Health

J Roberts

Believe it or not bankruptcies as a result of medical bills increased by nearly 50 percent, from  2001 to 2007. Most of those who filed for bankruptcy were middle-class, well-educated homeowners with insurance. Imagine that!

By Theresa Tamkins

This year, an estimated 1.5 million Americans will declare bankruptcy. Many people may chalk up that misfortune to overspending or a lavish lifestyle, but a new study suggests that more than 60 percent of people who go bankrupt are actually capsized by medical bills.

Bankruptcies due to medical bills increased by nearly 50 percent in a six-year period, from 46 percent in 2001 to 62 percent in 2007, and most of those who filed for bankruptcy were middle-class, well-educated homeowners, according to a report that will be published in the August issue of The American Journal of Medicine.

“Unless you’re a Warren Buffett or Bill Gates, you’re one illness away from financial ruin in this country,” says lead author Steffie Woolhandler, M.D., of the Harvard Medical School, in Cambridge, Mass. “If an illness is long enough and expensive enough, private insurance offers very little protection against medical bankruptcy, and that’s the major finding in our study.”

Woolhandler and her colleagues surveyed a random sample of 2,314 people who filed for bankruptcy in early 2007, looked at their court records, and then interviewed more than 1,000 of them.

They concluded that 62.1 percent of the bankruptcies were medically related because the individuals either had more than $5,000 (or 10 percent of their pretax income) in medical bills, mortgaged their home to pay for medical bills, or lost significant income due to an illness. On average, medically bankrupt families had $17,943 in out-of-pocket expenses, including $26,971 for those who lacked insurance and $17,749 who had insurance at some point.

Overall, three-quarters of the people with a medically-related bankruptcy had health insurance, they say.

“That was actually the predominant problem in patients in our study — 78 percent of them had health insurance, but many of them were bankrupted anyway because there were gaps in their coverage like co-payments and deductibles and uncovered services,” says Woolhandler. “Other people had private insurance but got so sick that they lost their job and lost their insurance.”

However, Peter Cunningham, Ph.D., a senior fellow at the Center for Studying Health System Change, a nonpartisan policy research organization in Washington, D.C., isn’t completely convinced. He says it’s often hard to tell in which cases medical bills add to the bleak financial picture without being directly responsible for the bankruptcies.

“I’m not sure that it is correct to say that medical problems were the direct cause of all of these bankruptcies,” he says. “In most of these cases, it’s going to be medical expenses and other things, other debt that is accumulating.”

Either way, he agrees that medical bills are an increasing problem for many people.

“I think medical bills are something that a lot of families are having a lot of difficulty with and whether it’s the direct cause of bankruptcy or whether it helps to push them over the edge because they already were in a precarious financial situation, it’s a big concern and hopefully that’s what medical reform will try to address,” he says.

The study may overestimate the number of bankruptcies caused by medical bills yet underestimate the financial burden of health care on American families, because most people struggle along but don’t end up declaring bankruptcy, according to Cunningham.

“Bankruptcy is the most extreme or final step for people who are having problems paying medical bills,” he says. “Medical bills and medical costs are an issue that can very easily and in pretty short order overwhelm a lot families who are on otherwise solid financial ground, including those with private insurance.”

His group’s research found that medical bills unduly stress 1 in 5 families.

Either way, the high cost of health care is a problem that’s probably getting worse for people in the United States, particularly since the economic picture became grimmer after the study was conducted.

“The recession didn’t happen until a year after our study,” says Woolhandler. “We’re quite sure that the problem of bankruptcy overall is worse, the numbers have been soaring, and the number this year is expected to be higher than it was before Congress tightened bankruptcy eligibility in 2005.”

In 2005, bankruptcies peaked at two million filings.

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Insurers point finger at fees

J Roberts

Sarasota Herald-Tribune – Online

Attend any town hall meetings over healthcare lately? It should be no surprise that a hot topic of discussion is the outrageous and exorbitant medical charges by doctors and hospitals to patients. Make no mistake, doctors, hospitals and other healthcare professionals can charge any amount without any sound economic basis or rationale. On the flip side, while charges often border the absurd in terms of excessiveness, most healhcare providers are willing to negotiate.  Medical Cost Advocate can assist in reducing those charges and bringing them down to a fair and equitable level to save you money.

