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President Signs Health and Student Aid Reconciliation Bill

Yesterday, President Obama signed a bill of “fixes,” worked out between the House and Senate, to the health insurance reform bill that was signed into law last week. The changes, advanced as part of a budget reconciliation package, included the much anticipated overhaul of the federal student loan programs.

The March Federal Report, provided on the right-side user bar of this website, provides coverage of the health insurance and student aid legislation.

President Signs Historic Health Insurance Overhaul Into Law

**UPDATE: The Federal Report, provided on the right-side user bar of this website, provides greater coverage of the health insurance and student aid legislation.

After more than a year of debate, on Sunday March 21st, the  House of Representatives voted 219-212 to approve the Senate’s health insurance reform package, which passed that body in December.  Additionally, the House passed by a 220-211 vote a reconciliation bill that contained a set of desired fixes to the Senate bill and an overhaul of the federal student loans programs.  Yesterday, in a ceremony at the White House, President Obama signed the underlying health insurance bill into law. The reconciliation package is now being considered in the Senate, where passage is virtually assured, given that only a simple majority is needed to send the legislation to the President. 

Health Insurance Provisions of Note from Underlying Reform and Reconciliation Bills
Extension of Coverage

  • Overall, the underlying bill and reconciliation fixes will extend health insurance coverage to 32 million people, 95% of legal residents and 92% of all U.S. residents. The Congressional Budget Office estimates that the legislation will cost $940 billion over 10 years.
  • Creates state-based exchanges where individuals without employer-provided insurance could purchase health care coverage. Federal subsidies would be available to help cover the cost for individuals who earn between 133 percent and 400 percent of the federal poverty level ($24,352 to $73,240 for a family of three in 2010).
  • Individuals who earn enough to pay income taxes would pay a penalty of either $325 or 2 percent of their income, whichever is higher, in 2015 if they failed to purchase health insurance.

Graduate Medical Education

  • Increases the number of Graduate Medical Education (GME) training positions by redistributing currently unused slots, with priority given to primary care and general surgery and to states with the lowest resident physician-to-population ratios.
  • Increases the flexibility in laws and regulations that govern GME funding to promote training in outpatient settings and ensure the availability of residency programs in rural and underserved areas.
  • Supports training of health professionals through scholarships and loans; supports primary care training and capacity building; provides state grants to providers in medically underserved areas; train and recruit providers to serve in rural areas; establishes a public health workforce loan repayment program; provides medical residents with training in preventive medicine and public health; promotes training of a diverse workforce; and promote cultural competence training of health care professionals. (Effective dates vary) Support the development of interdisciplinary mental and behavioral health training.

Medicare/Spending Offsets

  • Reduces the amount of the Medicare cut from $24.4 billion to $21.4 billion and the Medicaid cut from $18.5 billion to $14.1 billion. However, both reductions would begin in 2014 instead of the original start date of 2015.
  • Increases the Medicare payroll tax for individuals making more than $200,000 and couples making more than $250,000 and impose an additional 3.8% surtax on investment income.
  • Provides a $250 rebate to seniors who reach a gap in Medicare prescription drug coverage known as the “doughnut hole,” starting in 2010. The doughnut hole would be phased out by 2020.
  • Imposes fines on employers of 50 or more full-time workers if the employer does not provide health insurance coverage. Fines would have to be paid if one or more workers obtains federal subsidies for insurance, at a rate of $2,000 for every worker beyond the first 30 employees.
  • Advances Medicare disproportionate share hospital (DSH) cuts to begin in fiscal year 2014 but lowers the ten-year reduction by $3 billion.

Student Aid Provisions of Note from Reconciliation Bill
Pell Grant

  • The maximum Pell award would increase annually (starting in academic year 2013-14) from the current level of $5,550.  The annual increase would be at the rate of the Consumer Price Index (CPI). The maximum would reach its peak in 2017-2018 and level off for the remainder of the life of the legislation.
  • The legislation would allocate $13.5 billion for the shortfall in the program.  The funds would be available through the end of FY2012.

Student Loan Program Changes

  • The Federal Family Education Loan (FFEL) Program would be terminated on July 1, 2010.  All new loans after that date would be originated through the Direct Loan (DL) program.
  • Borrowers would be allowed to consolidate into DL.
  • “Not-for-profit servicers,” including state entities, would be allowed to service loans, if they had contracts before July, 2009.
  • $50 million for the Department of Education to provide technical assistance to institutions making the switch to DL.
  • Income-based repayment (IBR):  Effective July, 1, 2014, repayments would be capped at ten percent of adjusted gross income (AGI) (currently capped at 15 percent) and the balance of the loan would be cancelled after 20 years (currently cancelled after 25 years).
  • State-owned banks:  State-owned banks would qualify as a government entity for the purposes of originating student loans.

College Access Challenge Grants

  • Created by the most recent higher education reauthorization bill, the program would receive $750 million over five years (FY2010 – FY2014) under this legislation.  Each state would be guaranteed at least one percent of the funding.

