Mayor-Elect Gray Appointments to Date & Inaguration/Swearing In Ceremony

See attached. Also note that on Sunday, January 2nd the District of Columbia will hold a swearing-in ceremony for the Members of the Council, Chairman-elect Kwame Brown, as well as the inauguration of Mayor-elect Vince Gray.

Inauguration of the Mayor and Swearing-in of the DC Council

Sunday, January 2nd

10AM (Doors open at 9AM)

Walter E. Washington Convention Center

Ballroom A/B

Happy New Year to all of you and your families!

Kevin Wrege

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Gray Appointments as of 12.31.10.xls

Washington Post: Examining the Fenty Record

Fenty’s record, from schools to safety

Saturday, December 25, 2010; 5:40 PM

Population

Long-standing demographic trends continued unabated during the last four years as the city gained affluent, educated and white residents and lost African Americans.

The District ended the decade with the city on the cusp of losing its status as a majority black city, though African Americans will remain the single largest group for many years to come.

Annual census estimates between 2006, the year before Mayor Adrian M. Fenty took office, and the 2010 Census show a city that grew despite the recession that hit some residents especially hard and ushered in program cuts.

In 2006, Washington had 582,000 residents who were 56 percent black, 35 percent white and 8 percent Hispanic. This year, the city surpassed 600,000 for the first time in two decades. Its residents were 53 percent black, 39 percent white and 9 percent Hispanic.

Median household incomes rose from under $52,000 in 2006 to over $59,000 in 2009, the last year for which figures are available. More residents held college degrees. Every age group older than 25 grew in size, particularly the generation aged 25 to 34, and empty nesters in their early 60s.

The changes contributed to a drop in the overall poverty rate, from 20 percent to 18 percent. But poverty among black children soared during the recession, from 31 percent in 2007 – below the national average – to 43 percent in 2009, well above the national average.

Some say the changes were driven by forces outside Fenty’s control, like the return-to-the-city movement and a recession that took a harsh toll on those workers with high school degrees or less.

"Some call it gentrification, some call it displacement," said Benjamin Orr, an analyst with the Brookings Institution. "The increased income of District residents has forced prices up, particularly housing costs. And that has pushed lower-income residents out. That effect has been disproportionately felt by African Americans in the District."

But Ed Lazere of the D.C. Fiscal Policy Institute said the administration did not focus on affordable housing and improving literacy among adults.

"No doubt the recession made it harder," he said. "But there wasn’t a lot of proactive response to address the trends."

- Carol Morello

Education

Adrian M. Fenty announced the game-changing decision of his mayoralty June 12, 2007, just hours after he assumed control of the District’s public school system. He stunned the city by introducing the little-known head of a New York educational non-profit as D.C’s first chancellor.

Standardized test scores grew double-digits on the three-year Fenty-Michelle A. Rhee watch, including an average of nearly 16 points at the secondary level. But elementary scores dipped after two years of similar gains. And an analysis by ward shows that the gulf in achievement between the city’s poorest children and its most affluent remains wide. Enrollment began to edge upward after decades of decline, although it’s not clear whether the system is actually capturing a larger proportion of school-age children or merely benefiting from mini-baby booms in some neighborhoods.

Fenty and Rhee shrank the oversized system from 150 schools to 123, shuttering those with low enrollment. A top-heavy central office bureaucracy dropped from 900 to fewer than 600. With Fenty’s blessing, Rhee turned over more than half of the city’s 4,200-member teaching corps, seeding it with graduates of alternative training programs such as Teach for America, where she and Interim Chancellor Kaya Henderson began their careers.

But Fenty may have placed his most enduring contribution to education in motion as the Ward 4 D.C. council member. In 2006, he led the passage of bill to set aside $1 billion in city sales tax revenue to rebuild the system’s crumbling buildings. A new agency created by the mayoral control legislation, the Office of Public Education Facilities Management, spent $500 million to modernize 23 schools. The new Hardy and Deal middle schools and Eastern and Phelps high schools, have drawn acclaim from students and parents.

Fenty recently presided over the announcement of the winning design for the new Dunbar Senior High School that is scheduled to break ground soon.

"The biggest thing happened before he became mayor," said D.C. State School Board president Ted Trabue. "It was one of the landmark pieces of legislation."

- Bill Turque

Spending

During his 2006 mayoral campaign, Adrian M. Fenty stumbled at a forum when he could not name Wall Street’s three bond-rating agencies. His opponents and critics pounced. How could voters replace Mayor Anthony A. Williams – the District’s former chief financial officer – with someone who knew so little about government finances?

The stumble didn’t stop him from getting elected. And four years later, he points to four balanced budgets, though some council members and other questioned how he did it.

Limited by a campaign promise that he would not propose new taxes and impacted by the national recession, Fenty and his administration shrank government and increased fees to fill budget gaps.

The most talked-about increases were on parking meters, rising from as low as 75 cents an hour to a maximum $2 an hour during his term. Drivers also had to pay on Saturdays and until 10 p.m. in some areas. The Fenty administration noted that District’s prices were just catching up with other big cities, like New York, but the D.C. Council refused Fenty’s proposal earlier this year to squeeze $3 an hour out of some meters.

But Fenty’s fees and council-sponsored tax increases on cigarettes, sales and gas were not enough to keep the nearly $9 billion government running. During the September Democratic primary, Mayor-elect Vincent C. Gray effectively attacked Fenty’s decision to dip into the city’s $1.5 billion in reserves (from Williams’s term). In fiscal 2011, the reserves have dwindled down to $654 million.