Maria Davis poses last month with sons Ryan and Jack, left, at home in Miller Place, N.Y. Ryan fell and received three stitches; she got a $6,000 bill. Insurers say a survey shows how medical fees are a significant part of the nation’s health care problem.NEW YORK TIMES / MAXINE HICKS

A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation for which Medicare pays $584. And a New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629.

The charges were cited in a survey sponsored by America’s Health Insurance Plans in which insurers were asked for some of the highest bills submitted to them in 2008. The group, which represents 1,300 health insurance companies, said it had no data on the frequency of such high fees, saying that to its knowledge no one had studied that question. But it said it did the survey in part to defend itself against efforts by the administration to portray certain industry practices as a major part of the nation’s health care problems.

The health insurers, saying they felt unfairly vilified, gave the report to The New York Times before posting it online today, explaining that they wanted to show that doctors’ fees are part of the health care problem.

The group said it had used Medicare payments for comparison because Medicare was so familiar and payments are, on average, about 80 percent of what private insurers pay.

“It’s the Wild, Wild West when it comes to prices of anything in the U.S. health care system, whether for a doctor visit or for hospital charges,” said Jonathan S. Skinner, a health economist at Dartmouth.

The situation is so irrational, said Uwe E. Reinhardt, an economist at Princeton, that it simply cannot go on.

“We will not emerge out of this decade with this lunacy,” Reinhardt said, adding, “You worry about credit card charges, you scream for consumer protection — why not scream for it here?”

But Dr. Robert M. Wah, a spokesman for the American Medical Association, says there is another side to the story — insurers’ low payments to doctors who enter into contracts with them and the doctors’ difficulties, in many cases, in getting paid at all. That is why, he said, doctors may simply abandon insurance plans. Then patients end up with extra fees because they have to go outside their networks.

Karen Ignagni, president and chief executive of America’s Health Insurance Plans, had a different view, saying “As we think about the health care debate, what’s been talked about is, What are the cost-sharing levels? What are the premium levels? How much do health plans pay? No politician has asked how much is being charged.”

Some of the legislation being considered by Congress would require insurers to increase their disclosure to patients of possible out-of-network costs. And President Barack Obama has proposed changing how Medicare sets its payments to doctors and hospitals. But there are no specific proposals to control prices for out-of-network medical services.

In the survey, patients were insured but saw doctors out of their networks of care providers. When patients go outside their networks, doctors have no obligation to accept the out-of-network fee from insurers as payment in full. Patients may then be accountable for the balance.

The survey looked at 10 companies that insure patients; the companies provided some of the highest bills from 2008.

State laws protecting patients from getting stuck with medical bills in excess of their normal deductibles or co-payments to providers in their insurance networks, vary widely, said Betsy M. Pelovitz, the group’s vice president for state policy. And, she said, the laws often offer little or no protection to patients who seek care outside their insurance networks.

No one intervened for Maria Davis when her son fell and hit his mouth on a floor. Davis, a respiratory therapist on Long Island, took 4-year-old Ryan to an emergency room. “He was bleeding a lot,” Davis said.

She said a doctor said he would put in a couple of stitches but seemed uncomfortable treating the agitated child. When he said he could call a plastic surgeon, Davis agreed. The surgeon, Dr. Gregory J. Diehl of Port Jefferson, “was very nice,” Davis said. He put in three stitches, and Davis assumed his bill would be fully covered by her insurer, United Healthcare. It was not. The bill was $6,000. The Davises paid their deductible of $350. After United Healthcare paid $2,024.80, Diehl reduced his bill by $2,100 and billed the Davises for the balance, $1,525.20.

He did not return calls to his office.

So far, the Davises have not paid the balance.

“I told them I thought it was an unreasonable amount,” said Jonathan Davis, Ryan’s father.

“We have gotten several letters, and they have gotten more than a little threatening,” Davis said.

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A Guide Through a Medical Wilderness

Doug

 

As the government churns through health care reform, the media has realized that consumers can negotiate their health care with doctors and hospitals.  The article indicates that it is best to choose an advocate with a successful track record in health care cost reduction.  Medical Cost Advocate is a leader in health care cost reduction through expert negotiation.

 

 

 

New York Times

 

By WALECIA KONRAD

 

THESE days, dealing with medical bills and insurance claims makes April 15 look easy. The medical jargon and inscrutable coding on invoices and explanations of benefits are indecipherable for most lay people. Worse, seriously ill patients may simply be too sick or too broke to deal with the mountains of red tape. That can lead to unpaid medical debts and even bankruptcy.

