By Washington Post

President Obama on Thursday signed into law a measure that repeals the unpopular 1099 tax-reporting provision of the national health-care law.

The move marked the first successful effort by Congress to repeal a portion of Obama’s signature health-care legislation.

The Senate earlier this month voted 87-to-12 to repeal the 1099 provision. The House passed the measure in March on a bipartisan 314-to-112 vote.

The White House released a statement announcing the Obama had signed the measure, which it said “repeals the expansion in the Affordable Care Act of requirements for businesses to report information to the Internal Revenue Service on payments for goods of $600 or more annually to other businesses and increases the amount of overpayment subject to repayment of premium assistance tax credits for health insurance coverage purchases through the Exchanges established under the Affordable Care Act.”

Obama’s signing of the legislation into law marks the end of a nearly eight-month-long effort by lawmakers to do away with the 1099 tax-reporting provision. Sen. Mike Johanns (R-Neb.) had led the effort in the Senate, but each time repeal seemed close, the parties reached an impasse over how to pay for the repeal, which would result in the loss of an estimated $22 billion over the next decade.

The law signed by Obama on Thursday would pay for repeal by forcing greater repayment of health insurance subsidies for families whose income unexpectedly exceeds certain thresholds.

by National Underwriter Company

A majority of large U.S. employers are planning to change their 2011 health care benefit programs in the wake of both health care reform and expected large health care cost increases, according to a new survey by the National Business Group on Health (NBGH).NBGH, Washington, found that 53% of employers taking part in its survey were still planning to make changes to their benefit plans despite uncertainty about how to comply with the Patient Protection and Affordable Care Act (PPACA).

Another 19% are going to scale back changes they had planned to make, while an equal number are making no changes. Remaining respondents were still undecided as they continued to review the final regulations.

Among employers that said they would be making specific changes to their health benefit plans to comply with the new law, 70% said they would remove lifetime dollar limits on overall benefits, while 37% said they would change to annual or lifetime limits on specific benefits.

Also, 26% would remove annual dollar limits on overall benefits, while 13% would remove pre-existing condition exclusions for children.

The survey, covering 72 of the nation’s largest corporations with more than 3.7 million employees, was conducted in May and June.

Health care reform has forced employers to assess their health care benefit strategies and decide whether to comply with the law or lose grandfathered status, said Helen Darling, president of NGBH. But they are still mindful that controlling rising costs is among their highest priorities.

“They have to foot the bill, not the government,” Darling commented.

Surveyed employers estimated their health care benefit costs would rise an average of 8.9% next year, compared with an average increase of 7% this year. To help control those increases, 63% plan to boost the percentage employees contribute to the premium, up from 57% who did so this year, while 46% plan to raise out-of-pocket maximums next year, compared with 36% this year.

Other survey findings:

—61% will offer a consumer-directed health plan (CDHP) in 2011.

—64% will offer is a high-deductible plan combined with a health savings account.

—Among employers offering a CDHP, 20% will move to a full replacement plan in 2011, from 10% this year.

—5% plan to drop retiree health coverage in 2011, while 60% are considering doing so.

—41% offer premium discounts for completing health assessments, while 22% offer premium discounts for participating in stop-smoking programs.

—25% plan to raise the copay or coinsurance for retail pharmacy prescription drug benefits, while 21% plan to do the same for mail-order pharmacy benefits.

A copy of the survey by NBGH can be found here

Included in the federal health care overhaul passed earlier this year, the small business health care tax credit can offset up to 35% of the insurance premiums that a small company pays to cover its employees this year, according to the federal Small Business Administration. The rate will increase to 50% in 2014. The U.S. Department of the Treasury recently released detailed guidance as to how a small business could take advantage of the credits.

Small businesses face unique challenges to providing health insurance for their employees, such as higher costs and fewer choices than those available to larger companies. Nationally, an estimated four million small companies might qualify for the tax credit, which is designed to help subsidize insurance coverage by about $40 billion over the next 10 years, according to the federal government. The tax credit can also be used to cover add-on dental, vision, and other limited insurance coverage. In Ohio, for example, an estimated 118,000 businesses that cover at least half of their employees’ health care costs would be eligible for the tax credit, according to the Ohio Department of Insurance.

