Incredible reporting from
Bob Cesca on the new House Health Care bill:
I think we now know what the public option will end up looking like. It'll still be the most affordable and reliable choice for health insurance, but it won't be as inexpensive as a Medicare-rates plan.
The House bill was announced this morning and there are lots of good things besides the public option. One of the new items to pop up is the ability for kids to stay on their parent's family policy until their 27th birthday. The bill also caps out of pocket expenses, eliminates co-pays for routine doctor visits (huzzah!) and it closes the donut-hole in Medicare Part-D. There's also the pre-existing condition language and the controversial mandates included in the House bill.
This was also fun to watch.
Speaker Pelosi had a zinger:Early in her remarks, there was some loud off-camera noise -- apparently from protesters nearby.
"Thank you, insurance companies of America," Pelosi said.
UPDATE: Some
highlights of the Affordable Health Care for America Act [H.R. 3962]:
It will end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and strictly limit age rating.
The proposal will also eliminate co-pays for preventive care, and cap out-of-pocket expensesto protects every American from bankruptcy.
Provides better preventive and wellness care. Every health care plan offered through the exchange and by employers after a grace period will cover preventive care at no cost to the patient.
Guarantees that every child in America will have health care coverage that includes dental, hearing and vision benefits.
Strengthens Medicare and Medicaid and closes the Medicare Part D "donut hole" so that seniors and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.
All individuals will generally be required to get coverage, either through their employer or the exchange, or pay a penalty of 2.5 percent of income, subject to a hardship exemption.
The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.
And finally,
here's the full summary of the House version of the public insurance plan. The language in the summary is politically very defensive, which is strange. But one thing you'll notice is that the plan is operated by HHS --
not a private insurance company, as was rumored there for a while.
All in all, what this bill does -- and what the final bill should do -- is to create an infrastructure to bridge the gap in coverage between 18 and 65. In other words, those of us who don't qualify for SCHIP or Medicare will have many more options over and above Medicaid. Ultimately, this infrastructure will evolve and grow into something resembling a single-payer system. Meanwhile, health insurance will be vastly more reliable, portable and affordable.
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UPDATE 2: The list of guaranteed minimum benefits for the exchange
is very solid. Inpatient hospital services
Outpatient hospital services
Physician services
Equipment and supplies provided incident to physician services
Preventive services
Maternity services
Prescription drugs
Rehabilitative and habilitative services
Well baby and well child visits and oral health, vision, and hearing services for children
Durable medical equipment, prosthetics, orthotics and related supplies
Mental health and substance abuse services, including behavioral health treatments
That last one is fantastic. Mental health coverage became mandated under the Wellstone amendment in the recovery bill, but it's nice to see it specifically included as guaranteed in the exchange plans (public and private).
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UPDATE 3: Some of the
restrictions on the health insurance cartel: Insurers will be prohibited from excluding coverage based on pre-existing conditions.
Insurers will be prevented from selectively charging people different premiums based on their gender, health status, or occupation.
Eliminates bankruptcy due to medical expenses by requiring a standardized annual out-of-pocket spending limit.
Medicare beneficiaries enrolled in private plans will no longer be charged out-of-pocket expenses above traditional Medicare.
New requirements on plans will ensure that they keep administrative costs down to 15 percent of premiums and pass on savings to consumers.
Insurers will be prevented from rescinding or dropping coverage when a person gets sick.
Insurers will be prevented from denying reconstructive surgery for children with birth defects or injuries.
Insurers will be required to publicly disclose and justify insurance rate increases to discourage excessive price increases.
Removes antitrust exemption for health insurance companies so that they are no longer shielded from liability for price fixing, dividing up territories, or monopolizing their market ” all of which reduce competition and increase prices for consumers.
UPDATE 4: McJoan
has the rundown of the reforms that would go into effect immediately.
GO HERE for details comparing the House and Senate health care bills.
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