Health Insurance News

WASHINGTON (AP) -The Senate is expected to introduce a new long-term care health insurance program to help the elderly and medically disabled avoid nursing homes.  The legislation which is likely to be introduced by the Senate Majority Leader is supposed to offer a voluntary long term care program possibly tomorrow.

The Community Living Assistance Services and Supports Act, or CLASS Act as it is called was one of Senator Kennedy’s most important issues.  This act is necessary in much the same way as Medicare became necessary as it will help alleviate the financial strain on the elderly.

Of course the main gripers of the bill, the conservatives are likely to question the sustainability of such a program and of course the Long Term Care industry is fiercely opposed to it as it is quite a lucrative field for them.

The Health Reform bill passed by the House last week does contain the program which is endorsed by the Obama team.  The Senate version of the health reform bill ended up omitting it when the Senate Finance Committee removed it.  The Senate Majority Leader Harry Reid is trying to seperate the premiums that the Long Term Care program would bring in as they could not be added into the offset of the entire bill.

As of 2009 the average nursing home cost a whopping $70,000 per year and a home health care aide was charging an industry average of $29.  These are both exorbitant numbers and they are typical of the industry practice of everyone putting their hand into the pot.  Medicare which does offer some Long Term Care only covers the temporary nursing home stays and in order for a middle class family to qualify they would need to wipe out their savings to qualify for Medicaid which would foot the bill for the difference.

Much like Medicare, the proposed bill would collect premiums during the insured’s working years, and upon disability should it occur a cash benefit could be elected of $50 that could go towards a home health care aide, or for nursing equipment, or adding handicap accessible features to a home, or finally to pay for a nursing home, or in the case of this bill defray the costs which would literally equate to an hour and a half of a home health care aide.

The first question that comes to mind is, what Home Health Care Aide gets $29 an hour?  These are low skilled workers who basically help feed, clean, and assist those that can’t take care of themselves.  Most of them are not even Registered Nurses!

The Congressional Budget Office has claimed that the program could be financially solvent (unlike Medicare) over a 75-year-period with no additional tax payer money.  These numbers use a monthly premium of $123 and a $75 benefit, and would allow workers to elect the coverage through their employer if they wanted it.  Premiums and benefits would be adjusted for the CPI every year.

The Senior Lobbying groups of course support this, but why wouldn’t they as seniors would receive benefits with no premiums as the benefits would be funded by current workers!  This would be a free gift to our nations elderly who already enjoy the best health care in the country at the cost of the young who don’t get Medicare.

Critics’ concerns got validation recently from a report by Medicare economists who are expert in long-range cost estimates. In a report issued last weekend, they said a voluntary insurance program is likely to attract people who expect they’ll need the coverage. Without taxpayer subsidies, premiums would keep going up, discouraging healthy people from signing up and triggering an “insurance death spiral.”

“Individuals with health problems or who anticipate a greater risk of functional limitation would be more likely to participate than those in better-than-average health,” the report said. “There is a significant risk that the problem … would make the CLASS program unsustainable.”

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I personally have been selling the Cigna individual health insurance plans for about a year as they just came out.  I had always though of Cigna as a good company who could be trusted.  I mean their rates are incredibly low firstly, and secondly they pay their brokers (like me) very low commissions.  As an honest health insurance brokerage I prefer companies that pay lower commissions as it shows that the company values their clients more than new business, or the opportunity for new business.

So when I read an article like this one, I get a little weirded out as I don’t want to be the guy that sells you the health insurance plan that kills you, literally.  If you have had an experiences like the stuff that I found on Crooks and Liars because I want to know.  The 50 clients that we have placed with Cigna this year, have been fairly happy, but again this means nothing, as all it takes is one person or one death to enlighten people.  Please let me know via our Health Insurance Contact Form or by calling 888 803 5917.

CIGNA Denies Cancer Patient Care, CEO Makes $120 Million In Five Years – Not A Coincidence

By dday Monday Sep 14, 2009 3:00pm

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The current bill as it stands now still has plenty of loopholes to guarantee the health insurance industry its profits are able to continue.