According to the federal Small Business Administration, the health care bill would also benefit small companies by blocking dramatic premium increases when one employee gets sick.

The U.S. Department of the Treasury issued guidance designed to simplify eligibility information and allow companies to choose the most favorable method of determining worker hours in order to maximize the tax credit, which is available to companies with fewer than 25 employees.

Below are key elements of the program:

• Detailed Guidance. To help small businesses make employee benefit decisions with full knowledge and to provide a clear incentive to offer health insurance coverage, the new IRS Notice 2010-44 lays out detailed guidance on how a business can determine whether it is eligible and how large a credit it will receive.
• No Reduction Due to State Credits. Responding to a number of taxpayer questions about the interaction of the credit with state-level health care tax credits and subsidies, the guidance announces that the new tax credit will not be reduced by a state health care tax credit or subsidy (except in limited circumstances to prevent abuse of the credit). In particular, an employer that receives such a state tax credit or subsidy will also receive the full federal credit based on its entire contribution so long as the federal credit does not exceed the employer’s net contribution. According to lists compiled by the National Conference of State Legislatures, about 20 states offer these benefits.
• Dental and Vision Coverage Qualify. The guidance clarifies that small businesses can receive the credit not only for traditional health insurance coverage but also for add-on dental, vision, and other limited-scope coverage. The employer must meet the requirements for limited-scope coverage that are similar to those that apply for single coverage: the employer must offer to pay at least 50% of the premium.
• Employers Can Choose Most Favorable Method of Determining Hours Worked. Because the tax credit’s matching rate is highest for employers with 10 or fewer full-time equivalent employees (FTEs), the number of hours worked is an important factor in calculating the credit. The new guidance allows employers to choose among 3 different methods of determining hours to minimize their bookkeeping duties while receiving the maximum tax credit for which they are eligible. Employers can look at actual hours of service, or can use simple rules of convenience to estimate hours based on total days or weeks of service.
• Transition Relief for 2010 Formalized. Because the tax credit is effective for 2010 but was not enacted until March 23, 2010, some small businesses that are providing health insurance in 2010 may not meet all the requirements for a qualifying health insurance offer. To ensure that these businesses benefit from the credit, the Administration is providing special transition relief for tax year 2010. The transition rules simplify the requirements for what constitutes a qualifying health insurance offer while maintaining the core requirement that an employer make a significant contribution to the employee’s coverage. The transition relief was first mentioned in FAQs released on the IRS website on April 1, 2010, and has now been formalized in the new notice.

Guidance has been issued with regard to the new health care reform coverage for children up to age 26.  The Employee Benefits Security Administration (EBSA) has issued a fact sheet, a series of questions and answers, and an interim final regulation about the new requirements. Basically, the health care reform act signed by President Obama will allow children to remain on their parents’ health coverage up to age 26. This provision is effective for plan or policy years beginning on or after September 23, 2010. Plans and issuers must give children who qualify an opportunity to enroll that continues for at least 30 days, regardless of whether the plan or coverage offers an open enrollment period. This enrollment opportunity and a written notice must be provided not later than the first day of the first plan or policy year beginning on or after September 23, 2010.

Employers with cafeteria plans can now allow employees to make pretax contributions to cover benefits under the company’s heath plan for dependent children up to age 27, the Internal Revenue Service said April 27 (Notice 2010-38).  The change is related to the new health reform law, IRS said.  The notice will appear in the May 17 edition of the Internal Revenue Bulletin 2010-20.