The city’s outstanding debt rose $7.1 billion in fiscal 2010 from $5.9 billion in fiscal 2007. The debt cap also increased to 10.4 percent from 9.1 percent.

Though the Fenty administration was using the rainy day fund to soften the blow of deficits, the administration also tapped it during the high-profile, $31 million cost overrun of the Summer Youth Employment Program in 2008.

"Overall, he gets good marks," said Council member Jack Evans (D-Ward 2). "The major criticism is the spending down of the reserves."

- Nikita Stewart

Quality of life

Spurred on by Mayor Adrian M. Fenty’s "get-it-done-now" leadership style, the District has built 10 new community parks, modernized 10 recreational centers, rebuilt 23 schools, added 25 playgrounds and constructed or refurbished eight new libraries.

Although many of the projects were conceived under former mayor Anthony A. Williams, Fenty pushed some neighborhood amenities to completion, such as premier turf athletic fields, the Wilson Aquatic Center in Tenleytown and the Deanwood Recreation Center in Northeast.

He invested heavily in giving residents alternatives for getting around the city, including the construction of more than 25 miles of bicycle lanes, the expansion of the Circulator bus service and pushing along the proposed street car line on H Street Northeast.

But Fenty’s efforts to give District residents what referred to as "the best" came at a cost. After borrowing hundreds of millions of dollars to pay for capital improvements, the city is on course to exceed its self-imposed debt limit of 12 percent of total expenditures by 2015, according to the Office of the Chief Financial Officer.

A Washington Post analysis found that Fenty appeared to spread the wealth equitably across the city’s eight wards. But he was dogged by criticism that he didn’t do enough to boost the quality of life of residents in the poorest neighborhoods.

Despite the national recession, the city has added 4,866 new apartment units and 5,676 condominiums since Fenty took office, according to Delta Associates, an Alexandria-based real estate and economic research firm. Ten new or refurbished grocery stores have opened, including a new Giant and Yes! Organic in Ward 8. And there are now more than 100 city businesses that serve beer, wine and spirits than there were in 2006.

In July, Kiplinger’s Personal Finance Magazine named the District the nation’s third best city, saying it’s "chock-full of job prospects, entertainment venues and great neighborhoods."

"Quite frankly, there is a buzz about the city and the region, that is very real, and it’s a good buzz," said Matt Erskine, executive director of the Greater Washington Initiative.

- Tim Craig

Health

The District has by many measures made great strides during Mayor Adrian M. Fenty’s term in trying to stem the spread of HIV and AIDS. More residents are getting tested and receiving free condoms and antiretroviral drugs. Fewer people are dying from AIDS, and fewer babies are born with HIV now than in the years before Fenty took office, according to statistics from the Department of Health.

The District’s ranking in an annual "report card" on the illness by the non-profit public policy group, D.C. Appleseed, has steadily improved under Fenty’s leadership.

The mayor gets credit for appointing highly regarded professionals such as Shannon L. Hader, the former head of the HIV/AIDS Administration – an agency that had a long history of failures before her arrival in 2007.

Despite the District’s epidemic infection rate, Appleseed’s executive director Walter Smith said the city is headed in the right direction in combating the virus. His organization was critical of Fenty, however, for not speaking out more forcefully from the bully pulpit to encourage residents to change risky behaviors.

When it comes to providing health insurance, the District has the second-highest rate of coverage for residents in the nation behind Massachusetts. Only 3.2 percent of the city’s children are uninsured – the lowest rate among children nationally.

But independent reports have shown that health care coverage has not necessarily translated into access to primary care. A study released last year by the RAND Corporation found that one in four District children covered by publicly funded insurance received care at least once in a year in an emergency room. The study also found troubling health indicators among the city’s children, such as asthma and obesity.

D.C. Council member David Catania (I-At Large), who chairs the Health Committee, said Fenty deserves more credit for the city’s multi-million investment in keeping open United Medical Center, the District’s only hospital east of the Anacostia River.

"Most people don’t see it because he hasn’t really messaged his commitment to the underserved," said Catania. "But the commitment and the resources are there even in these difficult times."

- Ann E. Marimow

Economic development

The city that Adrian M. Fenty took over in 2007, was in the throes of an economic boom, one fueled by escalating real-estate values and easy financing for development projects. The city he leaves next month is amid a much different climate, one that has not only slowed business investment but also widened the city’s economic divides.

His legacy is closely bound to the economic downturn and his efforts to mitigate it.

By the city’s traditional benchmark of economic progress – real-estate deals – Fenty managed to keep development from grinding to a halt amid a dramatic credit crunch. Early in his term, Fenty’s team took advantage of the takeover of two formerly independent development authorities to quickly push deals involving public land – too quickly, some contended.

An early push to embark on a massive redevelopment of Ward 8′s Poplar Point, for instance, stalled when private investors thought the area ready for development. But Fenty presided over a groundbreaking for the long-delayed anchor hotel for the Washington Convention Center. Meanwhile, his efforts kept several large-scale projects – including redevelopments of the former D.C. General Hospital campus, the former convention center site, and the Southwest waterfront – are poised to move forward once markets improve.

But Fenty, like mayors before him, was not able to fully shift the city’s economic efforts from its traditional real-estate focus to a more holistic strategy. To Fenty’s political peril, unemployment soared among District residents even while the city’s economy added jobs by the thousands. Fenty betrayed little interest in tackling the problem of adult unemployment, spending the bulk of the city’s jobs budget on the politically popular Summer Youth Employment Program.