For one, disclosures about the health insurance plans that help the public understand what their buying are still missing from the legislation.  In other words, its still very simple for the health insurance companies to hide important facts about their plans and policies.

Another alarming fact is that the health plans would still be allowed to discourage the ill from applying and enrolling  if they operate outside the health insurance exchange.  Additionally, they would be allowed to limit the choice of medical providers and thus would most likely use the low income health providers like the county hospitals to keep costs down.

So, the health insurance companies that operate outside the health insurance exchange would still be doing whatever they want (the status quo) like Mega Life and Health did in Massachusetts where they continue to rip off tons of Massachusetts residents daily.

Additionally, this would allow the insurance companies that operate outside the realm of the Insurance Exchange to only take the healthy people which would drive up the costs for the companies inside the Exchange including the Government Public Option.

At least the House bill in its current incarnation made it mandatory for all health plans to be inside the exchange if they wanted to offer a new plan.

The Senate health committee would give plans operating outside the exchanges another break: Only those inside an exchange would have to pay a surcharge — as much as 4 percent of premiums — to defray the exchange’s overhead costs. That could allow outside plans to undersell inside plans. In a written response to questions, the committee’s Democratic staff said it would not work out that way because plans inside the exchanges would have to spend less on marketing.

Why are the Democrats in the Senate and House allowing these loopholes?  Supposedly as a way of encouraging choice is their answer.  And keep in mind how strong the health insurance lobby is, who have been pushing hard to keep plans outside the exchange.

Karen Ignagni, president of America’s Health Insurance Plans, wrote that offering plans to individuals outside the exchange would “improve choices for individuals and employers.”

One of my biggest concerns as a health insurance broker is how complicated and different all of these health insurance options are right now.  As a result it becomes very difficult for me to explain the myriad of options to the clients that we get and service.

The health committee bill would cut through some of the confusion by offering three tiers of coverage within exchanges. Plans competing within each tier would be required to have the same actuarial value, meaning that overall they cover the same percentage of anticipated expenses.

The health reform bill as it stands right now allows this craziness to continue at the expense of the consumer.

Even within the exchanges, there could be limits to consumer protections. The health committee bill would not explicitly guarantee consumers the right to an external appeal when a health plan refuses to pay for medical services. The right to an external appeal is a hallmark of the health-benefits program for federal employees, which has served as a model for the proposed exchanges.

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Many of our health insurance clients and prospects are happy enough to wait for the so called Health Care Reform Bill to spastically make its way through Congress, with the hope that as soon as it passes they will be able to piggy back onto the Public Option thus saving money on purchasing an individual health insurance plan.

The fact is that only 1 out of 10 Americans will even be eligible for the plan, and even they will have to qualify.  Furthermore, the GAO only expects 6 million Americans total to qualify for the plan at the final count.  The insurance exchange as it exists in Massachusetts will not be available to most Americans as they will have to stay with their employer plan.

Only certain categories of people could use the exchange: the self-employed, small businesses, lower-income people who qualify for tax credits to purchase insurance and those who are otherwise unable to find affordable private coverage. (from Politico)

170 Million Americans would have to stay with their current health plan as the Exchange would not be for them.  Not to mention that the Public Option won’t even be available until 2013 at the earliest.

The Peter G. Peterson Foundation recently predicted the House bill would add more than $1 trillion to the deficit over the next 20 years

So, at this point armed with this information you might be asking yourself, “why even bother with the public option, why not just expand Medicaid or Medicare?”

And you would be right!  There is simply no reason to reinvent another Medicaid.  Medicare and Medicaid are slowly bankrupting the nation with administrative costs and fraud.

But the real reason for this nonsensical plan is because Obama promised health reform and needs to deliver to save political face.  That’s right, this ridiculous plan that will further rack up deficits for no reason is so Obama and Company can look good.

I am by no means a Republican either and fully support anyone willing to fix this health care system, but it has to be for the right reasons with the right solution.  And that solution is only a Single Payer plan.  The rich can keep their expensive plans but will still have to pay the same Single Payer tax as everyone else.

