Change to the Senate bill

[one...two...tree 2,762]

by Ezra Klein

Here's the summary document Reid's office is sending around on the changes in the manager's amendments. I've bolded the bits I think are important.

Tougher Accountability Policies for Health Insurance Companies

• Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenue on clinical services and quality activities, with less going to administrative costs and profit – or else pay rebates to policyholders. These more rigorous limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans.

• Accountability for excessive rate increases. A health insurer’s participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded – a powerful incentive to keep premiums affordable.

• Immediate ban on preexisting condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of preexisting conditions for children.

• Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care.

• Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014.

• Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.

Stronger Policies to Make Health Care Affordable

• Innovation. Medicare will be able to test new models and, if successful, implement them via a stronger Innovation Center, Independent Payment Advisory Board, and other authorities.

• Transparency. New requirements will ensure that insurers and health care providers report on their performance, empowering patients to make the best possible decisions.

• Small businesses. A package of improvements include starting the health insurance tax credit in 2010, expanding eligibility for the credit, and improving the buying power of small businesses.

More Health Insurance Choices

• Multistate option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be nonprofit, and the plans will be available nationwide. This will promote competition and choice.

• Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.

Improved Access to Quality Health Care for Seniors, Children, and Vulnerable Populations

• Quality of care in Medicare. Seniors will benefit when additional health care providers are reimbursed by Medicare for the quality of care they deliver, not the quantity of services they provide.

• Children’s health. Support will be extended for the Children’s Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage.

• Community Health Centers. A substantial investment in Community Health Centers will provide funding to expand access to health care in communities where it is most needed.

• Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.

• Vulnerable populations. A range of new programs will tackle diseases such as cancer, diabetes and children’s congenital heart disease, will improve the Indian Health System and will provide support for pregnant teens and victims of domestic violence.

Identifying Alternatives to Litigation

• Testing new models. States will be eligible for grants to test alternatives to civil tort litigation that emphasize patient safety, disclosure of health care errors, and early resolution of disputes, with a provision for patients to opt-out of these alternatives at any time. Alternatives will be evaluated to determine their effectiveness.

http://voices.washingtonpost.com/ezra-klei...enate_bill.html

[SMR 368]

by Ezra Klein

Here's the summary document Reid's office is sending around on the changes in the manager's amendments. I've bolded the bits I think are important.

Tougher Accountability Policies for Health Insurance Companies

• Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenue on clinical services and quality activities, with less going to administrative costs and profit – or else pay rebates to policyholders. These more rigorous limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans.

• Accountability for excessive rate increases. A health insurer’s participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded – a powerful incentive to keep premiums affordable.

• Immediate ban on preexisting condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of preexisting conditions for children.

• Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care.

• Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014.

• Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.

Stronger Policies to Make Health Care Affordable

• Innovation. Medicare will be able to test new models and, if successful, implement them via a stronger Innovation Center, Independent Payment Advisory Board, and other authorities.

• Transparency. New requirements will ensure that insurers and health care providers report on their performance, empowering patients to make the best possible decisions.

• Small businesses. A package of improvements include starting the health insurance tax credit in 2010, expanding eligibility for the credit, and improving the buying power of small businesses.

More Health Insurance Choices

• Multistate option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be nonprofit, and the plans will be available nationwide. This will promote competition and choice.

• Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.

Improved Access to Quality Health Care for Seniors, Children, and Vulnerable Populations

• Quality of care in Medicare. Seniors will benefit when additional health care providers are reimbursed by Medicare for the quality of care they deliver, not the quantity of services they provide.

• Children’s health. Support will be extended for the Children’s Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage.

• Community Health Centers. A substantial investment in Community Health Centers will provide funding to expand access to health care in communities where it is most needed.

• Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.

• Vulnerable populations. A range of new programs will tackle diseases such as cancer, diabetes and children’s congenital heart disease, will improve the Indian Health System and will provide support for pregnant teens and victims of domestic violence.

Identifying Alternatives to Litigation

• Testing new models. States will be eligible for grants to test alternatives to civil tort litigation that emphasize patient safety, disclosure of health care errors, and early resolution of disputes, with a provision for patients to opt-out of these alternatives at any time. Alternatives will be evaluated to determine their effectiveness.

http://voices.washingtonpost.com/ezra-klei...enate_bill.html

Thanks for posting this. It's hard to find a summary of what this health care bill really is. I think there are a lot of good measures in this bill.

[Mr. Big Dog 10,747]

Thanks for posting this. It's hard to find a summary of what this health care bill really is. I think there are a lot of good measures in this bill.

There are. Aside from the immediate benefit for children with pre-existing conditions, I do like the portion that seeks to chip away at the fee for service model in favor of a result and quality oriented reimbursement models. Also noteworthy is the provision that actually gives incentives to states to explore meaningful and sensible alternatives to civil litigation.

