House Releases Health Care Reform Legislation (UPDATED TABLE)
House Releases Health Care Reform Legislation (UPDATED TABLE)
Today, three separate House committees — Ways and Means Committee, Energy and Commerce Committee, Education and Labor Committee — released a single health care reform bill, the Tri Committee Proposal. In a press release announcing the legislation, the three panels with jurisdiction over health policy in the House announced that they had developed “a single bill that fulfills President Obama’s goals of reducing health care costs, protecting and increasing consumers’ choices, and guaranteeing access to quality, affordable health care for all Americans.”
Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option. While details are still being worked out, the proposal establishes a public plan in 2013 that will compete with private insurers, within the Exchange, on a level playing field. The public option will be required to abide by all marketing, operations, and rating rules and would initially be allowed to use Medicare plus rates. After some time, the plan would have to independently negotiate fees with providers.
On the whole, the bill’s affordability measures are impressive. Full details are after the jump but the plan offers subsidies on a sliding scale (up to 400 percent of poverty) and opens up Medicaid to Americans at or below 133% of the federal poverty level. While I haven’t seen the cost-sharing details, the robust public plan that could use Medicare plus rates would be able to force private insurers to aggressively negotiate with providers and pass on savings to consumers.
Below is a comparison table of all three bills, full details of the Tri Committee’s proposal are after the jump:
| HELP Bill (About $1 trillion/10 years) | Senate Finance Draft ($774 billion/10 years) | Tri House Bill($1.04 trillion/10 years) | |
| Individual Mandate | Yes | Yes | Yes |
| Employer Mandate | Yes (Large employers would pay $750 per full-time employee, $375 for each part-time employee or provide adequate coverage.) | No, but employers with workers at or below 300% FPL have to pay | Yes |
| Medicaid Expansion | 150% FPL, but still unclear | 133% FPL | 133% FPL |
| Subsidies | between 150 – 400% FPL on sliding scale | between 133 – 300% FPL on sliding scale; flat rate for 300%-400% | between 133 – 400% FPL on sliding scale |
| Public Option | Yes (Will have to compete on a level playing field with private providers and offer competitive rates and premiums. ) | No (Conrad’s co-op compromise) | Yes, Medicare + 5% |
| Insurance Regs | Guarantee issue, modified community rating (2:1), no rescissions | Guarantee issue, modified community rating (7.5:1), no rescissions | Guarantee issue, modified community rating (2:1), no rescissions |
Next week, all three committees will hold hearings on the legislation. Mark-up (each committee will hold three markups on the same bill) will begin in mid-July and the bill will likely go to the floor of the House before the August recess.
Details on the Tri-Committee bill:
The bill establishes a National Exchange in 2013 and phases in participation for individuals and employers. If states and regions establish their own exchanges, they would substitute for the National Exchange, but would have to follow the rules established by it. After 2015, employers may choose to offer coverage through the Exchange and would have to finance their employees’ plans.
Under the legislation, all insurance companies would have to offer coverage to everyone who applies, and can offer rates that vary based on family status, geography and age (insurers would only be able to charge and older person twice as much as they charge a younger person). Families with incomes between 133% and 400% of Federal poverty level will be offered subsidies on a sliding scale and Medicaid subsidies will be available to Americans 133% of poverty. Individuals would be required to purchase coverage once the Exchange is operating (in 2013) and employers would have to either provide credible coverage or finance their employees in the Exchange. Small employers (definition yet to be determined) are exempt from providing coverage and will receive a tax credit up to 50 percent of basic premiums.
- Increasing the price of soda and other sugary drinks by 10 cents a can.- Applying a potential 2 percent income tax increase to single taxpayers earning more than $200,000 a year and households earning more than $250,000.- A new employer payroll tax could target 3 percent of employers' health care expenditures.- Taxing employer-provided health insurance benefits above certain levels — a less likely option but one that still is in the running.
14 Responses to “House Releases Health Care Reform Legislation (UPDATED TABLE)”
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FPL?
June 20th, 2009 at 2:31 amWhy is the tax increase on all workers greater than the tax increase on high income earners? Since when are Democrats into regressive taxation, or is that what it takes to call yourself a blue dog these days?
June 20th, 2009 at 2:33 amI got a bad feeling about this, particularly with the 2013. Seems to me like some kind of game is being played, it’s start date is the year after Obama’s first term is up.