Members of the organization MoveOn.org hold a rally in Nebraska in support of a public option for health insurance. The reform debate has emphasized the public option, but only about 10 percent of the population would be eligible. Photo: AP

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Americans are beginning to doubt the economics and the effectiveness of the ObamaCare legislation and by all rights they should!  According to a new poll 43% oppose and 41% support it with the rest not knowing what we are even talking about because they are worried about how they are going to pay rent.

And seemingly, the supporters of Obamacare are less enthusiastic than the opposers.  Worse, they are more vocal.  From the Dittoheads to the Crazy Christian right they are screaming bloody murder everyday.

The latest survey was conducted by Stanford University with the nonprofit Robert Wood Johnson Foundation.

Very surprising to me was the fact that the Opinion Poll demonstrated that most Americans seemed happy to allow the discriminatory health insurance practices of denying coverage to the sick to continue unabated.  In fact, rather then help their fellow citizens which would make them have to pay higher premiums to cover the uninsured sick people most people surveyed vocally announced their support for the continuation of the prejudicial underwriting practices.

In the AP poll, when told that such a ban would probably cause most people to pay more for their health insurance, 43 percent said they would still support doing away with pre-existing condition denials but 31 percent said they would oppose it.

In Massachusetts where they currently have mandatory health insurance and New York, the costs for a 20 year old healthy male can be over a $1000.  In Florida where insurance is not mandatory they are usually under $100.  By forcing the acceptance of the sick by health insurance companies, it will push up the premiums for the healthy 20 year olds and such by a considerable percent much like it did in New York and Massachusetts.

I am not opposed to this in theory but in practice it is downright silly!  The only way to fix this issue entirely is to have everyone pay taxes on a Universal Health Care, Single Payer Plan.  Otherwise, we will keep seeing health care costs escalate as well as billions of dollars of fraudulent claims and administraitive costs pushing health care costs up to becoming the only significant output of our economy.  We are becoming the joke of the civilized world with our absolute archaic health insurance laws.

“These trade-offs really matter,” says Robert Blendon, a professor at the Harvard School of Public Health who follows opinion trends. “The legislation contains a number of features that polls have shown to be popular, but support for the overall legislation is less than might be expected because people are worried there are details about these bills that could raise their families’ costs.”

Another important fact is that these polls don’t make a difference at all because the average American is totally uneducated about Health Care.  They have no idea what is the right thing and believe that Rush Limbaugh is descended from Angels.  To let average American’s decide the health care issue is bordering on ludicrous.   Their job is to elect their Representatives to make the policy decisions on their behalf.  Not to write the freakin thing.

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Paul B. Ginsburg, Ph.D.

No issue has dominated the health care reform debate as much as whether the U.S. government should offer a health insurance plan to compete with private insurers — the so-called public option. Congress has discussed two approaches to the public option, one of which would have the public plan pay providers at rates close to Medicare rates (generally, substantially below those of private insurers). Opposition by insurers, providers, and the business community, as well as fears that such a payment structure would lead to a single-payer system, has pushed this “robust” public option off the table. Instead, both the House bill and, presumably, a final Senate bill will call for the public plan to negotiate rates with providers. There is little reason to expect that such a plan would bring much, if any, competition to the market, since anticipated enrollment levels would give the public plan less negotiating clout than private insurers boasting many more enrollees. Clearly, whatever decision is made about a public option is much less important than decisions about the level of subsidies for expanding coverage, as well as details of the regulatory reform of the individual insurance market (including enforcement of an individual mandate), reform of the delivery system, and financing of reform.

Despite all the distracting rhetoric about the public option, congressional consideration of reform appeared to be nearing a climax until Senate Majority Leader Harry Reid (D-NV) recently signaled that the Senate may not vote on a bill until next year. As of early November, the full House had narrowly passed a reform bill, while Senate leaders had reportedly combined two committees’ bills into a single proposal. Although details of the combined Senate bill were not yet public, the House and Senate proposals are likely to be broadly similar but to differ in important details. Each will have four major components: expansion of the number of people with insurance, reform of the individual and small-group insurance markets to provide more people with affordable options, changes to the health care delivery system to encourage high-value care and slow the rate of cost increases, and tax increases and spending reductions to finance reform.

