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Agenda for Health Care Reform
Affordable Health Care for America Act Introduced in Congress
On October 29th, the Democratic Leadership introduced H.R. 3962, the Affordable Health Care for America Act, in the U.S. House of Representatives. H.R. 3962 blends and updates the three versions of previous bills passed by the House committees of jurisdiction in July. Since that time, Congress has received an unprecedented amount of feedback from the American people through town halls, emails, phone calls and faxes. The input from my constituents was greatly appreciated, and while there were differences in the details, the majority were overwhelmingly supportive of the need to improve quality, expand coverage, and contain the rising costs of health insurance. This bill, which I intend to support, would accomplish these goals. Below you will find a summary of the key provisions in the bill, and links to more resources.
Congressman Dicks has stated his priorities for health care reform:
- Preserving what people like about the current insurance system that provides health care benefits to a broad cross-section of Americans, including the ability to keep their health plans and their doctors if they choose to do so;
- Some type of public option as a way to offer a more comprehensive and competitive plan in the health care marketplace;
- Reforms must resolve the inequities that exist in the current system, including the glaring geographic variation in Medicare reimbursement rates that have disproportionately hurt Washington and a few other states while they have unfairly benefitted a few key larger states.
- Any plan that is adopted should suggest a method to cover the millions of currently uninsured people in this country - including kids-who represent a huge cost to society when they show up in hospital emergency rooms for urgent care that is ultimately much more costly.
- And finally, it must be cost-effective: substantial savings can be achieved by reducing duplication of efforts, eliminating wasteful expenditures and simplifying paperwork burdens.
The key components of the Affordable health Care for America Act include:
Increasing choice and competition. The bill will protect and improve consumers’ choices.
- If people like their current plans, they will be able to keep them.
- For individuals who aren’t currently covered by their employer, and some small businesses, the proposal will establish a new Health Insurance Exchange where consumers can comparison shop from a menu of affordable, quality health care options that will include private plans, health co-ops, and a new public health insurance option. The public health insurance option will play on a level playing field with private insurers, spurring additional competition.
- This Exchange will create competition based on quality and price that leads to better coverage and care. Patients and doctors will have control over decisions about their health care, instead of insurance companies.
Giving Americans peace of mind. The legislation will ensure that Americans have portable, secure health care coverage – so that they won’t lose care if their employer drops their plan or they lose their job.
- Every American who receives coverage through the Exchange will have a plan that includes standardized, comprehensive and quality health care benefits.
- It will end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and strictly limit age rating.
- The proposal will also eliminate co-pays for preventive care, and cap out-of-pocket expensesto protects every American from bankruptcy.
Improving quality of care for every American. The legislation will ensure that Americans of all ages, from young children to retirees have access to greater quality of care by focusing on prevention, wellness, and strengthening programs that work.
- Guarantees that every child in America will have health care coverage that includes dental, hearing and vision benefits.
- Provides better preventive and wellness care. Every health care plan offered through the exchange and by employers after a grace period will cover preventive care at no cost to the patient.
- Increases the health care workforce to ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.
- Strengthens Medicare and Medicaid and closes the Medicare Part D ‘donut hole’ so that seniors and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.
Ensuring shared responsibility. The bill will ensure that individuals, employers, and the federal government share responsibility for a quality and affordable health care system.
- Employers can continue offering coverage to workers, and those who choose not to offer coverage contribute a fee of eight percent of payroll.
- All individuals will generally be required to get coverage, either through their employer or the exchange, or pay a penalty of 2.5 percent of income, subject to a hardship exemption.
- The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.
Protecting consumers and reducing waste, fraud, and abuse. The legislation will put the interests of consumers first, protect them from problems in getting and keeping health care coverage, and reduce waste, fraud, and abuse.
- Provides transparency in plans in the Health Exchange so that consumers have the clear, complete information, in plain English, needed to select the plan that best meets their needs.
- Establishes consumer advocacy offices as part of the Exchange in order to protect consumers, answer questions, and assist with any problems related to their plans.
- Simplifies paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all encounter a streamlined, less confusing, more consumer friendly system.
- Increases funding of efforts to reduce waste, fraud and abuse; creates enhanced oversight of Medicare and Medicaid programs.
