Many of you have heard that HR 3962 ("Affordable Health Care for America") passed yesterday in the House 220-215.
The summary of the bill (NYTimes) is copied/linked at length below, as is a PDF of the bill.
This is both a historic piece of legislation in and of itself... and also one that, if merged with a future Senate Bill and signed by the President, will have a significant and immediate impact on your profession and your patients fairly immediately.
I have attempted to compile some useful articles and resources here:
Status of Health Care Legislation (NYTimes)
Interactive Timeline of Health Care Policy and Reform (New England Journal of Medicine)
Interactive PDF of HR 3962 (NYTimes)
Where Things Stand Now (NYTimes)
Frequently Asked Questions (NYTimes)
Other Recommended Resources:
- AAFP News Now (essentially mandatory for Family Docs) - http://ow.ly/Avye
- NYTimes Prescriptions Blog - http://prescriptions.blogs.nytimes.com/
- NEJM Health Care Reform - http://healthcarereform.nejm.org/
- AMA Health Care Reform - http://www.hsreform.org/
Comparison of the Various Health Care Proposals (NYTimes) - HR 3962 info is copied below...
Individual Mandates: Require nearly all Americans to have a minimum level of health insurance or pay a penalty. (http://ow.ly/Avkn)
- Would include mandate.
- Penalty: 2.5 percent of adjusted gross income over a certain level, which is $9,350 for singles and $18,700 for couples.
- Exempt those with incomes below the above-mentioned thresholds, American Indians, people with religious objections and people who can show financial hardship
Employer Contributions: Some kind of requirement for employers to contribute to the cost of coverage for some or all of their employees. (http://ow.ly/AvkS)
- Would require employers with annual payrolls of $500,000 or more to provide health insurance or pay a new federal tax.
- Employers would have to contribute at least 72.5 percent of the premium cost for individuals and 65 percent for families for the lowest cost plan that meets the minimum benefit requirements set by the government.
- Penalty: Up to 8 percent of wages in payroll taxes. Employers with payrolls of $500,000 to $750,000 would pay 2 percent to 6 percent of wages, and those with payrolls above $750,000 would pay the full 8 percent.
- Employers that offer health insurance must automatically enroll employees into the lowest cost plan available. But employees may opt out of employer coverage.
Insurance Exchange: Create a new health insurance marketplace, national or state, where people could shop for insurance and compare prices and benefits. (http://ow.ly/AvkY)
- Would create a national exchange. Allows states to opt out and operate their own exchange if they follow federal rules.
- Open to people who do not have qualifying coverage through an employer or a public program.
- Open to employers with 25 or fewer employees in the first year, 50 or fewer in the second year and 100 or fewer in the third year. The exchange could be expanded to larger employers over time, “with the goal of allowing all employers access.”
- Until the exchange is established, a temporary program would provide health coverage to “those who have been uninsured for several months or denied a policy because of pre‐existing conditions.”
Public Plan: Create a government-run insurance plan or nonprofit insurance cooperatives to compete with private insurers. (http://ow.ly/Avl3)
- Would create a new government insurance plan that would negotiate rates with doctors and hospitals, rather than using Medicare rates set by the government
- The public plan would have to offer different levels of benefits, covering between 70 to 95 percent of health care expenses.
- Like private plans, the public plan must offer the same benefits, comply with the same insurance market reforms, follow provider network requirements and other consumer protections. The plan would not provide abortion coverage.
- Health care providers would not be required to participate in the plan. But the bill assumes that providers participating in Medicare are participants of the public plan, unless they opt out.
- The government would allocate $2 billion in start-up money but the public plan must be financially self-sustaining. The bill would require premiums, paid by beneficiaries, to cover the plan’s cost. The government would also provide loans to start up non-profit insurance cooperatives to compete with private insurers and the public plan.
- The legislation would also create a public long-term-care program that would provide cash assistance — not less than an average of $50 per day — to people who become disabled. The program would be financed through premiums deducted from paychecks of people who choose to participate. Workers would have to contribute for at least five years before they can collect benefits.
Subsidies for Individuals: Provide credits to lower-income people to help them buy insurance. (http://ow.ly/Avl9)
- Would provide credits for premium costs and other health care expenses to citizens or legal immigrants who buy insurance through the exchange. Verification of legal immigration status would be required to receive subsidies.
- Households with incomes up to 400 percent of the federal poverty level ($88,200 for a family of four) would be eligible to receive premium credits, if they pay specified percentages of their income toward the premium. Premium contributions would range from 3 percent to 12 percent depending on the income. People with insurance from employers would be eligible for the credits if the cost of their premium exceeds 12 percent of their income.
- The proposal would also offer cost-sharing subsidies and reduce out-of-pocket spending limits for those under 400 percent of the poverty level.