The proposals have followed the Massachusetts approach to expanding coverage — a blend of Medicaid-eligibility expansion for the lowest-income people and subsidies for purchasing insurance for those with somewhat higher incomes. Medicaid expansion would have the largest effect on low-income people, such as young adults and the near-elderly, who do not qualify for Medicaid today because they have no dependent children or disability. The federal government would fund a much higher proportion of the costs for the newly eligible than for the currently eligible, but states, overwhelmed by existing fiscal responsibilities for Medicaid, are resisting. Subsidies for private insurance would be provided on a sliding scale, but the Senate bill is likely to be less generous than the House bill. And the desire to keep the cost of reform down has led to questions about whether insurance will really be affordable for those targeted for assistance.

Both proposals would revamp regulation of the individual and small-group insurance markets, with the House favoring a national insurance exchange and the Senate presumably supporting state exchanges in which at least those Americans receiving subsidies would have to purchase insurance. Carriers would offer a limited number of products standardized by actuarial value (a measure of the comprehensiveness of coverage), a step intended to increase competition by facilitating comparison and choice for consumers. Medical underwriting — denying coverage or varying the premium on the basis of the enrollee’s medical history — would be banned, and insurers would have to accept all applicants. Rates could vary with the enrollee’s age but only by a prescribed ratio that is less than the expected age-related variation in claims.

Individuals would be required to carry coverage. As compared with continuing the voluntary coverage system, mandating coverage will lead to an increased number of insured people — for any schedule of federal subsidies. But it is also essential to insurance-market reform. Without a mandate, many people would buy insurance only when they got sick, as they have in states that require insurers to sell to everyone at the same premium regardless of health status. Subsidies for low-income people will limit the magnitude of adverse selection, which will be influenced by the size of the subsidies — a factor that will also affect Congress’s willingness to support strong enforcement of the mandate. The House bill probably has larger subsidies and stronger mandate enforcement than those that will be included in whatever bill emerges from the Senate. Both chambers would require that employers over a certain size offer employees coverage and pay a portion of their premiums. The House bill would require employers who do not offer such an option to pay taxes amounting to as much as 8% of their payroll; the final Senate bill is expected to require much smaller payments.

Policies that are designed to improve the efficiency of care delivery are related to expanding coverage and reforming the insurance market mainly in the sense that if spending continues to increase much faster than incomes, declining affordability of insurance will undo much of the gain in coverage, and costs will exceed the fiscal capacity of government. Many observers believe that the delivery system is inefficient enough that spending growth can be slowed without sacrificing quality. But it will not be easy.

Provider-payment reform and changing the tax treatment of health insurance probably hold the greatest potential for slowing cost trends. Proposed payment reforms would affect only Medicare directly — but with the expectation that other payers would follow — and would consist primarily of piloting broader reforms that would introduce elements of capitation and payment per episode. How much of a difference such changes would make depends on the degree to which Congress grants authority and resources to the executive branch or an independent board to implement successful approaches more broadly. But even with full support, success will also depend on whether the ideas for payment reform turn out to be worthy.

The reform bills include provisions for advancing health information technology and supporting comparative-effectiveness research. Many experts believe that both efforts will improve the quality of care, but it is hard to predict whether the gains will be substantial and whether costs will rise or fall as a result. The reform proposals would also expand prevention efforts, but Congress now recognizes that even though prevention may improve health outcomes, it is unlikely to reduce costs.

To avoid increasing the federal deficit, both chambers rely on a combination of tax increases and reductions in the growth of Medicare spending and other cuts — reductions in the growth of payments for providers other than physicians and payment cuts to Medicare Advantage plans. Although some observers have criticized these reductions for diminishing Medicare benefits, a more important criticism is that in the absence of reform, these policies would probably have been enacted to address the budget deficit but will no longer be available for that purpose. The House has emphasized tax increases for high-income families, and the Senate has emphasized taxing health insurance plans costing more than $21,000 per year for family coverage. The Senate approach is likely to have a powerful effect on health care costs by inducing people to shift to less-comprehensive insurance.

