Senator Baucus released an outline for health care reforms (Click for full PDF version). Below is essentially an outline of the outline, or an index page for the reform summary. It should be noted that Senator Baucus qualified the outline as not being a mark-up for a bill and that elements are changable/adaptable.
In this summary the Senate appears to be taking a more reasonable approach to health care reform than the House. There is no government run health insurance or public plan. Likely the co-ops will be what receives the most scrutiny. It would have been nice to see tort reform included, and little detail is given on combating fraud, but hopefully fraud will be addressed more substantively in a full mark-up.
Page 1
IMMEDIATE RELIEF FOR FAMILIES AND SMALL BUSINESSES
Small Business Tax Credits
Part D Drug Discount Program
Health Insurance Exchange
Ombudsman
Transparency
High Risk Pools .
Page 2
ENSURING AFFORDABLE HEALTH COVERAGE
INSURANCE MARKE T REFORMS
Insurance Reform in the Small Group Market
Risk Sharing.
Interstate Sale of Insurance
Page 3
State Health Insurance
Benefit Options .
ENSURING AFFORDABLE COVERAG E
Health Care Affordability Tax Credits
Page 4
Small Business Tax Credits
SHARED RESPONSIBI L I T Y
Individual Responsibility
Page 5
Employer Responsibility.
HEALTH CARE COOPERATIVES
In order to be eligible for federal funds under the CO-OP program, an organization must meet
the following requirements:
1. It must be organized as a nonprofit, member corporation under State law.
2. It must not be an existing organization that provides insurance as of July 16, 2009, and ust not be an affiliate or successor of any such organization.
3. Its governing documents must incorporate ethics and conflict of interest standards rotecting against insurance industry involvement and interference.
4. It must not be sponsored by a state, county, or local government, or any government nstrumentality.
5. Substantially all of its activities must consist of the issuance of qualified health benefit lans in the individual and small group markets in each state in which it is licensed to ssue such plans.
6. Governance of the organization must be subject to a majority vote of its members (i.e., eneficiaries).
7. As provided in regulations promulgated by the Secretary of Health and Human Services HHS), it must operate with a strong consumer focus, including timeliness, esponsiveness, and accountability to members.
8. Any profit must be used to lower premiums, improve benefits, or for other programs ntended to improve the quality of health care delivered to members.
Page 7
ROLE OF PUBLIC PROGRAMS
Medicaid Coverage for the Lowest Income
Page 8
Children’s Health
Enrollment
Prescription Drug
Page 9
Transparency in Medicaid and CHIP
Medicaid Disproportionate Share Hospital Payments.
Dual Eligibles
Medicaid Quality
Indians
Addressing Health Disparities
Maternal, Infant, and Early Childhood
Page 10
PROMOTING DISEASE PREVENTION AND WELLNESS
MEDICARE
Coverage for a Personalized Prevention and Wellness
Coverage of Preventive
Incentives for Healthy
MEDICAID
Improving Access to Preventive Services for Eligible
Removing Barriers to Preventive
Incentives for Healthy
Medical Home State Option for Beneficiaries with Chronic Conditions
Page 11
IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
LINKING PAYMENT TO QUALITY OUTCOMES IN MEDICARE
Hospital Value-Based Purchasing
Physician Value-Based Purchasing
Medicare Home Health Agency and Skilled Nursing Facility Value-Based Purchasing
Quality Reporting for Other
Strengthening the Quality Infrastructure
ENCOURAGING DEVELOPMENT OF NEW PATIENT CARE MODELS
Accountable Care Organizations
Page 12
CMS Innovation
National Pilot Program on Payment Bundling
Reducing Hospital Acquired
Reducing Avoidable Hospital
STRENGTHENING PRIMARY CARE AND OTHER WORKFORCE IMPROVEMENTS
Primary Care and General Surgery
Graduate Medical Education
ENSURING BENEFICIARY ACCESS TO PHYSICIAN CARE AND OTHER SERVICES
Medicare Sustainable Growth Rate
Page 13
Ensuring More Appropriate Physician Payment
Provider Access
IMPROVING PAYMENT ACCURACY
Home Health Payment Reform
Hospice Reform
Medicare Disproportionate Share Hospital
Medicare Improvement Fund
Imaging Use-Rate
Oxygen Payment Improvements
Page 14
Power Wheelchair Payment
Wage Index
Durable Medical Equipment Outlier Payment Rule
Updating Outpatient Payments for PPS-Exempt Cancer
MEDICARE ADVANTAGE
Page 15
MEDICARE PART D
Low-Income Subsidy
Part D Premium Means Testing and Indexing
Other Provisions
ENSURING MEDICARE SUSTAINABILITY
Revisions to Annual Market-Basket Adjustments for Part A
Part B Productivity
Temporary Adjustment to the Income-Related Premium for Part B of Medicare
Medicare
PATIENT ENTERED OUTCOMES RESEARCH
Page 16
ADMINISTRATIVE SIMPLIFICATION
TRANSPARENCY AND PROGRAM INTEGRITY
Limitation on the Medicare Exception to the Prohibition on Certain Physician Referrals forHospitals
Transparency Reports and Reporting of Physician Ownership or Investment
Improving Transparency of Nursing Home Information
Prescription Drug Sample Transparency
Page 17
FRAUD, WASTE, AND ABUSE
REVENUE PROVISIONS
High Cost Insurance Excise Tax
Increasing Transparency in Employer W-2 Reporting of Value of Health
Limit Health Flexible Savings Account Contributions
Eliminate Exclusion for Employer Part D Subsidy
Standardize the Definition of Qualified Medical Expenses
Increase the Penalty for Use of Health Savings Account Funds for Non-qualified Medical Expenses
Corporate Information Reporting
Page 18
Non-profit Hospitals Requirements
Pharmaceutical Manufacturing Companies Fee
Medical Device Manufacturers Fee
Health Insurance Provider Fee
Clinical Laboratories Fee
OK. 900 Billion total cost. But not my focus.
For example, I’m 72, on SSI and elligible for Medicare, Medi-cal,
and VA services.
What’s this going to cost me? I feel that my coverage is adequate.
More broadly, of the 29 million with no coverage, who are the 10 largest categories, and what will it cost them to join – so they won’t be fined.
Thank you
Dann Thompson
San Jose, CA
By: Dann Thompson on September 22, 2009
at 10:56 am
Good point Dann. Supposedly much of the cost is going to be squeezed out of Medicare, and while that isn’t supposed to effect benefits they haven’t yet done much to explain how that will work for people.
They have a lot of questions to answer on this bill.
By: kmorrison33 on September 22, 2009
at 2:24 pm
nice one. There is some great infomation here good work. I cannot really leave a constructive comment as i am abit out of my deph but i will be checking back here for further updates. london insurance 30 St Mary Axe, london, EC3A 8EP 020 7193 4776
By: Audrey Matilda on February 1, 2010
at 1:07 am