Democrats in the house this week released a “Discussion Draft” of the health care reform overhaul they hope to pass, but recent media coverage is suggesting that their hope is more like a wish.
The Draft was released by three committees: Ways and Means, Energy and Commerce, and Education and Labor. While the draft is certainly not definite, it shows the end game, and early signs of disagreement with moderate and fiscally conservative Democrats, as well as Republicans.
The draft claims to protect current coverage – allowing individuals to keep the insurance they have if they like it – and preserves choice of doctors, hospitals, and health plan. It achieves these reforms by:
– Creating a Health Insurance Exchange and offering a public health insurance option
– Guaranteeing coverage and insurance market reforms: Insurance companies will no longer be able to engage in discriminatory practices that enable them to refuse to sell or renew policies today due to an individual’s health status. In addition, they can no longer exclude coverage of treatments for pre‐existing health conditions.
– Protecting consumers by prohibiting lifetime and annual limits on benefits. The proposal also limits the ability of insurance companies to charge higher rates due to health status, gender, or other factors. Under the proposal, premiums can vary based only on age (no more than 2:1), geography and family size.
– Offering Essential benefits through a new independent Advisory Committee with practicing providers and other health care experts, chaired by the Surgeon General, that will recommend a benefit package based on standards set in the law. The basic package will include preventive services with no cost‐sharing, mental health services, dental and vision for children, and caps the amount of money a person or family spends on covered services in a year.
– Provides sliding scale affordability credits to low‐ and moderate‐ income individuals and families.
– Capping annual out‐of‐pocket spending to prevent bankruptcies from medical expenses.
– Increasing competition by opening many market areas in our country to new competition, spurring efficiency and transparency.
– Expanding Medicaid to individuals and families with incomes below 133 percent of the federal poverty level.
– Improving Medicare by eliminating cost‐sharing for preventive services, improving the low‐income subsidy programs in Medicare, fixing physician payments, and making other program improvements. The proposal will also address future fiscal challenges by improving payment accuracy, encouraging delivery system reforms and extending solvency of the Medicare Trust Fund.
– Individuals will be responsible for obtaining and maintaining health insurance coverage, and those who choose to not obtain coverage will pay a penalty.
– Employer responsibility: Employers will have the option of providing health insurance coverage for their workers or contributing funds on their behalf. Employers that choose to contribute will pay a fee based on eight percent of their payroll. Employers that choose to offer coverage must meet minimum benefit and contribution requirements specified in the proposal.
– Assistance for small employers: An exemption from the employer responsibility requirement will be put in place for certain small businesses. In addition, a new small business tax credit will be available for those firms who want to provide health coverage to their workers, but cannot afford it today.
Also included in the draft are ways to strengthen the health care workforce, and increase prevention and wellness measures by:
– Expanding Community Health Centers;
– Prohibiting cost‐sharing for preventive services in benefit packages;
– Creating community‐based programs to deliver prevention and wellness services, and focusing on community‐based programs and new data collection efforts to better address racial, ethnic, regional and other health disparities;
– Providing funds to strengthen state, local, tribal and territorial public health departments and programs, and increasing the National Health Service Corp;
– More training of primary care doctors and an expansion of the pipeline of individuals going into health professions, including primary care, nursing and public health and greater support for workforce diversity;
– Expanding scholarships and loans for individuals in needed professions and shortage areas, encouraging training of primary care physicians by taking steps to increase physician training outside the hospital, and redistributing unfilled graduate medical education residency slots for purposes of training more primary care physicians.
Lastly, the discussion draft proposes to reduce the growth in health care spending by:
– Modernization and improvement of Medicare to reward efficient provision of health care, including testing of innovative concepts such as accountable care organizations and bundling of acute and post‐acute provider payments;
– New payment incentives to decrease preventable hospital readmissions;
– Improving the Medicare Part D program by creating new consumer protections for Medicare Advantage Plans, and improving low income subsidy programs and coverage or preventive services.
– Reforming the flawed physician payment mechanism in Medicare with an update that wipes away accumulated deficits, provides for a fresh start, and rewards primary care services, care coordination and efficiency.
– Innovation and delivery reform through the public health insurance option
– Improving payment accuracy and eliminating overpayments to Medicare Advantage plans and improves payment accuracy for numerous other providers.
– Preventing waste, fraud and abuse by using new authorities for pre‐enrollment screening of providers and suppliers, permitting designation of certain areas as being at elevated risk of fraud to implement enhanced oversight, and requiring compliance programs of providers and suppliers.
– Administrative simplification of paperwork.
The Bill also creates an independent agency in the executive branch of the Government, known as the “Health Choices Administration,” headed by a Health Choices Commissioner, who is appointed by the President and confirmed by the Senate to oversee all of the above.