Today the House released a public document called "Key Features of the Tri-Committee Health Reform Draft Proposal in the U.S. House of Representatives" (.PDF). I have included the full unedited text below. It is of course full of jargonese and code words.
It is also pretty sucky (that too is a code word) as a starting point (being a pessimist I tend to believe it will get weakened, not strengthened as they move forward), even by public option standards, to say nothing of single payer: It uses the "self-sustaining" and "level playing field" language that is code for being pre-crippled to not compete with the private for-profit insurance companies. In the insurance market reforms, the "guaranteed issue" and "community rating" language is also weaker than it could be.
I welcome others to parse and analyze the language, and comment below.
I am also including at the bottom the contact info for the key committee and subcommittees.
Press Release:
FOR IMMEDIATE RELEASE
Ways and Means Contact: Matthew Beck (202) 225-8933
Energy and Commerce Contact: Karen Lightfoot (202) 225-2927
Education and Labor Contact: Rachel Racusen (202) 225-0853
June 9, 2009
House Committees Brief Members on Draft Health Reform Outline
Effort will reduce costs, protect current coverage and preserve choice to ensure affordable, quality care for all
WASHINGTON, DC – Today, leaders of the Committees with jurisdiction over health policy briefed members of the House Democratic Caucus on the current framework and timing of health reform efforts in the House of Representatives. The discussion, led by Ways and Means Committee Chairman Charles B. Rangel (D-NY), Energy and Commerce Committee Chairman Henry Waxman (D-CA), and Education and Labor Committee Chairman George Miller (D-CA), focused on the key principles of reducing health care costs, protecting current coverage and preserving choice for patients to ensure affordable, quality care for all.
The three Chairmen released the following joint statement on their efforts to develop health reform legislation:
"Our Committees are working as one to develop a uniquely-American solution to the health care crisis that is endangering the financial security of individuals and businesses. This solution will fulfill President Obama's commitment to provide quality, affordable health care for all. This framework will build upon what works by ensuring that patients can keep their health coverage if they like it, preserve patients’ choice and reduce costs. We will also fix what is broken through marketplace reforms, sliding scale credits to make coverage more affordable, and provisions to combat waste, fraud and abuse, strengthen Medicare and Medicaid, and invest in the health care workforce and public health. By improving the current system and offering a public health insurance option to promote honest competition with private insurance plans, we will provide individuals and small businesses with better, more affordable choices.
"We will continue to seek input and work closely with our colleagues, outside stakeholders, and the Administration and are on track to introduce legislation shortly. We anticipate Committee action on health reform in the coming weeks, with legislation on the House Floor prior to the August district work period. Reforming America’s health care system is critical to our country’s long-term economic recovery and long-term fiscal health. We are confident that we will achieve reform that will give Americans peace of mind and return our great nation to a path of prosperity for generations to come."
Here is the "key features":
UNITED STATES CONGRESS
Prepared by the House Committees on Ways and Means, Energy and Commerce, and Education and Labor
Key Features of the Tri-Committee Health Reform Draft Proposal in the U.S. House of Representatives
June 9, 2009
President Obama’s Commitment:
The Tri-Committee bill fulfills the President’s commitment to health care reform via legislation that:
• Reduces costs;
• Protects current coverage and preserves choice of doctors, hospitals and health plans; and
• Ensures affordable, quality health care for all.
Plan Overview:
• Maintains the ability for people to keep what they have and minimizes disruption;
• Invests in health care workforce to improve access to primary care;
• Invests in prevention and public health programs;
• Creates a new national health Exchange that permits States the option of developing a State or regional exchange in lieu of the national Exchange;
• Establishes shared responsibility among individuals, employers, and government;
• Offers sliding scale credits to ensure affordability for low and middle-income individuals and families;
• Jump starts health care delivery system reforms to reduce costs, maintain fiscal sustainability, and improve quality; and
• Expands authority to prevent waste, fraud and abuse.
Workforce Investments:
• Expands the National Health Service Corps;
• Boosts training of primary care doctors and expands pipeline of individuals going into health professions, including primary care, nursing and public health;
• Supports workforce diversity efforts; and
• Expands scholarships and loans for individuals in needed professions and shortage areas.
Prevention and Wellness:
• Expands Community Health Centers;
• Waives cost-sharing for preventive services in benefit packages;
• Creates community-based programs to deliver prevention and wellness services;
• Targets community-based programs and new data collection efforts to better identify and address racial, ethnic and other health disparities; and
• Strengthens state, local, tribal and territorial public health departments and programs.
Insurance Market Reforms:
• Ensures availability of coverage by prohibiting insurers from excluding pre-existing conditions or engaging in other discriminatory practices;
• Prohibits rating based on gender, health status, or occupation and strictly limits premium variation based on age;
• Establishes a new Health Insurance Exchange to create a transparent marketplace for individuals and small employers to comparison shop among private insurers and a new public health insurance option; and
• Introduces administrative simplification and standardization to reduce administrative costs across all plans and providers.
