hr 3200: health care reform, in short form

8/14/2019 HR 3200: Health Care Reform, in Short Form

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1

Rep. Robert C.Rep. Robert C. BobbyBobby ScottScott

Wednesday, September 2, 2009Wednesday, September 2, 2009WTKR News Channel 3WTKR News Channel 3

Norfolk, VANorfolk, VA

THE NEED FOR HEALTH CAREREFORM


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2

TheStatus

Quo

is

Unsustainable.

TheStatusQuoisUnsustainable.


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3

Health Expenditure as Percentage of GDPHealth Expenditure as Percentage of GDP

0

2

46

8

10

12

14

16

18

Percent

US

FranceGermany

Ireland

Japan

CanadaOCED Average

Prepared by the Office of Congressman Robert C. Bobby ScottSource: OCED Health Data, 2009

TheUSspendsmoreonhealthcarethananyothernation. EvenTheUSspendsmoreonhealthcarethananyothernation. Even thoughthoughwepaymore,wegetless. 15%uninsured,moreunderinsured,peowepaymore,wegetless. 15%uninsured,moreunderinsured,peopleple whowhodon'taccesshealthcarebecauseofdon'taccesshealthcarebecauseoflackofinsurancelackofinsurance andpooroutcomesinandpooroutcomesintermsofinfantmortality,lifeexpectancyanddeathduetoprevtermsofinfantmortality,lifeexpectancyanddeathduetopreventableentabledisease.disease.


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4

Lack of Security:Lack of Security:Denial Based on PreDenial Based on Pre--existing Conditionsexisting Conditions

IfyouloseyourjobandcurrenthealthinsuranceIfyouloseyourjobandcurrenthealthinsurance

coverageand

you

have

aprecoverage

and

you

have

apre

existing

condition

you

existing

condition

you

mayhavetroublegettingremayhavetroublegettingreinsured.insured.

InVirginia,premiumscanvarybasedonInVirginia,premiumscanvarybasedon

demographicfactors

and

health

status,

and

coverage

demographic

factors

and

health

status,

and

coverage

canbealltogetherexcludedbasedonprecanbealltogetherexcludedbasedonpreexistingexistingconditions.conditions.

Thosewith

preThose

with

pre

existing

conditions

that

have

existing

conditions

that

have

insuranceoftenpayhigherpremiums.insuranceoftenpayhigherpremiums.


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5

Lack of Security:Lack of Security:Many Who Have Insurance May Lose ItMany Who Have Insurance May Lose It

Employeebasedcoverageisdeclining:Employeebasedcoverageisdeclining:ThepercentofThepercentofVirginianswithemployerprovidedhealthinsurancefellfrom68Virginianswithemployerprovidedhealthinsurancefellfrom68to62%between2000and2007.to62%between2000and2007.

SmallBusinessescannotaffordcoverageforemployees:SmallBusinessescannotaffordcoverageforemployees:WhileWhilesmall

businesses

make

up

71%

of

Virginia

businesses,

only

48%

small

businesses

make

up

71%

of

Virginia

businesses,

only

48%

ofthemofferedhealthcoveragebenefitsin2006.Nationally,ofthemofferedhealthcoveragebenefitsin2006.Nationally,thenumberofsmallbusinessesofferinginsurancehasfallenthenumberofsmallbusinessesofferinginsurancehasfallenfrom61%in1993to38%.from61%in1993to38%.

Americansarelosingtheirhealthinsuranceatarateof14,000Americansarelosingtheirhealthinsuranceatarateof14,000Americansperday.Americansperday. 46millionAmericanshavenohealthinsurancetodayand46millionAmericanshavenohealthinsurancetodayand

millionsmoreareunderinsured.millionsmoreareunderinsured.


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6

We are Already Paying for theWe are Already Paying for the

UninsuredUninsured

ThecostsofcaringfortheuninsuredareThecostsofcaringfortheuninsuredare

shiftedontoAmericansintermsofshiftedontoAmericansintermsof

higherpremiums

higher

premiums

an

additionalan

additional

$1,017annuallyforfamiliesand$368$1,017annuallyforfamiliesand$368

annuallyfor

individuals.

annually

for

individuals.


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7

ItIts Getting Worses Getting Worse

Healthcarecostscontinuetorisefasterthaninflation:Healthcarecostscontinuetorisefasterthaninflation:AlthoughwageshaveincreasedataboutthesamerateasAlthoughwageshaveincreasedataboutthesamerateas

inflation,insurancepremiumshavemorethandoubled.inflation,insurancepremiumshavemorethandoubled.

Since2000alone,percapitapremiumshavedoubledandareSince2000alone,percapitapremiumshavedoubledandare

projectedtodoubleagaininthenext10years.projectedtodoubleagaininthenext10years.

