HOUSE: Health Reform Bill Contains Moderate-Favored Public Option With Negotiated Rates
House Democratic leaders on Thursday unveiled the chamber’s final health reform bill (HR 3962), which includes a public health insurance option favored by moderates that would have providers negotiate their reimbursement rates directly with the government, the Washington Post reports. When announcing the bill, House Speaker Nancy Pelosi (D-Calif.) said, “Today we are about to deliver on the promise of making affordable, quality health care available for all Americans. … We are putting forth a bill that reflects our best values and addresses our greatest challenges” (Murray [1], Washington Post, 10/29).
The final version of the bill is more centrist and less costly than versions of reform legislation passed by two House committees earlier this year (Murray [2], Washington Post, 10/29). House Democrats held a rally Thursday to release the bill and aim to take it to the floor by next week, with a final vote before Veterans Day on Nov. 11 (Pear, New York Times, 10/29).
Public Option
The most contentious issue for Democrats in recent weeks has been what form the chamber’s version of a public option would take. Moderate Democrats advocated including a public option in which doctors directly negotiate reimbursement rates with the government. Liberals prefer a more “robust” version of the public option in which reimbursement rates are tied to Medicare rates plus 5%. A third option would created a negotiated-rate option but would trigger a Medicare-plus-5% system if the negotiated rates failed to generate sufficient savings (American Health Line, 10/28).
Medicaid
The House bill also would expand eligibility for Medicaid in an effort to reduce the legislation’s cost (Murray [1], Washington Post, 10/29). Those who earn less than 150% of the federal poverty level — about $16,245 annually for an individual and $33,075 annually for a family of four — would be eligible for Medicaid coverage under the bill (Los Angeles Times, 10/29). Previous versions of the bill had raised the threshold to 133% of the poverty level. Proponents of the eligibility expansion say that it would be cheaper to provide low-income people with insurance coverage under Medicaid than it would be to offer them subsidies for private insurance coverage. The bill still would include subsidies for middle-class residents who do not have access to affordable coverage through their employers (Murray [1], Washington Post, 10/29).
Costs, Coverage
Democratic leaders say that the bill would cost less than the $900 billion limit Obama has set for health care legislation and that it would not increase the federal deficit over the next 10 years (New York Times, 10/29). The bill is projected to provide coverage for 35 million people who are currently uninsured. The bill would include mandates for U.S. residents to purchase insurance and for large employers to provide health benefits for workers (Los Angeles Times, 10/29).
Much of the bill’s cost would be paid for with a new surtax on high-income U.S. residents, commonly called a “millionaire’s tax.” Earlier versions of House legislation had set the threshold for the tax at annual earnings of $280,000 for individuals and $350,000 for couples. The final bill is expected to raise those levels to $500,000 for individuals and $1 million for couples, meaning it would affect three-tenths of 1% of U.S. households (New York Times, 10/29). That tax plus changes to Medicare and Medicaid are expected to net $500 billion in cost savings over 10 years, according to analyses from the Congressional Budget Office (Murray [1], Washington Post, 10/29).
Implementation
According to Pelosi spokesperson Nadeom Elshami, some of the bill’s components would be implemented before 2013, a change from earlier versions of the House bill. Most of the taxes in the bill would take effect in 2010, and many benefits — such as insurance industry reforms — would take effect in 2013 (CongressDaily, 10/29).
– compiled by Zach Swiss
Note: This is an abridged version of the story that appeared in American Health Line this morning. For complete access to the full version, plus all of AHL’s other stories and content, subscribe to AHL.