Fenty also found his housing policy frustrated by the economic downturn. Early in his term, the city financed thousands of affordable units through funding from taxes on real-estate transactions. But after the markets declined, so did affordable housing production. And as city budgets shrunk, Fenty put fewer resources into housing programs, such as rent supplements and assistance to tenant purchases, preferring to preserve education and public safety spending.

- Mike DeBonis

Public safety

Mayor Adrian M. Fenty appointed a police chief who is well liked and who has overseen a dramatic decrease in crime, most notably a 20 percent drop in homicides over the past four years (this is subject to change, depending on how the rest of the year plays out).

"There has been a steady decrease in crime, there haven’t been a lot of curveballs," said Chuck Wexler, chief executive of the Washington-based Police Executive Research Forum. "That means something in this city."

In addition to killings, other gun crimes and violence have also decreased in the past four years.

The crime-fighting strategy of Fenty and Chief Cathy L. Lanier has been to strengthen ties in city neighborhoods so detectives can get information quickly to make arrests. The homicide closure rate is 74 percent – higher than the national average.

Under Fenty, the police department has increased the number of crime surveillance cameras across the city, extended the reach of gunshot sensor-recognition technology, computerized police reports and upgraded squad cars with laptops.

However, Fenty has been criticized for being too involved in police matters.

When 14-year-old DeOnte Rawlings was killed after a confrontation with two off-duty officers in September 2007, it was Fenty who was in charge of the daily updates to the public. He also helped pay for Rawlings’s funeral, which outraged rank-and-file officers, who had said Rawlings fired first at the officers and that the city had no business extending financial help for his burial.

Fenty, Lanier and Attorney General Peter J. Nickles came up with the controversial military-style checkpoints in the troubled Trinidad neighborhood after seven men were killed in a nine-hour span, mostly in Trinidad. Residents had to show identification to get past police blockades, prompting strong backlash and several court hearings. The checkpoints were eventually declared illegal.

- Allison Klein

Kevin Wrege

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

National Underwriter: Exchanges and Marketing Challenges 

Exchanges May Face Marketing Challenges

By ALLISON BELL

Published 12/16/2010

About a third of the uninsured people who might be eligible to buy subsidized coverage through a health insurance exchange in 2014 have had no recent health or care access problems, researchers say.

The researchers, at the Center for Studying Health System Change (CSHSC), Washington, come to that conclusion in a paper based on a 2007 coverage survey of about 18,000 U.S. adults, including 4,500 people ages 19 to 64 with family incomes between 138% and 400% of the federal poverty level, and a second survey, on attitudes, conducted from 2005 to 2007.

The second survey sample includes 20,000 adults ages 19 to 64 with family incomes between 138% and 400% of the federal poverty level, and about 3,250 of those people are uninsured with no access to employer-sponsored group health coverage, the researchers say.

About 25% of the uninsured participants with incomes between 300% and 400% of the poverty level and 38% of the uninsured participants with incomes between 200% and 300% of poverty level said they have had no recent problems with their health, medical bills or access to health care, and about 31% of uninsured adults ages 27 to 39 said they have had no recent problems with health, medical bills or access to care.

The Affordable Care Act, the federal legislative package that includes the Patient Protection and Affordable Care Act (PPACA), includes provisions that will require states to create a system of state-based health insurance exchanges in 2014. The exchanges are supposed to help individuals and small groups buy standardized, federally subsidized health insurance packages that meet exchange program quality standards.

Some fear that younger, healthier uninsured people with moderately high incomes, will get smaller subsidies because they are closer than other moderate-income people to earning 400% of the federal poverty level, will avoid buying coverage through the exchange system.

But 50% of the uninsured, moderate-income survey participants with no health, medical bill or care access problems described themselves as “risk averse,” rather than as “risk takers,” and that might be a sign that many of those people will be willing to buy coverage through an exchange system, the researchers say.

A majority of uninsured, moderate-income adults ages 26 to 39 believe having coverage is important, the researchers add.

About 55% of the participants in that category said they disagreed with the statement that, “I’m healthy enough that I don’t need health insurance,” and 38% disagreed with the statement that, “Health insurance is not worth the money it costs.”

But persuading healthy, moderately high-income people to pay for coverage may still be harder than enrolling low-income people in Medicaid or other free and highly subsidized health coverage programs aimed at poor people, the researchers say.

“Designating defined open-enrollment periods in the exchanges will help reduce the adverse selection created when people can wait to enroll until they need care,” the researchers say. “Continuous open enrollment has been cited as a contributor to adverse selection in the combined small and nongroup health insurance market in Massachusetts.”

PPACA will require the exchanges to provide an initial open-enrollment period, along with annual and special open-enrollment periods, but the timing and length of the enrollment periods still must be determined through regulation, the researchers say.

“Efforts to educate the public about the exchanges during open-enrollment periods should stress not only the financial penalties associated with the individual mandate, but also the much greater access to medical care that comes with insurance coverage and the personal financial risk of going without coverage if they incur unexpected medical costs,” the researchers say.

MD Exchange Early Innovators App

Md. health secretary urges action on health care

Dec 17, 2010

By The Associated Press

ANNAPOLIS, Md. (AP) — Maryland lawmakers should set up the basic framework for a health benefit exchange required under a new federal law during the 2011 legislative session, the state’s secretary of health and mental hygiene told a health care reform council Friday.

