Budget negotiators tabled a rider to eliminate PPACA’s medical loss ratio restrictions as part of the deal cut Friday to avoid a government shutdown.

The MLR provisions requiring insurers to spend a minimum percentage of premium revenues on medical care were among a number of roadblocks to health care reform implementation erected by Republicans in their 2011 budget proposals. By the end of Friday’s nail-biter negotiations, however, the MLR rider was set aside for future consideration in Congress.

In the weekend drama Congress approved a stopgap measure giving members this week to consider and vote on a compromise spending package for this fiscal year, ending Sept. 30. Details of that compromise, which would cut about $39 billion from spending levels set earlier this year, are still under review — although congressional leaders believe they will receive enough votes for approval.

 To reach the deal, Democrats agreed that the final 2011 package would be paired with Senate votes on two other bills that mimic controversial riders: a proposal involving abortion services and one to bar federal agencies from using funds to implement the health care law, a senior Democratic leadership aide was reported as saying. Republican lawmakers leaving Friday night’s caucus said they were told those votes would occur, perhaps as soon as this week, some news agencies reported.

According to the Capitol Hill newspaper Roll Call, Republican Policy Committee Chairman Tom Price predicted that the separate Senate votes would appease House GOP lawmakers who had been pushing hard for the riders. But Price also seemed to suggest that the effort, and upcoming vote, is somewhat symbolic at this stage.

“Those are pluses that I don’t think many of us dreamed we would be able to get,” the Georgia Republican told Roll Call. “So I think they’re huge — to put folks on record as to whether or not they support the government takeover of health care. Part of all of this is to demonstrate to the American people that there is a huge contrast between the leadership of the left and the leadership of the right.”

At this writing it is uncertain whether an MLR restriction will come to a separate budget vote in Congress, or be swept into other legislative debates. A bill accomplishing much the same thing is still pending in the House, and lawmakers are still awaiting recommendations from stakeholders such as state insurance commissioners.

As the countdown to a government shutdown ticked on Friday night, Democrats and Republicans offered fundamentally different accounts of the reason agreement could not be reached: House Speaker John Boehner (R-Ohio) said it was all about spending, while Senate Majority Leader Harry Reid (D-NV) said the problem was a host of riders sought by the GOP.

One of the most contentious of those riders concerned government funding for Planned Parenthood. The Hyde Amendment already prohibits federal funds from being used for abortions, and Planned Parenthood uses only privately raised funds for abortion services that the group says constitutes only 3% of its total services. However, some Republicans also pressed the view that federal funds should not be used to any group that assists abortions, even with private funding.

Less publicized riders included variously worded measures to undercut the year-old federal health reform law. Riders attached by the House in its budget proposal sought to:

  • Prohibit funding for the IRS to implement health care reform.
  • Prohibit funds for a White House director of health care reform.
  • Strip funding for any provision of PPACA.
  • Prohibit the payment of salaries for any officer or employee of any federal department or agency with respect to carrying out PPACA.
  • Bar funds to implement the individual mandate and penalties and reporting requirements of PPACA.
  • Block funds for state health insurance exchanges.
  • Prohibit funds for salaries for any officer or employee of the government to issue regulations on essential benefits under PPACA.

Currently, it appears Republican strategists will settle for a symbolic vote on health reform implementation, then look for other ways to achieve a roadblock. That will likely include high-profile efforts to make health reform an issue in 2012 budget negotiations — and the presidential election campaign.

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