The Right Thing to Do – Passing Senate Health Bill

Early Monday morning the Senate took the first of three major votes required to pass the health care reform bill in the Senate.  The second took place today. We believe this continued movement on reform is a critical and positive step.

While we recognize that the Senate bill is not perfect or everything health care proponents had hoped to gain, it is a strong bill that will result in significant and critical changes in our health care system.  This bill will curb the insurance industry’s worst practices, expand coverage to millions of Americans, make health insurance more affordable, reign in costs and improve quality.  These benefits seem to have been lost In all the political maneuvering and the discussions of a few controversial provisions.  We thought it might be helpful to remind people of what we stand to gain under reform.

The reform bill will hold insurance companies accountable and eliminate the industry’s worst practices.

  • There will be an immediate ban on denying children coverage for pre-existing conditions.
  • Pre-existing condition denials will be dramatically reduced for everyone (insurers will only be able to use pre-existing conditions for three months instead of twelve) and will be prohibited altogether by 2014.
  • The practice of retroactively canceling your coverage when you need it the most will be prohibited.
  • Insurers will be prohibited from charging higher premiums just because you’ve ever been sick or because you are a woman.
  • Annual and lifetime caps on your coverage will be eliminated and insurers will be required to offer coverage to everyone and renew their policyholder’s coverage.
  • Insurers will be required to spend more of our premium dollars on actual medical care (85% in most cases, 80% in the individual market) with less going to administrative costs, advertising, and executive bonuses. If those insurance companies don’t spend the required minimum, they will owe their policyholders rebates.
  • The bill will protect patients’ choice in doctors and provide guaranteed opportunities to appeal coverage denials.
  • The reform package also requires both insurers and health care providers to report on their performance, providing greater transparency for patients.
  • If insurance companies drastically increase their premiums before the health insurance exchange is created they can be barred entirely from offering policies in the Exchange—an enormous incentive for insurers to keep rates affordable.

The reform bill will expand coverage to millions of Americans and make health insurance more affordable.

  • 30 million uninsured Americans will gain access to coverage.
  • Health insurance will become more affordable for millions of Americans. Premium tax credits will be available to those who make less than 400% of the federal poverty level – $73,240 for a family of three.
  • Premiums tax credits will be available in the Exchanges, or marketplaces, where insurance plans will be easily compared and rated to help families choose the plan that best fits their needs.
  • Reform will cap out of pocket costs and eliminate co-pays on preventative services.
  • The reform package provides enormous investments to increase access to primary care providers, particularly in underserved communities, and expands existing community health care centers’ capacity.
  • Tax credits and other assistance will also be available to the many small businesses who struggle to provide basic coverage.
  • Insurers will be required to extend coverage to dependents on family plans through age 26.
  • Expansions in Medicaid coverage will provide critical health care coverage to millions of low-income Americans.
  • Health care will also become more affordable to millions of America’s seniors. The Senate bill eliminates Medicare co-pays on preventive screenings, strengthens traditional Medicare coverage, and reduces inefficient existing fraud, waste, and abuse in the program. Additionally, the reform package will reign in the expanding cost ratio between young and senior citizens.

Reform will improve quality, including measures that begin to address the racial and ethnic disparities in our current system.

  • A National Quality Strategy will be developed as a result of reform and a new Center for Innovation at the Centers for Medicare and Medicaid will test and evaluate innovate models of care.
  • The reform legislation creates a focus on wellness and prevention with pilot programs, including care coordination and medical homes, particularly for those with chronic illnesses
  • Federal health programs will be requires to track more data to better analyze the health disparities in our system.

There are many other improvements in the bill as well.  And it is important to remember that these improvements are paid for and the Congressional Budget Office has said the bill will reduce the deficit.

Nebraskans have an enormous amount to gain by passing these crucial reforms.  We must not let the perfect become the enemy of the good.  Proponents of reform have not gained ground, but rather lost ground when efforts have failed in the past.  The current legislation moves this country forward and sets us on the path to an ever-improving health care system.  And in doing so it will save lives and provide health care to millions who have gone without it for far too long.

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