If legislators act promptly, Secretary John Colmers said, the state will improve its odds of receiving certain federal funding available for "early innovators" and make it easier to hire an executive director for the program.

Colmers said the state could delay decisions on more controversial items such as whether all insurance carriers will be able to participate in the exchange.

"A lot of the decisions can’t be made this year, we don’t have enough information," Colmers said during a meeting of the Health Care Reform Coordinating Council. The panel was appointed by Gov. Martin O’Malley last spring and is studying how the new federal health care reform law will affect Maryland. Council members have held public meetings around the state to collect input from residents about how Maryland should implement health care reform.

Staffers advising the panel are recommending the initial benefit exchange be a public entity to ensure accountability and transparency, since government organizations are required to hold open meetings and provide access to financial records. They note that the exchange could possibly be turned over to a nonprofit organization several years down the road, depending on how the program evolves, but Colmers said he was not aware of any interested groups at this time.

The major elements of federal health care reform become effective in 2014, but Lt. Gov. Anthony Brown, who co-chairs the state reform council with Colmers, urged immediate action on exploring how financial incentives could be used to address racial and ethnic disparities in areas such as infant mortality.

"There is some data we already know, " Brown said. "Where we do have data, we have to act on it today."

Brown also stressed that the state should pinpoint an agency to lead the reform efforts and that would likely report to the governor.

"You need an individual that can provide directions or offer instructions," Brown said.

Maryland has roughly 700,000 to 800,000 uninsured residents at this time, according to state health department estimates. Once the federal reform law is fully implemented, that number will likely be cut in half, according to a report issued by the council over the summer. The federal law won’t help all uninsured residents because it doesn’t apply to people who aren’t citizens and not everyone who is eligible for Medicaid applies for it.

Copyright © 2010 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

®2010 BLOOMBERG L.P. ALL RIGHTS RESERVED.

Kevin Wrege

Founder & President

Pulse Issues & Advocacy LLC

kwrege

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Politico: State Assess Exchange Costs/5 States to be Named “Early Innovators”

The 5 states referenced below are rumored to include MA (and possibly other NE states exploring a potential regional exchange), MD, WI, and OR. The two-year grants will be awarded by HHS to up to five states or groups of states on Feb. 15.

States fear health care portals’ costs
By: Jennifer Haberkorn
October 29, 2010 05:00 AM EST
The administration is asking the states to help craft one of the most expensive and technologically complex pieces of the health care overhaul.

The legislation requires by 2014 that all states have health insurance exchanges, or portals similar to Travelocity or Orbitz, where consumers can compare insurance plans and purchase coverage. They’re designed to make it easier for small businesses or individuals to buy coverage and figure out if they qualify for the health reform law’s tax credits or other state assistance, such as Medicaid.

But states view the project as an enormous undertaking, requiring them to design a system, develop the information technology and put it into action in just three years amid tight budgets. In response, the Department of Health and Human Services is planning to ask five states to develop systems that can hopefully serve as prototypes for other states to replicate.

“As we’ve been out with the states talking about 2014 and the possibility of as many states as possible doing their own exchange, they’re most concerned about the IT piece, [saying] it’s going to be expensive and it’s going to take some time,” said Joel Ario, director of health insurance exchanges at HHS’s Office of Consumer Information and Insurance Oversight.

HHS is planning to announce the program, dubbed “Early Innovators,” on Friday. States will have to apply for it and will receive grants to fund their work. Ario said the agency hasn’t yet determined how much money will be available.

“We didn’t want to put a constraint on it,” Ario told POLITICO, adding that the agency hopes for creative proposals.

Ario says the program will likely make it easier for other states to establish their own exchanges. The health reform law requires the federal government to set up the programs if the states don’t.

The agency also doesn’t want the states to feel that they have to reinvent the wheel 50 times over.

HHS says states will have to have already started on planning for their exchanges to qualify for the program. Several states, such as Wisconsin, California and Pennsylvania have already formed task forces to start setting up the exchanges and other reform-related programs.

On the other hand, some states have resisted participating in anything related to the health reform law for political reasons or hope that it will get overturned in court.

© 2010 Capitol News Company, LLC

Kevin Wrege

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Council Committee Assignments for 2011-2012

Attached are the new committee assignments for councilmembers in the next session.

Please note that the new Chairperson of the Committee on Public Services and Consumer Affairs (PSCA) is CM Yvette Alexander, replacing CM Muriel Bowser. As many of you know, the PSCA has oversight of the Department of Insurance, Securities and Banking. The other members of the Committee are CMs Bowser, Cheh and Graham. Another member is expected to be added to the Committee soon.

A second committee of interest is the Committee on Health. CM David Catania has retained the Committee Chairmanship and the other members are CMs Alexander, Barry, Cheh and Mendelson.

CM Mary Cheh, a close ally of the new mayor, has been appointed the new Council Chairman Pro-Tem, a symbolically important position previously held by CM Evans.

Kevin Wrege

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Council Committee Assignments for Council Period 19 Dec 22 2010.docx

Wash Post: DC Council Session Ends with Budget Bill Approval

D.C. Council ends Vincent Gray era and the year with a flourish

By Tim Craig
Washington Post Staff Writer
Tuesday, December 21, 2010; 10:15 PM

The D.C. Council adjourned for the year Tuesday, capping Mayor-elect Vincent C. Gray’s term as chairman and ending a period that saw passage of some of the most ambitious legislation since the city gained home rule.

After approving a flurry of bills – including a measure that would require homeless families to demonstrate their ties to the District before receiving shelter – the council went on recess until next month.