Ensuring Affordability and Access:
• Includes sliding scale affordability credits in the Exchange to support individuals and families with incomes between Medicaid eligibility levels and 400% of the federal poverty level (FPL); (NOTE: The average cost of family coverage today is 14% of a family’s income at 400% of poverty.)
• Expands Medicaid for the most vulnerable, low-income populations and improves payment rates to enhance access to primary care under Medicaid; and
• Caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses.
Public Health Insurance Option:
• Enhances transparency and accountability by creating a new public health insurance option within the Exchange to offer choice and ensure competition;
• The public health insurance option is self-sustaining and competes on "level field" with private insurers in the Exchange; and
• When individuals "enter" the Exchange, whether on their own or as employees of a business that is purchasing in the Exchange, they are free to choose among available public and private options.
Benefits:
• Independent public/private advisory committee recommends benefit packages based on standards set in statute;
• Guarantees choice and fair, transparent competition by creating various levels of standardized benefits and cost-sharing arrangements, with additional benefits available in higher-cost plans; and
• Phases-in requirements relating to benefit and quality standards for employer plans.
Shared Responsibility:
• Once market reforms and affordability credits are in effect to ensure access and affordability, individuals are responsible for having health insurance with an exception in cases of hardship;
• Employers choose between providing coverage for their workers or contributing funds on behalf of their uncovered workers;
• Government is responsible for ensuring affordability of insurance through new affordability credits, insurance market and delivery system reforms and oversight of insurance companies; and
• Protects small businesses by exempting small low-wage firms and providing a new small business tax credit for firms providing health coverage.
Reforming the Health Care Delivery System and Ensuring Sustainability:
• Uses federal health programs (Medicare, Medicaid and the new public health insurance option) to reward high quality, efficient care, and reduce disparities;
• Adopts innovative payment approaches and promotes better coordinated care in Medicare and the new public option through programs such as accountable care organizations; and
• Attacks the high rate of cost growth to generate savings for reform and fiscal sustainability, including a program in Medicare to reduce preventable hospital readmissions.
Modernizing, Improving and Preserving Medicare:
• Replaces the currently flawed Sustainable Growth Rate (SGR) formula that determines physician pay rates in Medicare;
• Increases reimbursement for primary care providers, improves the Part D program, and implements many other MedPAC recommendations;
• Extends solvency by eliminating overpayments to Medicare Advantage plans, and refining payment rates for certain services;
• Creates new consumer protections for Medicare Advantage beneficiaries;
• Improves low-income subsidy programs to ensure Medicare is truly affordable and accessible for those with lower incomes; and
• Eliminates cost-sharing for all preventive services.
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Update from comments:
Given that the House has more real progressives overall (and especially on these committees), and does not have to deal with 60 vote supermajority filibuster threat, their starting point was "expected/supposed" to be much better than this. It seems in some ways weaker, not stronger than Kennedy's Senate HELP Committee version.
Hence the "this kinda sucks tone."
Even if one excludes single payer, and just thinks in terms of HCAN/Campaign for America/Hacker approach.
Which I don't. :)
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Now here is what I at least am asking for:
- Single payer policy wonks and advocates be included in ALL hearings from now on.
- There must be a complete, honest, side-by-side comparison of all major proposals, including Single Payer HR-676, by the Congressional Budget Office. The side-by-side comparison must include projected costs not only to the federal government, but also to state government, employers and to individuals and households of different income levels. Not just for 2010, but with projections beyond.
Let there be an honest and complete comparison of policy and economics.
This way, if we are not going to get single payer this time around due to the politics, then at least we can fight to make sure that Americans know what it is that they are getting, and what they are not getting.
Out there in the real world, there is a very real danger that the distinction is lost and not understood. Too many people in America think what they are getting IS national health insurance.
There is a danger that the general public actually thinks that what has come to be known as public option is the progressive, liberal, left solution. Regardless of the no doubt good faith efforts of the public option, it really is not. It is a pre-compromised kludge of a camel. It is designed to prop up the inherent failure of the for-profit private insurance model, rather than replace it. In addition, it is pre-designed to fail: it will not get us to universal coverage and actual access to care, it will not provide coverage that is comprehensive for all care necessary; it will not control total costs; it will not control individual out of pocket costs.
Now, if single payer policy wonks and advocates are wrong, and this reform is all that is needed and works out great, then let us at least make it the best we can get now. I call it the 51 Senate vote version (I have no interest in the 61 vote version).
However, if we are going to be fighting for Reform 2.0 in a few years, then we need plan strategically now in order to win the "I told you so" argument. At the very least we want to be sure that after this "reform" does pass, that if it fails, the next step is forward to single-payer ("see you left the private for-profit in as wasteful cheating unneeded intermediaries that also prevents real planning"), and not backward ("see liberal big government tries to fix things and it went badly") to market fundamentalism.
