What is in the Health Reform Bills?

This summer, the Senate HELP Committee, House Ways and Means, Energy and Commerce and Education and Labor committees have introduced and passed health care reform bills.  This document outlines what is consistent between the two packages. 

How The Health Insurance System Will Improve for Every American:

If you like your insurance, you can keep it. There is nothing in this bill that will force individuals out of the coverage they currently have.

Put an end to pre-existing conditions:  Insurers can deny coverage based on existing health problems including seasonal allergies, birth defects, and pregnancy.  Insurers can also exclude parts of your body from being covered.  The health care reform bill will ban this practice.

• 12.6 million Americans have been denied health insurance based on pre-existing conditions (Commonwealth Fund)

End unfair denial of coverage: Your insurance company will no longer be able to drop coverage because you would be too costly if you got sick while insured.  Insurers must cover everyone seeking coverage.

• Blue Cross has been accused of using data on the number of dropped patients to in employee evaluations. (Energy and Commerce)

Fair pricing rules: The bill provides new protections to prevent additional charges based on health status, gender, and age.  Currently, unfair pricing is common practice.

• For example, women are charged more than men for health coverage. (AHIP)

Defined benefits: Underinsurance is a major problem facing many Americans.  By setting a minimum benefit standard, individuals will receive comprehensive and sufficient coverage.

• An estimated 25 million Americans are considered underinsured and financially vulnerable in case of a medical emergency. (Center for American Progress)

Consumer driven health insurance: The insurance system is difficult to navigate.  This bill will simplify administrative processes such as billing, appealing decisions, and outlining benefits.

• Whether in a public or private plan, insurers will be required to provide understandable information to consumers. (Division A Title I Subsection D)

Providing Those in Need Accessible and Affordable Coverage:

A marketplace to easily purchase insurance: The Exchange is a marketplace where it is easy to compare plans and purchase a plan that is right for you. Someone is initially eligible for the exchange if unemployed or an employer does not offer insurance.

• The individual market for health insurance has a small risk pool and drives up coverage costs.

Subsidies for those that need it in the Exchange: Those earning below a certain level that do not have insurance through their job will receive subsidies to purchase insurance through the Exchange.

• For low income workers, health insurance costs are often a large percentage of a person’s take home pay. 

Medicaid expansion covers those who need it: Medicaid will be expanded to serve a larger number of individuals unable to afford health insurance.

• People who need Medicaid often are in most need of medical care.  Medicaid covers people up to 80% of the federal poverty level which includes 40 million individuals. (CBO)

Public health insurance option decreases costs: A public health insurance option is available for those without employer sponsored coverage and will compete with private insurers in the exchange.

• In 95% of the country is dominated by a single insurance carrier. (Center for American Progress)

Universal coverage and shared responsibility covers everyone:  This bill will require businesses to provide health insurance and individuals to purchase health insurance. Doing this will greatly reduce the number of uninsured and lower costs for the insured who currently subsidize those without insurance.

• Nearly 50 million Americans lack health insurance.  The reform proposals will greatly reduce this number. (US Census)

No charge on preventive medicine: Insurance will completely cover vaccinations, cancer screenings, and nutrition counseling, without any out of pocket charge. 

• Obesity, diabetes, and many viral diseases are preventable through physician counseling and screenings.

Cap on consumer spending: Medical bankruptcies will be reduced by capping the annual amount an individual and families can spend on out of pocket health care costs.

• 75% of Americans who have been pushed into personal bankruptcy by medical problems actually had insurance when they got sick or were injured. (Harvard University Study by Elizabeth Warren)

Solving Health Care’s Additional Looming Problems:

Primary care shortages prevent many from receiving care: A shortage of nurses and primary care workers burdens our health status.  This bill encourages people to become primary care workers and encourages service in regions with shortages.

• Only 31% of American physicians pursue primary care due to misaligned incentives which encourage doctors to pursue more lucrative careers. (Kaiser)

Long Term Care leaves seniors and families in debt: A new method of paying for Long-Term-Care both inside and out of the home.  This payment scheme will protect against loss of assets due to illnesses such as Alzheimer’s.

• Of the 10 million Americans needing Long-Term-Care 1/3^rd are below the federal poverty level. (Kaiser)

Small businesses face mounting health care costs: One of the largest expenses for small businesses is health care costs.  The exchange allows small businesses to grow without the added burden of health care expenses.

• Without health care reform, small businesses will pay $2.4 trillion in health care costs. (Small Business Majority)

Medicare has financial problems looming with the growing baby boomer population: This bill eliminates waste in Medicare and will save the program money through administrative simplification and rewarding quality care.

• Medicare will go broke by 2017 if nothing is changed to reduce wasteful spending. (Medicare Trustees)

Public and community health receives less funding: Refocusing the system to keeping people healthy before diseases develop will reduce costs, improve our health, and save money.

• 90 percent of what influences a person’s health is determined outside of the medical arena.