If combined House–Senate reform legislation makes it to the President’s desk for signature, enactment would be only a start to the reform process. Regulations will need to be written, organizations (such as exchanges) will need to be built, and midcourse corrections will need to be legislated to deal with unforeseen consequences. And since only tentative steps will have been taken to reform care delivery, policymakers will inevitably have to return to battle on that front.

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By: Carrie Budoff Brown
November 11, 2009 06:26 PM EST

No independent group has taken a comprehensive look at how the legislation would impact premiums for the 170 million Americans who receive insurance through their employers. Photo: AP

Barack Obama ran for president on a promise of saving the typical family $2,500 a year in lower health care premiums.

But that was then.

No one in the White House is making such a pledge now.

It’s one of the most basic, kitchen-table questions of the entire reform debate: Would the sweeping $900 billion overhaul actually lower spiraling insurance premiums for everyone?

No one really knows.

And in fact, for all the ink spilled on the effects of health care reform, no independent group has taken a comprehensive look at how the legislation would impact premiums for the 170 million Americans who receive insurance through their employers – a population that would receive little direct financial assistance under the various congressional proposals.

For small businesses and individuals who purchase their own plans, economists remain sharply divided over the impact on premiums.

“This town continues to miss what is going to be the real issue,” Sen. Ron Wyden (D-Ore.) said. “The real lodestar, the thing people are focusing on at home, is all premiums, premiums, premiums. All you have right now is what the insurance industry has said.”

At a recent Senate health committee hearing, two health care rivals – Douglas Holtz-Eakin, an economic adviser to Sen. John McCain’s presidential campaign, and Jonathan Gruber, an economics professor whose work is cited often by the White House – agreed comprehensive, objective evidence wasn’t available for small and large businesses.

“It’s insane,” Holtz-Eakin said.

The lack of data prompted Sen. Evan Bayh (D-Ind.) to request a broad analysis from the nonpartisan Congressional Budget Office on premiums, which he said was “a basic, bottom-line question that we have to have answered before we can decide if this is an intelligent thing to do.”

Aides expect to see the report ahead the Senate floor debate on health care, which is causing anxiety among Democrats because of the uncertainty of what the famously cost-conservative CBO will produce. The possibility that congressional scorekeepers will conclude that premiums won’t flatten out or decrease would make centrists even more leery of reform, forcing adjustments to the bill just as Senate Majority Leader Harry Reid (D-Nev.) is already scrambling to meet a Christmas deadline.

Obama was the one who raised expectations of lower premiums. From one city to the next, and during the presidential debates, Obama made the pledge almost as often as he vowed to remove troops from Iraq: “We estimate we can cut the average family’s premium by about $2,500 per year.”

He has barely uttered it since taking office. The last recorded mention by Obama was in May, when he announced that six health industry groups agreed to lower the growth rate in health care spending by $2 trillion over 10 years, resulting in a savings of $2,500 per family “in the coming years.”

Campaign advisers sought to make Obama’s plan tangible to voters. But the $2,500 estimate was controversial, even among progressive health care economists. First, the figure represented not simply a family’s share of premiums, but also savings that would accrue for employers, Medicare and Medicaid. Second, experts did not expect the savings to materialize for many years.

David Cutler, a Harvard University economist who helped develop the estimate for the Obama campaign, said the savings are still achievable, but perhaps not for a decade. It depends almost entirely on whether Congress is strict about reducing the growth rate of health care spending in Medicare and Medicaid – and the private sector follows the government’s lead in wringing inefficiencies and waste out of the system.

“Far and away, what happens to premiums is dependent on whether you can bend the cost curve,” Cutler said.

And there are questions as to whether the bills even meet that goal.

