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Health Care Reform 2010


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Congressional Democrats have unveiled the final changes to a sweeping healthcare overhaul they hope will clear the House of Representatives on Sunday. Democrats are using a two-step process that involves the House approving the Senate-passed version of the bill and passing the proposed final changes. The Senate must act on the changes before President Barack Obama can sign them into law. (Reuters)

I created this slideshow for anyone interested in health care reform or confused about the process. I have attempted to include the most relevant, current information in a simple, organized manner. I was diligent in my research and performed several fact checks, but things are moving quickly. If there are any major errors, I apologize in advance. Please note that with a few exceptions most of the slides are active links. Simply click the slide or link to be redirected to data, documents, websites, and other helpful tools.

Thanks for viewing my presentation. Onward, forward!

Health Care Reform 2010

  1. Health Care Reform 2010<br />Created by Stephanie Williams, J.D. <br />
  2. Affordable Health Care for America Act, H.R.3962(House Bill)<br />
  3. Patient Protection & Affordable Care Act, H.R. 3590(Senate Bill) <br />
  4. The House & Senate Bills Common Features<br />Expand coverage to 95% of Americans (i.e., an additional 32 million insured) <br />Individual mandate to purchase health care with financial penalty for not enrolling<br />More than 60% of people will retain insurance through their employers, with financial penalties for those who do not provide coverage. <br />There would be a basic package that would provide comprehensive coverage beyond catastrophic care (e.g., well care, screenings, and prevention). <br />Health insurance exchanges would help individuals and small businesses afford coverage by creating a competitive market and pooling purchasing power. <br />Subsidies would help individuals and families afford premiums .<br />Medicaid would be expanded<br />Changes in Medicare would move payments for outcomes rather than fee for service. <br />Reduce Medicaid and Medicare fraud and abuse, reduce the size of Medicare Advantage programs <br />Widespread use of electronic records <br />Leaves approximately 23 million Americans uninsured, the bulk of which would be young, healthy adults who might decide to pay the cost of premiums rather than the fee for being uninsured. Undocumented residents (i.e., illegal aliens) will not be covered. <br />The CBO scoring concluded that the cost of the bill is $940 billion, less than expected. By 2020, the bill will reduce the deficit by $138 billion. It will reduce the deficit by $1.3 trillion dollars in 20 years. <br />Read CBO letter to Pelosi and full CBO report.<br />
  5. President Obama’s Bipartisan Health Care Summit<br />
  6. The President’s Proposal<br />
  7. Republican Ideas Included in the President’s Proposal<br />Review the new Republican initiatives included in the President’s Proposal:<br />Comprehensive Sanctions Database. The President’s Proposal establishes a comprehensive Medicare and Medicaid sanctions database, overseen by the HHS Inspector General.  This database will provide a central storage location, allowing for law enforcement access to information related to past sanctions on health care providers, suppliers and related entities. <br />(Source: H.R. 3400, “Empowering Patients First Act” (Republican Study Committee bill))<br />Registration and Background Checks of Billing Agencies and Individuals. In an effort to decrease dishonest billing practices in the Medicare program, the President’s Proposal will assist in reducing the number of individuals and agencies with a history of fraudulent activities participating in Federal health care programs.  It ensures that entities that bill for Medicare on behalf of providers are in good standing.  It also strengthens the Secretary’s ability to exclude from Medicare individuals who knowingly submit false or fraudulent claims.  <br />(Source:  H.R. 3970, “Medical Rights & Reform Act”)<br />Expanded Access to the Healthcare Integrity and Protection Data Bank.  Increasing access to the health care integrity data bank will improve coordination and information sharing in anti-fraud efforts. The President’s Proposal broadens access to the data bank to quality control and peer review organizations and private plans that are involved in furnishing items or services reimbursed by Federal health care program.  It includes criminal penalties for misuse. <br />(Source:  H.R. 3970, “Medical Rights & Reform Act”)<br />Liability of Medicare Administrative Contractors for Claims Submitted by Excluded Providers. In attacking fraud, it is critical to ensure the contractors that are paying claims are doing their utmost to ensure excluded providers do not receive Medicare payments. Therefore, the President’s Proposal provision holds Medicare Administrative Contractors accountable for Federal payment for individuals or entities excluded from the Federal programs or items or services for which payment is denied.  <br />(Source:  H.R. 3970, “Medical Rights & Reform Act”)<br />
