House, Senate release health care reform drafts

Members of both the House and the Senate have released draft summaries or draft legislative language for comprehensive health care reform legislation. Staff members of three House committees -- Ways and Means, Energy and Commerce, and Education and Labor – released a three-page summary of a possible health care reform bill that includes a public insurance option, insurance market reforms, and insurance premium support for families up to 400 percent of the federal poverty level.

The House outline also includes several changes to improve the quality of care provided under the Medicare and Medicaid program, including:

• using Medicare, Medicaid and the new public health insurance option to reward high quality, efficient care, and reduce disparities;
• adopting innovative payment approaches and promotes better coordinated care in Medicare and the new public option through programs such as accountable care organizations; and
• including a program in Medicare to reduce preventable hospital readmissions.

The proposal also includes changes in the way providers are reimbursed under Medicare, including:

• replacing the Sustainable Growth Rate (SGR) formula that determines physician pay rates in Medicare;
• increasing reimbursement for primary care providers, improving the Part D program, and implements other  recommendations of the Medicare Payment Advisory Commission (MedPAC);
• extending solvency by eliminating overpayments to Medicare Advantage plans, and refining payment rates for certain services;
• creating new consumer protections for Medicare Advantage beneficiaries;
• improving low-income subsidy programs to ensure Medicare is truly affordable and accessible for those with lower incomes; and
• eliminating cost-sharing for all preventive services.

The Senate proposal is a 615 page draft from the Senate Health, Education, Labor and Pensions committee. Some of the major elements of the draft include the following:

• A group health plan and a health insurance issuer offering group or individual health insurance coverage may not establish lifetime or annual limits on benefits for any participant or beneficiary.
• A group health plan that has 250 or fewer members shall not self-insure the group.
• The federal government shall provide grants to states to facilitate the establishment of Affordable Health Benefit Gateways in each state. A gateway facilitates the purchase of health insurance at an affordable price by qualified individuals and groups.(modeled after the Federal Employee Health Benefits Plan). There may be more than one Gateway per state or one regional Gateway for several states.
• An affordable access plan offered by the federal government will be one of the choices available through a gateway. The affordable access plan would be modeled on Medicare and must conform to state licensing rules.
• Credits would be available to employers with 27 or fewer full time employees.
• Individuals without qualifying health care coverage could be fined.
• Employers not providing coverage would be required to pay the government an as yet unspecified amount (includes a small employer exemption).

The HELP committee will meet June 10 to discuss issues such as the employer mandate and has scheduled a public hearing for June 11. It plans to begin marking up legislation June 16.

A copy of the draft bill is available at http://help.senate.gov/BAI09A84_xml.pdf