Reducing the deficit and ensuring the solvency of Medicare and Medicaid. The legislation will be entirely paid for – it will not add a dime to the deficit. It will also put Medicare and Medicaid on the path to a more fiscally sound future, so seniors and low-income Americans can continue to receive the quality health care benefits for years to come.
- Pays for the entire cost of the legislation though a combination of savings achieved by making Medicare and Medicaid more efficient – without cutting seniors’ benefits in any way – and revenue generated from placing a surcharge the top 0.3 percent of all households in the U.S.(married couples with adjusted gross income of over $1,000,000) and other tax measures.
- The Congressional Budget estimates the bill will reduce the deficit by at least $100 billion over ten years.
- Estimates also show the bill will slow the rate of growth of the Medicare program from 6.6 percent annually to 5.3 percent annually.
Resources for Further Information
H.R. 3962 - Affordable Health Care for America Act Resources:
H.R. 3962 is the most current proposal for health care reform in the House, and is a blend and update of the three previous versions passed by House committees of jurisdiction in July.
Related News from Congressman Dicks:
Other Sources of Information:
There has been a tremendous amount of misinformation utilized by various interest groups during this sharp congressional debate over health care reform this year. In a search for objective views of the essential issues involved in this reform effort, Congressman Dicks would like to suggest a review of the following issue papers that have been prepared by scholars at The Urban Institute, a non-partisan policy center that is currently headed by the former Director of the Congressional Budget Office. These include the initial study, entitled “Health Reform: The Cost of Failure,” funded by the Robert Wood Johnson Foundation, which addresses the concerns of many 6th District residents who have questioned the need to adopt reforms now. All links to follow are the intellectual property of The Urban Institute:
“Health Reform: The Cost of Failure” [clicking here takes you to The Urban Institute site]
- The cost of doing nothing is high. Without reform, the number of uninsured Americans will swell from a projected 49 million in 2009 to 62 million in 2019, according to the intermediate economic case.”
- Employer spending on health insurance premiums would rise from $430 billion in 2009 to $847 billion in 2019, while individual and family spending on health care would jump from $326 billion to $521 billion. And government spending on Medicaid and the Children’s Health Insurance Program would go up 82 percent to $458 billion, necessitating higher taxes.
“Beyond the $1.6 Trillion Sticker Shock” [clicking here takes you to The Urban Institute site]
- The Congressional Budget Office’s $1.6 trillion estimate for 10 years of health care reform is less than 1 percent of estimated gross domestic product—and a tiny fraction of expected health care spending for the period. Eliminating the costs of caring for the uninsured once coverage is near universal brings the total price tag down to $1.2 trillion.
- Without reform, health care spending will total an estimated $33 trillion from 2010 through 2019. The added $1.2 trillion cost of reform signals an increase of just 3.5 percent.
- There is no health care money tree, but there are many ways to save and many revenue sources available. Savings from health care cost cutting and investments would be $853 billion over 10 years. Of that, $627 billion would be government savings.
“How We Can Pay for Health Reform” [clicking here takes you to The Urban Institute site]
- Medicare and Medicaid cost savings could come from reducing the pricing edge of Medicare Advantage, Medicare payments to doctors for some services, payment rates to hospitals and post-acute care readmissions within 15 days, and funds for safety net providers no longer needed under near-universal coverage.
- Targeted investments in the following would help curb health care spending growth: chronic care management and coordination, new approaches to end-of-life care, diabetes and hypertension prevention, health-information technology, malpractice reform, “medical homes” that coordinate a patient’s care, and technology-effectiveness research.
- Ways to pay for broader coverage and more efficient care include sin- or income-tax hikes, an assessment on every employer of 10 or more workers that doesn’t provide health insurance, and caps on tax breaks individuals get from employer contributions to health insurance. Capping tax breaks would also be fair since this benefit now disproportionately subsidizes the wealthiest Americans.
“Is the Public Plan Option a Necessary Part of Health Reform?” [clicking here takes you to The Urban Institute site]
- A public plan can make a key contribution to containing health care costs. With fewer players in the insurance and hospital markets, competition deteriorates, so there is less incentive to control costs. A public plan could save health care dollars through lower administrative costs and lower provider payment rates. This approach would prod private insurance companies to become more efficient, but wouldn’t drive them out of business.
- A public plan could also protect chronically ill patients denied coverage by private insurers.
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