Health Reform Update March 3, 2010

While both Houses of Congress have passed health reform bills, there is no final proposal or definitive plan of action to enact a health reform law at this time.  The House and Senate bills are different, which means neither can be enacted into law without further action.

In order to bridge the gaps between the House of Representatives, the Senate, and the Republican party, the President held a bipartisan meeting on health reform on February 25.  Leadership from the House of Representatives and the Senate were invited to discuss the concerns about the current health reform proposals and potential new proposals.

The President opened the summit with the following remarks:

My mother, who was self-employed, didn’t have reliable health care, and she died of ovarian cancer. And there’s probably nothing that modern medicine could have done about that.

It was caught late and that’s a hard cancer to diagnose, but I do remember the last six months of her life, insurance companies threatening that they would not reimburse her for her costs and her having to be on the phone in the hospital room arguing with insurance companies when what she should have been doing is spending time with her family. I do remember that.

Republicans and Democrats alike agreed that our health care and health insurance system need reform.   There are more than 40 million uninsured Americans, and millions more who are underinsured.  The United States spends the most money of any country on health care[1], but does not have the best health outcomes.[2]  Some problems include: pre-existing condition exclusions, the expense of both care and insurance, lifetime and annual caps on health care expenses, insurance plans that do not offer full or very good coverage,

Here are some highlights of the plans, which have many similarities:

  • The House, Senate and President’s plan all have some sort of insurance mandate. 
  • The House and President’s plan require large businesses (those with more than 50 employees) to offer insurance or pay a fine. 
  • The House, Senate and President’s plan call for an expansion of Medicaid to those under 65 with incomes up to either 133% or 150% of Federal Poverty Level.
  •  The House, Senate and President’s proposal all provide credits to individuals and families with incomes up to 400% of the Federal Poverty Level to purchase insurance; the Republican plan includes tax credits for the purchase of insurance plans.
  • The House, Senate, Republican and President’s proposal create some sort of insurance exchange – a marketplace to buy insurance plans. 
  • The House, Senate and President’s proposal include an “essential health benefits package”, requiring some adequacy of insurance.   
  • The House, Senate and President’s proposal establish a temporary high risk pool so that individuals who are uninsured and have a pre-existing condition will be able to receive subsidies for insurance premiums; the Republican plan expands high risk pools. 
  • The House, Senate, Republican and President’s proposal all contain sections focusing on prevention of illnesses, and wellness programs.

Resources:

 


[1] OECD, 2007 (http://www.oecd.org/document/21/0,3343,en_2649_34631_44219221_1_1_1_1,00.html).

[2] In 2000, the United States was ranked 37th out of 191 countries according to a study by the World Health Organization (http://www.who.int/healthinfo/paper30.pdf).