June 20th, 2009 at 8:33 amHow many will die needlessly by 2013? Any bill needs to contain the words PUBLIC OPTION and NOW.
June 20th, 2009 at 11:36 amFPL=federal poverty line
June 21st, 2009 at 10:39 amWe seem to be headed for big business, big Government being dominant and a single entity. I do not know why a business or Government should have the responsibility for personal healthcare insurance. Every business or Government can provide the goods or services it provides equally whether it offers insurance or not. These additional costs are driving US businesses to relocate to other Countries.
The following is something I have never heard anyone address.
You are not calculating the true cost of our current healthcare system. The cost of our current system includes many costs directly and indirectly related to paying claims.
Government, Insurance Companies, and Lawyers each take a cut of healthcare dollars before it gets to the medical facilities. When multiple Government plans are coupled to multiple insurance plans to settle a single claim, a very expensive and confusing system is created
We are all covered by and pay for thousands of healthcare policies every day.
A single injury (i.e. ankle injury) might be covered by a personal healthcare policy, auto liability insurance, workers comp, or property liability insurance, depending on the circumstances of the injury.
Currently healthcare policies are plentiful but too fractured and specific. Health insurance is included in personal healthcare plans, product liability insurance, property liability insurance, workers’ comp insurance, auto liability insurance, medical malpractice insurance, and government programs such as Medicare, Medicaid, VA, or Indian health benefits. Gaps in coverage and redundant coverage cause lawsuits, which delay payments and add direct and indirect costs to consumers.
Healthcare is never going to be affordable when Government, Insurance Companies, and Lawyers each take a cut of healthcare dollars before it gets to the medical facilities. When multiple Government plans are coupled to multiple insurance plans to settle a single claim, a very expensive and confusing system is created.
The replacement system should be, each person has and pays for one “No Fault Personal Healthcare Policy” eliminating redundant healthcare cost and coverage in all other plans. The plan should be sold on the open market through existing insurance Companies.
Congress passing a Bill stating, “Each person will be covered by a single No Fault Personal Healthcare Policy which replaces all other medical healthcare policies”, would implement this plan.
The Government would have to make it mandatory that every person has this coverage.
In certain cases government assistance might have to happen, but working with one plan, one agency, and one set of rules there should be savings.
It would still be illegal to create unsafe products or work places and the current laws and penalties would still apply. If long-term injuries occurred Lawsuits for compensation would still happen. Lawyers would still have job security.
The savings from eliminating redundancy is not being subtracted in calculating the true cost.
June 21st, 2009 at 6:57 pmI would hope the plan being sold on the open market would satisfy the Republicans.
I would hope the plan being a Universal Healthcare Plan would satisfy the Democrats.
Where’s coverage of HR 676? It’s got over 200 sponsors and calls for free universal health care, unlike the three half-assed measures above.
June 21st, 2009 at 9:23 pmI’m surprised and disturbed by the 2013 start date. It’s shades of the 7 year trigger.
June 21st, 2009 at 10:26 pmI would want the Exchange and Public plan to start much sooner. Something like Spring 2010.
I find the discussion of the “robust public option” to be incomplete and lacking an understanding of how we will ultimately achieve universal, affordable health care. I support employer-based health plans and self-organized networks like the accountable care organizations mentioned in a number of blogs and comments. However, a public plan has three inherent drawbacks, compared with a state-of-the-art employer-sponsored plan, like the plans offered at companies like Safeway, Pitney Bowes, and Quad Graphics, to name a few:
1. Employers can realize a financial and productivity benefit from keeping employees’ healthy, because of the reduction in not only medical costs, but disability, workers compensation, and sick days. They also gain from better productivity and quality. No other system, including a public plan, delivers as good an alignment between health and financial benefit.
2. Care delivered on or near the locations where any individual spends his or her waking hours is more likely to result in earlier treatment of emerging illnesses, more extensive use of good screenings and immunization, and less aggressive and less costly use of drugs.
3.A less centralized system and one with less concentration of covered lives than a large public plan would have is better able to react to fast-changing medical developments. By its nature, CMS reacts slowly to changes in the way medical science has defined “best practices.” Moreover, public plans are subject to more politically-powerful, but sometimes medically-questionable coverage decisions, as evidenced by the decision by CMS and many states in the early 1990’s to pay for high-dose chemotherapy, combined with autologous bone marrow transplants, a treatment option that was subsequently discredited by clinical studies.
