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What’s in the Senate health care bill?

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Finally, the Senate has passed its health care measure, HR 3590.

In my opinion, this country needs a much stronger and effective plan and strategy. However, after a year of agonizing debate, at least the Senate has passed a bill. And the House of Representatives, too.

AARP CEO A. Barry Rand said:

The bill passed by the Senate makes needed progress to prevent coverage denials due to health status and limit insurance companies from charging older Americans much more for coverage because of their age. It also begins to close the dangerous gap in Medicare drug coverage known as the doughnut hole, and Senate leaders have committed that a final bill will close the gap entirely by 2019, in keeping with the president’s pledge.

In addition, the Senate bill adds important new Medicare benefits, like free preventive care, and encourages states to provide more home and community-based long-term care services and supports instead of costlier institutional care.

Here are the key provisions of the Senate bill, the Patient Protection and Affordable Care Act, according to a Senate fact sheet. The bill:

  • Provides uninsured Americans with a pre-existing condition the access to an insurance program to help them.
  • Establishes health insurance exchanges to make coverage affordable and accessible for individuals and small businesses. Premium tax credits and cost-sharing assistance will help those who need assistance.
  • Bars insurance companies from discriminating based on pre-existing conditions, health status, and gender.
  • Expands eligibility for Medicaid to include all non-elderly Americans with income below 133 percent of the federal poverty level, with substantial assistance to states for the cost of covering these individuals.
  • Protects and strengthens the Medicare program for seniors. It includes proposals to move away from reimbursing Medicare health care providers on the basis of the volume of care they provide to paying for quality and value.
  • Eliminates co-pays and deductibles for recommended preventive care and provides individuals with the information they need to make healthy decisions. It improves education on disease prevention and public health as part of a national public health strategy.
  • Addresses the shortages in primary care and other physicians by investing in the National Health Service Corps, scholarship, and loan repayment programs. Incentives also are provided for primary care practitioners and for providers to serve underserved areas.
  • Provides consumers with information about physician ownership of hospitals and medical equipment as well as nursing home ownership and other characteristics.
  • Includes provisions that will crack down on waste, fraud, and abuse in Medicare, Medicaid, CHIP, and private insurance. It will establish a private, non-profit entity to identify priorities for and provide for the conduct of comparative outcomes research.
  • Establishes a regulatory pathway for Food and Drug Administration approval of biosimilar versions of previously licensed biological products. It will also expand the existing drug discount program, so that patients at children’s hospitals, cancer hospitals, rural hospitals, and in other underserved communities have access to medicines at lower cost.
  • Makes long-term supports and services more affordable by providing a lifetime cash benefit that will help people with severe disabilities remain in their homes and communities. CLASS is a voluntary, self-funded, insurance program provided through the workplace. For those whose employers participate, affordable premiums will be paid through payroll deductions. Participation by workers is entirely voluntary.
  • Pays for its costs by tightening current health tax incentives, collecting industry fees, and slightly increasing the Medicare Hospital Insurance tax for high income earners. It also includes a fee on insurance companies when they sell high-cost health insurance plans. Changes to health care tax incentives include capping FSA contributions, conforming definitions of deductible medical expenses, and changing penalties for HSA spending that isn’t devoted to health care. It also assesses a small excise tax on elective cosmetic surgery and contains a 0.5 percentage increase in the Medicare Hospital Insurance tax for individuals who earn more than $200,000 and couples who earn more than $250,000.

To read the full text of the bill, click here.

The next step is for members of the House of Representatives and Senate to begin merging their bills so health care reform can be passed next year. Hopefully sooner than later.

Copyright 2009, Rita R. Robison, Consumer Specialist

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