Healthcare Reform Update

June 26, 2009
E-Newsletter
June 26, 2009

Greetings!

Each and every oneof us has a personal stake in healthcare reform and because of thecritical importance of this issue, I want to keep you fully informed asCongress begins its work on a bill.

On June 19th theHouse Committee on Energy and Commerce, (which I'm a member of)released a draft bill to address the urgent healthcare needs in ourcountry. The legislation is 852 pages long and the full text andsummaries can be found at: http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1687:health-care-reform&catid=156:reports&Itemid=55

We know ourhealthcare system is broken. Forty-seven million Americans areuninsured and millions more have insurance but can't afford theirco-pays and deductibles. Premiums have more than doubled in the lastdecade, and every day families go bankrupt because they can't affordtheir medical bills. On the other hand, we also have the best doctorsin the world, the most cutting edge medical equipment, and the world'sleading minds in life-saving research. The goal of healthcare reform isto build on what works and to fix what's broken.

There are six core principles that the legislation is built upon:
1) Healthcare reform must be universal-- access to care and coverage for every American.
2) Maintain choice. It is important to Americans to have choices and protect the doctor/patient relationship.
3) Coverage must be affordable. All individuals and families should be able to be insured without consuming half their income.
4) We must strengthen Medicare. We have to ensure theprogram's solvency for years to come and we must remove the excessspending from our healthcare system, from overhead costs toover-prescribed tests and medications, as well as weeding out waste,fraud and abuse. This will save billions of dollars and eliminate theneed for new taxes.
5) A higher quality of care with loan reimbursementsand scholarships to doctors and nurses who enter into primary care.This will ensure access to care as we cover all Americans.
6) The legislation must be paid for and accomplished without any new taxes.

Below are some of the most critical parts of the draft bill which deal with the implementation of the key goals.

 

ACCESS TO COVERAGE AND CHOICE

  • A Public Health Insurance OptionThis would be one of many options for health insurance. The Departmentof Health and Human Services, not a private company, would administerthe plan.
  • A National Health Insurance Exchange A newtransparent marketplace for individuals and small employers tocomparison shop among private and public insurers. It will set andenforce insurance reforms and consumer protections, facilitateenrollment, and administer affordability credits to help low andmiddle-income individuals and families purchase insurance. Over time,the Exchange will be open to all employers as another choice forcovering their employees.
  • Guaranteed Coverage and Insurance Market Reforms Discrimination based on pre-existing conditions, lifetime caps or annual limits on benefits will all be eliminated.
  • Essential Benefits A new independent advisorycommittee with providers and other healthcare experts (chaired by theSurgeon General) will recommend a benefits package based on standardsset in statute. This new essential benefit package will serve as thebasic benefit package for coverage in the Exchange, and over time willbecome the quality standard for employer plans. It will includepreventive service at no cost sharing, mental health services anddental and vision for children. It will will cap the amount of money aperson or family spends on covered services in a year to $5,000 for anindividual and $10,000 for a family.

 

AFFORDABILITY FOR INDIVIDUALS AND FAMILIES

 

  • Provides Sliding Scale Affordability CreditsThesecredits will be available on a sliding scale, phasing out at 400percent of the federal poverty level ($43,000 for individuals or$88,000 for families of four) to help individuals and families whodon't qualify for Medicaid or Medicare to purchase insurance.
  • Expands Medicaid Individuals and families withincomes below 133 percent of the federal poverty level will be fullyfederally financed in an expanded and improved Medicaid program.
  • Cap On Total Out-of-Pocket Spending All new policies will cap out-of-pocket spending to prevent bankruptcies due to medical expenses.

 

SHARED RESPONSIBILITY

 

  • Individual Responsibility Every Americanwill be responsible for having health coverage. Those who do not obtaincoverage will face a tax penalty of two percent of their income, cappedat the average cost of a premium in the exchange.
  • Employer Responsibility Employers will have theoption of providing health insurance coverage for their workers orcontributing funds to the Exchange on their behalf.
  • Assistance for Small Employers Small businesses withpayrolls less than $250,000 per year, will be exempt from the employerresponsibility requirement. New small business tax credits will beavailable for firms that want to provide health coverage to theirworkers, but can't afford to do it today.
  • Government Responsibility The government will beresponsible for ensuring that every American has access to affordablequality health insurance through the new affordability credits,insurance reforms and consumer protections.

 

PREVENTION AND WELLNESS
  • Expansion of Community Health Centers
  • No co-payments for preventive visits
  • Creation of community-based programs to deliver prevention and wellness services
  • A focus on community-based programs and new data collection effortsto better identify and address racial, ethnic, regional and otherhealth disparities
  • Funds to strengthen state, local, tribal and territorial public health departments and programs.

 

WORKFORCE INVESTMENTS

 

  • Increases to theNational Health Service Corp to offer scholarships and loanreimbursements to doctors who will practice in underserved areas
  • Greater support for workforce diversity
  • Expansion of scholarships and loans for individuals in needed professions in areas where shortages exist.

 

CONTROLLING COSTS
  • Health Care Delivery System ReformsFederal health programs including Medicare, Medicaid and the new publichealth insurance option will reward high quality and efficient carethrough better care coordination and through reductions of hospitalreadmissions. Innovative programs such as Accountable CareOrganizations and Medical Homes will coordinate care for a patientbetween doctors, hospitals, and outpatient care to keep them healthier,reduce costs, and not repeat unnecessary tests and procedures.
  • Modernization and Improvement to Medicare Replacesthe flawed physician payment formula in Medicare (the SGR), with anupdate that wipes away accumulated deficits, provides for a freshstart, and better rewards primary care services, care coordination andefficiency. The bill also improves the Medicare Part D program, extendssolvency to and creates new consumer protections for Medicare AdvantagePlans, and improves low-income subsidy programs, so that Medicare isaffordable for all seniors and other eligible individuals.
  • Waste, Fraud and Abuse Prevention New tools will be provided to combat waste, fraud and abuse within the entire health care system.
  • Administrative Simplification The Health and HumanServices Secretary will have the authority to simplify the paperworkburden that adds tremendous costs to today's health care system.
  • The American Recovery and Reinvestment Act originallyprovided $19 billion to accelerate adoption of Health InformationTechnology (HIT) systems by doctors and hospitals in order to modernizethe health care system, save billions of dollars, reduce medical errorsand improve quality.

The issue of healthreform will affect each one of us and that's why I promise to keep youinformed each step of the way. I ask you to let me know your thoughtsand questions, as well as your critiques. I need your thoughts andideas and I welcome hearing from you.

If at all possible,email your comments to me. It is far more efficient and saves your taxdollars when we respond to you electronically

Sincerely,


Anna G. Eshoo
Member of Congress