House Ways and Means, Energy and Commerce and Health, Education and Labor committees have come to some agreement on a $1.7 trillion bill to provide universal health care and require that all citizens obtain health care insurance.

In a four page circular released June 9, 2009, the House committees outline the “Key Features of the Tri-Committee Health Reform Draft Proposal in the U.S. House of Representatives.”

For a copy of the actual circular use this link: http://waysandmeans.house.gov/media/pdf/111/tri.pdf

Summarizing the circular, is the following:

The house ways and means committee explains their commitment to health care reform that will:

  • Reduce costs
  • Protect current coverage
  • Preserve choice of doctors, hospitals and health plans
  • Ensure affordable, quality health care for all.

Plan Overview

  • Allow people to keep their current coverage and to minimize disruption of the current health care system.
  • Provide for investment the health care workforce and improve access to primary care.
  • Invest in disease prevention and public health care programs.
  • Establish a new Health Care Exchange system that provides States the opportunity to create State or regional exchanges in addition to any national exchange for the purpose of comparing and enrolling in health care plans.
  • Establish “shared responsibility” among individuals, employers and government. Shared responsibility includes a mandate that individuals would “share responsibility” via a per month fee for every month they go uncovered. This fee would be collected via the federal tax system.
  • Outlay a sliding scale of “credits” to help low and middle income individuals and families afford coverage.
  • Push through health care delivery reforms to “reduce costs, maintain fiscal sustainability, and improve quality.”
  • Lastly, the House measures propose to expand federal authority in order to curb waste, fraud and abuse.

Workforce Investments

  • Include expansion of the National Health Services Corps.
  • Assist in training of primary care physicians and increase the influx of individuals entering health professions, including primary care, nursing and public health.
  • Support workforce diversity.
  • Add scholarships and student loans to individuals seeking to study in needed health care professions and health care shortage areas.

Prevention and Wellness Efforts

  • Expand Community Health Centers
  • Eliminate cost sharing in preventive services benefits.
  • Create “community-based” programs to deliver wellness and prevention services.
  • Promote collection on a community wide basis for new data gathering efforts in order to identify and address racial, ethnic and any other health disparities.
  • Seek to strengthen public health departments on a State, local, territorial and a tribal level.

Insurance Market Reforms

  • Prohibit insurers from excluding coverage due to pre-existing conditions and/or engaging in other discriminatory practices.
  • Eliminate rating based on gender, health status, occupation and place limits on age rating.
  • Establish a new Health Insurance Exchange (or Gateway) to provide a transparent marketplace for individuals to compare and enroll among private insurers as well as a new public health insurance option.
  • Seek to attain administrative simplification and standardization so as to reduce administrative costs across all providers and plans.

Affordability and Access Provisions

  • Create a sliding scale of “affordability credits” to help individuals and families purchase insurance through the Exchange. Credits would be eligible for individuals and families who are within 400% (500% in the Senate version) of the federal poverty level. The report makes the note that the average cost of family coverage today is 14% of a family’s income at 400% of poverty.) View the 2009 Federal Poverty Guidelines at: http://www.coverageforall.org/pdf/FHCE_FedPovertyLevel.pdf
  • Expand Medicaid for the “most vulnerable, low income populations” (Up to 150% of poverty in the Senate version). Increase reimbursement rates to bolster access to to primary care services under the Medicaid program.
  • Place caps on out of pocket maximums in benefit plans in order to curb bankruptcies due to medical expenditures.

Public (Government) Health Insurance Option

  • “Enhances transparency and accountability by creating a new public health insurance option within the Exchange to offer and ensure competition.”
  • This option is “self-sustaining” and is intended to compete evenly with private insurers.
  • Employees and individuals will be free to choose between public and private options in the Health Care Exchanges.

Benefit Levels

  • Independent advisory on a both public and private level will assess and recommend “standards” for benefit packages.
  • Create varying levels of standardized benefits and cost sharing arrangements. Additional benefits will be available in higher cost plans.
  • Establish a “phase-in” period in order to bring employer based plans up to benefit quality standards.

Shared Responsibility

  • Once market reforms and affordability credits are in place, individuals are “responsible for having health insurance” with exceptions in cases of hardship.
  • Employers can choose between providing health insurance for workers or “contributing funds” on behalf of their uncovered workers.
  • The Federal Government is responsible for making health insurance affordable via “affordability credits,” insurance market and industry reforms, as well as oversight of insurance companies.
  • Protect small businesses by exempting small, low-wage companies and adding a new “small business tax credit” for firms providing health care coverage.

Reforming Health Care Delivery and Ensuring Sustainability

  • Use federal health programs (such as CHIP, Medicare, Medicaid and the new public health insurance option) to promote high quality care and reduce inequities.
  • Add new payment approaches to promote coordination of care in Medicare and the new public health insurance option using “accountable care organizations.”
  • Attack the high rate of health care cost increases, thereby creating savings for reform and fiscal sustainability. Adding a program in Medicare to reduce preventable hospital re-admissions.

Modernize and Improve Medicare

  • Replace the currently “flawed” Sustainable Growth Rate (SGR) reimbursement formula in Medicare.
  • Increase reimbursement levels for primary care.
  • Improve Medicare Part D.
  • Implement MedPAC recommendations. (See their website at:http://www.medpac.gov/index.cfm)
  • Eliminate over payments to Medicare Advantage beneficiaries.
  • Improve upon low income subsidy plans to make Medicare more affordable for low income individuals.
  • Remove cost sharing for all preventive benefits.

Tagged with: •

Filed under: Health Care Reform

Like this post? Subscribe to my RSS feed and get loads more!