 

It’s no wonder that a cottage industry has sprung up to fill this void. Known as medical billing advocates, these middlemen and women help patients deal with the paperwork and haggling often associated with medical costs.

 

 

In general, medical billing advocates help you find errors in your bills, negotiate with your insurer to appeal coverage denials, or negotiate lower fees with your medical care providers. Some advocates do all three tasks equally well. But others, because of their training or background, may specialize in one area or another.

 

Still others give the client the ammunition he or she needs to negotiate. That’s what happened to Susan Redstone, a freelance fashion stylist and author. When she broke her back in a horseback riding accident last summer, she held only a bare-bones insurance policy. So Ms. Redstone, who has since recovered, knew that she would be responsible for the bulk of her medical expenses.

 

 

Five months after the accident, just when she thought she had paid everything off, she got a bill for $16,000 from the helicopter ambulance service that ferried her from the remote location in Colorado where the accident occurred to a large medical facility 75 miles away. “I was completely taken by surprise to get this bill so long after the accident happened,” Ms. Redstone said. She consulted with Victoria Caras, a medical advocate in Aspen, Colo., who coached her on how best to approach the medical transportation company to lower her bill. With Ms. Caras’s advice, Ms. Redstone was able to negotiate a 25 percent discount in exchange for paying the bill in full. (more…)

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Insured, but Bankrupted by Health Crises

J Roberts 1 Comment

Health advocates warn of the dangers of the underinsured – the millions of Americans who have a basic form of health insurance, but not enough to cover a chronic or catastrophic illness. This group of people represents a “great hidden risk to our health care system” according to the below article published in the New York Times.  More and more people are facing financial hardship and burden due to the rise in healthcare costs and increased out-of-pocket expense.

New York Times

 

Health insurance is supposed to offer protection — both medically and financially. But as it turns out, an estimated three-quarters of people who are pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured.


And so, even as Washington tries to cover the tens of millions of Americans without medical insurance, many health policy experts say simply giving everyone an insurance card will not be enough to fix what is wrong with the system.
Too many other people already have coverage so meager that a medical crisis means financial calamity.


One of them is Lawrence Yurdin, a 64-year-old computer security specialist. Although the brochure on his Aetna policy seemed to indicate it covered up to $150,000 a year in hospital care, the fine print excluded nearly all of the treatment he received at an Austin, Tex., hospital.


He and his wife, Claire, filed for bankruptcy last December, as his unpaid medical bills approached $200,000.


In the House and Senate, lawmakers are grappling with the details of legislation that would set minimum standards for insurance coverage and place caps on out-of-pocket expenses. And fear of the high price tag could prompt lawmakers to settle for less than comprehensive coverage for some Americans.


But patient advocates argue it is crucial for the final legislation to guarantee a base level of coverage, if people like Mr. Yurdin are to be protected from financial ruin. They also call for a new layer of federal rules to correct the current state-by-state regulatory patchwork that allows some insurance companies to sell relatively worthless policies.
“Underinsurance is the great hidden risk of the American health care system,” said Elizabeth Warren, a Harvard law professor who has analyzed medical bankruptcies. “People do not realize they are one diagnosis away from financial collapse.”
Last week, a former Cigna executive warned at a Senate hearing on health insurance that lawmakers should be careful about the role they gave private insurers in any new system, saying the companies were too prone to “confuse their customers and dump the sick.”


“The number of uninsured people has increased as more have fallen victim to deceptive marketing practices and bought what essentially is fake insurance,” Wendell Potter, the former Cigna executive, testified.


Mr. Yurdin learned the hard way.

