The Official Points on the HealthCare Bill

Arrowwind09 · � #1 � 09-01-2009, 04:20 PM

Official Summary (not sure just how official this is and I just can't seem to find my way to the actual bill so I can read it myself... 1000 pages? No sweat

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7/14/2009--Introduced.
America's Affordable Health Choices Act of 2009 - Sets forth provisions governing health insurance plans and issuers, including:
(1) exempting grandfathered health insurance coverage from requirements of this Act;
(2) prohibiting preexisting condition exclusions;
(3) providing for guaranteed coverage to all individuals and employers and automatic renewal of coverage;
(4) prohibiting premium variances, except for reasons of age, area, or family enrollment; and
(5) prohibiting rescission of health insurance coverage without clear and convincing evidence of fraud. Requires qualified health benefits plans to provide essential benefits. Prohibits an essential benefits package from imposing any annual or lifetime coverage limits. Lists required covered services, including hospitalization, prescription drugs, mental health services, preventive services, maternity care, and children's dental, vision, and hearing services and equipment. Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family. Establishes the Health Choices Administration as an independent agency to be headed by a Health Choices Commissioner. Establishes the Health Insurance Exchange within the Health Choices Administration in order to provide individuals and employers access to health insurance coverage choices, including a public health insurance option. Requires the Commissioner to:
(1) contract with entities to offer health benefit plans through the Exchange to eligible individuals; and
(2) establish a risk-pooling mechanism for Exchange-participating health plans. Provides for an affordability premium credit and an affordability cost-sharing credit for low-income individuals and families participating in the Exchange. Requires employers to offer health benefits coverage to employees and make specified contributions towards such coverage or make contributions to the Exchange for employees obtaining coverage through the Exchange. Exempts businesses with payrolls below $250,000 from such requirement. Amends the Internal Revenue Code to impose a tax on:
(1) an individual without coverage under a health benefits plan; and
(2) an employer that fails to satisfy health coverage participation requirements for an employee. Imposes a surtax on individual modified adjusted gross income exceeding $350,000. Amends title XVIII (Medicare) of the Social Security Act to revise provisions relating to payment, coverage, and access, including to:
(1) reduce payments to hospitals to account for excess readmissions;
(2) limit cost-sharing for Medicare Advantage beneficiaries;
(3) reduce the coverage gap under Medicare Part D (Voluntary Prescription Drug Benefit Program);
(4) provide for increased payment for primary health care services; and
(5) prohibit cost-sharing for covered preventive services. Requires the Secretary of Health and Human Services (HHS) to provide for the development of quality measures for the delivery of health care services in the United States. Establishes a Center for Comparative Effectiveness Research within the Agency for Healthcare Research and Quality, financed by a tax on accident and health insurance policies, to conduct and support health care services effectiveness research. Sets forth provisions to reduce health care fraud. Amends title XIX (Medicaid) of the Social Security Act to:
(1) expand Medicaid eligibility for low-income individuals and families;
(2) require coverage of additional preventive services; and
(3) increase payments for primary care services. Sets forth provisions relating to the health workforce, including:
(1) addressing health care workforce needs through loan repayment and training;
(2) establishing the Public Health Workforce Corps;
(3) addressing health care workforce diversity; and
(4) establishing the Advisory Committee on Health Workforce Evaluation and Assessment. Sets forth provisions to:
(1) provide for prevention and wellness activities;
(2) establish the Center for Quality Improvement;
(3) establish the position of the Assistant Secretary for Health Information;
(4) revise the 340B drug discount program (a program limiting the cost of covered outpatient drugs to certain federal grantees);
(5) establish a school-based health care program; and
(6) establish a national medical device registry.

Arrowwind09 · � #2 � 09-01-2009, 04:22 PM

https://www.opencongress.org/articles...Public-Option-

The public option as proposed in the House health care bill, is a government-run health insurance plan, like Medicare, that would compete along side private insurers in a new Health Insurance Exchange that the bill would set up. The exchange is basically a place where people who aren�t on Medicare or Medicaid and don�t have insurance through their employers would go to comparison shop for a health plan. One of the plans available on the exchange would be the public option. Like all plans on the exchange, the public plan would have to meet certain minimum standards for care � minimum services that must be covered, mental health benefits parity, a fair grievance and appeals mechanism, etc.

