The Current Health Care Reform Proposal

I tried to place this info in the preceding post, but for some reason when I did so it threw the rest of the post off-balance. I thought it was worth laying out some details of the current proposal:

--Affordability: Makes it easier for low-income families and middle-class families to purchase insurance; if a family's income is <$55,000, that family would have between 73%-94% costs covered.

--Fine for not purchasing insurance: $2,850 or 2.5% family income.

--Employer responsibility: Senate bill lacked employer mandate; President endorses the Senate approach but increased the fees on employers if ANY employee purchases insurance on the exchange. Employers with fewer than 50 employees are exempt; there is no employer mandate, but there are provisions to make providing insurance more attractive.

--Medicaid/CHIP: coverage extends to 133% federal poverty level (for a family of 3 this would be less than $24,000); there would be a 100% match 2014-2017, 95% 2018-2019, 90% 2020 and beyond for all states. President’s plan removes the “Cornhusker Kickback" that would have provided disproportionate benefits for Nebraska.

--Health insurance exchange in both plans; national in House, state in Senate. The President endorsed state-based exchange for individuals & small businesses must be administered by govt agency or non-profit.

--President proposed a plan without a public option, but develops Health Insurance Rate Authority to provide Federal assistance and oversight to States regarding unreasonable rate increases and other unfair practices. There must be at least two multi-state “qualified” plans in each exchange, at least one non-profit and one w/o abortion coverage.

--President’s plan probably leaves 20 or 21 million uninsured; of those about 7 million would be illegal immigrants (who were not covered in either congressional proposal, either).

--Neither bill includes coverage assistance for undocumented immigrants and (in Senate) cannot buy policies from exchanges.

--Abortion coverage: President’s language would permit a state to prohibit any plan from providing coverage (so it is possible that NO plan on an exchange would provide coverage); plans that offer coverage must create allocation accounts to ensure that no federal $ goes to abortion coverage and plans are not allowed to discriminate against providers who do not provide coverage.

--Phase out Medicare D prescription coverage donut hole. --Both bills provide significant support for increased primary care workforce and President’s bill provides $11 billion for community health centers.

--Physician payment system would move away from the “fee for service” model, move towards accountable care organizations or other models.

--4 Republican ideas are included in compromise legislation: $50 million to reduce state demonstration projects for malpractice reform, improve Medicaid reimbursement to physicians, include health savings accounts in the exchange, and begin random undercover investigations to reduce fraud.