this fall, including fiscal year 2010 appropriations, Section 811 housing legislation introduced in the Senate in July (S. 1481), Section 202 legislation included in a broad housing preservation bill expected to be introduced in the House in September, and the reauthorization of child nutrition programs, among others. Stay tuned to this blog, our Twitter updates, and LSA Washington for the latest info!

We’ve taken a little bit of a blogging break the past few weeks, as things on Capitol Hill have slowed down as Members of Congress headed home for the August work period. As has been widely reported, health care reform is on the minds of many across the country, and we in the LSA DC office are working to continue assessing health care reform legislation to understand its impacts on LSA organizations and the people served by them.

The Lutheran church bodies of which LSA is an alliance have each released statements on health care reform in the last few weeks; Dr. Gerald B. Kieschnick, President of the Lutheran Church-Missouri Synod, released a statement on August 14, and the ELCA Churchwide Assembly passed a resolution on health care reform on August 20.

A big change has occurred in the LSA DC office this August, with Lisa Carr leaving LSA after 10 years of service to the organization. We wish Lisa well in her new ventures! LSA’s presence in DC continues to be strong, and Lisa Hassenstab and Heather Ansley look forward to continuing to work with LSA organizations to support their advocacy efforts and act as liaisons to Capitol Hill and the Administration. If you have questions about this transition or anything else related to LSA’s public policy and advocacy work, please don’t hesitate to contact us!