The public option and the private insurers on the exchange could still offer different levels of care � from catastrophic-only to comprehensive � but plans would be relatively standardized by type so that comparison shopping is easier for consumers. The exchange would be available to the public as a website and a toll-free hotline, and would be focused on making information about the plans more transparent.

Conservatives argue that the government-run public option plan would drive private insurers out of business because, not being burdened by the need to generate profit, they could offer the same level of care at a lower price. They fear that this would happen to such an extent that eventually there would not be any private insurers left. Liberals on the other hand see the competitive advantage of a public plan as a way to bring costs down throughout the industry, thereby increasing the number of affordable health insurance choices for consumers. Without the public option there will be no real change to the current system that has kept health insurance out of reach for millions of Americans, they argue.

Who�s right? The Congressional Budget Office (CBO), a politically independent, non-partisan government agency whose job is to provide economic data to Congress on the bills they propose, has done some analysis (.pdf) of the public option�s likely effects. This is as close as we can get to an unbiased, scientific take. Based on how the CBO sees the public option working, it�s safe to say that even if the conservatives are right and the goal is to crowd out the private insurers, as written into the bill, it�s not going to have that effect:

Quote:

Another significant feature of the insurance exchanges is that they would include a public plan that largely pays Medicare-based rates for medical goods and services. CBO estimates that the premiums for that plan would generally be lower than the premiums of the private plans against which it would be competing. Because all plans offered in the exchanges would vary their premiums to reflect the costs incurred in each area, the difference in premiums between private plans and the public plan would vary geographically�but on average the public plan would be about 10 percent cheaper than a typical private plan offered in the exchanges. That difference in premiums is itself the net effect of differences in the major factors that affect all insurance plans� premiums, including their payment rates to providers, their administrative costs, the degree of benefit management they apply to control spending, and the pool of enrollees they attract (the effects of which would be partly offset by the risk-adjustment provisions described above).

Enrollment in the public plan would also depend on the number of providers who chose to participate in it. Providers would not be required to participate in the public plan in order to participate in Medicare, and CBO assumed that some providers would elect not to participate in the public plan because its payment rates would be lower, on average, than private rates. Even so, CBO�s judgment is that a substantial number of providers would elect to participate in the public plan, in part because they would expect a plan run by HHS to attract substantial enrollment. Taking into account both the access to providers in the public plan and the relative premiums its enrollees would pay, CBO estimates that roughly one-third of the people obtaining subsidized coverage through the insurance exchanges would be enrolled in the public plan�so enrollment in that plan would be about 9 million or 10 million once the proposal was fully implemented. Given all of the factors in play, however, that estimate is subject to an unusually high degree of uncertainty.

This CBO report is from July. Since then, one of the three House committees with jurisdiction over the bill, the Energy and Commerce Committee, has marked up a version that would require the public option to be reimbursed on rates negotiated with the insurance industry. That would make the public option less competitive than it would be how it�s set up in the bill the CBO looked at (public option reimbursement rates based on Medicare rates). At this point, it�s unclear whether or not the Energy and Commerce Committee changes will be incorporated in the bill the House finally votes on.

If you want to read and comment on the official legislative text on the structure of the public option, it�s all in Title II, Subtitle B.

jfh · � #3 � 09-01-2009, 08:36 PM

Things will change when congress returns from recess. I've heard that there will be no public option. This will make the whole debate so watered down, that it will be worthless - to me at least.

https://www.factcheck.org/2009/08/twe...about-hr-3200/

There are no official bills. Three of them, in congress, have not even been open for debate yet. The one, in the Senate, hasn't come out of committee either.

I see the problem as Obama not taking the lead for his party. He turns these things over to congress, where they just mess them up. He has said that he will not sign it if there is any increase in the deficit. If he changes his mind on that, he will lose the public on anything else he does.

GreenLiving · � #4 � 09-01-2009, 10:23 PM

I find it quite hard to understand the bill, maybe many people also rely on others to explain it.

Mad Scientest · � #5 � 09-02-2009, 07:10 PM

That our medical system is broken and needs fixing is a given. But is a government controlled system the way to do it?
What government agency or programs can we look to as a model that would show us how government is able to provide an efficient cost effective service?

jfh · � #6 � 09-03-2009, 04:35 AM

I think the Veteran's health program is a good one. Also the Federal Employees. I don't know the costs of these. I think the congress people like theirs. Medicare is nearly broke. I know nothing of Medicaid.

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