Haven't digested yet, but here are some immdediate highlights.
*individual mandate to purchase or be covered via employer
*Insurance market reforms, but allowing much more premium variation than do HR 3200 or Senate HELP bill. Those plans (HR 3200, Senate HELP) allowed plans to range no more than 2:1 within geographic areas. Here are allowable varies (high to low):
- 1.5:1 tobacco
- 5:1 Age
- Family composition (Single 1:1; Adult w. child 1.8:1; Two adults 2:1; Family 3:1
- Can also vary by georaphy, with variation across areas capped at 7.5:1 (aka a lot)
*Set up state insurance markets to provide policies so folks can shop for policy
*people with no group coverage can keep what they have (grandfathered)
*Vauge notions of allowing use of risk adjustment, reinsurance and risk cooridors to help set up competition where there is not so much now....important idea, don't know what this means
*States can set up auto-enroll mechanisms....similar to republican bill, Patients' Choice Act
*Benefit Options....color scheme to aid shopping...similar to Medigap conceptually: Bronze level [65% of expenses covered by insurance]; Silver [73%]; Gold [81%]; Platinum [90%]. Creating of a 'young invincible' policy that is catastrophic and only for folks age 25 and lower.....and one annual visit first dollar.
*Make illegal selling plans at lower 'actuarial' levels than these....the bronze level is lowest acceptable that could be sold.
I believe HR 3200 is set at about 95%....so Finance committee providing 'less insurance' and folks facing more of the cost of their care. That is no surprise.
*Tax credits for those with income 133%-300% of poverty. Refundable and advanceable, again a la the main Republican bill, the Patients' Choice Act. Amount of credit received based on income....more credit to lower income.
*cost-sharing assistance (deductibles and the like for those covered) for those 100%-300% of poverty. Essentially bumps people up from one level of plan (bronze, gold, etc.) up a level or two depending on income....with poorer bumped to platinum and declining.
*tax credits to small businesses not providing insurance....small = fewer than 25 employees with average wage of $40,000
*No employer mandate "employers would not be required to offer..." (page 5). But, employers with 50 FT employees (30hrs+) would have to pay a fee for each employeed who used a tax credit to get insurance.....designed to prevent current employers from dropping coverage...if employee offered employer plan, not eligible for tax credit....unless plan is unaffordable with unaffordable defined as premium more than 13% of employees income.
*Creates co-ops....I think this is mostly a waste of time....not a deal killer for me.
*Medicaid expansion roughly to 133% of poverty....with individuals also able to purchase private plan via exchange....I think. Lingo in this part confusing to me.....
*No big benefit changes to Medicare or Medicaid...some expanded preventive stuff.
*Some boosting of GME payments via Medicare for primary care
*Big thing: repeal scheduled cut in Medicare payment rates (21%, 2010) and add 0.5% increase.
*Create a panel to look at doc payment rates in Medicare
*Create a Medicare Commission aka IMAC. The mandate says it would "submit proposals to congress to extend Medicare solvency and improve quality of care in Medicare." This one isn't insulated enough from Congress for me....but of course, it is Congress writing it.....but this is good that this is in here.
*Increased funding for cost effectiveness research. Both this item and one just above is also reminiscent of Patients' choice Act (main republican bill)
*High cost insuranc fee....so this is not a cap of tax exclusion, but after same idea...for plan with premiums of $8,000 individual, $21,000 family tax of 35% of the premium above these amounts levied on insurance company. To put in perspective, total premium for Duke's family coverage best plan is about $13,000....so this must be 75percentile or higher.
*employer must report amount paid in premiums on W-2 so individual knows how much tax free income they got
*Health Insurance provider fee....this is $6 billion per year, not over 10...so raises $60 billion over 10. Fee allocated by market share. It is essentially just saying you have to hand over some of your profit in return for us forcing people to purchase insurance.
OK Corral tomorrow night....not a word on malpractice in here....the republicans should be able to get alot on this issue....but not a word?????? I think the lawyer is going to offer this one up...