Public health insurance option, which is called "The Community Health Insurance Option" is included in the Senate comittee's final health care reform bill and is going to the Senate floor. Senate’s Health, Education, Labor and Pensions Committee (HELP) made a big step in its effort to make affordable health insurance and quality health care coverage available to all Americans. Here is what the bill says.
America needs an alternative to private health insurance and the public option may serve that purposes. We have choices with our doctors, but currently no choice with health insurance companies. Now that may soon change.
More about the Affordable Health Choice Act from the bill itself.
The Senate’s Health, Education, Labor and Pensions (HELP) Committee today passed The Affordable Health Choices Act, landmark legislation that will reduce health costs, protect individuals’ choice in doctors and plans, and assure quality and affordable heath care for Americans. The bipartisan bill includes more than 160 Republican amendments accepted during the month-long mark-up, one of the longest in Congressional history.
The legislation builds on the existing employer-based system and strengthens it. If an individual likes the health insurance he or she has, they get to keep it. The bill provides better choices for those with no coverage now, and those for whom coverage is unaffordable. The legislation also gives small businesses better options for high value health coverage.
Under the insurance reforms in The Affordable Health Choices Act, no American can be denied health coverage because of a preexisting medical condition, or have that coverage fail to help them when they need it most. No American will ever again be subject to annual or lifetime limits on their coverage, or see it terminated arbitrarily to avoid paying claims.
Moreover, the bill reduces health care costs through stronger prevention, better quality of care and use of information technology. It also roots out fraud and abuse, reduces unnecessary procedures and creates a system that allows everyone to obtain insurance thereby gaining access to doctors, medication and procedures essential for prevention and disease management. By sharing in this responsibility, these nearly 50 million uninsured Americans will avoid eleventh-hour treatment in emergency rooms that drive up costs for everyone else.
Shared responsibility requires that everyone - government, insurance companies, medical providers, individuals and employers - has a part in solving America’s health care crisis. The Affordable Health Choices Act requires those businesses which do not provide coverage for their workers to contribute to the cost of providing publicly sponsored coverage for those workers. It includes an exception for small businesses.
The bill also includes a strong public option that responds to the wishes of the American people to have a clear alternative to for-profit insurance companies. Like private insurance plans The Community Health Insurance Option will be available through the American Health Benefit Gateway, a new way for individuals and small employers to find and purchase quality and affordable health insurance in every state.
The non-partisan Congressional Budget Office estimates the bill to cost less than $615 billion over 10 years.
A complete summary follows the below statements from the Democratic Members of the HELP Committee:
“I could not be prouder of our Committee. We have done the hard work that the American people sent us here to
do. We have considered hundreds of proposals. Where we have been able to reach principled compromise, we have done so. Where we have not been able to resolve our differences, we have treated those with whom we disagree with respect and patience,” Chairman Kennedy said. “As we move from our committee room to the Senate floor, we must continue the search for solutions that unite us, so that the great promise of quality affordable health care for all can be fulfilled.
“We began this process with a blank sheet of paper and a mandate from the American people. We all knew the history, marked with too many disappointments, and I said that this time would be different. Well, this time is different,” said Senator Dodd. “The American people demanded legislation that protects their choice of doctors, hospitals, and insurance plans; cuts costs for families, businesses, and the federal government; and ensures that, in the wealthiest nation in the world, everyone has access to affordable, high-quality care. This time, we have produced the legislation Americans wanted. This time, we have delivered on the promise of real change.” “It was not enough to talk about how to extend insurance coverage and how to pay for health care – as important as those things are. It made no sense just to figure out a better way to pay the bills for a system that is broken and unsustainable. We also had to change the health care system itself. And that is what this bill would do,” said Senator Harkin. “This legislation puts prevention and public health at the very heart of comprehensive health
reform. It will jumpstart the process of replacing our current sick care system with a genuine health care system.
And it doesn’t just tinker around the edges; it changes the paradigm.”
“This is an historic moment. Today, we have moved one big step closer to guaranteeing high –quality, affordable and accessible health care for all Americans,” Senator Mikulski said. “I am proud to have led the HELP Committee in writing the quality title of this landmark legislation. Emphasizing quality in health care improves lives, saves lives and fixes the problems – medical errors, preventable hospital readmissions, and failure to manage chronic diseases -- in our current system that severely impact people’s lives and checkbooks. Now is the time for health care reform. We will send President Obama a health care reform bill this year.”
