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New health bill might have New York fixes

White House officials today described in broad terms some fixes contemplated for the final health care overhaul that appear to address some of the concerns of the New York Congressional delegation.

The details remain sketchy, but White House Communications Director Dan Pfeiffer and Nancy DeParle, director of the White House office of health care reform, touched on three provisions: Medicaid money, Medicare Advantage and the Cadillac plan excise tax.

-- Medicaid money. The Senate health bill would help thousands of insured people by extending coverage under the Medicaid program for the poor to people from 100 percent to 133 percent of the poverty line, and then give states more federal money to help pay for it and some states, most infamously Nebraska, would get all of its new costs paid for. New York and other generous states already covering up to 133 percent have complained they are being left out.

DeParle said the special deals for Nebraska and other states would be removed, and that all states will get more money. And for New York and other generous states, she said, "So as not to penalize them it rewards those early expansion states with a little additional money." But she did not say how much or how it would work.

-- Medicare Advantage. The Senate bill would end this program, in which seniors sign up for private Medicare Advantage plans under which insurance companies administer the basic Medicare benefits and add a few others. Democrats say that the plans have cost 14 percent more than government administration of Medicare benefits.

The Senate bill crafted an additional benefits fund to ease the transition, DeParle said. But Senate and House aides have come up with a different provision. "We've come up with something that we believe is equitable that does phase the payments down, but is not disruptive to beneficiaries who have been getting the extra benefits," DeParle said. "The formula is fair and phases down the benefits in such a way that it doesn’t penalize seniors who have signed up for this."

-- Cadillac plan excise tax. One way the Senate health bill raises revenue and reins in health care spending is to put an excise tax on the more expensive health insurance plans. New Yorkers complain that this hurts them and others in states with high health care costs, and labor unions complain it would affect the health insurance plans they've won in negotiations with industry.

DeParle said the fix for the bill would raise the threshold at which the tax would kick in and pushes it back to 2018.

House Speaker Nancy Pelosi is expected to make a detailed version of the final language of the Senate bill fixes public, possibly as soon as tomorrow but definitely by Thursday when it measure goes to the House Rules Committee.

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