Update on Federal Health Care Reform

Missouri Health Care for All members rally for health care reform.

11/18/09

Overview of Process in Congress So Far:

• On Sat., Nov. 7, the US House of Represented made history by approving significant, comprehensive health care reform that will provide affordable, quality health care to millions families and communities.  The bill is the Affordable Health Care for America Act, and is available online at http://docs.house.gov/rules/health/111_ahcaa.pdf.
• The Senate is finalizing its health reform bill, and we expect the bill to go to the Senate floor this week or next.

What Comes Next:

• The Senate will be debating health reform for many weeks.  Senate leaders are working to pass a bill before the winter holidays.
• GOAL:  A bill must pass both the House and the Senate so differences can be reconciled by a Conference Committee. 
• After the Senate votes, a conference committee will be created to work out the differences between the House and Senate bills.  Then both the House and Senate will vote again on the Conference Committee bill.  Conference committee negotiations will be a critical time to impact final legislation.  Conference Committee is most likely to occur in January of 2010.
• On the Senate side, one bill will be put together for the Senate to vote on.

There is much confusion about what is in proposed legislation.  Unfortunately, there is also much misinformation being spread through email, on the internet, through talk radio and other media.  Missouri Health Care for All, with help from endorsing organizations and national experts, believes we have a moral imperative to provide clear, accurate information to members of our communities.  This update is intended to equip our faith and community leaders in answering questions and leading our organizations and congregations during this historic time of social change.

Missouri Health Care for All staff and representatives are available to make presentations, facilitate discussions and support our leaders and member organizations in working for a just health care system that reflects our Principles.

Proposed legislation would bring better health care security and choices for working families – those we see every day in our community and in our places of worship.  Health insurance will become more affordable, more portable and coverage will be guaranteed.  (For a side-by-side comparison of current draft proposals visit www.kff.org)  Some of the main provisions being considered are:

1. Health Insurance Reforms that will change how private insurance companies offer their plans. These changes are designed to guarantee access to health insurance and control health care costs.

• Prohibiting private insurance companies from turning down individuals because of pre-existing medical conditions
• Stopping insurance companies from charging higher premiums because of pre-existing conditions or gender.  Proposals also limit whether insurance companies can charge higher premiums because of our age or because of where we live.
• Requiring insurance companies to spend a minimum amount of the money they receive from the payment of premiums on actual health care. 
• Requiring health insurance plans to have annual out of pocket spending caps for consumers. 

2. The creation of a “Health Insurance Exchange” where individuals and small businesses can purchase health insurance.  The new Insurance Reform rules would be required of companies offering plans in the exchange. 

• The exchange will be for individuals who are not covered by their employers—those who rely on the private insurance market. 
• The exchange will not eliminate or replace employer-sponsored health insurance for those that have it.
• In one proposal, a person without “affordable” health coverage from an employer may be able to purchase in the exchange, but could not take the employer contribution with them.

3. Providing Affordable Health Insurance Coverage to More People

• Providing coverage to more low income working families and individuals.  Proposals seek to expanding state health insurance (Medicaid) programs to adults with incomes up to 133 percent of Federal Poverty Level (FPL).  This will cover an estimated 11 million uninsured individuals from working families.  (The House bill would extend state Medicaid programs to individuals and families up to 150% of FPL)
• Implementing a sliding scale with premium subsidies for people purchasing insurance through the exchange.  This would help make insurance affordable for lower and middle income families.  This will also help part time workers.
• Premium subsidies could be available to families up to 400% of poverty level if their health care premiums costs exceed 12% of their income.
• Lower income working families would get help if their premium costs are more than 2-3% of their income.

4. Providing assistance to small business to purchase insurance, mostly in the form of tax credits.  In addition, small businesses will also benefit from the more affordable coverage available in the exchange, regardless of health status of employees.

• 1/3 of the uninsured (13 million), work for businesses with fewer than 100 workers.
• People who work in small businesses could be subsidized two ways:  their employers could get a subsidy and they could be eligible for premium subsidies.

5. Strengthening Medicare and Medicaid for seniors and people with disabilities

• Making prescription drug coverage more affordable – House proposals would eliminate or significantly reduce the Part D “doughnut hole.”
• Preventive services would be easier to obtain and afford under Medicare because they would not be subject to co-pays or deductibles.
• Phases in a change in payments to Medicare Advantage plans.  Currently, MA plans are paid 14-20% more than regular Medicare reimbursement rates. The proposal is to gradually reduce their payments until they equal the cost of “Original Medicare” benefit rates. 
• Improving Medicare and Medicaid payments to doctors, especially primary care doctors and those in communities with few providers.

6. Creating a public insurance plan with standard benefits and costs to compete with private insurance companies.

• This is in the House bills and may be included in the Senate bill
• The proposal is to create a non-profit, public health insurance plan that will be one choice in the insurance Exchange—a publicly administered health insurance plan that anyone shopping in the Exchange can purchase.  The goal is to create a plan with good benefits and fair policies that will compete with private insurance plans and bring down costs.