The facts regarding healthcare reform are currently being muddled by many rumors, lies, and unclear explanations. This brief memo is designed to offer to the tools to intelligently answer questions or refute unfounded claims regarding Congress’ and the President’s work on health care and insurance reform. Though I am not an expert, please feel free to contact me and I can help you to find the correct information. I hope you will disseminate this information in order to assuage fears and gain better understanding and support for much needed healthcare reform.

Great references for understanding the history of the debate and many of the most important developments is available at Healthcare Reform, NYTimes and Healthcare Timeline.

The President’s Healthcare Plan

A part of Obama’s campaign promise was to reform the broken healthcare system. Meaningful work on a plan began in June 2009 with the three goals of:

1. Reduces Cost
2. Guarantees Choice
3. Ensures affordable, quality healthcare for all Americans

The President has put forward “Health Insurance Reform Guarantees”. Those eight guarantees are as follows:

1. No discrimination for pre-existing conditions: Insurance companies will be prohibited from refusing coverage because of medical history
2. No exorbitant out-of-pocket expenses, deductibles or co-pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses
3. No cost-sharing for preventive care: Insurance companies must fully cover – without charge – regular checkups and tests that help prevent illness, including mammograms or eye and foot exams for diabetes
4. No dropping of coverage for seriously ill: Insurance companies will be prohibited from dropping or lessening coverage for people who become seriously ill
5. No gender discrimination: Insurance companies will be prohibited from charging people more because of their gender
6. No annual or lifetime caps on coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage people receive
7. Extended coverage for young adults: Children will be eligible for family coverage through the age of 26
8. Guaranteed insurance renewal: Insurance companies will be required to renew a policy as long as the policyholder pays their premium in full. Insurance companies won’t be allowed to refuse renewal if someone becomes sick.

CONGRESSIONAL ACTION

There are several bills being worked on by different groups in Congress. Below are general descriptions of the three primary plans, but a great breakdown of all plans and exactly what they are proposing for specific issues can be located at http://www.kff.org/healthreform/sidebyside.cfm.

Senate Health, Education, Labor, and Pensions (HELP) Committee Affordable Health Choices Act: Championed by Kennedy-Dodd, the bill passed committee on July 15, 13-10, with all Republicans opposing the package. Senator Enzi is ranking member on the HELP Committee.

The overall approach is: Require all individuals to have health insurance. Create state-based American Health Benefit Gateways through which individuals and small businesses can purchase health coverage, with subsidies available to individuals/families with incomes up to 400% of the federal poverty level (or $73,240 for a family of three in 2009). Require employers to provide coverage to their employees or pay an annual fee, with exceptions for small employers, and provide certain small employers a credit to offset the costs of providing coverage. Impose new regulations on the individual and small group insurance markets. Expand Medicaid to all individuals with incomes up to 150% of the federal poverty level.

The HELP committee bill is part of what will eventually be a single Senate measure once the Finance Committee completes work on its version of the legislation. For more info see http://help.senate.gov/

House Tri-Committee America’s Affordable Health Choices Act of 2009 (H.B. 3200): Three committees -- Energy and Commerce, Ways and Means, and Education and Labor -- have different versions of this piece of legislation. Representative Lummis does not sit on any of these committees.

The overall approach is: It would require all individuals to have health insurance and create a Health Insurance Exchange through which individuals and smaller employers can purchase health coverage, with premium and cost-sharing credits available to individuals/families with incomes 400% of the federal poverty level (or $73,240 for a family of three in 2009). Require employers to provide coverage to employees or pay into a Health Insurance Exchange Trust Fund, with exceptions for certain small employers, and provide certain small employers a credit to offset the costs of providing coverage. Impose new regulations on plans participating in the Exchange and in the small group insurance market. Expand Medicaid to 133% of the poverty level.

After recess the 3 versions will need to be reconciled in a markup, but they are not so different that many see this as a terrible obstacle.

Senate Finance Committee Policy Options: The negotiations are being conducted by a so-called, bi-partisan “gang of six”, led by Senator Baucus (D-MT). Senator Enzi is one of the six members.

The Senate Finance Committee released a series of papers laying out options for health reform. While not a formal proposal, these papers offer a framework for achieving health reform goals and present the range of options the Committee will consider as it works to draft health reform legislation. Require all individuals to have health insurance. Create a Health Insurance Exchange through which individuals and small businesses can purchase health coverage, with subsidies available to individuals/families with incomes between 100 and 400% of the federal poverty level. Impose new regulations on the non-group and small group insurance markets. Expand Medicaid and CHIP and offer a temporary Medicare buy-in for the pre-Medicare population.

REFERENCES

Health Care Reform and You – This is a good op-ed in the New York Times that offers a good perspective regarding the different bill versions and how it will affect individuals.

Side-by-Side Comparison – This comparison of all the different plans was by far the most helpful piece of information I could find. They break it down on every aspect from financing to employer requirements and compares on the topics you select for the proposals you are interested in.

Healthcare Reform, NY Times – One of the “Times Topics” is healthcare reform. It gives great issue background as well as having links to all the NYTimes articles written on the subject.

Healthcare Timeline – This is a great interactive timeline put out by the Kaiser Family Foundation.

Whitehouse Reality Check - This website features experts and Cabinet staff speaking about the actual plans and what they will mean in light of certain rumors.

Politifact - This is an independent, non-partisan website which checks the veracity of particular statements and claims.