For millions of Americans, the health care system in place today is not working. In this landmark legislation we
have a great framework for an improved system that reduces costs, requires more of health insurance plans, focuses on prevention, and ensures high quality and affordable heath care for all Americans,” said Senator Bingaman. “I hope the legislation we ultimately send to the president this summer resembles this bill closely.”
“With health care premiums rising three times faster than wages, it is clear that our current system is not sustainable. That’s why we have produced a bill that protects patient choice, lowers costs and helps those who have no coverage at all. And as we worked to provide quality, affordable health care coverage to all Americans, I worked closely on the part of the bill that ensures that there are enough health care professionals to provide that care,” Senator Murray said. “I am very proud of my colleagues on this committee for their commitment and dedication. Our legislation is the culmination of hundreds of hours of meetings and testimony, and hundreds of amendments worked through from both sides of the aisle. We have been talking about reforming health care for years, but the American people need help now more than ever and I am confident that this year we high quality, affordable health care a reality for all.”
“This is an historic first step and a signal that the status quo isn’t enough. Skyrocketing health care costs are
threatening the economic stability of American families and businesses, and the fiscal health of our nation. One out of every six dollars we earn is spent covering the costs of medical bills, and that’s unhealthy for our economy. The Affordable Health Choices Act will begin reining in costs and provide millions of Americans access to more reliable and affordable coverage,” said Senator Reed. “Every American family should have access to a family doctor. The strong public option and a host of other insurance reforms in this plan will give Americans more choices of providers, provide families with more health care stability, and transform our current health care system from one that provides sick care to one that truly promotes health and wellness.”
“This is a historic moment for our nation. This is not a partisan victory. This is a victory for the millions of
American families and businesses whose health care costs have soared out of control. This is a victory for 50 million uninsured Americans. While there is still much work to do, today is a critical first step in national health care reform. I applaud Chairmen Kennedy and Dodd for their leadership,” said Senator Brown.
“Today’s vote is a major step toward reducing health care costs, providing stability for those worried about losing
coverage and expanding coverage to 97% of Americans,” said Senator Casey. “As I travel in Pennsylvania, the top issues I hear from my constituents are the related issues of economic insecurity and the need for health care reform. This legislation will go a long way toward providing peace of mind for families and an economic boost for our
country.”
"We have passed a compromise health care reform bill that will stabilize costs and ensure that people who are happy with their health care and doctors can keep them. Our bill also ensures that a pre-existing condition will not prevent you from getting coverage. This compromise package focuses on prevention and wellness, which will keep our nation healthier and save taxpayers’ money in the long run. I will continue working with my colleagues to get reform legislation to the President that stabilizes costs, expands coverage and improves the quality of care for all Americans,” said Senator Hagan.
“The Senate HELP Committee bill is a once in a generation opportunity for affordable, accessible, quality health
care. The bill gives every citizen a full range of health insurance options, including a community health plan. It is
our best bet to heal a broken health system by increasing coverage, investing in prevention and decreasing costs,”
said Senator Merkley.
“The reform bill we passed today will let you keep the health insurance you have, if you like it – and if you can’t
afford your coverage or you’re uninsured, you’ll have new choices,” said Senator Whitehouse. “Its emphasis on
quality improvement, disease prevention, and a public insurance option will mean high-quality, efficient health care that invests not only in treating you when you’re sick, but in keeping you well. And never again will an insurance company be able to deny you coverage because of a pre-existing condition.”
Of particular interest is the Public option, which is called Community Health Insurance Option
Community Health Insurance Option. The Secretary will establish a community health insurance option that
complies with the health plan requirements established by this title and provides only the essential health benefits
established in section 3103, except in States that offer additional benefits. There are no requirements that health care providers participate in the plan or that individuals join the plan. The premiums must be sufficient to cover the
plan’s cost. The Secretary shall negotiate rates for provider reimbursement. Reimbursement rates will be negotiated by the Secretary and shall not be higher than the average of all Gateway reimbursement rates. A “Health Benefit Plan Start-up Trust Fund” will be created to provide loans for the initial operations of the community health insurance plan, which the plan will be required to pay back no later than 10 years after the payment is made. After the first 90 days of operation, the community health plan will be subject to a Federal solvency standard, established by the Secretary, and will be required to have a reserve fund that is at least equal to the dollar value of incurred claims. Each state will establish a State Advisory Council to provide recom
In the meanwhile, the public is waiting for the day to see an affordable health insurance option available to individuals and families.
