News from Advocacy for Patients with Chronic Illness, Inc.

Health Care Reform
This issue of our Newsletter focuses on federal health care reform proposals. Over the next two months, the Senate Finance Committee, Senate Health Education, Labor and Pensions Committee (HELP Committee), and the three Committees in the House of Representatives with jurisdiction over health care are expected to mark-up (discuss, amend, refine) their various proposals before they are debated by the full Senate and House of Representatives.

Luckily for you, we have reviewed the more than 1,500 pages of proposals that are available to the public, so we can give you the broad outlines. Note that the House and HELP Committee have drafted legislation, whereas the Finance Committee has provided a discussion paper with the details left to be determined.

All plans for health care reform would eliminate pre-existing condition exclusions or limitiations. All insurance would be "guaranteed issue," which means it has to be offered to everyone. In addition, all of the plans eliminate lifetime benefit maximums. Further, all of the plans would impose some sort of obligation on people -- either individually or through employer requirements -- to be insured unless they are exempted due to unaffordability, even with subsidies for individuals and families depending on their income level.

One aspect of the reform debate that has received a lot of public attention is whether there should be a public plan option in addition to the alternatives available in the commercial insurance market. Of course, the insurance industry does not want a public plan, and they have begun to run commercials intended to scare us into thinking that government will "ration" our health care. Those of us who have had to deal with an insurance company's denial of coverage know that health care already is rationed by insurance companies, so the question really is whether, as President Obama says, we would benefit from competition between commercial plans and a government option. Both the House and the HELP Committee would include a public plan, although the HELP Committee's proposal for what a public option would look like remains vague; the Senate Finance Committee is still studying the issue, and is considering, in the alternative, some sort of state-run "co-ops" that would make it easier for people to find and purchase insurance, but would not really constitute an alternative to commercial insurance.

One public option that we are very concerned about is a Medicare for All approach because of the 20% coinsurance for Medicare services, which will disproportionately impact those who use more services, i.e., the chronically ill.

In addition, at least the House and HELP plans would limit copays or coinsurance or annual out-of-pocket maximums in some way. The House version defines an essential benefit package, and requires that all plans offer at least that level of coverage. The Senate HELP version provides that the essential benefit package will be defined by an outside Council created by the legislation. The Senate Finance version remains sketchy on the benefit package that would be required -- if any.

It appears that all three proposals will have some sort of Exchange or Gateway that would present consumers with their options in choosing plans. The House version would put employers into the Exchange and essentially eliminate the distinction between group and individual insurance; the HELP Committee version focuses on individuals purchasing through the Gateway. The House Exchange or HELP Gateway will offer three levels of plan, with varying copays and deductibles, and no cost-sharing for preventive care.

Of particular interest to those of us with chronic illnesses, the HELP Committee proposal and the House proposal both include some degree of implementation of a "medical home" model of chronic care management. The basic idea is that primary care physicians will coordinate care among specialists, and will be the point person for the patient. In addition, it looks like all versions will provide incentives for medical students to become primary care providers.

Finally, there is great concern for cost. All of the Committee Chairs have promised the President that their reform bills will be cost-neutral by reducing current costs by streamlining the system, and reducing payments to Medicare Advantage Plans (which are paid 14% more than it costs traditional Medicare to provide the same care). The Finance Committee has already stated that it will provide premium subsidies only to people earning up to 300% of the federal poverty level, as opposed to the 400% that is in the House bill and 500% in the HELP draft.

Obviously, there is much more to say about private insurance, Medicare, and Medicaid, but hopefully this will provide you with enough of an overview so that you can follow our national discussion of health care reform as it proceeds over the coming months.

We have submitted written comments to the Finance and HELP Committees, and our comments are posted on our blog. Click on the Committee name for the relevant comments, or just go to our blog here. To the extent that things happen more frequently than we send out these monthly newsletters, the blog will be a good place for you to go to get the latest.