During the 18th session since home rule took effect in 1973, the council legalized same-sex marriage and medical marijuana, rewrote gun-control laws, imposed a 5-cent tax on plastic bags to advance the cleanup of the Anacostia River, and adopted standards for healthier school lunches.

After the session ended, Gray ceremoniously passed the gavel to his successor, D.C. Council Chairman-elect Kwame R. Brown (D-At Large). Brown, on the behalf of the council, gave Gray an Apple iPad and wished him well as the next mayor.

"I will put this legislative body up against any," said Gray, who received an extended standing ovation. "I look forward to working with all of you in this next life."

The just-concluded council session will be known as one in which members appeared to find legislative confidence in the aftermath of the financial control board. The council embraced an activist agenda and exerted more control over city government, increasing oversight of the administration of Mayor Adrian M. Fenty (D).

"The legislature has strengthened," said council member Phil Mendelson (D- At Large). "Our response during the Fenty administration was to pass laws and impose new requirements on budgeting, financial planning and policy analysis."

Gray, who became emotional in an interview, said he is most proud of the council’s high ratings in recent public opinion polls and a collaborative spirit that led to significant pieces of legislation during his four years as council chairman, including mayoral control of schools and the expansion of pre-kindergarten.

Looking forward, many observers expect Brown, 40, will have a management style different from that of the 68-year-old Gray. But with the council gaining only one new member – a vacancy to be filled temporarily by the D.C. Democratic State Committee – few expect its approach to change dramatically.

Some observers say the council’s efforts to distinguish itself may have contributed to what some members described as unprecedented hostility between the legislative and executive branches. The council initiated a spate of investigations into Fenty’s administration, which to date have failed to turn up conclusive evidence of wrongdoing.

"It was just a very contentious relationship . . . and I think it will overshadow a lot of the good things being done," council member Jack Evans (D-Ward 2) said.

The council was tested by several ethical controversies, including an investigation into whether council member Marion Barry (D-Ward 8) misused earmarks and questions about whether council member Harry Thomas Jr. (D-Ward 5) properly accounted for money he raised for his nonprofit group Team Thomas.

Last year, the FBI also raided the John A. Wilson Building as part of a probe into allegations that the former chief of staff of council member Jim Graham (D-Ward 1) accepted bribes.

Despite the investigations, council member Tommy Wells (D-Ward 6) said Gray will probably be remembered as "one of the best chairs the District has ever had."

"This council has performed exceedingly well," said Wells, who remarked on the frequency of oversight hearings and the rapid pace with which the council approved legislation.

Despite the national economic downturn, the council also enjoyed relative prosperity compared with many of its counterparts in the D.C. suburbs.

When Gray became chairman in 2007, the city had a $5.5 billion general fund budget. The fund has grown to about $6.7 billion, according to budget officials. During the same period, the city’s reserve funds dropped from about $1.5 billion in fiscal 2007 to an estimated $655 million this year, far less than what officials say is needed for an emergency.

The city faces a $440 million budget shortfall next year, prompting many members to predict the next council will be consumed by a debate over taxes and spending. And with the Republicans set to regain control of the U.S. House of Representatives, council members said the era of approving bold legislation has passed.

"I think that progress at times requires a moment of reflection and a moment of shoring up victories as opposed to the constant trajectory, which is financially unstable," said council member David A. Catania (I-At large).

On Tuesday, the council voted to make the city’s open meetings law apply to more government bodies but also voted to exempt council committee meetings.

Members also supported a 10-year extension of the city’s rent control laws, enacted a bill limiting city agencies’ ability to inquire about a possible criminal record on a job application, and approved a tax break for a proposed hotel in Adams Morgan.

In another move, the council backed off plans to gradually eliminate welfare benefits for those on the rolls of the Temporary Assistance for Needy Families program at least five years. Instead, the council agreed to cut payments to long-term recipients by 20 percent after five years but to drop from the program only those who fail to participate in job- training and job-placement programs.

The fiercest debate centered on a proposal by Wells to impose proof-of-residency requirements for homeless families seeking shelter in the District. The discussion sparked an argument about whether Jesus was homeless, as Thomas suggested, or was born in a manger in Bethlehem for other reasons, as Evans contended.

During an unusually personal debate, Graham, Thomas, Mendelson and Mary M. Cheh (D-Ward 3) invoked the cold weather, religion and the Christmas season in an unsuccessful effort to derail the measure.

The debate over homeless shelters and welfare benefits may foreshadow how the next council session will differ from the one that just ended.

"It’s not going to be easy for any of us," Brown said to Gray after he received the gavel. "Working together, we will get through these times."

Staff writer Ann E. Marimow contributed to this report.

Kevin Wrege

Founder & President

Pulse Issues & Advocacy LLC

Office: 202-625-1787

Mobile: 202-253-4929

4410 Massachusetts Ave., NW, #150

Washington, DC 20016

Politico: HHS Rule Proposes “Unreasonable” Rate Review Trigger @ 10% Increase

HHS reg: Magic number is 10 percent
By: Sarah Kliff
December 21, 2010 01:09 PM EST
Health insurers will be required to justify double-digit premium increases under a proposed health reform rule the Obama administration released Tuesday.

Beginning in 2011, Health and Human Services will require insurers to publicly disclose any rate increases higher than 10 percent. While such rates will not automatically be deemed “unreasonable,” either state or federal regulators will have to review any proposed increases above the 10 percent threshold to determine whether they are justified.