House Democrats, meanwhile, asked health insurers to stop canceling coverage for policyholders who become sick before a provision in the new law takes effect in 2014.  The chairmen of three House committees urged seven insurers in a letter April 27 to stop the rescissions, a move that they said would be consistent with changes allowing older dependents to remain on a parent’s health plan.  Separately, WellPoint said it would implement a nonrescission provision May 1.

from MHA

Under the Patient Protection and Affordable Care Act (PPACA), both fully-insured and self-funded group plans that provide dependent coverage must provide coverage until age 26 for dependent children regardless of student or marital status. The new requirement is effective for plan years beginning on or after Sept. 23, 2010. This meant that many children, especially those graduating school this summer, would lose eligibility under their plan’s current eligibility definition and would have a gap in coverage before being permitted to re-enroll under the new PPACA definition of eligible dependent. To resolve this issue, many insurance carriers including Humana, Blue Cross Blue Shield, United Healthcare and Wellpoint have all issued statements indicating that they will work with employers to continue coverage for any dependent children currently enrolled in the plan until age 26, regardless of the plan’s next renewal date.

• Humana
• Blue Cross Blue Shield
• UnitedHealthcare
• Wellpoint

For questions or to learn more: Alyshia Foster 214-461-1129 or alyshia.foster@staffone.com

The recent passage of the Patient Protection & Affordable Care Act (H.R. 3590) and the Health Care & Education Affordability Reconciliation Act of 2010 (H.R. 4872) will impact every business. How will it affect you? For your convenience, we have created a chronological summary for employers in general and also a bonus edition for small business owners.

Summary of the Legislation by Number of Employees:
50 employees or more | 100 employees or less | 25 or less

Effective January 1, 2014
**Applies to firms with greater than 50 employees

• Promoting Employer Responsibility. The Act requires employers with 50 or more employees who do not offer health coverage to their employees to pay $2,000 annually for a “full-time employee” (i.e., an employee working 30 or more hours per week).

• The 50-employee threshold is based on the employer’s average number of employees on business days during the preceding calendar year.
• Both full-time and part-time employees are considered in determining whether the employer has 50 or more employees; however, the number of part-time employees to be counted is determined by dividing the aggregate number of hours of service for those part-time employees for each month by 120.
• The $2,000 penalty then applies only to full-time employees who work 30 or more hours per week.
• In order to encourage employers to expand beyond 50 employees, the first 30 employees are not included in calculating the applicable penalty amount.
• The penalty can also increase to $3,000 for a full-time employee receiving a federal tax credit in the exchange where the employer offers health coverage, but that coverage would be deemed “unaffordable” because the employee has to pay more than 9.8 percent of his or her income, or the employer contributes less than 60 percent of the actuarial value of the plan.
• Therefore, while employers are not required to offer health coverage under the Act, significant penalties may be imposed on those employers that do not offer it or that only offer health coverage deemed “unaffordable.”
• In addition, employers may still impose a waiting period for coverage without being subject to a penalty, but this waiting period may not exceed 90 calendar days.

Effective January 1, 2011
**Applies to Firms with 100 employees or less

• Cafeteria Plans. The Act creates a Simple Cafeteria Plan to provide a vehicle through which small employers can provide tax-free benefits to their employees.

• Small employers are defined as employers who on average employ 100 or fewer employees over the previous two years. The Act aims to ease the administrative burden of sponsoring a cafeteria plan for such small employers.
• The Act also exempts small employers who make contributions for employees under a Simple Cafeteria Plan from pension-plan nondiscrimination requirements applicable to highly compensated and key employees.

Effective January 1, 2014

**Applies to firms with 100 employees or less

• Exchanges. The Act provides for the creation of health-insurance exchanges at the state level in 2014, where individuals and small employers would be able to buy health coverage in a manner similar to that of larger employers. Initially, the state exchanges would be open to individuals and small employers with 100 or fewer employees, unless the state opts to limit this to

organizations with 50 or fewer employees. Beginning in 2017, states would have the option to expand the exchange to larger employers.

**Applies to Firms with 100 employees or less

• Wellness Programs. The Act provides that employers can offer increased incentives to employees for participation in a wellness program or for meeting certain health-status targets. The Act permits rewards or penalties, such as premium discounts of up to 30 percent of the cost of coverage. Existing wellness regulations are limited to wellness incentives of up to 20

percent of the total premium, provided that certain conditions are met. In addition, the Act creates a $200 million, five-year program to provide grants to certain small employers (fewer than 100 employees) for comprehensive workplace-wellness programs. The grants would go to small employers that did not have a wellness program when the Act was enacted.