  8. Republican Ideas Included in President’s Proposal (Cont’d)<br />Community Mental Health Centers. The President’s Proposal ensures that individuals have access to comprehensive mental health services in the community setting, but strengthens standards for facilities that seek reimbursement as community mental health centers by ensuring these facilities are not taking advantage of Medicare patients or the taxpayers.  <br />(Source:  H.R. 3970, “Medical Rights & Reform Act”)<br />Limiting Debt Discharge in Bankruptcies of Fraudulent Health Care Providers or Suppliers. The President’s Proposal will assist in recovering overpayments made to providers and suppliers and return such funds to the Medicare Trust Fund.  It prevents fraudulent health care providers from discharging through bankruptcy amounts due to the Secretary from overpayments. <br />(Source:  H.R. 3970, “Medical Rights & Reform Act”)<br />Use of Technology for Real-Time Data Review. The President’s Proposal speeds access to claims data to identify potentially fraudulent payments more quickly.  It establishes a system for using technology to provide real-time data analysis of claim and payments under public programs to identify and stop waste, fraud and abuse.  <br />(Source:  Roskam Amendment offered in House Ways & Means Committee markup)<br />Illegal Distribution of a Medicare or Medicaid Beneficiary Identification or Billing Privileges.  Fraudulent billing to Medicare and Medicaid programs costs taxpayers millions of dollars each year.  Individuals looking to gain access to a beneficiary’s personal information approach Medicare and Medicaid beneficiaries with false incentives.  Many beneficiaries unwittingly give over this personal information without ever receiving promised services.   The President’s Proposal adds strong sanctions, including jail time, for individuals who purchase, sell or distribute Medicare beneficiary identification numbers or billing privileges under Medicare or Medicaid – if done knowingly, intentionally, and with intent to defraud. <br />(Source:  H.R. 3970, “Medical Rights & Reform Act”)<br />Study of Universal Product Numbers Claims Forms for Selected Items and Services Under the Medicare Program. The President’s Proposal requires HHS to study and issue a report to Congress that examines the costs and benefits of assigning universal product numbers (UPNs) to selected items and services reimbursed under Medicare. The report must examine whether UPNs could help improve the efficient operation of Medicare and its ability to detect fraud and abuse. <br />(Source:  H.R. 3970, “Medical Rights & Reform Act”, Roskam Amendment offered in House Ways & Means Committee markup)<br />
  9. Reconciliation H.R. 4872<br />
  10. The Final Bill: The Facts<br />March 19, 2010 <br />REUTERS- Congressional Democrats have unveiled the final changes to a sweeping healthcare overhaul they hope will clear the House of Representatives on Sunday.<br />Democrats are using a two-step process that involves the House approving the Senate-passed version of the bill and passing the proposed final changes. The Senate must act on the changes before President Barack Obama can sign them into law. Here are key provisions of the legislation including the proposed changes.<br />INSURANCE MARKET REFORM<br />The legislation would require substantial insurance market reforms that would bar insurers from excluding people for pre-existing conditions and prevent them from arbitrarily dropping policy holders.<br />Insurance exchanges would be created where small businesses and individuals without employer-sponsored coverage would be able to shop for coverage. Plans offered on the exchange would have to meet minimum benefit requirements.<br />The proposed changes would allow dependent children to remain on their parents' health policies until age 26.<br />The Senate bill requires insurers to spend at least 85 cents of every premium dollar on medical care in small group markets and 80 cents in large group markets. The proposed changes also would require Medicare Advantage insurers to spend at least 85 percent of revenues on medical care.<br />COVERAGE MANDATES, SUBSIDIES AND MEDICAID<br />Individuals would be required to obtain health insurance. Those who fail to purchase coverage would face fines of up to 2.5 percent of income by 2016.<br />Firms with more than 50 workers who do not offer medical coverage could face fines of $2,000 per full-time employee.<br />