While HHS does not have the power to deny or reject unreasonable rate increases, administration officials believe the greater transparency and scrutiny will discourage insurers from jacking premiums dramatically.

“This does not give HHS authority to disapprove rates,” Jay Angoff, director of the Office of Consumer Information and Insurance Oversight, told reporters Tuesday. “On the other hand, it does something arguably more important: make insurers make public their proposed rate increases and the assumptions they’re based on. If they know that they will become public, insurers will make sure their assumptions are reasonable and that they’re submitting moderate increases. It gives greater incentive to improve quality and drive down cost.”

The much-anticipated new premium review leaves most regulatory authority to the states, allowing them to review rates using their current definitions of “unreasonable” rate hikes. The new rule “does not require a numerical standard to be applied under state law to determine whether a rate increase is unreasonable,” the new regulation states. “Rather, a state regulator would apply applicable standards that exist under state law.”

Moreover, while the federal regulation sets the threshold for review at 10 percent, states could potentially lower it, into the single digits, as early as 2012, Angoff said Tuesday.

For rates reviewed by HHS, the agency will determine a proposed increase “unreasonable” if it “is an excessive rate increase, an unjustified rate increase or an unfairly discriminatory rate increase.” The regulation does not provide any hard-and-fast numbers but, rather, directs the agency to investigate actuarial data alongside an insurer’s spending on medical costs to make its ruling.

HHS Secretary Kathleen Sebelius admitted that the definition of “unreasonable” was a “tricky” one to write. “There may well be rates above 10 percent that are justified,” said Sebelius, giving the example of a plan that hasn’t raised rates for a number of years. “There are very different ways to get to that 10 percent threshold.”

Democrats seized on the new regulation to challenge Republican cries to repeal the health reform law.

“Repeal this? Greater transparency of premium hikes is good for the consumer,” said Rep. George Miller (D-Calif.), chairman of the House Education and Labor Committee. “Families facing double-digit premium hikes should know precisely why insurance companies are raising their rates.”

Likewise, consumer groups immediately cheered the new regulations.

"For the first time, there are rules to hold the insurance companies accountable for huge rate hikes by shining light on the financial data they claim justifies double-digit rate increases year after year,” Ethan Rome, executive director of Health Care for America Now, said in a statement Tuesday. “The days of insurance companies running roughshod over consumers and jacking up our rates whenever they want are over. The new rate review rules represent a key step toward finally ending the insurance companies’ stranglehold on our health care.

Insurers criticized the regulation, saying it is an “incomplete” threshold for rate review.

“It does not adequately factor in all of the components that determine premiums, including the cost of new benefit mandates and the impact of younger and healthier people dropping coverage,” said Karen Ignagni, president of insurer trade group America’s Health Insurance Plans. “Premium review must consider the unique circumstances of small employers that are struggling to afford coverage for their employees and of the individual market in which people move in and out of coverage, depending on whether they anticipate needing medical services.”

The proposed rule requires insurers to submit data in eight areas, including historical trends of rate increases and executive compensation data from the insurer’s financial statements.

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CQ HEALTHBEAT NEWS: Meeting Suggests Many States May Delay Exchange Legislation Until 2012, Attendee Says

Meeting Suggests Many States May Delay Exchange Legislation Until 2012, Attendee Says
By John Reichard, CQ HealthBeat Editor
The first of a two-day, closed-door, HHS meeting with representatives from 44 states suggested that in many cases states will delay passing laws to create health insurance exchanges until 2012, according to one attendee.

“The bottom line is that there are a lot of unanswered questions states have about creating exchanges” under the health care law, said the attendee, who asked not to be identified because the meeting was private.

States have flexibility under the law to structure exchanges in different ways. HHS has urged that, if possible, they begin passing legislation in 2011 to get that process underway.

States must prove to HHS by January 2013 that they will have an effective exchange ready to go by January 2014 or else the federal government will operate the new health insurance marketplaces.

One issue facing the states is what to do if they have laws on the book that mandate benefits that exceed those required in any federal minimum benefits package for exchanges.

States must either adopt the federal package or pay the added costs of care required under any more extensive state mandate.

But it was clear at the meeting that state officials won’t know what is in the federally-mandated package before late next year, complicating decisions on what would go into state legislation, the attendee said.

“Instead of seeing a lot of states take this up [in 2011] I think we’ll see some states” do so, the participant said.
The attendee added that HHS officials appear to be listening to concerns expressed by state representatives. “When we talk, they incorporate the feedback,” the attendee said. Federal officials are “forthcoming that they can’t be forthcoming.”

Asked why they can’t be forthcoming, the attendee cited the slow nature of rulemaking relating to exchanges and said it appears that key policy decisions haven’t yet been made at the federal level relating to aspects of these insurance marketplaces.

Are state officials becoming more pessimistic about getting the job done on time? “I didn’t see anybody throw up their hands and say ‘we give up,” the attendee responded.Top of Form 1

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Source: CQ Online News
© 2010 CQ Roll Call All Rights Reserved.

CQ Healthbeat News: Exchange Overseer Ario Aims to Help Heal a Broken Market

CQ HEALTHBEAT NEWS
Dec. 16, 2010 – 6:22 p.m.
Exchange Overseer Ario Aims to Help Heal a Broken Market
By John Reichard, CQ HealthBeat Editor
Running any enterprise is an exercise in finding the right balance between being firm and being flexible. If you’re not firm enough, the enterprise won’t move forward; if you’re too firm, it will break down.

For Joel Ario, the enterprise is carrying out the health care law requirement that insurance exchanges be up and running in every state by 2014.