Effective January 1, 2010
**Applies to firms with 25 employees or less

• Small-Business Tax Credit. A small-business tax credit of up to 35 percent of the employer’s contribution to purchase health insurance for employees is now established for “qualified small employers.”

• A “qualified small employer” is an employer that has no more than 25 full-time employees for the taxable year and the average annual wages of those employees do not exceed $50,000 (indexed for inflation.
• Employers with 10 or fewer employees and average annual wages of less than $25,000 would be eligible for the full credit.

• Small-Business Tax Credits. When health-insurance exchanges are established in 2014, the available tax credit will increase to 50 percent of premiums.

For questions or to learn more: Alyshia Foster 214-461-1129 or alyshia.foster@staffone.com

The recent passage of the Patient Protection & Affordable Care Act (H.R. 3590) and the Health Care & Education Affordability Reconciliation Act of 2010 (H.R. 4872) will impact every business. How will it affect you? For your convenience, we have created a chronological summary for employers in general and also a bonus edition for small business owners.

Summary of the Legislation by Effective Date:
2010 | 2011 | 2013 |  2014 | 2018

Effective January 1, 2010
• Medicare Part D. The Act provides a $250 rebate check for all Part D enrollees who enter the “donut hole.” Currently the “donut hole” coverage gap falls between $2,830 and $6,440 in total drug spending by Part D enrollees.

• Adoption Tax Credit. The Act increases the adoption tax credit and adoption assistance exclusion by $1,000 (now set at $13,150), makes the credit refundable and extends the credit
through 2011.

Effective 90 Days After Enactment (i.e., June 21, 2010)
• Early Retirees. The Act establishes a temporary reinsurance program to provide reimbursement to employer health plans offering health coverage for early retirees (ages 55 to 64) and their families. The reinsurance program would reimburse employer health plans for 80 percent of the cost of benefits provided per enrollee in excess of $15,000 and below $90,000. The employer health plans are required to use the funds to lower costs assumed directly by participants and beneficiaries, and the program incentivizes plans to implement programs and procedures to better manage chronic conditions.

• Pre-Existing Conditions. The Act provides that group-health plans and health-insurance issuers offering group or individual health-insurance coverage may not impose any pre-existing condition exclusions with respect to such plans or coverage. Therefore, group-health plans that include such pre-existing condition exclusions will no longer be permitted.

Effective 90 Days After Enactment (i.e., June 21, 2010)
• Pre-Existing Conditions. The Act provides that group-health plans and health-insurance issuers offering group or individual health-insurance coverage may not impose any pre-existing condition exclusions with respect to such plans or coverage. Therefore, group-health plans that include such pre-existing condition exclusions will no longer be permitted.

Effective Six Months After Enactment (i.e., September 23, 2010)
• Additional Protections for Children. The Act: (1) bars health-insurance companies from imposing pre-existing condition exclusions on coverage for children and (2) requires any group-health plan or plan in the individual market that provides dependent coverage to continue to make that coverage available until the child turns 26 years of age, if the child does not have access to other health coverage (without regard to the child’s marital status).

• Lifetime Limits. The Act prohibits insurers from imposing lifetime limits on benefits. Additionally, beginning in 2014, the Act prohibits insurers from imposing annual limits on the amount of coverage an individual may receive.

• Preventive Health Services. The Act requires that all new group-health plans and plans in the individual market provide first-dollar coverage for preventive services (i.e., not subject to a deductible). Examples of preventive services include well-childcare visits and certain immunizations.

Effective January 1, 2011
• W-2 Reporting. The Act requires employers to disclose the value of the benefit provided by the employer for each employee’s health-insurance coverage on the employee’s annual Form W-2. This is a W-2 reporting obligation and will not result in additional taxable income to employees.

