6 Treats in the New House Health Care Bill

by Tim Foley

categories: Medicare and Medicaid, National Health Exchange, Obama and Congress, The Uninsured and Underinsured

Published October 31, 2009 @ 08:38PM PT

For a bill introduced during Halloween week, there was very little to shock and alarm us in the new combined House health care bill, HR 3962, the Affordable Health Care for America Act.

As much as progressive reform advocates rejoiced, there was a touch of anticlimax in the mainstream reporting. The only two parts that attracted media attention -- the price tag and the configuration of the public option -- haven’t moved at all from where we left them at the end of July. I know it doesn’t feel that way, in that said news coverage has made the evolution of the bill both seem like seat-of-the-pants, anything-can-happen toss-up on both issues. But we began August with a negotiated rates public option and a price tag just above $1 trillion -- and end with a negotiated rates public option and a price tag just above $1 trillion.  From that point of view, ain't nothing new under the sun.

But that’s a deceptive way of looking at the House bill. Look closely and you’ll see some big surprises -- some vast improvements over the previous version, HR 3200, that was passed out of committee this summer. Here are 6 examples that we’re just not talking about enough when evaluating the impact of this bill, were it to pass.

1. CLASS ACT joins the party -- This is a huge win for advocates for the disabled, and a huge cost-saver for the bill as a whole. Where currently Medicare’s reimbursement incentives all point towards institutionalization, either in a hospital or nursing home, and private insurance often has no provisions for long-term care, the CLASS ACT would create a new, voluntary, publicly run long-term care program that individuals can buy into with payroll reductions. This will allow more and more disabled Americans who can stay in their homes with regular visits from a nurse or aide to do so, and save a lot of money in the process.
2. Take THAT prescription drugs! -- Pharma has really had an easy time in this season of reform. Few have been taking their name in vain or burned them in effigy. More to the point, we know Sen. Max Baucus and the White House struck a deal with Pharma over the summer to cap their contribution to reform at some $80 billion over 10 years – enough to partially close the Medicare Part D doughnut hole but not to wring even greater savings out of the system. Well, as Speaker Pelosi was fond of saying, the House wasn’t party to that deal -- and the new bill shows it. Not only does it completely eradicate the payment gap for Medicare Part D seniors over 10 years, but it requiring the Secretary of HHS to actually negotiate for the best drug prices in Medicare, rather than allowing Pharma to name its own price. Imagine that!
3. The House version of IMAC is an old friend -- The White House originated the idea of IMAC, a board of experts similar to the existing Medicare Payment Advisory Committee, tasked with making changes to Medicare to lower costs and improve quality that have the force of law. The goal is to divorce the policy process of continuing to improve and strengthen Medicare from the political process that helps tilt it towards waste. Well why bother creating a new bureaucracy when you have one that already works great? The House bill gives this responsibility to the long-respected Institute of Medicine.
4. Republicans get one of their top priorities -- To quote Luke Perry in Anchorman after someone has just cut his arm off, “I did not see that coming!” Conservatives have been clamoring to allow individuals to buy policies across state lines to inject more competition into the market. Well, now, they’ll be able to -- State Health Insurance Compacts will allow state exchanges to link up if both states agree to do so. Practically, this means New York could strike a deal with Delaware whereby an individual or small business who's going shopping for insurance in the Health Exchange would have their choice of any New York or any Delaware plan. You wanted it, Republican House members who won’t vote for the bill anyway? You got it!
5. A better option than a Young Invincible Plan -- Over 38% of adults aged 19 to 24 are uninsured (that number is similar at 32% for those aged 25 to 29). The reasons are obvious -- some are in college, but most are likely to have shaky finances, low-income and/or entry-level jobs which may or may not come with any benefits. They’re called the Young Invincibles, as though their youth and probable health made them arrogantly spurn unaffordable insurance, but many of them are just Young and Broke. The Senate Finance Committee added an unnecessary level of complexity by allowing people in their early 20s -- and only them -- to purchase substandard, catastrophic-only coverage at reduced rates. The House approach is much simpler, and follows what states like Massachusetts have already tried.  Those aged 27 would be able to stay on their parents' plans until they can afford comprehensive insurance or get a job with benefits.
6. The bill reduces the deficit, more than the Senate Finance Committee bill -- Despite its many flaws and giveaways to the insurance industry, we were told that the Baucus bill should rightly be the basis of the combined legislation because a.) it was bipartisan (where bipartisanship = 1 Republican Senator) and b.) it was the only one to reduce the deficit. Well, not so fast, suckah. The Congressional Budget Office scores the House bill as reducing the deficit by $104 billion over the first ten years, netting even more savings than the Baucus bill. Not only that, it continues reducing the deficit in the second ten years. So do me a favor? The next time someone tells you health care reform can only be done by adding to the national debt, please tell them they’re full of crap. There’s not a bill on the table that adds to the debt.

There are plenty more changes in the House bill, nearly all of which are worth a post in and of themselves. Clearly House leadership has taken their time out of the spotlight to dramatically improve a bill that was already the best proposal on the table.  The House bill covers more Americans (96% at the last count) than the Senate bill, gives them more affordable insurance, particularly for the middle class, than the Senate bill, and does not fall into the trap of building their cost containment mechanism on a presumption that the cost of insurance would continue to rise.

They could have rested on their laurels and merely shored up their votes, or focused on getting a public option.  We’re all better off that they didn’t.  Now we need to hope they're up to the task of negotiating -- and prevailing -- over whatever the far more industry-friendly Senate will pass.

(Photo credit: http://www.flickr.com/photos/speakerpelosi/ / CC BY 2.0)