Ario, who is head of the Office of Exchanges at the Department of Health and Human Services, must find that balance in dealing with many different players whose cooperation he will need to make exchanges successful.

It’s quite a lineup: officials from 50 states with different ideas about how exchanges should work; insurers historically hostile to exchanges; small businesses and the individual consumers who will shop at exchanges, and hospitals and other providers looking to make up losses from Medicare cuts with newly insured patients enrolled in health plans offered on the exchanges.

Affable, quick, and business-like, the 57-year-old Ario appears to have the temperament and experience to get the job done. Whether he has the tools, however, is uncertain. States worry about the funding, staffing, and technical expertise needed to operate effective exchanges. Republicans don’t like the blueprint the overhaul law creates for these new insurance marketplaces. And the timelines are deceptively tight.

But Ario says the law allows the experimentation needed to make states willing partners. He says it structures the exchanges in a way that will draw in many consumers. And insurers have too much riding on the success of exchanges to let them fail, he adds.

“If this doesn’t work, I don’t think very many of them believe that we’ll go back to a system in which they will be more in charge, rather than less in charge,” Ario said in an interview.

For Ario, exchanges are a way to heal an insurance market that is broken. Millions of Americans not on the payroll of the federal government or big businesses can’t get access to affordable, comprehensive coverage. Exchanges, which spread treatment costs across large pools of people, “are a powerful antidote,” he says.

But however much insurance companies have riding on the success of exchanges, these companies are run by executives who must meet short-term profit goals. If insurers think exchanges are going to get in the way with heavy-handed regulations, they have GOP allies in Congress only too happy to go after all things “Obamacare.”

That means federal officials like Ario will have to have a deft touch with insurers. And that requires a practical understanding of what insurers need to operate.

At first glance, he might not seem like the guy for the job.
Divinity School, Harvard Law, and “PIRGs”
Take a quick look at his background and Ario might seem like a paranoid insurance executive’s worst nightmare — a guy with a Harvard Law degree apparently eager to take on corporate America, and maybe even a person who thinks he has some kind of divine calling to do it. After all, he enrolled in Harvard Divinity School before getting his law degree.

If anything, the divinity school experience seems to reflect a drive to question and analyze dogma, not to rigidly force it on people. And while Ario is willing to reflect on his experience at divinity school when asked, he doesn’t call attention to it in the speeches he gives.

A chuckling Ario says that people make fun of him because his divinity degree came before law school, suggesting that it should have been the other way around because “after law school you need to go cleanse yourself.”

A 1975 graduate of St. Olaf College in Northfield, Minnesota, Ario said that one of his college professors suggested he go to divinity school.

“I said, ‘why would I do that? I was confirmed…but I haven’t really paid much attention to the church all the way through college.’ And he said ‘Because you ask the kind of questions people ask in divinity school.’” Ario got a full scholarship through a program designed for people willing to seriously consider the ministry who otherwise would have gone into another profession.

“I said at that point, ‘well, I’m an interested agnostic.’” At divinity school Ario found “my professor was right. These guys ask exactly the kinds of questions I’d ask” — questions on “the meaning of life, and social justice, and how you make a good life for yourself, and how do you make for a good society.”

“My best buddy at that point wanted to be a Lutheran minister and he’d come home and complain about how Harvard divinity school was not training ministers. I’d say, ‘I know. It’d be boring if everyone just wanted to learn how to be a minister. This is a place to search your soul and answer the big questions. So I did that for three years,’” Ario said.

“I kind of thought about the ministry, and considered it, even prayed about it, but it was never a close call.”
“Reinhold Niehbuhr said the purpose of the ministry is to comfort the afflicted and afflict the comforted. I was always good at number two and not so much at number one, either in my own life or for others…I just couldn’t be pastoral with somebody who lost their two-year-old kid for no reason. I mean I’d be angry about that.”

But Ario said even though he didn’t become a minister, the divinity school training has had a lasting impact on his career, including in his current post.

“It’s made me very nimble in the way I look at issues. You can be in a lot of situations where you’re trying to think through an issue and there’s the received wisdom on the issue. I want to question why you’re starting with the assumption behind that question, let’s back up and think about first principles. I use that all the time when people get into kind of group think about an issue where it seems like the premises are too narrow.”

“Afflict the comforted” was a theme of his career after he graduated from law school in 1981. He organized and ran Public Interest Research Groups (PIRGs), Ralph Nader inspired organizations which lobby for consumers on product safety, public health, the environment, and other issues. After organizing a PIRG in Wisconsin and directing Oregon’s PIRG for seven years, Ario moved into state government in Oregon where he worked on an overhaul of the small group insurance market that instituted “guaranteed issue” provisions.

Several years later, he was named the top insurance regulator in Oregon, serving in that position from 2000 to 2007. He was Pennsylvania’s insurance commissioner from 2007 to 2010.

A Flexible Approach
State insurance regulators must protect consumers. But they also have to safeguard insurers by taking steps to assure their solvency. That may mean no knee-jerk denials of rate hikes, for example. To do their jobs, regulators must develop a sophisticated understanding of how insurance companies work and apply regulations in a way that doesn’t severely disrupt markets.

“As regulators, we don’t have the luxury, the time, or the capacity really to be ideological,” said Illinois Insurance Director Michael T. McRaith, who worked with Ario on exchange issues at the National Association of Insurance Commissioners earlier this year before Ario was named to the HHS post.

