Moving from Policy Options to Draft Legislation
June 10, 2009, Jocelyn Richgels.
The first attempt at reform legislation has made an appearance and there are few major surprises and lots of details to be filled in. Late on Friday, major news organizations obtained a copy of "a draft of a draft" legislation from Senator Edward M. Kennedy and the Health, Education, Labor and Pensions Committee (HELP), one of the two Senate committees that will be drafting health care reform legislation.
The legislation is truly "a draft of a draft," as a Kennedy spokesman indicated. Left out are many details about financing this major attempt to revamp our nation's health care system, although the Senate Finance Committee, with its taxation and health care responsibilities, will have more say in the spending and revenue provisions. The general outline of many proposals is included, however, and suggests that the government will have a larger role in health care provision and insurance regulations. Individual responsibility to obtain coverage, a prime requirement from insurance companies to be on board with reform effort, is also included. A few key proposals, with details to be determined later, include:
- A "bill of rights" designed to garner support from on-the-fence Members that would guarantee the right to choose your own doctor and the rights of doctors and nurses to determine courses of medical treatment;
- "pay or play" requiring a mandate for individuals to obtain coverage and for employers to provide insurance to their employees or help pay for it;
- A government run plan called "affordable access plan" that would pay health providers the same rates as Medicare plus 10 percent and premiums high enough to cover its costs;
- A health insurance exchange called the American Health Benefits Gateway that would be managed by individual states and implemented by the federal government if a state refuses to participate in the exchange;
- Subsidies for insurance premiums for low-and-middle income families, perhaps up to five times the federal poverty limit ($110,000 for a family of four) and expanding Medicaid to cover families earning up to 1.5 times the federal poverty level ($33,000 for a family of four);
- a limit, by program design, on insurers profit by requiring them to rebate their customers any revenue from premiums exceeding up to 25 percent of their costs, not including medical expenses;
- Quality enhancement measures for insurers, including better coordination of patient care, reducing hospital readmissions and providing preventive care
- Insurers would be unable to deny coverage for pre-existing conditions or charge higher premiums for the sick.
While there do not appear to be any rural-specific provisions, criteria based on geography could have a rural impact, both potentially positively and negatively. For instance, penalties for employers that do not provide coverage could be waived in certain cases, such as when affordable coverage is not available in a particular area. Premium rates charged by insurance providers could vary by a few narrowly defined characteristics, including place of residence.
$200 Million in ARRA National Health Service Corps scholarships available
Late last week, $200 million from the American Recovery and Reinvestment Act was made available to the National Health Service Corps (NHSC) to provide new loan repayments for health professions training. This $200 million is anticipated to fund at least 3300 new loan repayments over the next 18 months. The new provisions expand the eligible geographic areas able to qualify for the loan repayments by accepting applications from areas with lower Health Professions Shortage Areas. Limits on the number of health professions per site will be significantly raised to allow more providers to practice within one site.
Will this substantially increased expansion of the NHSC funding be a harbinger of the ability of health reform efforts to increase the supply of primary care physicians and mental health providers? There is little question of the need for more primary care providers if reform efforts are to succeed. Expanded funding for NHSC is one of the primary ways to attract providers to medically under-served areas, which includes many rural areas and urban centers. This temporary, but substantial, increase in NHSC funding may be a good early test of that effort.
President Obama steps up engagement in health reform effort
Previously content to let Congressional leaders suggest policy direction and levers for health reform, President Obama and the White House Office on Health Reform this week jump started their efforts to engage in the policy details. The White House released a report from the Council of Economic Advisors that makes the case for reform for economic reasons. Following that, he held a closed-door meeting with Democrats from the Senate Finance and HELP committee to begin a process of ironing out the inevitable differences that will emerge in their two bills. Following that meeting, the President also sent a letter to Capitol Hill late last week strongly encouraging the creation of a public plan that will give Americans "a better range of choices, make the health care market more competitive and keep insurance companies honest." Until now, the President has been willing to talk compromise on a public plan. The President's forceful support of a public plan has also given Republicans more opportunities to voice their disapproval of any type of public plan in the final version of reform.
