Highlights of the House Bill (Snips & Summary)

[quiet.american]

There is some very, very good stuff in here.

Highlights of the House Bill
(7-page summary)
http://edlabor.house.gov/documents/111/pdf/publications/AHCAA-TOPLINE-102909.pdf

snip
Repeals the Antitrust Exemption for Insurers. The bill promotes competition among health insurers and medical malpractice insurers by removing the antitrust exemption so that it no longer shields these insurers from liability for fixing prices, dividing up territories, or monopolizing their market.

snip
Immediate Sunshine on Price Gouging (Rate Review). Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases and rationale for such increases.

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Public Health Insurance Option. Modifies policy so that the Secretary shall negotiate rates with providers that participate in the public plan and provides greater clarity regarding the opt-out policy for providers.

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Affordability Credits. In order to reduce the cost of the new coverage to meet the $900 billion goal, affordability premium credits have been scaled back to reflect an amendment adopted by the Committee on Energy & Commerce. Individuals and families between 150 percent and 400 percent of FPL will pay a larger share of health premiums over time compared to HR 3200 as introduced. Also, the exception for individuals and families with employer coverage who can receive affordability credits in the Exchange is increased to 12 percent of income. Specific out-of-pocket maximums are added to protect individuals’ level of cost sharing at each income tier (specified below) -- table at link.

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Begins Closing the Medicare Part D Donut Hole Immediately. Effective January 1, 2010, closes the Part D donut hole by $500 and institutes a 50 percent discount for brand-name drugs in the donut hole. Gap in coverage is completely eliminated by 2019.

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Small Employers and the Exchange. Increases the size of small employers automatically allowed to purchase coverage through the Exchange to at least 100 employees within the first three years; permits additional expansion to even larger employers in future years.

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Essential Benefits Package. Provides for the coverage of behavioral health treatments as mental health services, and clarifies that durable medical equipment, prosthetics, and orthotics are covered in the essential benefits package.

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Veterans and Members of the Armed Forces. Ensures veterans, members of the armed forces, and their families have access to the Exchange to obtain health insurance if they choose and that they fulfill their responsibility to have qualified health insurance if they are enrolled in VA healthcare or TRICARE. Also provides that TRICARE is not changed based on the essential benefits package.

Much more:
http://edlabor.house.gov/documents/111/pdf/publications/AHCAA-TOPLINE-102909.pdf

[quiet.american]

1. Okay, one selfish kick here - this is at least as much worth seeing as Orly Taitz threads. :) nt

[bvar22]

2. Repealing the Anti-Trust exemption is GREAT...

...but dropping the Medicare +5 and substituting "the Secretary shall negotiate rates with providers" is a HUGE step weakening the already weak Public Option by reducing the price advantage (if any) of the Public Option on "The Exchange".

[quiet.american]

3. I see direct negotiations with doctors and hospitals as something that will still work.

If the bill contained a provision that stated the government would be barred from negotiating prices directly with doctors and hospitals, that is something I would tear my hair out over.

However, since the votes were not there for set rates for the government-run plan, this still provides some leverage for the negotiation of lower prices, in that it still provides competition against the insurance companies. If the government is providing attractive rates based on their negotiating power, it would seem to me insurance companies will have to work (read: lower their prices) to be competitive with that.

[lumberjack_jeff]

5. The medicare +5 reimbursement paradigm was better.

I understand that some compromises need to be made to get the house and senate bills reconciled, but... :(

[quiet.american]

7. Yes, I hear you -- someone mentioned a "foot in the door" w/this bill....

... and I know others will inevitably call it a "foot in the ass" :) -- but I do like a lot of what I'm reading -- hopefully this is a foot in the door that will pave a way in future for the "robust" option.

[quiet.american]

4. Dupe. nt

[rucky]

6. K&R