Ario “is an excellent listener, open to learning and hearing different angles of one specific issue. More importantly perhaps is that Joel is guided by priorities and principles but is very practical in his approach to problem solving,” says McRaith.

An interest in dialogue, in re-examining assumptions, and a pragmatic knowledge of insurance markets suggests that Ario isn’t a rigid moral crusader to be feared by insurance executives. And some in the industry even say nice things about him. At a conference of industry executives in November, America’s Health Insurance Plans President Karen Ignagni introduced Ario by praising him as a fair regulator.

He earned similar praise during his tenure as Oregon’s insurance administrator. “I’m from an association that deals with regulators in nine states, and Joel is No. 1,” said Clark Sitzes, executive vice president of the Vancouver-based Professional Insurance Agents Western Alliance, in a 2006 profile of Ario in the Portland Business Journal. The alliance represents 1,000 independent property and casualty insurance agents in nine states. “He’s receptive to our opinions and concerns where others are less so.”

Ario emphasizes that he wants states to take advantage of the overhaul law’s provisions that allow for the creation of exchanges that reflect their particular markets. Even states that choose to let Washington run their exchanges will be closely involved in any federal effort in that regard, he says.

Two states have signaled that they won’t do their own exchanges by not filing for initial planning grants. But Ario said he expects that officials in one of them, Minnesota, will reverse that decision now that there’s a new governor. Democrat Mark Dayton is replacing Republican Tim Pawlenty, who may run for president in 2012 based in part on his opposition to the health care overhaul law. Ario says he hasn’t given up on the second state, Alaska, opening its own exchange either.

Ario adds that some states may take advantage of the flexibility the overhaul allows to create regional exchanges. Thus Maine, New Hampshire, and Vermont, for example, which have similar regulatory schemes, might take a regional approach toward some exchange functions while performing others themselves. Similarly, “spine of the West” states like Montana, Wyoming Utah, and New Mexico might join in a regional effort, he said.

The law also permits states to decide whether or not to combine individuals and small businesses in the same exchange. Pooling different groups raises concerns among one or the other that their costs will go up. Ario suggested that states will be cautious about doing so. “Most people would have a bias toward saying, ‘Let’s not create new changes in the marketplace until we’re sure they can work.”

Ario sees states moving ahead to create their own exchanges even as many Republicans hostile to the overhaul law move into state houses next year. “There’s all this talk now about governors changing, and is everything going to change — well, most of the people who do the day to day work don’t change every time the governor changes.” Staff in state agencies such as the insurance department, Medicaid, and the health department “know that this law will make things better. That’s where our focus is, to get in with those people.”

Skepticism and Doubt
As open as Ario might be to discussion, and as much as the overhaul might allow some experimentation, insurers are wary of the Obama administration. And state officials are worried that they don’t have the know-how and the resources to prove to HHS by the January 1, 2013 deadline that they’ll have an effective exchange ready to go by 2014. If they can’t, the feds must do the job.

A veteran managed care executive who requested anonymity said “most of us are reserving judgement” about Ario. The executive said he thinks Ario prefers the “prudent purchaser” type of exchange in which insurers who don’t offer low enough premiums can be excluded from participation. The overhaul law lets states decide whether they want that kind of exchange, or whether they will basically offer all plans that meet certain basic requirements.

Insurers feel burned by the administration after the Centers for Medicare and Medicaid Services rejected certain plans’ bids to participate in the Medicare Advantage program earlier this year. The affected plans complained that they were given little time to revise their bids and had no specific guidance on how to make them acceptable. That kind of unpredictability could be a hallmark of prudent purchaser exchanges, the executive said. “It’s the same issue; it’s just playing out in different contexts.”

The executive acknowledged that states have the power to reject that model. In states with Republican governors and Republican legislatures, exchanges probably won’t follow the prudent purchaser model. “But it is an industry concern,” he said.

Ario also has come in for some criticism from the state of Louisiana.
“We still don’t have the most basic set of guidance” from HHS on setting up an exchange, said Louisiana Secretary for Health and Hospitals Bruce Greenstein on Nov. 30, Greenstein made the comment despite the issuance by HHS of “preliminary guidance” on exchanges.

States have to tap into various data sources held by federal agencies to handle enrollment in plans offered by exchanges and to pay subsidies to buy coverage.

“We don’t know how information from the Social Security Administration gets transmitted, what the definitions look like with regard to certain income types, ’’ Greenstein said. Systems to establish eligibility of consumers for the exchanges and the subsidies they provide “are hard to spec out without having more guidance,’’ he added.

The managed care executive said that the HHS preliminary guidance document “was necessary, but not sufficient. It didn’t do enough. All of this data is supposed to interchange at the state level. Are the feds going to make that happen? If that capability is not funded and put in place very soon, you’re not going to have an efficient exchange.”

But Ario and his office are stepping up their meetings with states, including one Thursday and Friday with representatives from 44 states on exchange issues (see related story in this issue). More grant money and guidance is in the works.

A Moral Dimension
States and insurers can expect pressure from Ario to perform, despite his willingness to be flexible. Ario doesn’t deny that he sees a moral dimension to the job he’s doing either.

“I have the capacity to see most issues that I work on as having a missional aspect to them and can be preachy at times,” he said. “I try not to be but I can be,” he adds softly.

“If you ask me the basic thing, I thinks it’s a travesty that we live in a country that hasn’t figured out how to cover everybody in the system and also make the system affordable for everybody.”

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Source: CQ Online News
© 2010 CQ Roll Call All Rights Reserved.

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