[zqt3344 21]

This thing is a joke, Democrats are a joke, they talk about this "change", "bi-partisan support", "transparency" for what???? Nothing but business as usual, more pork in this insurance reform give away bill also known as health care reform. If anyone that voted for Ovomit thinks this is great stuff and good legislation then you are truly stupid and deserve any and all hardships that come your way. Our only hope is that this thing will not start for another 4-5 years and in that time, the political power for the Democrat party will be gone by then and you will see that all this junk legislation repealed and changed again by the next group of politicians in charge. What is sad, Ovomit sold out all you liberal wing nut wacko socialist tree hugging Democrats by not giving us the government single pay option. Some leader you elected there, what a joke.

by Ezra Klein

Here's the summary document Reid's office is sending around on the changes in the manager's amendments. I've bolded the bits I think are important.

Tougher Accountability Policies for Health Insurance Companies

• Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenue on clinical services and quality activities, with less going to administrative costs and profit – or else pay rebates to policyholders. These more rigorous limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans.

• Accountability for excessive rate increases. A health insurer’s participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded – a powerful incentive to keep premiums affordable.

• Immediate ban on preexisting condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of preexisting conditions for children.

• Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care.

• Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014.

• Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.

Stronger Policies to Make Health Care Affordable

• Innovation. Medicare will be able to test new models and, if successful, implement them via a stronger Innovation Center, Independent Payment Advisory Board, and other authorities.

• Transparency. New requirements will ensure that insurers and health care providers report on their performance, empowering patients to make the best possible decisions.

• Small businesses. A package of improvements include starting the health insurance tax credit in 2010, expanding eligibility for the credit, and improving the buying power of small businesses.

More Health Insurance Choices

• Multistate option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be nonprofit, and the plans will be available nationwide. This will promote competition and choice.

• Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.

Improved Access to Quality Health Care for Seniors, Children, and Vulnerable Populations

• Quality of care in Medicare. Seniors will benefit when additional health care providers are reimbursed by Medicare for the quality of care they deliver, not the quantity of services they provide.

• Children’s health. Support will be extended for the Children’s Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage.

• Community Health Centers. A substantial investment in Community Health Centers will provide funding to expand access to health care in communities where it is most needed.

• Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.

• Vulnerable populations. A range of new programs will tackle diseases such as cancer, diabetes and children’s congenital heart disease, will improve the Indian Health System and will provide support for pregnant teens and victims of domestic violence.

Identifying Alternatives to Litigation

• Testing new models. States will be eligible for grants to test alternatives to civil tort litigation that emphasize patient safety, disclosure of health care errors, and early resolution of disputes, with a provision for patients to opt-out of these alternatives at any time. Alternatives will be evaluated to determine their effectiveness.

http://voices.washingtonpost.com/ezra-klei...enate_bill.html

[Mr. Big Dog 10,747]

This thing is a joke, Democrats are a joke, they talk about this "change", "bi-partisan support", "transparency" for what???? Nothing but business as usual, more pork in this insurance reform give away bill also known as health care reform. If anyone that voted for Ovomit thinks this is great stuff and good legislation then you are truly stupid and deserve any and all hardships that come your way. Our only hope is that this thing will not start for another 4-5 years and in that time, the political power for the Democrat party will be gone by then and you will see that all this junk legislation repealed and changed again by the next group of politicians in charge. What is sad, Ovomit sold out all you liberal wing nut wacko socialist tree hugging Democrats by not giving us the government single pay option. Some leader you elected there, what a joke.

Your emotions appear to run high in the face of historic defeat, Sarah.

Edited December 22, 2009 by Mr. Big Dog

[zqt3344 21]

The only historic defeat is going to be this sham of a health insurance profit subsidy bill that is about to pass US Senate. You simply do not get it do you. The only way there is any true health care reform is to have a one pay option or government run option, plan and simple, for Ovomit and the Democrats to run around and cry victory or lie about how great this thing is, well they are the ones that are going to pay the price in upcoming elections. By this time next year the republicans will be back in control. And then we shall see how Ovomit handles himself then, without his pet monkeys of Democrat Congress, it is a shame for all he promised, he sure did not deliver anything this year, a total joke!

Your emotions appear to run high in the face of historic defeat, Sarah.

[Mr. Big Dog 10,747]

The only historic defeat is going to be this sham of a health insurance profit subsidy bill that is about to pass US Senate. You simply do not get it do you. The only way there is any true health care reform is to have a one pay option or government run option, plan and simple...

I would be one of the biggest supporters of a single payer system and I have reservations with the bill currently making it's way through the Senate as I do with the bill passed by the House last month. The long and short of it is that there's no way to get a single payer system in the US - the debate over health care reform has shown that quite impressively. The question then becomes what the alternative approaches are seeing that the status quo is immoral, ineffective and unsustainable. The reform bill currently in the Senate provides a number of provisions to correct some of the issues we have with the broken and ineffective health care system we have.

You can sit there and begrudge it all you want. The fact remains that Obama and the Democrats in the Congress will succeed where President after President and Congress after Congress have failed. Is it all I wanted it to be? No. Is it perfect? Not even close. Does it beat the status quo? You betcha.