• Additional Tax for Health Savings Account (HSA) Withdrawals. The Act increases the additional tax for Health Savings Account withdrawals prior to age 65 that are not used for qualified medical expenses from 10 percent to 20 percent.

• Medicare Part D. The Act provides a 50-percent discount on all brand-name drugs and biologics in the “donut hole” and begins phasing in additional discounts in brand-name and generic drugs to completely fill the “donut hole” by 2020 for all Part D enrollees.

Effective January 1, 2013
• Healthcare Flexible Savings Accounts. The Act limits the amount of contributions to healthcare reimbursement flexible-spending accounts to $2,500 per year. No limit was previously imposed upon healthcare reimbursement flexible-spending accounts. This new limit will raise healthcare costs for employees with unreimbursed healthcare expenses in excess of $2,500 annually, to the extent the employee currently has a flexible-spending account that permits contributions in excess of $2,500—and would potentially create increased taxable income for employees.

• Limiting Deductibility of Executive Compensation for Insurance Providers. With respect to services performed after 2009, the Act limits the deductibility of executive compensation under section 162(m) of the Internal Revenue Code for insurance providers if at least 25 percent of the insurance provider’s gross premium income from health business is derived from health-insurance plans that meet the minimum creditable-coverage requirements. The deduction is limited to $500,000 per taxable year (as opposed to the typical $1,000,000 limitation) and applies to all officers, employees, directors and other workers or service providers performing services for, or on behalf of, a covered health-insurance provider.

• Medicare Part D. The Act eliminates the federal income-tax deduction for the 28-percent subsidy for employers who maintain prescription drug plans for their Part D eligible retirees.

• Itemized Deduction for Medical Expenses . The Act increases the income threshold for claiming the itemized deduction for medical expenses from 7.5 percent to 10 percent. Individuals over age 65 would be able to claim the itemized deduction for medical expenses at 7.5 percent of adjusted gross income through 2016.

Effective January 1, 2014
**Applies to Firms with 50 or more employees
• Promoting Employer Responsibility. The Act requires employers with 50 or more employees who do not offer health coverage to their employees to pay $2,000 annually for a “full-time employee” (an employee working 30 or more hours per week).

• The 50-employee threshold is based on the employer’s average number of employees on business days the preceding calendar year. Both full-time and part-time employees are considered in determining whether the employer has 50 or more employees; however, the number of part-time employees to be counted is determined by dividing the aggregate number of hours of service for those part-time employees for each month by 120. The $2,000 penalty then applies only to full-time employees.
• In order to encourage employers to expand beyond 50 employees, the first 30 employees are not included in calculating the applicable penalty amount.
• The penalty can also increase to $3,000 for a full-time employee receiving a federal tax credit in the exchange where the employer offers health coverage, but that coverage would be deemed “unaffordable” because the employee has to pay more than 9.8 percent of his or her income, or the employer contributes less than 60 percent of the actuarial value of the plan. Therefore, while employers are not required to offer health coverage under the Act, significant penalties may be imposed on those employers that do not offer it or that only offer health coverage deemed “unaffordable.”
• In addition, employers may still impose a waiting period for coverage without being subject to a penalty, but this waiting period may not exceed 90 calendar days.

**Note: firms with more than 200 employees must provide coverage, of which an employee can opt out.

Effective January 1, 2014 Continued
• Wellness Programs. The Act provides that employers can offer increased incentives to employees for participation in a wellness program or for meeting certain health-status targets. The Act permits rewards or penalties, such as premium discounts of up to 30 percent of the cost of coverage. Existing wellness regulations are limited to wellness incentives of up to 20 percent of the total premium, provided that certain conditions are met.

• Waiting Period. In addition, employers may still impose a waiting period for coverage without being subject to a penalty, but this waiting period may not exceed 90 calendar days.

• Exchanges. The Act provides for the creation of health-insurance exchanges at the state level in 2014, where individuals and small employers would be able to buy health coverage in a manner similar to that of larger employers. Initially, the state exchanges would be open to individuals and small employers with 100 or fewer employees, unless the state opts to limit this to organizations with 50 or fewer employees. Beginning in 2017, states would have the option to expand the exchange to larger employers.

