Today the chairs of the Committees with jurisdiction over health policy in the House briefed members of the Democratic Caucus on the current framework and timing of health reform efforts on their side of the Hill. The three chairs--Ways and Means Committee Chairman Charles B. Rangel (D-NY), Energy and Commerce Committee Chairman Henry Waxman (D-CA), and Education and Labor Committee Chairman George Miller (D-CA), released an outline of the plan [pdf].
Bloomberg reports:
The plan's public insurance program would compete with private industry, with rates paid to doctors and hospitals at a level above those charged by Medicare, said House Ways and Means Committee Chairman Charles Rangel, a New York Democrat.
An outline of the plan also says Democrats drafting the House bill will propose new restrictions on insurers, including caps on out-of-pocket health-care expenses in policies to protect consumers from bankruptcy. The legislation also would bar insurers from excluding people based on pre-existing conditions, according to the outline, a copy of which was obtained by Bloomberg News.
Small, "low-wage" businesses would be exempt from the mandate that employers provide coverage, and small firms providing insurance benefits would also get a new tax credit, according to the outline.
The AP is reporting that sources say House Dems are "considering a new tax on employer-provided health benefits to help pay for expanding coverage to the uninsured." That is not included in the outline provided by the committees, which does include the bullet point: "Establishes shared responsibility among individuals, employers, and government."
Some highlights from the outlined proposal:
Workforce Investments:
- Expands the National Health Service Corps;
- Boosts training of primary care doctors and expands pipeline of individuals going into health professions, including primary care, nursing and public health;
- Supports workforce diversity efforts; and
- Expands scholarships and loans for individuals in needed professions and shortage areas.
Prevention and Wellness:
- Expands Community Health Centers;
- Waives cost-sharing for preventive services in benefit packages;
- Creates community-based programs to deliver prevention and wellness services;
- Targets community-based programs and new data collection efforts to better identify and address racial, ethnic and other health disparities; and
- Strengthens state, local, tribal and territorial public health departments and programs.
Insurance Market Reforms:
- Ensures availability of coverage by prohibiting insurers from excluding pre-existing conditions or engaging in other discriminatory practices;
- Prohibits rating based on gender, health status, or occupation and strictly limits premium variation based on age;
- Establishes a new Health Insurance Exchange to create a transparent marketplace for individuals and small employers to comparison shop among private insurers and a new public health insurance option; and
- Introduces administrative simplification and standardization to reduce administrative costs across all plans and providers.
Ensuring Affordability and Access:
- Includes sliding scale affordability credits in the Exchange to support individuals and families with incomes between Medicaid eligibility levels and 400% of the federal poverty level (FPL); (NOTE: The average cost of family coverage today is 14% of a family's income at 400% of poverty.)
- Expands Medicaid for the most vulnerable, low-income populations and improves payment rates to enhance access to primary care under Medicaid; and
- Caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses.
Public Health Insurance Option:
- Enhances transparency and accountability by creating a new public health insurance option within the Exchange to offer choice and ensure competition;
- The public health insurance option is self-sustaining and competes on "level field" with private insurers in the Exchange; and
- When individuals "enter" the Exchange, whether on their own or as employees of a business that is purchasing in the Exchange, they are free to choose among available public and private options.
It's particularly encouraging to see the workforce reforms so prominent. One of the key issues in our whole system mess is that it's not just enough to provide affordable insurance, that insurance doesn't equal access. Having the policy in hand does little good if you have to drive or take a bus two or three hours to get care, or if you have to wait three or four months to see a primary care doc. While the fight over the financials of overhauling the system is the key battle--without the money, you don't have it--it's important that more structural reforms aren't overlooked.
Other critical news from the House side today is that the Congressional Black Caucus is insisting on a strong public option being included in any reform bill.
The 41-member group also said in a letter to President Obama that such legislation also should address historic disparities in healthcare. The letter notes that CBC members' constituents are disproportionately under-insured or uninsured.
"We ... respectfully, but firmly urge you to ensure that efforts to reform the nation's health care system integrate aggressive solutions to the nation's current plight with health disparities," said the letter, obtained by The Hill.
The letter, sent Friday, was signed by CBC chairwoman Barbara Lee (D-Calif.), Rep. Donna Christensen (D-V.I.) and Rep. Danny Davis (D-Ill.)
The CBC position squares with that of the Congressional Progressive Caucus, who on Friday called for an expansive, Medicare-based public plan that is "available to all individuals and employers."
There is some overlap between the CBC and the Progressive Caucus, whose letter and plan are here, but that still shores up significantly the number of House members who will insist on a strong public option being included in any plan.
Update: There's plenty of discussion of the outline in DrSteveB's diary.
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