Prepared by Armen Hareyan
Comments
#1 state vs. federal reform
Insurance reform + medical provider reform = health care reform, right? Utah health insurance reform has been center focus for the state, UAHU and private insurance carriers over the past 24 months. Mike Oliphant (UAHU board webmaster) runs a small Utah based health insurance website http://www.healthinsurancetexas.biz as well as http://www.DentalInsuranceUtah.net . Mike’s viewpoint provides a unique analysis which comes from being a “fly on the wall” observer in countless state session and insurance meetings. “Utah has been thrust into a state insurance reform pressure cooker which isn’t necessarily negative where I am an insurer, insured and patient”. Several interesting changes took place with H.B. 188 passage earlier this year which seems all too familiar to the ongoing federal health care reform attempt under Obama’s administration. The spirit of the bill allows private Utah market place remedies. It essentially guarantees a Utah health insurance carrier a "no loss" or "no gain" premise over competing carriers that operate within the “Utah Insurance Exchange portal”. On the surface it would seem unattractive to a carrier’s consideration (voluntary at this point). But you have to understand the carriers’ goal is to cover their administration fees and maintain a 3% profit. The Utah health insurance reform model claims this can be accomplished now by legislation and the watchful eye of the state’s risk adjuster board. The medical claim risks are essentially shared equally among the participating carriers. Therefore, the carriers can focus on administration efficiencies more so than competition over a fluctuating market share. Insurance carriers such as SelectHealth have efficiencies and risk management experience polished by long tested actuarial tables with health statistics and claim trends. Is it a bad idea to share that experience with a national carrier such as Humana? Would it surprise anyone to know that maternity NICU and anti-depressants represent the highest utilization in health insurance costs for medical and pharmacy in Utah? Compare this to Texas which suffers from abnormally high levels of diabetes and liver disease per capita.
The other half of the “health care reform equation” is medical provider and billing practices. The state claims this is on the agenda. It is popular belief among Utah legislators that reform stops with the insurance carrier. However, how can the insurance carrier continue to bear the risk and re-distribution of health insurance premiums back out the door in claims without provider billing reform? Add to this obstacle a continuing shrinkage of the insured populace. Obama’s administration proposes mandatory participation in a health insurance policy by employers of all sizes, self employed and unemployed populace. The logic being to shore up the unhealthy with healthy premium. When analyzing the Massachusetts’s system, you actually pay a penalty if you have no proof of coverage. The benefit level and health insurance price is nowhere close when you compare Utah health insurance quotes through HealthInsuranceSource.net or dental insurance quotes at DentalInsuranceUtah.net. Utah premium is easily half. This insight comes from a Utah health insurance agent whom often interacts with employers and residents looking for affordable coverage, making sure claims are paid correctly, implementation and explanation of the many policy procedures and putting a complex SelectHealth insurance language in understandable terms. Yet legislators claim agents to be of no value all in the name to save 3-4 off of Utah health%
With the latest announcement of hospitals agreeing to contribute $155 billion, where are the costs going to be shifted for this donation? In Utah, studies conducted by BenefitsManager.net revealed that cost shifting already exists in the ER. There is apparent lack of legislators in Utah and on the federal level proposing TORT REFORM. It is factual that a majority of US senators and representatives are lawyers. To push liability insurance premiums down that absorb as much as 15% in expenses with most medical providers is significant. Take 15% off total medical expenditures in US and you will see savings in the trillions.
If we go down the path of nationalized health care reforms, will we at some point be forced to address usage and ration? Will we have to define when to refuse further care for patients receiving critical illness treatments, intensive care unit, disease management, neonatal intensive-care unit for? SelectHealth documents that the single most expensive bills are NICU for newborns and seniors in acute / intensive care / pre-hospice.
Without TORT REFORM, medical provider costs will never drop. Liability insurance costs are approaching nearly half of the operating expenses for specialty care physicians, units and facilities. Humana health plans state that their costs of medical liability and defensive medicine accounts for nearly 10 cents out of every premium dollar collected. Compare that to Humana’s reported pharmaceutical claims of 15 cents out of every premium dollar collected. Or better yet, 21 cents out of every premium dollar collected is paid back to physicians for physician treatments.