The Senate has proposed and debated amendments to its health care reform legislation these past two weeks and there is more to come. A vote in the Senate might come as early as next Wednesday, although we think that is unlikely, but is likely to come by next Saturday, December 19th. We are down to the wire and the 60 votes needed to end debate (“clotureâ€) and take a vote on the bill is still not guaranteed. They will have to reach a fragile balance in the Senate to find 60 votes and get this done. But as we know, it is critical that they succeed. We have waited too long and worked too hard to turn back now. This is the historic moment to take that first huge step towards a country that ensures everyone has access to quality affordable health care.
While all the tricky negotiations are going on there continues to be an onslaught of amendments on the Senate floor. Some seek to weaken or delay reform. But others would make important improvements to the bill. We wanted to highlight a few of those for you here:
Protecting Children’s Health Care Coverage – Sen. Casey (S. 2790)
Presently the House’s health care reform bill eliminates the Children’s Health Insurance Program (CHIP), which provides health insurance coverage to children of low-income families who are ineligible for Medicaid, in 2013 and moves up to 10 million children presently on CHIP into the health insurance Exchange. The Senate bill maintains CHIP until 2019, but does not fully fund it. Senator Bob Casey (D-PA) introduced an amendment that would keep and strengthen the CHIP program. The amendment would guarantee funding for eligible children and then transition them into the Exchange in 2019 on the condition that comparable coverage is affordable. It would also expand CHIP coverage to children in families at or below 250% of the federal poverty level in any state and would provide preventative and specialized services that children receive under Medicaid.
Removing the Five-Year Bar – Sen. Menendez (S. 2991)
Under Federal law, legal immigrants have to wait five years before they can access any public program, even those these same families are contributing the tax dollars that support those programs. Senator Robert Menendez (D-NJ) has introduced an amendment to remove the five year exclusion for legally-residing immigrants to access Medicaid. The amendment would not be a federal mandate, but would give states the option to cover these populations and received federal Medicaid funding for it. Nebraska decided long ago to remove the 5 year bar for legal immigrants and has been covering those families with state-only dollars. This amendment would allow Nebraska to access federal matching funds. The Congressional Budget Office (CBO) scored the amendment and stated that the costs would be negligible. It is estimated it would be cheaper to cover Medicaid-eligible people under Medicaid compared to providing federal subsidies for them to purchase insurance in the exchange.
Ensuring premium dollars are spent on medical care – Sen. Franken
Senator Al Franken (D-MN) introduced an amendment that would require insurance companies to use at least 90% of consumers’ health insurance premium dollars to pay for actual health care costs instead of administrative costs, advertising, executive salaries, sales commissions, and corporate profits. This is knows as a “medical loss ratio.†The current Senate bill would require health insurance policies in the Exchange to pay at least 85% of premium dollars toward health services, whereas individual plans not in the Exchange would have to pay at least 75%. Sen. Franken’s amendment would cover all health insurance policies. In 1993, the insurance industry’s average medical loss ratio was 95% but it has since plummeted to 81%. Under the amendment, if insurers spent less than 90% on health services they would be required to provide a rebate to policyholders.
Cost awareness and affordability amendments – Sen. Warner
Senator Mark Warner (D-VA) and ten other Democratic senators introduced amendments to control costs. The current bill requires Medicare to pay some health providers based upon the quality and outcome of their care instead of a fee-per-service model. The amendments would also require Medicare to employ pay-for-performance testing for hospices, psychiatric hospitals, long-term care hospitals, impatient rehab facilities, and inpatient psychiatric hospitals in addition to providers by 2016
The Senate bill makes important strides to reform our broken health insurance system. But these amendments can help make the underlying bill even stronger and make health insurance more affordable for low-income families