Gruber, the favorite economist of the White House, said the bill “really doesn’t bend the cost curve.”

“But I think this bill starts us down the road to the point where we can do that,” Gruber said. “The alternative is doing nothing. Relative to doing nothing, I think we are a lot closer to bending the curve.”

Reminded that Obama demanded a bill that lowers health care spending, Gruber said: “That is what he would like to do. But he’s not doing it.”

In the health reform debate, Democrats face a public-relations challenge similar to the $787 billion economic stimulus package. In the face of rising unemployment, Obama has defended the stimulus as preventing even worse job losses than the country is now experiencing.

Similarly, progressive health policy experts say it will be so hard to reduce the cost of health insurance, they’d be thrilled if they could simply slow down the rapid rise in premiums.

If premiums are the benchmark by which reform is judged, “we are setting ourselves up to fail,” Gruber said. “Premiums will still go up, but they will go up less than they would” without the overhaul.

People who currently purchase insurance on the expensive individual market are most likely to see lower premiums, Gruber said. Small businesses could also see more manageable premiums, he said, because they would shop for plans in an exchange, which would offer the kind of bargaining power now available only to large employers. But those savings would vary widely based on the health of the firm’s workers, he added.

“Older, sicker, small firms will clearly win” since they pay the highest premiums under the current system, Gruber said. “Probably the healthy firms will lose a little bit. … The truth is I don’t think there will be a huge swing either way.”

Nancy-Ann DeParle, director of the White House Office of Health Reform, said the congressional scorekeepers came up with “pretty compelling results” that there will be savings for small businesses and people who purchase their own insurance. As for large employers, “we have every reason to believe there will be savings there,” she said.

“I think you could always use more data,” DeParle said, but added that “we have plenty of data on where things are and where things are headed without reform.”

Obama has said he wants a bill that does not add to the deficit over the first decade, and launches programs that reduce health care spending through the second 10 years of the overhaul. A set of Medicare pilot projects aim to change the way medicine is practiced by rewarding or penalizing health care providers based on outcomes. An independent Medicare cost commission would make judgments on how to make the program more efficient.

Over the long term, Democrats hope investments in health information technology, prevention and wellness programs, and administrative savings would reduce overall health care spending and lower premiums.

Critics of the Democratic approach say other elements of the bill would do more to jack up premiums.

It would take years to implement the cost savings, but billions in new taxes would be levied immediately on insurers, device manufacturers, and drug makers, which the CBO and the Joint Committee on Taxation has said would be passed onto consumers. In the absence of an enforceable mandate on individuals to purchase coverage, various market reforms would also cause a spike in costs, Holtz-Eakin said.

“The only question is how big this problem will be,” Holtz-Eakin said.

The issue has steadily crept to the forefront of the debate since the insurance industry released three reports over the last month warning about higher premiums. Democrats largely dismissed the analyses because of the source. But Republicans have seized upon the issue, making it central to their argument against the Democratic bills.

House Republicans released a bill last week that aimed to create a contrast with Democrats on that very point – and the CBO boosted the GOP case by saying their legislation would lower premiums, but leave 52 million people without coverage in 2019.

Lawmakers say they are hungry for data that assures them they are not voting for a bill that does the opposite what they have intended.

“I want to see an objective, third-party analysis from people who don’t have a conflict of interest,” said Sen. Kent Conrad (D-N.D.). “I like evidence.”

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WASHINGTON — Majority Leader Harry Reid is considering a plan for higher payroll taxes on the upper-income earners to help finance health care legislation he intends to introduce in the Senate in the next several days, numerous Democratic officials said Wednesday.

These officials said one of the options Reid has had under review would raise the payroll tax that goes to Medicare, but only on income above $250,000 a year. Current law sets the tax at 1.45 percent of income, an amount matched by employers.

It was not known how large an increase Reid, D-Nev., was considering, or whether it would also apply to a company’s portion of the tax. President Barack Obama has said he will not raise taxes on wage earners making less than $250,000.

The officials spoke only on condition of anonymity, saying they were not authorized to disclose details of private deliberations.

