Here is the House version
This is the version to be debated in the Senate.
Senate version:
1. Hospitals to publish list of costs of all their services. The Senate version has some nice pro health consumer provisions. How many of us are baffled when we get the hospital bills and be completely surprised by the charges?
2. High Risk pool. I like this idea. This is for those people who do not have insurance, and have pre existing conditions. I wonder whether it is limited by state, or whether a nation wide high risk pool could be established? HIgh Risk Pool terminates in 2014, and then this will transition to the Exchange.
3. Reinsurance for early retirees: This allows some relief for employment based plans who are hit with the higher cost of an aging population. Again this is temporary - only until 2014.
4. More Pro Health Consumer provisions - availability of comparison pricing and coverage options to be available on a website.
5. Government oversight of health plans - health care providers have to be certified and file their health care plans for certification.
6. No pre existing condition exclusions. This is the same as the HR version.
7. Premium discrimination - allows for some fluctuation for premium for tobacco users etc. Seems to allow discounted premiums if consumer participates in some sort of approved wellness plan. I like that.
So what does this bill mean by a "qualified Health Plan"?
Essential health benefits see here.
Includes limitations on annual limits imposed and cost sharing. Also annual limitation on deductibles.
Provides different categories of coverage. Uses an actuarial percentage of benefit to determine coverage. Actuarial values (% of benefits) differ depending on level of coverage. Presumably the actuarial calculation needs to take into account the statutory limitations on annual limits, cost sharing and deductibles. At least that is a objective way to determine level of benefits.
Abortion coverage:
You don't hear the Republicans talking about this provision:
(3) PROVIDER CONSCIENCE PROTECTIONS. No individual health care provider or health care facility may be discriminated against because of a willingness or an unwillingness, if doing so is contrary to the religious or moral beliefs of the provider or facility, to provide, pay for, provide coverage of, or refer for abortions.
The Bill does not state that every certified health care plan has to have abortion coverage. Just that a minimum of 1 plan in the exchange has this option.
And another one:
(1) NO PREEMPTION OF STATE LAWS REGARDING ABORTION. Nothing in this Act shall be construed to preempt or otherwise have any effect on State laws regarding the prohibition of (or requirement of) coverage, funding, or procedural requirements on abortions, including parental notification or consent for the performance of an abortion on a minor.
Establishment of health benefit exchanges are devolved to the states, through a grant award system.That at least lets individual states have some flexibility in setting up their exchanges. What is nice is that there is an option for a Small Business Plan exchange. States are to charge user fees and the user fees are to make the maintaining of the exchange self supporting. So the burden on running the exchange falls back on individual states. Nice (sarcasm.) But there is a grant system whereby States would tap into Fed funding for their systems. Not entirely clear when the grants run out. Are the grants one time funding? Or time limited?... I found the answer - grants come to an end 2015. (well hopefully if the Mayan calendar and doomsday predictions come true, we don't have to worry about anything after 2014.)
CEntralized oversight of amount of premium charged, and any increases in premium. Not entirely clear what factors are going to be used. Presumably some kind of objective, actuarial value. Health care plan providers are required to report premium revenue and claims payouts and projections. (I presume!) I assume that the determination by the Secretary of premiums charged have to take into account all these factors.
I still think we are going to get an increase in premium (driven by increased claim costs of paying for pre existing conditions and other factors.) Reinsurance provisions increase capacity. (Think of it as a subsidy like the farm subsidies.)
Nice to see that the exchanges could be with more than one state. That might be beneficial to consumers to increase the pool of the hopefully healthy.
Optional community health care looks interesting. But the States must assume cost.
Health care choice compacts (offerings in more than one state.) Again idea here is to keep the pool as large as possible.
Premium assistance in the form of a refundable tax credit.
What I really don't like is that the bill requires mandatory health insurance. How are they going to enforce this? I guess when the uninsured goes to hospital for treatment, and it is found that they have no health insurance. They will be unable to pay for the hospital bills, what makes them able to pay the penalty? This is nutty.
So the hospitals and medical providers are going to have to report non compliance. Are they really going to be able to do that?
But the penalty does not apply to individuals that can't afford medical insurance.
