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Comprehensive Healthcare Reform

Achieving comprehensive healthcare reform is a top priority of the President and Congress. President Obama has outlined principles for health reform, seeking to address not only the 45 million people who lack health insurance, but also the rising cost of health care. The House of Representatives passed a comprehensive healthcare reform bill by a vote of 220-215 on November 07, 2009. The Senate passed a bill introduced by Senate Majority Leader Reid (D-Nev.) on December 24, 2009 by a vote of 60-39.  The two chambers are currently conferencing the two bills.

Summary of Major Provisions

Cost: The House bill covers 96 percent of Americans with a cost of more than $1 trillion over a decade. The Senate Finance Committee bill extends insurance to 94 percent of Americans and costs $871 billion over a decade. President Obama has asked Congress to deliver a bill that costs less than $900 billion.

Tax Credits to Purchase Insurance: The House bill limits premiums and out-of-pocket expenses for people who fall below 400 percent of the federal poverty line and who don’t qualify for Medicaid. A family of three making $32,000 a year would pay $1,360 in premiums each year under the House bill; under the Senate bill, the same family would pay $2,013.

Health Insurance Exchanges: The House bill creates a national marketplace for health insurance by 2013 in which individuals and small businesses could shop and compare insurance plans among private insurers and the government-run program (“public option”), with an option for states to establish their own exchanges if they meet all the federal requirements. The Senate bill does not provide for a national exchange, relying instead on the states to create the exchanges.

Mandate on Employers to Provide Coverage: The House bill requires employers with an annual payroll higher than $500,000 to provide health insurance coverage to employees, or contribute as much as 8 percent of their payroll to subsidize the expense of employees who enter the exchange. Under the Senate bill, employers would not face a similar requirement. However, companies with more than 50 employees would pay as much as $750 per employee to cover the cost of federal subsidies.

Mandate on Individuals to Purchase Coverage: The House bill requires people who do not buy health insurance to pay a fee equal to the lesser of 2.5 percent of their income or the average premium on the exchange. The Senate bill requires individuals to pay up to $750 and families up to $2,250.

Medicaid Expansion: The House bill provides Medicaid coverage to people whose incomes are up to 150 percent of the poverty line, while the Senate extends eligibility to those up to 133 percent of the poverty line.

For More Information:
Senate Healthcare Reform Bill
House Healthcare Reform Bill

Economic Stimulus Provisions

In addition, the economic stimulus package (H.R. 1, the American Reinvestment and Recovery Act), which was signed by the President on February 17, 2009, includes major expansions of funding for: health information technology; the Medicaid Federal Matching Percentage (FMAP); Indirect Medical Education (IME) payments; and the hospital disproportionate share (DSH) program.

• Health Information Technology
  $20 billion in funding for health information technology. $2 billion will be directed to various federal programs, and to the states, to use in developing health information exchanges (HIEs) and electronic health records (EHRs). The remaining $18 billion will be distributed to providers after national implementation of interoperability standards – no earlier than 2011 – through Medicare and Medicaid.
• Medicaid Federal Matching Percentage
  All states will receive an FMAP increase of at least 6.2% for 9 fiscal quarters. States with high unemployment will receive bonuses based on a sliding scale.
• Indirect Medical Education Payments
  The law contains a retroactive moratorium on a proposed 50 percent reduction to Medicare Indirect Medical Education capital payments. The IME capital payment is an essential part of the revenue stream that enables teaching hospitals to serve their communities and the nation. Without this provision teaching hospitals would face significant losses, potentially reducing payments by nearly $375 million annually.
• Medicaid Hospital Disproportionate Share
  For 2009 and 2010 state allotments for DSH increase by 2.5 percent.