Reid’s spokesman, Jim Manley, declined comment and said the majority leader has made no final decisions and is awaiting detailed information from the Congressional Budget Office about the cost and coverage implications of the proposals he has drafted.

Reid sent his proposals to the CBO more than two weeks ago and recently took the first step on the Senate floor to begin a debate on health care as early as next week.

The House passed its version of the legislation late last week on a near party line vote of 220-215, a victory for Obama as well as his allies in Congress.

In general, the House-passed measure and the one Reid is expected to propose are designed to expand coverage to tens of millions of uninsured, eliminate insurance industry practices such as denying coverage on the basis of pre-existing medical conditions, and slow the overall rate of growth in health care spending nationally.

Reid has been merging bills cleared earlier by two separate committees but has a virtual free hand in the bill he crafts.

On one contentious issue, he has already said his measure will include an option for consumers to purchase health care from the government as a way to create competition with private companies. States could drop out of the system.

The House bill is significantly more generous in providing subsidies to help lower-income individuals and families afford coverage, and Reid is under pressure to find additional financing. Additionally, a Senate Finance Committee-approved proposal to tax very high-cost insurance policies has drawn criticism from organized labor, which wants it either modified or dropped altogether.

The House-passed legislation includes a surtax of 5.4 percent on income above $500,000 for individuals and $1 million for couples, a proposal that has drawn little if any backing in the Senate.

The House’s passage of a health care bill was marked by last-minute controversy over abortion, the result of far-reaching restrictions that foes of the procedure succeeded in inserting into the measure. No government-run insurance plan could cover abortions, except in cases of rape, incest or if the life of the mother were in danger. Nor could any health plan provide abortion coverage except for those three exceptions if any of its customers received federal subsidies.

Obama has called for changes to ease the restrictions, and it was not known what the impact of the House-passed bill would have on the Senate. Officials have said Reid was ready to propose that individuals receiving subsidies would be able to buy abortion coverage with their own funds.

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WASHINGTON – Senate Democrats are looking to former President Bill Clinton to jump-start their push to overhaul America’s health care system, hoping a battle-scarred veteran of past health care fights can motivate their ranks to finish the politically tricky job this time.

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Clinton, whose failed attempt to revamp the delivery of medical care contributed to the Republican takeover of the House and Senate in 1994, is scheduled to speak to Senate Democrats about health care legislation during their weekly caucus Tuesday.

Sen. Ben Cardin, D-Md., said the former president would “help energize our caucus” to push through a health overhaul that would reduce health care costs and make coverage more affordable while keeping the growth of the federal budget in check.

“President Clinton brings a lot of credibility to that debate,” said Cardin, who was a congressman when Clinton’s effort imploded.

“We’re in worse shape today” than lawmakers projected they would be more than 15 years ago if they failed to act, Cardin said.

President Barack Obama wants to sign the legislation into law by the end of the year. But abortion opponents in the Senate are seeking tough restrictions in the health care overhaul bill, a move that could roil a shaky Democratic effort.

Sen. Ben Nelson, D-Neb., said he could not support a bill unless it clearly prohibits federal money from going to pay for abortions. Nelson is weighing options, including offering an amendment similar to the one passed by the House this weekend.

“While there may be different views about abortion, I think there’s a strong majority against using federal dollars to fund abortions,” Nelson said Tuesday on NBC’s “Today.”

The House-passed restrictions were the price Speaker Nancy Pelosi, D-Calif., had to pay to get a health care bill passed, on a narrow 220-215 vote. But it’s prompted an angry backlash from liberals at the core of her party, and some are now threatening to vote against a final bill if the curbs stay in.

Obama said the legislation needs to find a balance.

“I want to make sure that the provision that emerges meets that test — that we are not in some way sneaking in funding for abortions, but, on the other hand, that we’re not restricting women’s insurance choices,” Obama said in an interview with ABC News.

Senate Democrats will need Nelson’s vote — and those of at least a half-dozen other abortion opponents in their caucus. They face a grueling debate against Republicans who are unified in their opposition to a sweeping remake of the health care system. It’s unclear how the abortion opponents would line up; the pressure on them will intensify once the legislation is on the floor.