Effective January 1, 2018
• High-Cost Plan Excise Tax. The Act imposes a nondeductible excise tax of 40 percent on insurance companies and plan administrators (including self-insured plans) for any health-insurance plan where the combined annual employer/employee premiums exceed the threshold of $10,200 for self-only coverage and $27,500 for family coverage. The tax would apply to the amount of the premium in excess of the threshold. An additional threshold amount of $1,650 for singles and $3,450 for families would be available for retired individuals over the age of 55 and for plans that cover employees engaged in high-risk professions (e.g., law-enforcement professionals, EMTs, construction and mining).

U.S. businesses employ millions of unpaid student interns and recent college graduates to replace regular workers in violation of federal wage and hour laws, the Economic Policy Institute said in a research paper released April 5. “The increasingly competitive labor market for college graduates, combined with the effects of the recession, has intensified the trend of replacing full-time workers with unpaid interns,” EPI researchers Kathryn Anne Edwards and Alexander Hertel-Fernandez said.

The Labor Department’s Wage and Hour Division released an opinion letter in 2004 with six criteria that internships must meet for students not to be considered employees of a firm. The department recently restated the criteria for student interns to be considered a legal unpaid trainee under the Fair Labor Standards Act. Under the criteria, training is similar to that of a vocational school or academic instruction; training is for the intern’s benefit; interns do not displace regular employees; the employer derives no immediate advantage from the intern’s activities; and the student is not necessarily entitled to a job at the end of the internship. If all the criteria are not met, the intern is considered an employee under the FLSA subject to minimum wage and overtime laws.

Economic Institute Research Paper: The Kids Aren’t Alright – A Labor Market Analysis of Young Workers

by The Associated Press

Here are some of the features of the legislation.

HOW MANY COVERED: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 94 percent of eligible non-elderly Americans would have coverage, compared with 83 percent today.

COST: $938 billion over 10 years, according to the Congressional Budget Office.

INSURANCE MANDATE: Almost everyone is required to be insured or else pay a fine, which takes effect in 2014. There is an exemption for low-income people.

INSURANCE MARKET REFORMS: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more.

MEDICAID: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016.

If the Senate approves a package of changes this week, a special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity would be eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains.

TAXES: To make up for the lost revenue, the bill applies an increased Medicare payroll tax to the investment income and to the wages of individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent. If the Senate follows through, it would impose a 40 percent tax on high-cost insurance plans above the threshold of $10,200 for individuals and $27,500 for families. The tax would go into effect in 2018.

PRESCRIPTION DRUGS: Gradually closes the “doughnut hole” coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. Seniors who hit the gap this year will receive a $250 rebate. Beginning in 2011, seniors in the gap receive a discount on brand name drugs, initially 50 percent off. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare’s catastrophic coverage kicks in.

EMPLOYER RESPONSIBILITY: Employers are hit with a fee if the government subsidizes their workers’ coverage. The $2,000-per-employee fee would be assessed on the company’s entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement.

SUBSIDIES: The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges, opening for business in 2014. The exchanges would offer the same kind of purchasing power that employees of big companies benefit from. People working for medium-to-large firms would not see major changes. But if they lose their jobs or strike out on their own, they may be eligible for subsidized coverage through the exchange.

GOVERNMENT-RUN PLAN: No government-run insurance plan. People purchasing coverage through the new insurance exchanges would have the option of signing up for national plans overseen by the federal office that manages the health plans available to members of Congress. Those plans would be private, but one would have to be nonprofit.

ABORTION: The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

GOP HEALTH CARE SUMMIT IDEAS: Following a bipartisan health care summit last month, Obama announced he was open to incorporating several Republican ideas into his legislation. But two of the principle ones — hiring investigators to pose as patients and search for fraud at hospitals and increasing spending for medical malpractice reform initiatives — did not make it into the legislation. The legislation incorporates only one, an increase in payments to primary care physicians under Medicaid, an idea mentioned by Sen. Charles Grassley, R-Iowa.