  11. The Final Bill: The Facts <br />Federal subsidies would be provided to help people with incomes up to 400 percent of the poverty level purchase coverage on the exchange. Proposed changes would sweeten those subsidies for lower income people.<br />Medicaid, the government healthcare program for the poor, would be available to everyone with incomes up to 133 percent of the poverty level, which stood at $10,830 for an individual and $22,050, for a family of four. Many states have eligibility requirements below those levels.<br />The proposed changes would get rid of a special deal to help Nebraska pay for the expanded coverage and boost aid to all states.<br />FINANCING<br />The final proposal makes some adjustments to the revenue measures in the Senate-passed bill.<br />The Senate bill included a 40 percent excise tax on high-cost health insurance plans. The proposed changes would delay implementation of the tax until 2018 instead of 2013. The tax would kick in on plans costing $10,200 for individuals and $27,500 for family coverage. A higher threshold is allowed for plans covering mostly women, older workers and retirees as well as those in high-risk professions.<br />The bill calls for raising the payroll taxes for Medicare, the government health insurance plan for the elderly, to 2.35 percent from the current 1.45 percent for individuals earning $200,000 or more and for couples earning $250,000 or more. The proposed changes would apply the tax to some investment income as well for those high-income groups.<br />The bill would impose fees on medical device manufacturers, insurance providers and brand name pharmaceuticals. The proposed changes would delay implementation of those fees.<br />MEDICARE<br />The legislation would freeze payments to insurers that provide coverage to Medicare patients in 2011 and begin reducing the subsidy in 2012.<br />It would also gradually close the gap in drug coverage for Medicare beneficiaries by 2020. Those who enter the coverage gap, the so-called doughnut hole, in 2010 will get a $250 rebate. In 2011 they would get a 50 percent discount on brand-name drugs.<br />(Reporting by Donna Smith; Editing by Eric Beech)<br />See also New York Times <br />
  12. Health Insurance Reform in Your State<br />
  13. What Health Care Reform Means for You<br />
  14. The Numbers <br />To help raise awareness about why we just can’t wait for reform, the White House is promoting key numbers on and social networks like Facebook, MySpace, Linkedin and Twitter. <br />Today’s Number <br />Previous Numbers:<br />3<br />9<br />50-50<br />1<br />41<br />625<br />8<br />1115<br />32,000,000 -- that’s the number of Americans who will get health insurance under the President’s plan. [Source: Congressional Budget Office]<br />That’s also a little more than the populations of Ohio, Virginia, Kentucky and Arizona --- COMBINED. [Source: U.S. Census Bureau]<br />
  15. The Cost of Doing Nothing <br />
  16. The Cost of Doing Nothing <br />According to a recent Harvard Study, 45,000 Americans die every year because they lack health care insurance. <br />Commonwealth Fund estimates that Americans families currently pay approximately $13,000 for health insurance.<br />IF WE DO NOTHING, by 2020, American families will pay approximately $24,000 annually for health insurance – 25% of today’s median family income. <br />IF WE DO NOTHING, many companies might stop providing health insurance. Those that do continue to provide insurance will due so by lowering salaries, reducing other benefits, and increasing employee contributions. <br />The Urban Institute estimates that the number of uninsured will grow from 50 million to between 57-66 million by 2019. <br />Families USA estimates that over 275,000 people will die over the next decade because of lack of insurance. <br />FYI: The Commonwealth Fund analyzed the price we are currently paying for not enacting comprehensive health insurance in the past. Had we enacted Richard Nixon’s plan in the 1970s, we would be spending $1 trillion less annually. Had we enacted Bill Clinton’s plan in the 1990s, we would have saved $500 billion annually. <br />Other source: New York Times <br />
