The Newsroom News - Health reform Health Reform Bill Moves to Senate Floor
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Health Reform Bill Moves to Senate Floor
Written by David Norman
Thursday, 15 October 2009 23:43
A long-awaited sign of progress for consumer-focused health care reform, Senator Max Baucus’ bill, America’s Healthy Future Act, passed the Senate Finance Committee 14 to 9 and moves on to the Senate floor. The bill not only promises to cut costs – the Congressional Budget Office calculated earlier that the bill would cost $829 billion, far lower than the target, and estimated it will reduce the federal deficit by $81 billion in its first 10 years, and $450 to $900 billion in its next ten years – but it plans to make health care more accessible to all, and create transparency in the insurance market.
“The bill we passed today puts patients and doctors – not insurance companies – in the driver’s seat,” said Baucus.
While the bill aims to reform the health care industry on all levels, the goals most crucial to the consumer are in cutting costs and provision of care, which all other areas of the bill essentially spring from, as well. There has been much dispute regarding many areas of this bill. Below are the key points that must be understood by the consumer in understanding the changes this bill hopes to make and how those changes will work together to create a more humanistic and efficient health care system.
The largest entity in establishing clarity for the consumer and monitoring insurance companies is the health insurance exchange. The need creating the exchange is the need for transparency. It makes monitoring insurance companies easier by standardizing their applications and coverage formatting, and keeping all of their information updated and regulated on searchable, state-based web units. This also works to keep the consumer informed of each option available to them, the standardization aiming to leave no confusion about each plan’s coverage. Lawmakers hope this accessibility will force insurers to price and form packages competitively, as consumers would be able to make more informed decisions than in the past.
While this would mean a full restructuring of insurance plans, it still allows those with insurance currently to keep it. Consumers will not be forced into new plans. However, the exchange and the prospective changes in regulating insurance agencies will likely seem advantageous to many. This bill aims to open the insurance industry up by removing restrictions on pre-existing conditions and tackling gender discrimination to streamline costs and make insurance accessible to all. There would only be very limited variation in premiums regarding an enrollee’s tobacco use, age, family composition and geographic area. These measures would allow many who are unable to purchase insurance in the current system to do so and not sacrifice gross amounts of money to do so.
On a similar note, the bill targets a source of some of the highest costs for those already with insurance: out-of-pocket expenses. Under the bill’s proposals, out-of-pocket costs would be capped at $5,950 for individuals and $11,900 for families. It would also eliminate yearly or lifetime caps on coverage and not allow employers to create caps, the both of which have led to more Americans with insurance paying more throughout the years.
The large uninsured population would also be aided in this new system. To help low and middle-income people ease into purchasing insurance, tax credits would be made available as well as even lower caps on out-of-pocket costs. While this bill includes an individual mandate, or “personal responsibility” clause, these credits and the gradual nature of these many changes would help all Americans make this transition. Exemptions would be made, as well, for those whose least expensive option exceeds 8% of their adjusted gross income (AGI), those with strongly-held religious or cultural beliefs or who are experiencing hardship. Without the mandate, insurance companies could not be trusted to lower premiums and up coverage as the only group left willing to purchase insurance would be those already in a position to do so.
Along with mandating consumers to purchase insurance, insurance companies are mandated to provide it to every enrollee. This means they must create packages with prices and coverage in four categories: bronze, silver, gold and platinum. While the coverage would be more inclusive for the most expensive packages, all would be required to provide primary and preventative care; emergency care, surgical care, hospitalization and outpatient care; mental and behavioral health care; radiation and chemotherapy; and many other crucial elements of wellness that are currently scattered across plans.
The bill also aims to cut consumer costs from providers, strengthening the reporting of physician, hospital and other provider care quality to discourage abuse of power, cut down on unnecessary procedures. It would also funnel more funds into research to determine which practices and procedures benefit patients the most.
This bill reaches out to many neglected areas of health care, pulling them together to benefit those they were designed to protect: consumers. There are clauses in this bill specifically for the masses and there are those that work to provide for sections of the public long neglected. The bill shows a unifying vision for health care reform, one that not only keeps spending under control through reason and anti-fraud monitoring, but one that works wholly for the patient.