An intraparty fight over abortion is the last thing Majority Leader Harry Reid needs. Reid, D-Nev., is already facing a revolt among Democratic moderates over the government-sponsored health plan that liberals want to incorporate in the legislation as a competitor to private insurance companies.

Reid, who is himself opposed to abortion, will have to confront the issue directly as he puts together a Democratic bill for floor consideration. The committee-passed Senate versions differ on abortion, but none would go as far as the restrictive amendment passed by the House.

The House bill would bar the new government insurance plan from covering abortions, except in cases or rape, incest or the life of the mother being in danger. That’s the basic rule currently in federal law.

It would also prohibit health plans that receive federal subsidies in a new insurance marketplace from offering abortion coverage. Insurers, however, could sell separate coverage for abortion, which individuals would have to purchase entirely with their own money.

At issue is a profound disagreement over how current federal restrictions on abortion funding should apply to what would be a new stream of federal funding to help the uninsured gain coverage.

Cardin called the House’s approach “regrettable,” and said he would prefer health legislation that did not include it.

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HOUSTON (AP) — The American Medical Association on Monday rebuffed dissident members and voted to stick with support for ongoing health reform efforts, while reiterating wariness over proposals that threaten doctors’ pocketbooks and independence.

The action at the group’s semiannual meeting in Houston could be seen as a vote of confidence for AMA leaders who voiced support for the $1.2-trillion, 10-year bill the U.S. House passed Saturday.

Several dissident doctor organizations within the AMA had urged the group to reverse its position and come out with a strong statement opposing Democrat-led reform efforts. Some urged the AMA’s 544-member House of Delegates to vote to oppose any health overhaul that includes a public insurance option and Medicare payment cuts to doctors, and that excludes tort reform.

Discussions about the proposed resolutions spurred a lengthy debate Sunday that went on for more than eight hours.

However, during a two-hour discussion Monday, delegates – physician members who set AMA policy – voted instead to follow the more moderate path chosen by AMA’s leaders including its president, Dr. James Rohack. Delegates adopted a health reform statement similar to one approved at their annual meeting in June, after President Barack Obama came to Chicago to seek AMA approval for his health reform agenda.

“The message is that the House of Delegates met, and in a very democratic process, voted to support the AMA continuing to work with Congress for a reform of the health care system to make it better for patients and the physicians who take care of them,” said the AMA’s President-elect Cecil Wilson.

The measures adopted Monday say AMA will support health overhaul that is consistent with AMA policies, including freedom to choose health insurance and universal access for patients. Any health insurance options should not require physicians to participate, or restrict patients’ access to out-of-network doctors, the measure says.

The measures also say reform must include a Medicare physician payment system that keeps pace with the costs of running a medical practice. One resolution spelled out the group’s opposition to cuts in Medicare payments.

One of the most spirited debates Monday came while discussing a proposed resolution calling for the AMA to actively oppose “any new public health insurance option, which is defined as a federal government backed and/or funded insurance plan.”

“My strong concern is that a public option as defined in the resolve would become the only option for patients,” said Michael Greene, a representative of the Georgia delegation who introduced the resolution.

Lori Heim, president of the American Academy of Family Physicians, was one of several speakers opposing the resolution. “Despite dire predictions of what may occur, we don’t know that. There may be a public insurance option that provides the criteria we are looking for,” Heim said. “It’s important to keep our options open, to keep the discussion going.”

The resolution was voted down by a 315-199 margin, and the AMA’s position – neither opposing nor supporting any specific public option – stayed unchanged.

Another resolution stating that the AMA should oppose the just-passed House bill also was soundly defeated by a 350-167 vote, again showing delegate support for a previously-stated AMA stand. Last week, the organization expressed support for the bill, but did not give a full endorsement saying the bill was not a perfect fit.

“I would much have preferred to come out strongly against a public option, but I think we also made positive changes,” Greene said following the vote.

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