  17. The Public Option?<br />
  18. Latest News: Will there be a public option?<br />The government-run health insurance plan known as the "public option" has lived and died several times during the health care overhaul saga — and it may be back again. <br />House Speaker Nancy Pelosi has long been a supporter of the public option, which was in the bill the House passed last year. But that bill went nowhere, and instead it's the Senate's health care bill — with no public option — that has made it to the final round. <br />Late last year, Senate Democratic leaders got rid of the public option to sew up the 60 votes it needed to get the bill passed. But now that Congress is using an expedited procedure known as reconciliation, only 51 votes are needed to get a revised version of the bill through the Senate. First, that revision must pass the House, so proponents are demanding that Pelosi put the public option back in.<br />Asked about that a few days ago, she showed little inclination to do so: "We're talking about something that is not going to be part of the legislation, so why don't we talk about what is going to happen? Because I'm quite sad that a public option isn't in there," she said. "It isn't in there because they don't have the votes to have it in there."<br />That's an argument supporters of the public option aren't buying. To challenge it, several activist groups are airing an ad Wednesday on MSNBC and CNN in Washington, D.C., and San Francisco, Pelosi's home district. The ad is an exercise in political math: It tallies 41 senators who have pledged to support a bill with a public option with 10 others who have expressed support for it in the past. That's a total of 51 — the exact number of votes needed for final passage in the Senate. <br />Read more on NPR…<br />
  19. Is there Congressional support for the Public Option?<br />51 senators will vote for a public option in reconciliation if it's sent over by the House<br />24 have signed a letter to Harry Reid asking for a public option in reconciliation. 19 have given statements to us, reporters, or their constituents. 4 more have made statements on video. And 4 are extremely likely based on their previous support for the public option and Senate leadership, even though they haven't made an official statement yet. Click here or here for a complete list. <br />
  20. Civics 101: How a Bill Becomes Law<br />How Our Laws Are Made (PDF)<br />
  21. What is Reconciliation?<br />
  22. Reality Check <br />Get the facts about the stability and security you will get from health insurance reform.<br />Reality Check Home Consumer Protections  FAQs Health Reform Fliers Take a QuizContact the White House<br />
  23. Support for the President’s Proposal<br />Recent Statement of Support:<br />Federation of American Hospitals"It is no exaggeration to say this is the last opportunity in our generation to bring about durable reform that will bring health security to Americans and make a difference in the lives of all of us. The time for action has come..." -- Letter to House Speaker Nancy Pelosi <br />Featured Statements of Support:<br />American Nurses Association“If ever there was a time to trust a nurse—that time is now. Please trust me when I tell you that we can’t afford to put off reform for one more administration—one more political season—or even one more day… This legislation will enact very real and much-needed insurance reforms; it will place a new focus on wellness and prevention, improving access to primary care and expanding coverage to over 30 million people.”  -- American Nurses Association CEO Marla J. Weston, PhD, RN<br />Network, A National Catholic Social Justice Lobby"The health care bill that has been passed by the Senate and that will be voted on by the House will expand coverage to over 30 million uninsured Americans... It will make crucial investments in community health centers that largely serve poor women and children. And despite false claims to the contrary, the Senate bill will not provide taxpayer funding for elective abortions. It will uphold longstanding conscience protections and it will make historic new investments – $250 million – in support of pregnant women." -- Letter to Congress from organizations representing 59,000 Catholic Sisters<br />Small Business Majority"Two-thirds or more of small business owners we polled in 17 states agree that healthcare reform is needed now to get the US economy back on track.“<br />A complete list of supporters is available on the White House website.<br />
  24. Health Care Reform 2010<br />
  25. Health Care Reform 2010<br />
  26. Pass Health Care Reform NOW!<br />