Expansion of Medicaid to cover people making less than 133 percent of
the poverty line
An individual mandate, so that everybody gets into the system shares the
costs with fines of no more than $750 and waivers for hardships when
premiums are more than 8% of income. sstarts in 2016.
REFORMS - immediate,
limits on out-of-pocket
spending with no annual or lifetime limits, no rescission, medical-loss
ratio of 85%.
Investment in primary care and prevention
Essential Health Benefits Package creates levels
of coverage, bronze, silver, gold, or platinum based on actuarial values
from 60%-90%.
INSURANCE EXCHANGE
Subsidies, available to people making up to 400
percent of the poverty line, $88,000 for a family of four.
Sliding scale from 2% - 9.8% of income.
Guarantees of solid benefits for everybody, with limits on out-of-pocket
spending with no annual or lifetime limits.
Coverage expanded
to adult children up to age 26.
Insurers must
provide the percentage of premium that is expended on medical service
and non-claim costs.
HIGH RISK POOL (temporary)
Insurers must provide insurance to people with pre-existing conditions
and premiums can only vary based on family structure,
geographic region, the actuarial value of benefits provided, tobacco use
and by no more than a factor of 3-1 for age.
SMALL BUSINESS
Small Business Credits -
employers with 25 or
fewer employees with who pay 50 percent or more of their employees’
health insurance premiums will be permitted to receive tax credits for
subsidizing coverage, manager's amendment increases tax credits to six
years.
Self-employed
individuals who do not receive credits for purchasing coverage through
the Gateway are eligible.
Scty of HHS will make planning grants for state gateways within 60 days
of passage.Gateways will also
provide means to sign up for premium credits, Medicaid, SCHIP, etc.
Insurance outside the Gateway will operate as it currently does.
Retiree Reserve Trust Fund to assist employers in providing insurance to
those over 55 but not yet eligible for Medicare.
Assisted Living Benefit set by the Secy of HHS for those who have paid 5
years and the previous 12 months.
End discriminatory premium increases on women, the sick and elderly.
Exempt businesses with fewer than 50 employees from mandatory
regulations.
SENIORS & MEDICARE
Does Not Cut Medicare Benefits. Reductions in Medicare spending included
in health insurance reform will not cut Medicare benefits or negatively
affect beneficiaries’ health. In fact, the nonpartisan Congressional
Budget Office (CBO) has cited research findings that “nearly 30 percent
of Medicare’s costs could be saved without negatively affecting health
outcomes…and those estimates could probably be extrapolated to the
health care system as whole.” Health insurance reform will not reduce
Medicare spending by nearly that much, assuring seniors that their
Medicare benefits are safe. [CBO,
6/16/2008; Chairman’s Mark,
Senate Finance Committee,
9/16/09]
Medicare Recipients at Least One Free, Yearly Check-Up.
Currently,Medicare only covers one physical exam or check-up – when you
enroll in the program. Senate health insurance reform changes this
practice and gives every Medicare recipient at least one free yearly
physical with a primary care provider. During that visit, Medicare
beneficiaries would get a personalized health improvement plan and
information about Medicare covered and recommended preventive
screenings.
Begins
To Close Donut Hole Beginning in 2010, in order to have their drugs
covered under Medicare Part D, manufacturers must provide a 50% discount
off the negotiated price for brand-name drugs when middle-income
beneficiaries enter the coverage gap also known as the donut hole.
Makes Preventive Services Free. Medicare beneficiaries will receive free
preventive services recommended by the U.S. Preventive Services Task
Force (USPSTF). Things like mammograms, vaccinations, and other
preventive services and screenings recommended for seniors by the Task
Force will be free of charge to Medicare beneficiaries.
Creates Accountable Care Organizations. Senate health insurance reform
legislation encourages groups of health care providers, such as
hospitals, primary care physicians, specialists and other providers, to
take responsibility for all of their patient’s care and their health. By
better coordinating each individual’s health care and health needs,
seniors have better health outcomes and Medicare saves money, nearly $5
billion over ten years, according to CBO.