Public plans that have high qualifying income thresholds have the potential to siphon off the healthiest and most profitable young employees of a private insurance system, and eventually destroy that system. As that is happening, more people will be in public systems that are disconnected from their day-to-day activities and are less matched to fast-changing understandings of what constitutes good medical practice. We will miss a golden opportunity to expand on the innovation of state-of-the-art employer plans that truly have the potential to take cost down and make care affordable for all.
Ultimately, we have a health crisis that drives up the cost of health care and health insurance. The public plan does not create an environment in which those with the best ability to make people healthier, namely employers, are incented to continue to find ways to make the employees and families for whom they pay for care heathier. If we do not solve the health crisis, health insurance will continue to become more and more unaffordable.
June 22nd, 2009 at 4:32 amhow is something that doesnt go into effect til 2013 “Health Care Now!”?
June 22nd, 2009 at 7:34 amAs the cornerstone of healthcare reform it is very impractical for employers to be the provider of health insurance. Many of the towns in the Midwest have no large corporations in their communities. Most are self-employed or work for small independent employers. The only universal solution that applies to every situation, is personal healthcare paid for by each individual. Every time an exclusion or separate policy is implemented a loophole is created.
June 22nd, 2009 at 4:18 pmEach person owns and pays for a “No-fault Healthcare Policy” covering any medical treatment the owner of the Policy might need. Eliminating all other healthcare coverage including healthcare coverage in liability policies.
People not Big Corporations or big Government is the cornerstone of our Nation. It is the first time in history I have seen the Democrats and Republicans agree on trickle down economics.
Any insurance is based on collecting from the many, most of whom do not make claims, to distribute to the relatively few who do. The more who are in the program, the more the risk can be spread.
What is the value added by a health insurance company? It takes in money, invests it, takes a cut for profit and payroll, then distributes the money needed for claims. Unlike companies which specialize in products that we all gain from due to the expertise of the company, what do we benefit from a multitude of insurance companies doing the same thing and offering essentially the same thing?
Even worse – to have many companies all using different paperwork and procedures seems a huge waste of money when a giant pool of all of the customers of those many companies can be created under ONE paperwork/policy routine and ONE bureaucracy. To try to eliminate the public option is exactly the opposite of what should be attempted which is to create as large a pool of people in the public option as possible.
Can someone make a case for what benefit we derive from private health insurance companies? Please try to make a case because I’m at a loss to defend the many players we have right now.
Any public plan, of course, should have carrots and sticks: higher rates for unhealthy behavior such as smoking, for example. All the calculations for rates should be open to the public to make it clear that the costs are being covered and how.
June 22nd, 2009 at 5:14 pmI acquired some statistics from the US Census Bureau.
June 22nd, 2009 at 6:16 pmEvery liability policy has hospitalization liability insurance in the premiums. If there was a National healthcare policy or each individual had “No-fault Healthcare Coverage”, liability hospitalization could be removed from any liability policies. There are:
250,851,833 Registered Vehicles in the US
12,746,126 Personal Boats in the US
67,671,000 Homes in the US
7,601,160 Businesses in the US
338,870,119 Total
If removing hospitalization from each of these liability policies made an annual savings of $100.00 on each policy the annual savings to Americans would be $33,887,011,900.
Why do we keep talking about insurance instead of care. Insurance is just a means of financing the care. People don’t really want an insurance card, what they want is healthCARE. Now that we have that straight we can focus on the real peoblems. 1) Demand is increasing for two reasons A)Technology is getting better at finding and treating problems B)the incidence of disease is increasing due to demographics.
2)Supply is not keeping up with demand.
Thats it folks. You cannot control costs in the face of huge increases in demand without an offsetting increase in supply of caregivers. In my state the politicians celebrated when they got more enrollment in 2 months in medicaid programs than were predicted in one year. YIKES. Anyone know how to increase covered lives by 40-50 million uninsureds without increasing demand?
Sure you can save a billion here or there with streamlining, efficiencies, best practices etc etc. But when utilization is increasing without more doctors and hospitals forget controlling the costs.
June 25th, 2009 at 4:03 pm