Health Insurance Reform Update

Well, we now have a House Bill, and Senator Reid has introduced a Senate version that will be debated in the coming weeks.  There's a lot to like in both plans -- and a lot that's still unknown.  Here are some of the highlights.

Both plans eliminate pre-existing condition exclusions, lifetime caps on benefits, premium rates based on gender and health status/history, and cancellations of policies based on health status/history. 

Both plans have insurance "exchanges" or marketplaces where you can research all of your insurance options.  And both plans have, as one such option, a public option.  Both public options would have provider reimbursement rates that are negotiated, and are not tied to Medicare reimbursement rates.  States could opt out of the public option.  The Senate plan also allows nonprofit co-ops to start health insurance plans, and states can create a program for low income individuals who are not eligible for Medicaid.

Out of pocket costs and premiums are limited, and subsidies or tax credits for people who earn under 400 percent of the federal poverty level.  The out-of-pocket caps are higher under the Senate version, but both would eliminate the possibility of catastrophic losses, thereby (we hope) eliminating medical bankruptcy.  And both plans increase Medicaid eligibility to 133 percent of the federal poverty level.

Both plans delay implementation of the exchanges -- the House until 2013 and the Senate until 2014.  In the meantime, both Bills establish national high risk pools.  You would qualify for the high risk pool if you have a pre-existing condition and have not had insurance for at least 6 months.  The House Bill is slightly broader and allows you to enroll in the high risk pool if you've been turned down for affordable insurance. 

Both plans also make some improvements to Medicare, reducing the doughnut hole (the prescription drug coverage gap) by $500 and providing discounts for drugs during the coverage gap, at least for low and middle-income consumers. 

Both plans include a requirement that individuals have insurance.  The House penalty is greater than the Senate's, but neither is high enough for the insurance industry to feel comfortable that they will get a lot of new healthy enrollments to balance out the new enrollees with pre-existing conditions.  The House requires employers to provide insurance, whereas the Senate does not.  However, the Senate does impose a fee for each employee who is not covered and gets a tax credit.

The two plans pay for themselves in different ways -- this may be the biggest difference between the two.  The Senate taxes so-called "Cadillac plans" -- plans that cost more than $8500 for an individual and $23,000 for a family -- at 40%.  In addition, the Medicare payroll tax is increased from 1.45 percent to 1.95 percent for people earning more than $250,000.  The Senate draft also imposes a 5 percent tax on elective cosmetic procedures (procedures needed to correct congenital and other deformities are exempt).  In addition, the Senate would impose a $2 fee per person on insurers and health plans (including self-funded plans).  The House, instead, imposes a 5.4 percent income tax on individuals earning more than $500,000 and families earning more than $1 million. 

And then there is abortion.  The House bill prohibits all plans sold through the "exchange" from covering abortions for women receiving subsidies except to save the life or health of the mother.  The Senate bill attempts to segregate the private money from the tax credit (or subsidy), and prohibits the use of public funds to pay for abortions.  This is one of the toughest issues Congress is grappling with, and could entirely derail health reform.  The pro-lifers don't believe in an approach that uses accounting rules to segregate public and private funds; they believe anybody who gets a subsidy or tax credit cannot have abortion coverage.  The pro-choicers believe this seriously curtails their right to choose to have an abortion.  Frankly, I feel literally torn apart over this issue; I am very pro-choice, but I also really want health reform.  I remain hopeful that a compromise will be reached.

Both Bills prohibit illegal immigrants from participating in plans sold through the exchange, including the public option, and also including any plan towards which a person could receive a subsidy or tax credit.

The NY Times has created an excellent comparison of the two plans here.

This is, of necessity, a summary.  I hope that you will read and listen, educate yourself, and then contact your members of Congress and tell them what you like and what you don't.  And when you hear the lies -- and yes, there are still people out there talking about "death panels" despite the fact that this issue has been disposed of completely -- speak up and be heard.  Even if you are troubled by some aspects of these proposals -- indeed, even if you really hate the whole idea of reform (although how can a person with a chronic illness not want SOME reform?) -- let's make sure we're all telling each other the truth.

For information about some of the truths and  untruths of health care reform, see White House Reality Check and Factcheck.org, as well as our blog.

You can reach the Congressional switchboard at 1-866-210-3678.  To find your Representative, go here; to find your Senator, go here.

This is the space in our newsletter where we talk about health care policy affecting the chronically ill.

 

Here's an update on what's happening in the legislative arenas:

 

 

To find your Representative, go here; to find your Senator, go here.

Connecticut Jennifer will be receiving a citation from the Connecticut General Assembly on December 10 in the State Capitol Old Appropriations Room for her work on the Connecticut Restroom Access Act.  All are invited!

As always, it's never too late to contact your State Senator or Representative and thank them for their votes.
 

 

So many of you ask me what you can do.  First, be aware.  Read your local newspapers.  Find the website for your state legislature.  Read.  Write your state legislators about things that concern you.  One tool we like is the Kaiser Health News, to which you can subscribe for free.  But don't just read: ACT.  Go to hearings and testify.  Tell your story.  Put a real face on the healthcare crisis.