Okay, now for all those contacts:
Below is the basic contact information for the three key House committees that are going to deal with health reform, and the complete list of contacts for their health-specific subcommittees:
Energy & Commerce:
Committee Telephone: 202-225-2927
And the Subcommittee on Health
Democrats:
Henry A. Waxman (Chairman) CA-30th 202-225-3976
Frank Pallone, Jr., Chairman, Health Subcommittee) NJ-6th 202-225-4671
John D. Dingell, Chairman Emeritus MI-15th 202-225-4071
Lois Capps, Vice Chair CA-23rd 202-225-3601
Bart Gordon, TN-6th 202-225-4231
Anna G. Eshoo, CA-14th 202-225-8104
Eliot L. Engel, NY-17th 202-225-2464
Gene Green, TX-29th 225-1688
Diana DeGette, CO-1st 202-225-4431
Jan Schakowsky, IL-9th 202-225-2111
Tammy Baldwin, WI-2nd 202-225-2906
Mike Ross, AR-4th 202-225-3772
Anthony D. Weiner, NY-9th 202-225-6616
Jim Matheson, UT-2nd 202-225-3011
Jane Harman, CA-36th 202-225-8220
Charles A. Gonzalez, TX-20th 202-225-3236
John Barrow, GA-12th 202-225-2823
Donna M. Christensen, VI-delegate 202-225-1790
Kathy Castor, FL-11th 202-225-3376
John P. Sarbanes, MD-3rd 202-225-4016
Christopher S. Murphy, CT-5th 202-225-4476
Zachary T. Space, OH-18th 202-225-6265
Betty Sutton, OH-13th 202-225-3401
Bruce L. Braley, IA-1st 202-225-2911
Republicans:
Nathan Deal, GA, Ranking Member
Ralph M. Hall, TX
Ed Whitfield, KY
John Shimkus, IL
John B. Shadegg, AZ
Roy Blunt, MO
Steve Buyer, IN
Joseph R. Pitts, PA
Mike Rogers, MI
Sue Wilkins Myrick, NC
Tim Murphy, PA
Michael C. Burgess, TX
Marsha Blackburn, TN
Phil Gingrey, GA
Joe Barton, TX (ex officio)
Education & Labor:
Telephone 202-225-3725
Holding single payer hearings on June 10!
Democrats:
George Miller, Chairman CA 7th 202-225-2095
Robert Andrews, Chair Subcommittee HELP, NJ-1st 202-225-6501
David Wu OR-1st 202-225-0855
Phil Hare IL-17th 202-225-5905
John F. Tierney MA-6th 202-225-8020
Dennis J. Kucinich OH-10th 202-225-5871
Marcia Fudge OH-11th 202-225-7032
Dale E. Kildee MI-5th 202-225-3611
Carolyn McCarthy NY-4th 202-225-5516
Rush Holt NJ-12th 202-225-5801
Joe Sestak PA-7th 202-225-2011
David Loebsack IA-2nd 202-225-6576
Yvette Clarke NY-11th 202-225-6231
Joe Courtney CT-2nd 202-225-2076
Republicans:
John Kline, Ranking Member
Joe Wilson
Cathy McMorris Rodgers
Tom Price
Brett Guthrie
Tom McClintock
Duncan D. Hunter
David P. Roe
Ways & Means:
Tel: 202-225-3625 | Fax: 202-225-2610
Democrats:
Charles B. Rangel, Chairman Ways and Means NY-15th 202-225-4365
Pete Stark, Chairman Subcommittee on Health CA-13th 202-225-5065
Lloyd Doggett, TX-25th 202-225-4865
Mike Thompson, CA-1st 202-225-3311
Xavier Becerra, CA-31st 202- 225-6235
Earl Pomeroy, ND-At Large 202-225-2611
Ron Kind, WI-3rd 202-225-5506
Earl Blumenauer, OR-3rd 202-225-4811
Bill Pascrell Jr. NJ-8th 202-225-5751
Shelley Berkley, NV-1st 202-225-5965
Republicans:
Wally Herger, CA, Ranking Member
Sam Johnson, TX
Paul Ryan, WI
Devin Nunes, CA
Ginny Brown-Waite, FL
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Just to be clear: As I have said before... This is better than what we have now (I am not a nighlist; like many single payer advocates I actually work in serving the otherwise underserved)... BUT: it will not, in fact, cover everybody, the access will not be universal nor comprhensive, it will not adequately control individual costs (total out of pocket costs for individuals and families), nor will it control total (percent of national GNP going to health care)
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Update: Here is some quickie analysis from some senior PNHP colleagues:
The outline is so vague on most issues its hard to tell much of what they actually have in mind.
However, your assessment of the public plan option seems accurate.
We'd add that the insurance exchange will add substantial bureaucratic cost - about 3% of premiums on top of insurance overhead based on the Massachusetts experience.
Shared responsibility is presumably a code for "we're going to make it a crime to be uninsured".
Still allows insurers to vary premiums based on age - the ultimate pre-existing condition.
The caps on out-of-pocket spending probably don't apply to uncovered services (e.g. physical therapy visits exceeding 60 days, as is
customary in most private policies, despite the fact that recovery from many orthopedic procedures takes longer than that)
And the caps on spending for covered services are almost certain to be too high to prevent many medical bankruptcies.
Another:
The combined language relating public option and the private insurance companies guarantees that they will be able to engage in adverse selection. No protection at all.