And so the Congressional Budget Office estimates begat the release of a twelve-page document entitled Highlights of the Health Reform Reconciliation Bill as of 3/15/2010.
Remember, we start with the Senate bill as our starting point. The following are the changes that are being negotiated. So the Senate bill gets passed by the House (or the House "deems" it passed -- see yesterday's post for explanation), and then both the House and Senate pass these changes, and we end up with the final version.
I'm not going to give you all 12 pages, but here are the things that matter to me and to the patients who come to me for help:
1. Tax credits/subsidies for health insurance premiums will extend to families earning up to 400% of the federal poverty level.
2. Premiums, deductibles, copays, and coinsurance are limited for low income families to a percentage of income on a sliding scale equal to or lower than what was in the Senate bill.
3. Reduces the penalty for people who don't buy insurance, and phases in the penalty over 3 years, while increasing the penalty on large employers who don't offer coverage.
4. Phases out the Medicare Part D doughnut hole over the next 10 years (not fast enough for me, but better than nothing).
5. Converts Medicare Advantage (HMO) rates to fee-for-service rates, which eliminates the insurers' incentive to deny coverage. Medicare Advantage premium rates will be regulated.
6. Delays implementation of the so-called "Cadillac tax" on high cost plans until 2018 and raises the threshold for those plans.
7. Increases the Medicare payroll tax for individuals with incomes over $200,000 and families with incomes over $250,000, and extends the tax to income from investments.
8. Requires insurers to disclose the way they set their premium rates and to justify "potentially unreasonable" premiums.
9. Federal funding for states extending Medicaid to individuals up to 133% of federal poverty level is greatly increased. The special "deal" for Nebraska is gone!
Remember, these are just the changes to the Senate bill, which means everything else in the Senate bill -- elimination of preexisting condition exclusions, phasing out of lifetime and annual caps, creation of a high risk pool for people with preexisting conditions almost immediately after the bill is passed, Medicaid eligibility for single adults with incomes under 133% of the federal poverty level, creation of the exchange (Senate bill would be state exchanges and it looks like that's not changing to federal) -- all of the things we've been talking about for months -- are still there. The exceptions are these express changes.
There is NO change to the Senate abortion language, so the House would accept the less harsh language that still ensures that no federal funds go to paying for abortions or for insurance premiums to cover abortions. Similarly, there is no change to the prohibition on legal immigrants' purchasing insurance through the exchanges.
Those are the highlights. There are lots of other provisions strengthening protections against fraud and abuse, imposing excise taxes on health care industry participants to help pay for reform, and so on. And there are notes all over the place saying that there is more language in the works, so this definitely isn't the final version. But the plan was to get the CBO estimate, ensure budget neutrality (and we actually have projected savings, so better than neutrality), then get to final language, and post the final language on the internet for 72 hours before any votes are taken.
For those of you who want to follow I'd be looking for the language to be posted here, or on the White House health reform page here, or possibly even the main White House site here. I'll do my best to stay on top of this for you over the coming days, although I won't be around on Saturday, so you're on your own for at least part of the week-end. If there are updates before then, I'll post them for you here. So keep checking in. Jennifer