(more…)

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How to Cut Your Doctor Bill

J Roberts

J. Roberts

Looking to reduce your out-of-pocket expense on your medical bills?  Read the article posted in Forbes Magazine about reducing medical expenses through negotiations.  As the article states, the rise in out-of-pocket health care costs is providing incentive to people to bargain down prices with their doctor, hospital or other health care professional. In many instance though, patients doesn’t want to jeopardize an established patient/ physician relationship. That’s where Medical Cost Advocate can assist. Like the article indicates, we offer bill negotiation services to help reduce cost without having the patient get involved. At Medical Cost Advocate we understand the value of the patient physician relationship. We work collaborately with each physician or health care professional in all our negotiations to achieve true savings to you, without comprising your established relationship.  Follow the link to Forbes Magazine online and read the article about reducing your doctor bill. We think you’ll be surprised at just how often physicians and health care professionals are willing to negotiate. Then visit our website and learn more about what Medical Cost Advocate can do to assist you in negotiating your medical bills.

http://www.forbes.com/forbes/2009/0803/medicine-surgery-costs-cut-your-doctor-bills_print.html

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US Out-Of-Pocket Health Costs Up 34% In 3 Years

J Roberts

More information detailing the rising cost of healthcare with less coverage provided.  The average worker receives no more benefits in 2008 than he or she did in 2004. In fact, they may receive less, but his or her out-of-pocket expense is greater now than compared to 2004.

By Kristen Gerencher 

 

Americans with job-based health insurance saw their protection from higher out-of-pocket costs erode between 2004 and 2007, especially those who were sick and of modest means, according to a new study.

The majority of people with health insurance, about 160 million Americans, receive it through their jobs.

“American families with employer-based coverage were worse off in 2007 than they were in 2004,” said Jon Gabel, lead author of the study that was published in a June 2 Health Affairs Web exclusive. “This is during a period of time when the economy was expanding.”

The authors conclude that a growing number of people are underinsured, a term that refers only to what they pay out of pocket for medical services. Health-care affordability, which includes out-of-pocket costs plus employees’ premium contributions, also has taken a big hit.

Comparing expected health spending among different types of health plans, financial protection was greatest for those in health maintenance organizations (HMOs), the study found. Of five chronic conditions surveyed, patients with breast cancer suffered the highest out-of-pocket costs.

Workers faced an annual average of $729 in medical-services costs in 2007, including deductibles and other forms of cost-sharing such as co-payments and co-insurance. That’s up 34% from 2004, when the average out-of-pocket burden for those with employer coverage was $545.

With job-based health plans picking up 80% of total costs in 2007, they covered a slightly smaller percentage of overall expenses than they did in 2004 as more workers confronted plans with deductibles and as deductible levels were set higher, according to the study. But the main reason for rising out-of-pocket costs was the growth in overall health spending. 

 

Going To Extremes 

 

The report showed a widening gap between adults who need to tap their health insurance to cover medical visits and those fortunate enough not to need to use their benefits much. Adults with chronic medical conditions drove higher spending for both their health plans and themselves.

At the two extremes, the average out-of-pocket expense for the 50% of workers with the lowest health spending grew 23% to $85 in 2007. But expenses jumped 42% to $8,703 among the highest-spending 1% of workers, the study found. For the highest spending 10% of workers, the average out-of-pocket costs amounted to $3,364, an increase of 39% since 2004.

For some patients, co-insurance may seem like a small sum – set at 10% or 20%, for example, when services are from an in-network health provider – but costs can add up quickly as absolute dollar figures rise. Insurance paid for 84% of the bill for five selected chronic conditions: asthma, breast cancer, diabetes, chronic obstructive pulmonary disease and hypertension, the study found.

Breast-cancer patients faced the biggest sticker shock. Even though insurance paid for more than 90% of a bill that averages $66,489, they had the largest out-of-pocket spending, the study found. Breast-cancer patients paid an average $6,250 for their treatment. Patients with chronic obstructive pulmonary disease had the second highest out-of-pocket costs, at $2,200 a year.

“When that figure gets really high, even though you may be only paying 10% of the bill, it’s still a lot of money for somebody of modest means,” Gabel said. “For some high rollers…$6,000 for breast cancer is not much of a financial penalty, but it is for someone earning $30,000 a year.”

The researchers used simulated bill paying of actual claims histories in Thomson Healthcare’s MarketScan database to apply the spending of a large sample of adults to a representative national sample of employer-sponsored health plans.

In 2007, 71% of people earning 200% of the federal poverty level (about $41,300 a year for a family of four) who were among the top 25% in health-care spending were underinsured, the study found.

“In the United States, if you are sick and earn a modest income, then you are probably underinsured – even if you have employer-based health coverage,” the researchers wrote.

Overall, the recession may exacerbate the trend toward eroding financial protection as employers become more sensitive to the rising costs of workers’ health insurance, Gabel said.

