As mentioned in other earlier posts, there are two sets of committees working on the subject of health care reform or health care “modernization.”

The main bill being proposed originated in Senate, and the House objectives include a general rundown of issues that support or buttress the issues brought to bear in the Senate bill with some differences.

Some of the proposed health care reforms are as follows:

Individual and Group Insurance Markets

Insurers or health plan providers may no longer impose pre-existing condition exclusions. Further, plans will be required to accept all applicants and will be prohibited from increasing rates to insureds based on:

  • health concerns
  • gender
  • claims history
  • occupational class

Premiums can still differ from plan to plan, but only based on:

  • age of insureds
  • rating “area” (region in which coverage is secured)
  • value of benefits (actuarial value of benefits selected)
  • family structure

Health plans will also be required to provide:

  • preventative care
  • reimbursement incentives for quality
  • coverage for dependent children through age 26
  • And, be prohibited from limiting benefits via a lifetime benefit maximum

Establishment of Health Exchanges or Health Benefit Gateways

Proposed is a plan to establish health insurance purchasing clearinghouses on a state wide level. These “Exchanges” or “Gateways” will be used by individuals and groups for the purpose of comparing and enrolling in health care plans. The exchanges will also be used to help citizens enroll in other government sponsored plans such as the Children’s Health Insurance Program (or, CHIP), Medicaid, and other currently established federal health care programs. For buyers, participation in a health exchanges is optional. There will be a government agency that is responsible for determining what premiums are considered to be “affordable” for individuals and families based on various circumstances and income guidelines.

 Cost Sharing

There are three proposed levels of cost sharing available based on individual and family circumstances. They are as follows:

Premium credits will provided for individuals and families up to 500% of the federal poverty level, including a sliding scale based on a range of income.

Medicaid will be expanded to cover individuals and families who qualify as being under 150% of the federal poverty level.

A credit will be available to small employers (with fewer than 50 full time employees) to help those employers provide insurance to employees in groups where employee incomes average $50,000 per year or less.

Mandated Coverage

Individuals will be required to secure coverage or be assessed a fee for every month they are not covered. This fee or “shared responsibility payment” will be assessed via the income tax system. The bill currently does not specify an employer mandate to offer coverage, it does require coverage be secured by individuals. Exemptions will be made in certain areas where qualified coverage may be unavailable. Though the bill does not specify an employer mandate, it does suggest the possibility for a fee being assessed to employers that do not provide coverage. There is a possibility that small employers may be exempt from the fee.

Technological Uniformity

The bill requires an effort to achieve a technological uniformity in enrollment for individuals in state and federal human services programs. Grants will be established to help local governments and/or states develop new ways of adapting toward and achieving simplicity and uniformity in enrollment procedures in various state and federal human services programs.

Long Term Care

Establishes a fund, paid for by beneficiaries, that would help pay for long term care benefits for those who have “functional limitations” and would require long term care services beyond 90 days. The program would provide cash benefits, counselling assistance and advocacy services for enrollees. The plan would be managed by the Secretary of the Treasury. Employers who enroll employees in the plan would be eligible to up to a 25% credit for premiums.

Government/Public Insurance Plan Option

Lastly, the idea has been suggested that a public insurance plan option be created that would compete with private insurers. This public plan would be available to enrollees via the health care exchange or gateway system. The bill itself does contain language regarding a public plan option, see page 43:

(B) INCLUSION.—In making available coverage pursuant to subparagraph (A), a Gateway shall include a public health insurance option.

There is further reference to a government plan option in committee summary notes. The summary suggests that the government plan pay benefits to health care providers at a ten percent premium over established Medicare rates.

To view the 615 page proposed Senate bill directly go to:

http://help.senate.gov/BAI09A84xml.pdf

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Filed under: Health Care Reform

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