TriCommittee Health Care Bill Summarized

I'm still looking for the actual Bill(s), with the names of sponsors. Evidently the Kennedy Bill is going to be voted on next week.

In the meantime, the "Tri-Committee plan" is summarized, here.

Eliminates cost sharing, creates "accountable care organizations," allows employers to chose between offering coverage and "contributing funds on behalf of their uncovered workers," includes individual mandates (people must have one of the approved plans, except in "hardship"), Expands the National Health Service Corps, Expands Medicaid, and (according to the AMA) will force doctors who take Medicare to participate in the "Public Option."

UNITED STATES CONGRESS

Key Features of the Tri-Committee Health Reform Draft Proposal
in the U.S. House of Representatives
June 9, 2009


President Obama’s Commitment: The Tri-Committee bill fulfills the President’s commitment to health care reform via legislation that:

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Reduces costs;
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Protects current coverage and preserves choice of doctors, hospitals and health plans; and
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Ensures affordable, quality health care for all.
Plan Overview:

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Maintains the ability for people to keep what they have and minimizes disruption;
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Invests in health care workforce to improve access to primary care;
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Invests in prevention and public health programs;
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Creates a new national health Exchange that permits States the option of developing a State or regional exchange in lieu of the national Exchange;
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Establishes shared responsibility among individuals, employers, and government;
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Offers sliding scale credits to ensure affordability for low and middle-income individuals and families;
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Jump starts health care delivery system reforms to reduce costs, maintain fiscal sustainability, and improve quality; and
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Expands authority to prevent waste, fraud and abuse.

Workforce Investments:

• Expands the National Health Service Corps;
• Boosts training of primary care doctors and expands pipeline of individuals going into health professions, including primary care, nursing and public health;
• Supports workforce diversity efforts; and
• Expands scholarships and loans for individuals in needed professions and shortage areas.

Prevention and Wellness:

• Expands Community Health Centers;
• Waives cost-sharing for preventive services in benefit packages;
• Creates community-based programs to deliver prevention and wellness services;
• Targets community-based programs and new data collection efforts to better identify and address racial, ethnic and other health disparities; and
• Strengthens state, local, tribal and territorial public health departments and programs.


Insurance Market Reforms:

• Ensures availability of coverage by prohibiting insurers from excluding pre-existing conditions or engaging in other discriminatory practices;
• Prohibits rating based on gender, health status, or occupation and strictly limits premium variation based on age;
• Establishes a new Health Insurance Exchange to create a transparent marketplace for individuals and small employers to comparison shop among private insurers and a new public health insurance option; and
• Introduces administrative simplification and standardization to reduce administrative costs across all plans and providers.
Ensuring Affordability and Access:

• Includes sliding scale affordability credits in the Exchange to support individuals and families with incomes between Medicaid eligibility levels and 400% of the federal poverty level (FPL); (NOTE: The average cost of family coverage today is 14% of a
family’s income at 400% of poverty.)
• Expands Medicaid for the most vulnerable, low-income populations and improves payment rates to enhance access to primary care under Medicaid; and
• Caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses.

Public Health Insurance Option:

• Enhances transparency and accountability by creating a new public health insurance option within the Exchange to offer choice and ensure competition;
• The public health insurance option is self-sustaining and competes on “level field” with private insurers in the Exchange; and
• When individuals “enter” the Exchange, whether on their own or as employees of a business that is purchasing in the Exchange, they are free to choose among available public and private options.
Benefits:

• Independent public/private advisory committee recommends benefit packages based on standards set in statute;
• Guarantees choice and fair, transparent competition by creating various levels of standardized benefits and cost-sharing arrangements, with additional benefits available in higher-cost plans; and
• Phases-in requirements relating to benefit and quality standards for employer plans.

Shared Responsibility:

• Once market reforms and affordability credits are in effect to ensure access and affordability, individuals are responsible for having health insurance with an exception in cases of hardship;
• Employers choose between providing coverage for their workers or contributing funds on behalf of their uncovered workers;
• Government is responsible for ensuring affordability of insurance through new affordability credits, insurance market and delivery system reforms and oversight of insurance companies; and
• Protects small businesses by exempting small low-wage firms and providing a new small business tax credit for firms providing health coverage.


Reforming the Health Care Delivery System and Ensuring Sustainability:

• Uses federal health programs (Medicare, Medicaid and the new public health insurance option) to reward high quality, efficient care, and reduce disparities;
• Adopts innovative payment approaches and promotes better coordinated care in Medicare and the new public option through programs such as accountable care organizations; and
• Attacks the high rate of cost growth to generate savings for reform and fiscal sustainability, including a program in Medicare to reduce preventable hospital readmissions.

Modernizing, Improving and Preserving Medicare:

• Replaces the currently flawed Sustainable Growth Rate (SGR) formula that determines physician pay rates in Medicare;
• Increases reimbursement for primary care providers, improves the Part D program, and implements many other MedPAC recommendations;
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Extends solvency by eliminating overpayments to Medicare Advantage plans, and refining payment rates for certain services;
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Creates new consumer protections for Medicare Advantage beneficiaries;
• Improves low-income subsidy programs to ensure Medicare is truly affordable and accessible for those with lower incomes; and
• Eliminates cost-sharing for all preventive services.