“I would expect to see significant increases in cost-sharing in the next few years at a time when households are going to be less able to pay for it,” he said.

The study was conducted by researchers from the National Opinion Research Center and Watson Wyatt Worldwide, with funding from The Commonwealth Fund.

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Health insurance premiums increase for the healthcare industry |

J Roberts

 Healthcare premiums are on the rise in 2009 and, no surprise, the costs continue to shift to consumers.  More and more individuals and families are facing greater healthcare premiums and less coverage leaving them with greater out-of-pocket expenses. If you are faced with increased out-of-pocket expenses related to healthcare issues, Medical Cost Advocate can help.

Most U.S. healthcare organizations saw an increase in their health insurance premiums this year, according to information contained in the 2009 Compensation Data Healthcare report.

The 2009 Compensation Data Healthcare results reveal that, although the average premium increase had been decreasing in previous years, the average premium increase was 9.9 percent for all plan types. The data is collected by Compdata Surveys, a national compensation survey and consulting firm.

Comparatively, the average premium increase was 7.0 percent in 2008 and 10.9 percent the previous year. When comparing plans in 2009, 66.5 percent of organizations offering PPO plans saw an average increase of 9.5 percent. Those offering HMO and POS plans had average premium increases of 9.4 and 9.8 percent, respectively. HDHP plans had increases of 9.6 percent.

“Medical plans continue to be a source of scrutiny, as high health insurance costs are cutting into organizations’ bottom lines,” said Amy Kaminski, manager of marketing programs for Compdata Surveys. “Organizations continue to search for ways to reduce healthcare costs, but often higher costs are passed on to employees.”

To contain rising costs, healthcare providers used a variety of methods. The most often used method was coordination of benefits, at 81.4 percent in 2009, while a network of healthcare professionals was employed by 77.3 percent. Utilization review was prevalent, as 62.7 percent of organizations used it to contain costs.

The 2009 Compensation Data Healthcare results showed 63.6 percent of companies increased the employee portion of the premium in their efforts to reduce costs. This is higher than the percentage seen in 2007.

Currently, 37.4 percent and 16.4 percent of organizations increased deductible levels and employee co-insurance levels, respectively. On average, healthcare providers contribute 9.8 percent of payroll toward the cost of health benefits, which is the same cost to provide all of the following benefits: dental, life, retirement, disability and other non-mandated benefits.

Compensation Data Healthcare 2009 contains data on more than 200 industry-specific job titles and more than 250 benchmark titles ranging from entry-level to top executives. Data is collected annually from employers across the country.

The results provide a comprehensive summary of pay data, benefit information and pay practices with an effective date of January 1, 2009.


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Senate Report Finds Insurers Wrongfully Charged Consumers Billions

Doug

Another in the continuing series of reports about routine underpayment of health care for out of network coverage by the insurance industry.  Consumers need an Advocate to help reduce health care bills.

By David S. Hilzenrath
Washington Post Staff Writer
Wednesday, June 24, 2009

Health insurers have forced consumers to pay billions of dollars in medical bills that the insurers themselves should have paid, according to a report released today by the staff of the Senate Commerce Committee.

The report is part of multi-pronged assault today on the trustworthiness of private insurers by Commerce Committee Chairman John D. Rockefeller IV (D-W.Va.). It comes at a time when the insurance industry is battling efforts to offer consumers a public alternative to private health plans.

At a hearing this afternoon, Rockefeller’s panel is slated to air allegations by a former industry insider that insurers have put profits before people’s health.

The report released this morning alleges that insurers have systematically underpaid for so-called out-of-network care. The issue has been brought to light in past litigation and investigations, including a probe by New York Attorney General Andrew Cuomo.

Cuomo described it last year as “a scheme by health insurers to defraud consumers by manipulating reimbursement rates.” A dozen insurers have reached settlements with Cuomo agreeing to change their practices.

Many Americans pay higher premiums for the freedom to go outside an insurer’s network of doctors and hospitals. When they do, insurers typically pay a percentage of what they call the “usual and customary” rates for the services. How insurers determined the usual rates had long been opaque to consumers and difficult if not impossible for them to challenge.

As it turns out, insurers typically used numbers from Ingenix Inc., which was a wholly owned subsidiary of the big insurer UnitedHealth Group. As such, Ingenix had an incentive to produce benchmarks that low-balled usual and customary rates and shifted costs from insurers to their customers, the report said.