Reduces Hospital-Acquired Infections, Readmissions. Seniors shouldn’t
get sick from going to the hospital to get well, and once they leave the
hospital, they shouldn’t have to go back because they weren’t treated
properly the first time. Senate health insurance reform legislation
includes policies to reduce hospital-acquired infections and to reduce
avoidable hospital readmissions for certain high-cost conditions. Not
only is this the right thing to do, it saves money – CBO estimates these
policies will together save $3.3 billion over ten years.
Creates Competitive Bidding to Reduce Substantial Overpayments to
Private Insurance Companies. The Medicare Payment Advisory Commission (MedPAC)
found that in 2009, payments to private Medicare Advantage plans are 14
percent higher than the cost of insuring a beneficiary in traditional
Medicare, an even greater payment disparity than 2008, when private
insurers received a 13 percent overpayment. The Chief Actuary at the
Centers for Medicare and Medicaid Services (CMS) found that these
overpayments increase premiums for beneficiaries in traditional Medicare
by more than $86 per year. In addition to overpayments, CMS reports that
Medicare Advantage plans had an improper payment rate of 10.6 percent,
or $6.8 billion in 2006. Senate health insurance reform creates a
competitive bidding structure for Medicare Advantage plans, ensuring
that payments to private insurance companies reflect the actual cost of
caring for seniors and saving billions of dollars.
Reduces High Payments to Medicare Providers. Through small reductions in
future payment increases to various Medicare providers, the Senate
health insurance reform legislation will reduce Medicare spending by an
estimated $182 billion over ten years. The nonpartisan Congressional
Budget Office (CBO) found that annual payment increases to Medicare
providers have been too high, and “overstate actual increases in
providers’ costs. For example, providers can increase their productivity
by using fewer inputs or a less expensive mix of inputs to deliver care
or by adopting new technologies.” The Senate health insurance reform
legislation incorporates these productivity increases into future
Medicare payment updates for various health care providers, making these
payments more accurate and improving Medicare’s long-term fiscal
situation.
Targets Waste, Fraud, Abuse. Senate health insurance reform will combat
wasteful and fraudulent activity in health careby giving federal health
programs and law enforcement the tools they need to stay ahead of those
who seek to defraud seniors and taxpayers. Health insurance reform will
require the Medicare program to screen all health providers who seek to
bill Medicare to ensure that only those providers who actually treat
seniors receive Medicare payment. Reform will expand data sharing across
more federal agencies to ensure that those suspected of fraudulent
activity in other areas can’t continue to bilk Medicare. And Senate
health insurance reform will increase penalties for those who commit
fraud.
Archimedes Movement
Founded by Oregon's Governor Kitzhaber,
All Americans should be eligible for and have timely access to effective
treatment for “core benefit” of health care and that core benefit should be
portable and not tied to employment.
Physicians For National Health Program 15,000 health professionals for a
single payer system. Private insurance bureaucracy and paperwork
consume one-third of every health care dollar. Streamlining payment through
a single nonprofit payer would save more than $350 billion per year.
Health Care Can't Wait -
AFL-CIO
As the health care reform debate shapes and heats up, the AFL-CIO will post
many of the reports, papers and plans from organizations and individuals.
They also will provide readers with an AFL-CIO "Our Take" on the each item,
summarizing the contents, explaining its relevancy and offering a look at
health care reform through a working families lens.
NSBA
Oldest small business advocate, supports a program that mandates personal
coverage to equalize costs, federally mandated core benefit, sliding scale
subsidies.
Commonwealth Fund Reform must include benefits for all, but also
delivery and payment reform that must be led by the Federal Government.
The national kick-off meeting was convened by Labor for
Single-Payer Healthcare, a campaign spearheaded by scores of trade
union organizations. The national single-payer bill, HR 676 -
expected to be reintroduced in Congress later this month - has
been endorsed by 39 state AFL-CIO federations, 100 Central Labor
Councils, and more than 400 local unions. The bill has 92
co-sponsors in Congress, more than any other health care reform
bill.
National
Center For Policy Analysis - People
consume too much of free government services, causing costs to rise.
Need free market approach.
DIVIDED WE FAIL
Business Roundtable
Remove state regulations, increase market competition,
personal responsibility, basic government assistance for those at poverty
level.
NFIB Founded Fixed For America to support
health care reform. Remove state regulations, be portable, competitive
private market, maximize health.
AARP Access to affordable health care, focus on
wellness and prevention, choices in long term care
