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The President’s Proposal For Health Care

23 Feb

Over the past year the House and the Senate have been working on an effort to provide health insurance reform that lowers costs, guarantees choices, and enhances quality health thumbnail care for all Americans. Building on that year-long effort, the President has now put forth a proposal that incorporates the work the House and the Senate have done and adds additional ideas from Republican members of Congress. The President has long said he is open to any good ideas for reforming our health care system, and he looks forward to discussing ideas for further improvements from Republicans and Democrats at an open, bipartisan meeting on Thursday. 

The proposal will make health care more affordable, make health insurers more accountable, expand health coverage to all Americans, and make the health system sustainable, stabilizing family budgets, the Federal budget, and the economy:

  • It makes insurance more affordable by providing the largest middle class tax cut for health care in history, reducing premium costs for tens of millions of families and small business owners who are priced out of coverage today.  This helps over 31 million Americans afford health care who do not get it today – and makes coverage more affordable for many more. 
  • It sets up a new competitive health insurance market giving tens of millions of Americans the exact same insurance choices that members of Congress will have.  
  • It brings greater accountability to health care by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.  
  • It will end discrimination against Americans with pre-existing conditions.
  • It puts our budget and economy on a more stable path by reducing the deficit by $100 billion over the next ten years – and about $1 trillion over the second decade – by cutting government overspending and reining in waste, fraud and abuse.

Key Provisions in the President’s Proposal:

The President’s Proposal builds off of the legislation that passed the Senate and improves on it by bridging key differences between the House and the Senate as well as by incorporating Republican provisions that strengthen the proposal.

One key improvement, for example, is eliminating the Nebraska FMAP provision and providing significant additional Federal financing to all States for the expansion of Medicaid.  For America’s seniors, the proposal completely closes the Medicare prescription drug “donut hole” coverage gap.  It strengthens the Senate bill’s provisions that make insurance affordable for individuals and families, while also strengthening the provisions to fight fraud, waste, and abuse in Medicare and Medicaid to save taxpayer dollars.  The threshold for the excise tax on the most expensive health plans will be raised from $23,000 for a family plan to $27,500 and will start in 2018 for all such plans.  And another important idea included is improving insurance protections for consumers and creating a new Health Insurance Rate Authority to review and rein in unreasonable rate increases and other unfair practices of insurance plans.

Summaries of Key Elements of the President’s Proposal:

Republican Ideas Included in the President’s Proposal

It’s clear that the American people want health insurance reform.  They aren’t interested in Democratic ideas or Republican ideas.  They’re interested in the best ideas to reduce costs, guarantee choices and ensure the highest quality care.

They’re interested in ideas that will put them back in control of their own health care.

Throughout the debate on health insurance reform, Republican concepts and proposals have been included in legislation.  In fact, hundreds of Republican amendments were adopted during the committee mark-up process.  As a result, both the Senate and the House passed key Republican proposals that are incorporated into the President’s Proposal.

Review a few of the Republican initiatives included in legislation passed by Congress:

  • Includes personal responsibility incentives: Allows health insurance premium to vary based on participation in proven employer wellness programs
    • (Sources:  H.R. 3468, “Promoting Health and Preventing Chronic Disease through Prevention and Wellness Programs for Employees, Communities, and Individuals Act” (Castle bill); H.R. 4038, “Common Sense Health Care Reform & Accountability Act” (Republican Substitute bill); H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); H.R. 3970, “Medical Rights & Reform Act” (Kirk bill), "Coverage, Prevention and Reform Act")
  • Advances medical liability reform through grants to States:  Provides grants to States to jump-start and evaluate promising medical liability reform ideas to put patient safety first, prevent medical errors, and reduce liability premiums.
    • (Sources: S. 1783, “Ten Steps to Transform Health Care in America Act” (Enzi bill); H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); H.R. 4529, “Roadmap for America’s Future Act” (Ryan bill); S. 1099, “Patients’ Choice Act” (Burr-Coburn, Ryan-Nunes bill))
  • Extends dependent coverage to age 26: Gives young adults new options.
    • (Sources: H.R. 4038, “Common Sense Health Care Reform & Accountability Act” (Republican Substitute bill); H.R. 3970, “Medical Rights & Reform Act” (Kirk bill))
  • Allows automatic enrollment by employers in health insurance: Allows employee to opt-out.
    • (Sources: House Republican Substitute; H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill); “Coverage, Prevention, and Reform Act” )
  • Mechanisms to improve quality.
    • (Sources: H.R. 4529, “Roadmap for America’s Future Act;” S. 1099, “Patients’ Choice Act;” H.R. 3400, Republican Study Group bill; S. 1783, “Ten Steps to Transform Health Care in America Act” (Enzi bill))
  • In addition to the Republican ideas already included in the legislation that’s passed the House and the Senate, the President’s Proposal incorporates a number of additional proposals that were included in Republican plans that focus on combating waste, fraud and abuse in government.

The President remains open to other policies as well.  And the purpose of the Bipartisan Summit is to review all ideas and ensure that the best ideas are included in the plan.

Review the new Republican initiatives included in the President’s Proposal:

  • Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General.  This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities.
    • (Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))
  • Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs.  It ensures that entities that bill for Medicare on behalf of providers are in good standing.  It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims. 
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Expanded Access to the Healthcare Integrity and Protection Data Bank.  Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program.  It includes criminal penalties for misuse.
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied. 
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Community Mental Health Centers. The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers. 
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers. The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund.  It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments.
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly.  It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse. 
    • (Source:  Roskam Amendment offered in House Ways & Means Committee markup)
  • Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges.  Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year.  Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives.  Many beneficiaries unwittingly give over this personal information without ever receiving promised services.   The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud.
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”)
  • Study of Universal Product Numbers Claims Forms for Selected Items and Services Under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse.
    • (Source:  H.R. 3970, “Medical Rights & Reform Act”, Roskam Amendment offered in House Ways & Means Committee markup)
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Posted by on February 23, 2010 in Health, Political

 

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