Community Colleges

  • Through a Trade Adjustment Act program administered by the Labor Department, community colleges would receive $500 million annually for four years, with 0.5 percent guaranteed for each state.

Health Insurance/Student Aid Reconciliation Package Released

Shortly after receipt of a Cognressional Budget Office (CBO) score that found that the health insurance and student aid overhauls would reduce the deficit by roughly $138 billion over the next years ($1.2 trillion over the next 10 years), the Democratic leadership in Congress posted the details of the bill on-line -as they had promised to do 72 hours prior to a vote. The move sets-up a potential vote this Sunday. Efforts have now intensified to find the 216 votes in the House and 50 votes needed in the Senate to finish work on the package. Analysis of the reconciliation package will be posted shortly on this website. In the interim, the full bill can be accessed here.

Health Insurance and Student Aid Overhauls Likely Headed for Reconciliation

Yesterday, during a speech at the White House, President Obama called on Congress to give health care reform an up or down vote before the Easter congressional recess -beginning March 29th. The message seemed to make clear that the President, along with Speaker Pelosi and Majority Leader Reid, intend to pursue passage of health insurance reform through the budget reconciliation process. The process forward would have the House pass the Senate’s version of health reform without changes, sending the legislation to the President for signature. Changes to the Senate’s bill would be done through a separate piece of legislation advanced through the budget reconciliation process, avoiding a filibuster, as only a simple majority vote is required.

House and Senate Democratic leaders are working to finalize a reconciliation bill as early as this week. The reconciliation bill would then need to be scored by the Congressional Budget Office (CBO). As the reconciliation bill is scored by CBO, Democratic leaders will be working with members of their own caucus to gain consensus on a variety of health care issues and working with the Senate Parliamentarian to figure out which provisions can be included in the reconciliation bill since Senate rules prohibit “extraneous matters” from consideration. The reconciliation bill is seen as key to coaxing some House Democrats to vote in favor of the Senate’s bill, which is opposed by some liberal and conservative Democrats.

Since the Congress can only do one reconciliation bill for fiscal year 2010, the Student Aid and Fiscal Responsibility Act (SAFRA) would have to advance along with healthcare, be passed through the normal legislative process, or be deferred until a future date. At present, the votes do not exist in the Senate to advance SAFRA through the normal legislative process. As a result, if it is to happen this year, the reconciliation process is the only possible vehicle. The Senate has yet to reveal its own version of SAFRA. However, the legislation is likely to emerge in the next few weeks, and move rapidly in order to meet the Easter deadline set by the President.

Pell grant recipients interested in providing a testimonial to the Senate on the program’s impact are invited to contact Jonathan Nurse (jnurse@uw.edu).

President Obama’s Health Insurance Reform Plan (Updated 2/22)

FY11 Budget Overview

Despite an overall spending freeze proposal from the Obama administration, the student aid and research priorities of the higher education community faired relatively well in the President’s Budget Request for FY11. Within the Department of Education, the PBR seeks to increase the maximum Pell grant to $5,710 in FY11 from the current $5,550 level. More importantly, the proposal would make the Pell grant an entitlement, which would guarantee future increases. However, several of the agency’s student services programs (e.g. TRIO, GEAR UP, Graduate Assistance in Areas of National Need) were level funded in the proposal.

On the research side, the National Institutes of Health were provided an increase of $1 billion (3.2%) over FY10 in the FY11 PBR -representing the largest NIH dollar increase in 8 years (outside of the Recovery Act). Additionally, the National Science Foundation (NSF) is provided an 8% increase to $7.4 billion. Within NSF, the Ocean Observatories Initiative — a UW joint project — was provided $90.7 million for FY11 -as expected. The Department of Energy, Office of Science, is provided a 4.4% increase in the PBR. Within DoE, the Advanced Research Projects Agency -Energy (ARPA-E) is slated for its first significant regular annual appropriation -at a level of $300 million. Additionally, workforce investments for scientists and teachers is identified as a priority area for the agency.

The PBR includes an extension of an additional six months, through June 2011, the temporary Federal Medical Assistance Percentage (FMAP) increase provided by the Recovery Act. The extension will result in an additional $25.5 billion to States for maintaining support for children and families helped by Medicaid. Details on agency and program line items are provided in previous posts, and additional analysis will be provided by the Office of Federal Relations.

The UW FY11 Federal Agenda will express support for many of the increases in student aid and research contained in the PBR. Additionally, UW specific requests will be made in the following areas: tidal energy research and development; promoting health professions through dental, nursing, and physicians assistant programs; environmental sustainability; increasing student services for our returning veterans; emerging research on the treatment of battlefield injuries to eyes and bone; small business development in the Tacoma area; and increasing K-12 learning outcomes through the use of advanced technology in classrooms.

The FY11 appropriations process will play out in the halls of Congress over much of this calendar year, with the goal of having a final budget in place by October 1, 2010. However, as was the case last year, Congress often requires extra time to push spending bills across the finish line.