Making matters worse, Ingenix got all of its data from the same insurers that bought its benchmark information, the report said. Insurers that contributed data to Ingenix often “scrubbed” their data to remove high charges, and Ingenix further manipulated the numbers, removing valid high charges from its calculations, the report said.

Cuomo found that insurers systematically under-reimbursed New York consumers by up to 28 percent, the report said. Earlier this month, New York’s Department of Insurance issued a regulation prohibiting insurance companies in New York from obtaining data on usual and customary charges from anyone with a conflict of interest.

In March testimony to Rockefeller’s committee, UnitedHealth Group’s chief executive expressed regret that there was a conflict of interest inherent in his company’s relationship with Ingenix, the report said.

But chief executive Stephen J. Hemsley also said UnitedHealth stands by “the integrity of the Ingenix data” and the way UnitedHealth “used the data to make reimbursement decisions.” He said the company worked with Cuomo to transfer its databases to an independent, nonprofit entity.

Ingenix bought one of its original databases in 1998 from the Health Insurance Association of America, a precursor to the industry’s main trade association and lobbying group.

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Health-Care Costs Rise for 2009

J Roberts

Washington Post – Online

Medical costs continue to rise for American’s, even those with Health Insurance. The latest report from the health care consulting firm Milliman puts the cost at $17,000 a year for a family of four. Consistent with trends, the prediction is that more employers will shift the cost onto employees leaving them to pay more.

Families of four may want to stash away roughly $17,000 this year to pay for the cost of health-care services, according to the recently-released Milliman Medical Index. Produced by a consulting firm that advises health-care plan sponsors and participants, the MMI serves as a measure of the average annual medical spending of typical American families covered by a PPO. This year’s $17,000 price tag reflects a 7.4 percent increase from 2008. The median family income in 2008 was around $67,000, and if that amount does not change significantly, then this year’s projected spending represents about 25 percent of a family’s income.


Health economist Jane Sarasohn-Kahn crunched the 2009 projected cost in her blog, Health Populi and concluded that a rise in outpatient costs triggered this year’s projected increase. Outpatient costs have risen 10 percent this year, according to the MMI. Unit cost, rather than utilization, has gone up. As Congress continues to debate health-care reform, Sarasohn-Kahn believes companies will be unable to help cover the rise in health-care costs. She projects in her blog that “employers who sponsor health insurance will lay more health cost burden onto insured employees as their subsidy declines and the worker’s subsidy increases.”

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Health Reform: Costs, Variations in Care & Public Insurance

J Roberts

Wall Street Journal

A brief commentary from the WSJ on-line regarding some of the issues evolving around healthcare reform.  One thing is for sure, healthcare costs vary to the extreme from one end of the country to other and lack any apparent uniformity.  Something to take note of the next time you receive a medical statement and/or bill and are alarmed by the actual charge.

The health-reform theme of the day seems to be widespread variations in health-care costs in different areas around the country. If one city spends twice as much as another on health care without any noticeable benefit for patients, the thinking goes, there must be a way to find some savings.


This is an old idea among health wonks (see the Health Blog’s 2007 interview with Dartmouth’s Jack Wennberg, who has been talking about this for decades), but it has gained currency lately amid the big health-reform push in Washington.
Congress may wind up capping Medicare payments in areas where costs are unusually high, or sparing low-spending regions from cuts in Medicare reimbursement, the New York Times notes in a story today.


In 2006, this morning’s Washington Post notes, Medicare spent $5,812 on the average beneficiary in La Crosse, Wisc., compared with $16,351 in Miami, without clear evidence that the extra spending resulted in better care.


Meanwhile, the WSJ reports today, we could start seeing the first proposed health-reform bill as soon as this week from a Senate committee, the start of a stream of health-reform legislation likely to flow from different committees in both houses in the coming months. Congress is aiming to pass legislation by August and deliver a single bill to President Obama by October.


Two key debates remain central, the WSJ notes. One is whether to include a national, government-backed insurance plan; a group of Republicans from the powerful Senate Finance Committee sent a letter to Obama on Monday reiterating their opposition to a public plan, which the administration backs. The other debate is, of course, how to pay for health reform. One possibility to keep an eye on: taxing some health-benefit plans, an option we discussed in this post.

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