The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Two Unrelated Health Care Reform Items

Posted by Alan on December 14, 2010

Two items of interest concerning health care reform: one concerning repeal of an unpopular provision of the Patient Protection and Affordable Care Act; the other a bi-partisan effort to allow states to opt-out of some of the health care reform law’s provisions.


First, a quick update on the inevitable repeal of the Patient Protection and Affordable Care Act’s requirement that businesses issue a 1099 when they pay any vendor or contractor more than $600 for goods or services. The update: it’s still inevitable.

Virtually everyone agrees this part of the new health care reform bill needs to be repealed or, at the very least, greatly revised. President Barack Obama wants to lift this burdensome paperwork. 61 Senators have voted to repeal it. A majority of the House wants to repeal it. The Senate tried twice to repeal the PPACA’s 1099 provision in late-November. But the provision has yet to be repealed.

Just this week Democrats tried to repeal this tax reporting requirement by attaching it to the legislation the Senate is considering to extend the tax cuts about to to expire. Politico reports Republicans squashed the move because the deal ““wasn’t part of the original [compromise] framework, and nobody involved in the negotiations allowed any add-ons.” Apparently exceptions to the “no add-ons” rule are not allowed even by nearly unanimous consent.

There’s plenty of time to repeal the 1099 requirement as it doesn’t take effect until 2012. It’s inevitable repeal remains inevitable. That it’s taking this long says more about Congress than the policy underlying the 1099 provision. But even a broken clock is right twice a day. Eventually Congress will get the job done, even against its natural tendency not to.


Senator Ron Wyden is clever. He inserted a little noticed or discussed provision into the Patient Protection and Affordable Care Act that has the potential to, as The Hill’s Healthwatch blog put it “take the partisan venom out of the healthcare reform debate.

As reported by Healthwatch, Senator Wyden’s amendment allows states to seek waivers from various parts of the law, including, for example, the requirement that everyone obtain health care coverage.

Currently, this state waiver provision doesn’t take effect until 2017. However, Senator Wyden, a Democrat, has joined with Republican Senator Scott Brown to seek these waivers in 2014 which is, not coincidentally, when some of the most controversial elements of the PPACA take effect (think exchanges, guarantee issue, and the individual mandate to name a few items).

State’s can’t just choose not play in the PPACA sandbox because, well, they simply don’t want to play (sorry Governor Perry).  States seeking a waiver need to demonstrate that their own health care reforms will accomplish the same results as are expected to come from the federal reforms in terms of the number of people covered, affordability and comprehensiveness. Some might call this a “put up or shut up” requirement; others consider it a deal killer. Regardless of the interpretation, as The Hill quotes Len Nichols, a George Mason University professor of health policy as observing, “It really is a clever way to force an adult conversation. It brings the conversation to the level where the state has to consider its options.” In any event, it at least creates the potential for states to go their own way in making health care coverage more affordable and available.

The legislation by Senators Wyden and Brown is the first bipartisan effort to revise the PPACA since the midterm elections. Given split control of Congress (Republicans in command of the House; Democrats with a majority in the Senate) bi-partisanship will be required to make any changes to health care reform.

This might seem to completely undermine the potential


3 Responses to “Two Unrelated Health Care Reform Items”

  1. vince phillips said

    Re the Wyden/Brown waiver idea, it may be an adult conversation but it’s the same conversation. Does anyone truly think HHS will grant a state waiver for anything less than a state exchange complete with state versus federal mandates. By coincidence, the state mandates will look almost exactly like PPACA. This is sleight of hand, not a real state choice. This conversation, like the supposedly non-adult conversation, pits those who want a governmental takeover with a sorely diminished private sector versus those who recognize that PPACA does not address medical costs while it adds to what people pay either directly or through taxpayer subsidies.

    I am frankly amazed that Alan would paint Wyden/Brown with such optimistic colors. A brown turkey versus a blue turkey does not change the fact that it is still a turkey.

    • Alan said

      Thanks for the comment Vince. I wasn’t meaning to imply that the state waiver legislation in and of itself was cause for jubilation. What did intrigue me is that the legislation was co-sponsored by a Democrat and a Republican. I found that interesting, especially when juxtaposed against the other item discussed in that post: the inability of Congress to repeal the 1099 requirements contained in the PPACA even though a super-majority of Senators want to do so. It’s like finding an acorn in the aftermath of a forest fire — a glimmer of hope that things don’t always have to be the way they are.

  2. As a freelance business writer (with a broker’s license and health care specialty -in case you’re wondering why I’m lurking about) :-), I pray the inevitable repeal of the 1099 requirement comes to fruition.

    Can you imagine me sending a 1099 to Office Depot, et al? BTW-love your blog and was glad to see you pop up again in my RSS feed.

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