It is time for my message again...

In the last message we were still talking about the healthcare reform and where things stood.  Now our House of Representatives has passed the HR 3296 bill by a narrow margin (220 to 215) after a fractious debate.  It passed along party lines but 39 Democrats voted against the measure and one Republican voted in favor.  Now that we have a bill passed, what does this all mean?  I will try to outline some of the salient features because the bill itself is more than 1900 pages which are beyond the scope of this article.

The salient features include:

• If you like the insurance coverage you have, you don't have to change.

• Federal assistance will be available for individuals between 150 percent and 400 percent of the poverty level on a sliding scale basis.

• The new public option, which will include competitive reimbursement rates to providers, will operate through the Department of Health and Human Services on a level playing field with private sector providers.

• The bill will make all individuals under 150 percent of the poverty level eligible for Medicare.  Ohio currently covers children and pregnant women up to 200 percent of the poverty level and families with children up to 90 percent.

• Employers will be required to offer basic minimum standard coverage.  Those not complying will be fined a penalty up to 8 percent of the employee's salary.  Small business, with payroll under $500,000 (and phasing up to $750,000) will be exempt.

• Small businesses offering insurance will receive a tax credit of 50 percent of employer costs.

• Legislation would ensure Medicaid rates match Medicare rates.

• Pharmacists would be exempt from surety bond requirements.

• The bill will help make Medicare more efficient by updating the program to reflect inefficiencies and overpayments.  Over $500 billion in savings is projected with the program updates.

• Adjustments will be made to Medicare Advantage, which has been overcompensated for services.

• The bill expands the National Health Service Corps, which "creates loan forgiveness programs and scholarships that draw physicians to shortage areas."  In addition, the bill develops a new loan forgiveness program for physicians in "lesser shortage" areas.

• Creates a fund that would support public health initiatives.

• Revenue for the changes would come from a surcharge imposed on American couples making more than $1 million a year.

• A new grant program would be utilized that would give support to states implementing tort reform laws.

• The bill specifically excludes coverage for illegal immigrants.

• No funding is provided for abortions through the bill and further prohibits the federal government from "making abortion a required benefit under any new health insurance plan."

• The bill will allow for Medicare reimbursements to physicians "who offer counsel and advice to seniors about options for end-of-life care."  Insurance companies will also be required to provide consumers with information on living wills and other advanced directives.

• Insurance industry practices such as denying coverage on the basis of pre-existing medical conditions would be banned and insurers would no longer be able to charge higher premiums on the basis of gender or medical history.

• The measure would create a federally regulated market place where consumers could shop for coverage and the government would also sell insurance.

Paraphrasing Representative John Dingell of Michigan, "the bill provides coverage for 96% of Americans, and it offers everyone, regardless of health or income, the peace of mind that comes from knowing they will have access to affordable health care when they need it."

As you can see this is only the tip of the iceberg.  In the next coming months the Senate is going to hopefully help us understand the details.  I don't know what the right answers are but I do know that we as health professionals should be keeping a close watch as the Senate hearings unfold.  We should be proactive and inform the leaders of our issues and concerns by email and voice.