The House of Representatives released their universal (97% of Americans will be covered) health care reform bill (HR 3200) yesterday and it looks pretty darn good. Of course there are some pieces that need tweaking (not enough financial protection for those earning between 300%-400% of poverty), but it has all the major pieces to guarantee access to an affordable high quality health plan WITH A PUBLIC PLAN OPTION offered in the Federal Health Insurance Exchange along side a choice of qualified private health plans, with comprehensive benefits and limits on premiums and cost-sharing (and options for states and regions to apply for their own exchanges).
Here is the link to the full bill. It is 1,000 pages! More below the fold:
http://docs.house.gov/...
UPDATE: For those of you who don't want to wade through 1,000 pages of legalese, here is a nice summary of the bill:
http://edlabor.house.gov/...
There is also massive regulation of the insurance industry - all individual insurance policies must be sold through the Exchange. No pre-existing condition exclusions and no premium rating based on health status or anything other than age and region. Prohibits discrimination in health care based on any individual characteristic.
Affordability credits are available on both premiums and cost-sharing for people who earn less than 400% of the poverty level and who are not Medicaid eligible. Guaranteed renewability and transportability of your coverage if you move or change jobs. No cost sharing for preventive care. Medical loss ratios to be set to maximize use of premium dollars that go to provision of care. No annual or lifetime limits can be imposed on coverage. Reinsurance for employers for individual retiree costs exceeding $15,000.
Those who are eligible first are those who are not eligible for Medicaid and do not have a qualifying employer sponsored plan. SCHIP funded children can purchase in the Health Insurance Exchange. Expansion of Medicaid up to 133% of poverty that is fully funded by the Feds.
This is all good. Comprehensive provisions for building our public health infrastructure and community based prevention at the population level to complement the comprehensive coverage of evidence based preventive care including immunization schedules recommended by the CDC.
A new federal agency "The Health Choices Administration" to set standards and oversee the program. And a Health Benefits Advisory Council headed by the Surgeon General to oversee updates to the benefit package that take into account new treatments, drugs and technology.
As I said in the intro, the part that is most disturbing to me is the inadequacy of the affordability provisions for lower income folks (see page 137 of the bill):
% FPL Initial % Income Final % Income Actuarial Value
133% through 150% 1.5% 3% 97%
150% through 200% 3% 5% 93%
200% through 250% 5% 7% 85%
250% through 300% 7% 9% 78%
300% through 350% 9% 10% 72%
350% through 400% 10% 11% 70%
People whose TOTAL health care costs equal 10% of their income are considered UNDER-INSURED. This schedule would make everyone with incomes between 300-400% of poverty underinsured. And that is based on the premium alone. This is not an adequate subsidy. They will have cost-sharing on top of this. THIS HAS GOT TO BE REVISED. I would suggest that premiums should not be more than 7% of anyone's incomes. Otherwise, all of this will not really help those who need it most - the working poor.
I want to congratulate the House Democrats on this bill. For the first time in a long time, they have done something well and in the time frame necessary. Thanks to all of you. Now on to amendments!