[zqt3344 21]

You are either forgetful or not tuned into US history, it was LBJ and democrats & republicans of the 60s that passed medicare, which is a government option by the way for 65 and over. So you can sit there and continue to drink the Ovomit kool-aid and spew more lies like he does and the Democrats have about this is as good as it gets, when the reality is, they completely failed and oh by the way forgot about taking care of other more important business like this economy and Afghanistan instead of jet setting a record number of times out of the USA around the world and accepting a Dis-Nobel peace prize and playing around with the UN and climate change which is a joke and a lie. The fact of the matter is Ovomit and the Democrats have not succeeded and this bill they are about to pass shows that, they did nothing but give big insurance more profits at your and my expense. I love how you are so weak and tolerant of inept lying politicians, the reality is you cannot stand to admit you made a mistake thinking Ovomit and the Democrats could produce on all those campaign promises. Which they have not. FACT. Does it beat the status quo, NO it does not, tell me how could it possibly beat it, all it did is force more people to become customers of insurance companies whether they want to or not, now how is that paying for anything or solving anything. You have your head in the sand, just because you voted for Ovomit and supported him, face up to reality and be honest enough with yourself to admit he is not producing at all. Which is why he is at 45% approval rating and at the lowest of any president ever in his first year! FACT!

I would be one of the biggest supporters of a single payer system and I have reservations with the bill currently making it's way through the Senate as I do with the bill passed by the House last month. The long and short of it is that there's no way to get a single payer system in the US - the debate over health care reform has shown that quite impressively. The question then becomes what the alternative approaches are seeing that the status quo is immoral, ineffective and unsustainable. The reform bill currently in the Senate provides a number of provisions to correct some of the issues we have with the broken and ineffective health care system we have.

You can sit there and begrudge it all you want. The fact remains that Obama and the Democrats in the Congress will succeed where President after President and Congress after Congress have failed. Is it all I wanted it to be? No. Is it perfect? Not even close. Does it beat the status quo? You betcha.

[Mr. Big Dog 10,747]

You are either forgetful or not tuned into US history, it was LBJ and democrats & republicans of the 60s that passed medicare, which is a government option by the way for 65 and over.

I'm well aware of Medicare and the fact that it is a single payer system which was enacted in a bipartisan manner - a pretty good one at that. What you're forgetting and/or elect not to be tuned into is the fact that there is no majority to be had to expand the Medicare system to all citizens. There wasn't even a majority to be found to allow those 55 and older - those with few, if any options to obtain affordable health insurance - to buy into Medicare.

The proposal was out there - as was the single payer (Medicare for all if you will) - and the votes to pass either simply don't exist. Not a single Republican would get on board with a Medicare expansion whether limited (55&up) and unlimited (Medicare for all) - not one. That's sad but it's the reality.

Bipartisanship on major policy is a thing of the past. The GOP has made it clear from the start that they will not support any health care reform effort whatsover as they feel that sinking the effort entirely would pay a bigger political dividend than working with the Democrats on crafting a reform effort that will serve the people well. As the bill advances towards passage in the Senate and comes ever closer to the President's desk for signature, the GOP's strategy is clearly failing.

[one...two...tree 2,762]

This thing is a joke...

How sexy you are, isn't a joke though, my Ukrainian babushka.

[zqt3344 21]

Admit it Obot, your politician wunderkund Ovomit failed. And so has the Democrat party, they did not improve anything, this will not help you or me or anyone else and I can tell you that it will be repealed or thrown out in later legislation.

I'm well aware of Medicare and the fact that it is a single payer system which was enacted in a bipartisan manner - a pretty good one at that. What you're forgetting and/or elect not to be tuned into is the fact that there is no majority to be had to expand the Medicare system to all citizens. There wasn't even a majority to be found to allow those 55 and older - those with few, if any options to obtain affordable health insurance - to buy into Medicare.

The proposal was out there - as was the single payer (Medicare for all if you will) - and the votes to pass either simply don't exist. Not a single Republican would get on board with a Medicare expansion whether limited (55&up) and unlimited (Medicare for all) - not one. That's sad but it's the reality.

Bipartisanship on major policy is a thing of the past. The GOP has made it clear from the start that they will not support any health care reform effort whatsover as they feel that sinking the effort entirely would pay a bigger political dividend than working with the Democrats on crafting a reform effort that will serve the people well. As the bill advances towards passage in the Senate and comes ever closer to the President's desk for signature, the GOP's strategy is clearly failing.

[one...two...tree 2,762]

Admit it...

Admit it...how sexy you are when you talk politics.

[Justine+David 218]

I'm so happy to see all of this, being a nurse.

After so many months of debate, I didn't expect to get this close to being passed. PLEASE OH PLEASE let it get passed. And thank goodness all my patients (sick babies) are covered by the nature of their small size; we don't turn down babies just because their parents have no health insurance or can't afford to pay for it.

[ScottThuy 140]

In a recent news report they mentioned that uninsured would be penalized in the proposed new system... anyone know what they meant by this or if this is actually the case?

[Justine+David 218]

Yeah I'm curious about that too.