Subsidies for Employers: Provide tax credits to help small-business owners who want to offer coverage. Subsidize employer-sponsored health plans covering early retirees. (http://ow.ly/Avlq)
- Would provide tax credits to employers with 25 or fewer workers and average wages of $40,000 or less.
- The credit would not be allowed for employees earning more than $80,000 a year. The amount, up to 50 percent of premium costs, phases out as firm size and average wages increase.
- Would spend $5 billion from 2013 to 2015 to subsidize employer-sponsored health plans covering early retirees ages 55 to 64. The federal government would cover 80 percent of the cost of a retiree’s medical claims of more than $15,000, with a cap at $90,000 — at which point the employer’s plan would pay the rest.
Expanding Medicaid: Expand Medicaid, the federal-state health program for low-income people, to cover millions of additional people. (http://ow.ly/AvlH)
- Would include all individuals with incomes up to 150 percent of the federal poverty level ($33,075 for a family of four). The program currently covers millions of low-income older Americans, people with disabilities, pregnant women, children and some parents. Childless adults are generally not eligible.
- The federal government would pay all the costs for those who are newly eligible for the first two years and 91 percent of the costs after that.
- The legislation would end the Children’s Health Insurance Program, which benefits children of the working poor. Children with family incomes up to 150 percent of the poverty level would receive coverage through Medicaid. Families with higher incomes would receive subsidies to buy coverage through the exchange.
Defining Benefits: Require insurance plans to offer a minimum package of health insurance benefits, to be defined by the federal government. (http://ow.ly/AvlO)
- Would require the basic benefits package to cover 70 percent of the health care spending covered by the plan. Consumers would pay the remainder, in deductibles, co-payments and other charges. The plan would cap out-of-pocket health care spending to $5,000 for an individual and $10,000 for a family.
- Insurers could choose to cover or not cover abortion as they see fit. But people who receive federal subsidies to buy insurance cannot choose a plan that includes abortion coverage. Federal tax dollars can only be used for abortion as allowed by current law, in case of rape or incest or if the life of a pregnant woman is in danger.
- Insurers could not deny coverage because of a person’s pre-existing conditions. Variation in premiums is limited. Maximum difference in premiums based on age is 2 to 1 (for oldest group, compared with young adults).
- The legislation would also revoke the exemption from federal antitrust law that health insurance companies have long enjoyed. It would outlaw price-fixing, bid rigging and “market allocations” by companies that sell health insurance or medical malpractice insurance.
- Insurance plans covering children and their parents would have to continue “dependent coverage” for children through age 26. Rules and age limits for dependents under employer plans currently vary by state.
- Besides the basic plan, the legislation would create three other levels of coverage to be offered through the health insurance exchange, covering up to 95 percent of costs. The Congressional Budget Office says the actuarial value of policies bought in the individual insurance market now averages 55 percent to 60 percent.
What It Will Cost: Estimated 10-year cost. (http://ow.ly/Avm7)
- About $1.05 trillion, according to the Congressional Budget Office, to provide coverage to 36 million people. The costs would be fully offset by cuts in the growth of Medicare and by new fees and taxes. The bill would reduce projected federal budget deficits by $104 billion over 10 years.
- Earlier versions of the bill in the House included provisions to avert cuts in Medicare fees to doctors, scheduled to occur under existing law. Those provisions, which would cost more than $200 billion over 10 years, were put into a separate bill.
Raising Revenue: Increase taxes for wealthier households. (http://ow.ly/AvmU)
- Would raise $460 billion over 10 years by imposing an income surtax on high-income people — couples with adjusted gross incomes over $1 million a year and individuals over $500,000 — at a rate of 5.4 percent.
- Would raise about $100 billion with various other revenue provisions, which include a 2.5 percent excise tax on the medical devices sold for use in the United States, a $2,500 cap on contributions to health care flexible spending accounts and elimination of the tax deduction for employers who receive federal subsidies for providing retiree prescription drug coverage.
Cutting Costs: Reduce health care spending, especially on Medicare. (http://ow.ly/Avn9)
- Would raise more than $400 billion over 10 years by trimming Medicare payments to hospitals and most other health care providers. Cut nearly $200 billion in subsidies for insurers that offer the elderly private plans through Medicare Advantage. (The government pays about 14 percent more for the private plans than it would pay for the same people in traditional Medicare.) Demand better prices from drug makers participating in Medicare and Medicaid.
- The Institute of Medicine at the National Academy of Sciences would conduct two studies and recommend changes to the current Medicare reimbursement system. In the first, the institute would analyze geographical disparities in Medicare rates and send recommendations to be implemented by the secretary of health and human services. The other would assess whether to tie Medicare payments to quality of care. Those recommendations would be subject to a vote in Congress.
(Again, giving credit... the above was copied from 11 different pages of the New York Times.)