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House Democrats Release Sweeping Reform Plan

Jun 19, 2009

Democrats in the House of Representatives unveiled their bill to overhaul the U.S. health care system today. Senior Correspondent Mary Agnes Carey was there and spoke with Peggy Girshman, KHN's Executive Editor for Online, about the plan.

Listen to the audio here .

What are some of the highlights of the bill?

The aim is to lower health care costs and improve health care choice. There’s a very strong government-run public plan that should offer people all over the country an additional choice to what they currently have for health insurance. The members of the three committees assembled – Ways and Means, Energy and Commerce, Education and Labor – all made it clear to voters that if you like your health care insurance, you can keep it. If you like your doctor, you can keep your doctor. They say they simply want to make things better and give you more choices.

There will be an individual mandate for coverage, with some exclusions. But they’ll also provide subsidies to help people below a certain income level afford the coverage.

There’s an employer mandate – called “pay or play.” If employers don’t provide insurance, they’ll have to pay a certain percentage of payroll to cover the uninsured. It’s at 8 percent now, it could go up or down, just like all the provisions of this could change. The members basically presented a discussion draft today.

They’ve been talking about an insurance exchange, to give people lots of options for their coverage. There’s supposed to be a lot of focus on prevention and wellness.

They would also expand eligibility for the Medicaid program as well as pay providers – doctors and hospitals – more money. There’s been a lot of concern that people may qualify for Medicaid coverage, but they’re not getting access to care because providers are simply not being paid enough money.

So the idea is: if you demand that people get coverage, if you tell employers to provide coverage, if you expand Medicaid, then everybody is supposed to have insurance of some sort?

What they’re saying is they think they can get to a 95 percent coverage level. There are always people that you can’t get for whatever reason – they don’t enroll in programs, they don’t want to participate. There will be all sorts of outreach efforts to raise the number of people insured, but they’re hoping to get to that 95 percent.

Another provision of this is that they want to try to fill the Medicare drug “doughnut” hole. This is a Washington code name for the gap in coverage where beneficiaries pay a certain amount out of pocket before catastrophic coverage kicks in. There’s going to be an effort to close that doughnut hole over time.

Did the Congress members talk about how to pay for this plan?

They stressed that everything is on the table. They have some ideas. They want major Medicare and Medicaid system reform such as 'accountable care' organizations that really try to coordinate medical care to make sure it’s the best possible care for the patient and reducing hospital re-admissions.

But of course, they’re always talking about taxes as well. And these are some of the ideas that will be discussed in the coming weeks: a tax on the benefits that an employer provides, a payroll tax, a tax on sugary drinks, taxes on alcohol, value added taxes (also called VAT) on some goods and services.

All the members today who were talking with reporters would not really focus on one tax over another. They said everything has got to be on the table. They want to have committee hearings next week. After the July 4th recess, they’ll have markups, for the committee to consider the bill, where it could change at any time. Then it would be brought to floor for consideration with the idea that they would pass it before the August recess.

What relationship does this bill have to what they’re now talking about in the Senate?

There is a markup ongoing with the Senate Health, Education, Labor and Pensions Committee. Also, Sen. Max Baucus, D-Mont., who runs the Senate Finance Committee has been meeting with his members to try to craft a deal. It seems as if in the Senate, particularly in the Finance Committee, they may have to scale back some of these provisions. They may have a lower amount of subsidies for individuals than they wanted previously. They may have a lower level of expansion for Medicaid. They may not have anywhere near the ambition of the public plan that is in the House bill.

So the Senate will continue its work. The House will have its work. If both chambers move bills, eventually they’ll have a House-Senate conference, where those two versions will be resolved into one.

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