Health Insurance Reform Update

Well, we now have a House Bill, and a Senate Bill.

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.  Most of these changes will take effect in 2013 (House) or 2014 (Senate), but it looks like lifetime caps will be phased out sooner than that.

But in great news for those of us with pre-existing conditions, both Bills establish national high risk pools.  The Senate's high risk pool would be up and running within 30 days of passage of the Act.  You would qualify for the high risk pool if you have a pre-existing condition and can't get affordable insurance.

Both plans have insurance "exchanges" or marketplaces where you can research all of your insurance options.  The House version has as one such option, a public option.  But that cannot pass the Senate, so it will come out.  The Senate plan also allows nonprofit co-ops to start health insurance plans.

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 also make some improvements to Medicare.  The House bill eliminates the doughnut hole (the prescription drug coverage gap) and the word is that the Senate will agree to this.  This will be a HUGE improvement for the chronically ill on Medicare.

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) and tanning salons.  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.  We're likely to see the Senate version for the most part.

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.  Women who purchase coverage of abortion will actually have to write a separate check for that portion of their premium.  Since the Senate compromise makes both sides miserable, I suspect we will have a deal.

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 Kaiser Family Foundation has a great side-by-side comparison of the proposals here.

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 The Connecticut legislature is grappling with the deficit.  The Governor's deficit mitigation plan would be a disaster for the sick and the poor.  Indeed, there already have been many changes made that make it harder for low-income people, the elderly, and those with mental health illnesses to get prescription drugs.  In addition, the Department of Social Services succeeded in getting the authority to narrow the definition of "medical necessity" for HUSKY enrollees, thereby narrowing the scope of services that will be provided to Medicaid recipients. 

On a good note, as of January 1, 2010, primary care case management for HUSKY enrollees in Hartford, New Haven, Waterbury, Windham/Willimantic.  This program is a wonderful alternative to managed care for people with chronic illnesses.  Instead of having your care coordinated by an insurance company, it can be coordinated by your own doctor.  Sign up today.

As always, it's always good to contact your State Senator or Representative and tell them how you feel about things.
 

 

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.