Since1987,thecostoftheaveragefamilyhealthinsuranceSince1987,thecostoftheaveragefamilyhealthinsurancepolicyhasrisenfrom7%ofmedianfamilyincometo17%.policyhasrisenfrom7%ofmedianfamilyincometo17%.


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8

Cumulative Changes in HealthCumulative Changes in Health

Insurance Premiums, Inflation, andInsurance Premiums, Inflation, andWorkersWorkers Earnings, 1999Earnings, 1999--20082008

119%

34%

29%

0%

20%

40%

60%

80%

100%

120%

140%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Health Insurance P remiums

Workers' Earnings

Overall Inflation

Note: Due to a change in methods, the cumulative changes in the average familypremium are somewhat different from those reported in previous versions of theKaiser/HRET Survey of Employer-Sponsored Health Benefits. See the Survey Designand Methods Section for more information, available athttp://www.kff.org/insurance/7790/index.cfm.

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2000-2008.Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation(April to April), 2000-2008; Bureau of Labor Statistics, Seasonally Adjusted Data from

the Current Employment Statistics Survey, 2000-2008 (April to April).


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9

Source: Centers for Medicare and Medicaid Services, Office of the Actuary, National Health Statistics Group, at

http://www.cms.hhs.gov/NationalHealthExpendData/ (Historical data from NHE summary including share of GDP, CY 1960-2007, filenhegdp07.zip; Projected data from NHE Projections 2008-2018, Forecast summary and selected tables, file proj2008.pdf).

$8,160

(2009)

$13,100

(2018)

$2,814

(1990)

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

2016

2017

2018

Per Capita

Projected Per Capita

Actual P rojected

National Health Expenditures perNational Health Expenditures per

Capita, 1990Capita, 1990--20182018


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CurrentCurrent--Law Spending on Health Care asLaw Spending on Health Care as

Percentage of Gross Domestic ProductPercentage of Gross Domestic Product

Percentage of GDP

Source: CBOSource: House Budget Committee.


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11

AmericaAmericas Affordable Health Choicess Affordable Health Choices

Act: HR 3200Act: HR 3200

AmericaAmericasAffordableHealthChoicesActprovidesqualitysAffordableHealthChoicesActprovidesquality

affordablehealth

care

for

all

Americans

and

controls

healthaffordable

health

care

for

all

Americans

and

controls

health

carecostgrowth.Keyprovisionsofthebillinclude:carecostgrowth.Keyprovisionsofthebillinclude:

COVERAGEANDCHOICECOVERAGEANDCHOICE AFFORDABILITYAFFORDABILITY SHAREDRESPONSIBILITYSHAREDRESPONSIBILITY CONTROLLINGCOSTSCONTROLLINGCOSTS

PREVENTIONAND

WELLNESS

PREVENTIONANDWELLNESS WORKFORCEINVESTMENTSWORKFORCEINVESTMENTS


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12

H.R. 3200:H.R. 3200:

Greater CoverageGreater Coverage

Allbusinesses,

with

some

exceptions

for

the

smallest

businessesAll

businesses,

with

some

exceptions

for

the

smallest

businesses,

,

willprovidehealthinsuranceforitsemployeesorpayafee.willprovidehealthinsuranceforitsemployeesorpayafee.

PrivateinsurancecompanieswillnolongerbeabletoPrivateinsurancecompanieswillnolongerbeableto

discriminatebased

on

prediscriminate

based

on

pre

existing

conditions.existingconditions.

AllindividualsnotcoveredbytheiremployerswillbuyinsurancAllindividualsnotcoveredbytheiremployerswillbuyinsurance,e,

somewiththehelpofaffordabilitycredits.somewiththehelpofaffordabilitycredits.


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13

H.R. 3200:H.R. 3200:

Increased ChoiceIncreased Choice

Ifyoulikeyourinsurance,Ifyoulikeyourinsurance,

YOUCAN

KEEP

IT

YOUCANKEEPIT..


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The ExchangeThe Exchange If you are not covered by your employer,If you are not covered by your employer, youhavetheyouhavetheoptionoption toto

purchaseinsurancethroughthenewHealthInsuranceExchange.purchaseinsurancethroughthenewHealthInsuranceExchange.

ThebasicpackageoftheExchange,includingthepublicoption,ThebasicpackageoftheExchange,includingthepublicoption,ismodeledaftertheFederalEmployeeHealthBenefit(FEHB)ismodeledaftertheFederalEmployeeHealthBenefit(FEHB)plans,whichcoversallfederalemployees,includingMembersplans,whichcoversallfederalemployees,includingMembersofCongressandCongressionalemployees.ofCongressandCongressionalemployees.

ThiswillcreateatransparentandfunctionalmarketplaceforThiswillcreateatransparentandfunctionalmarketplaceforindividualsandsmallbusinessestocomparisonshopamongindividualsandsmallbusinessestocomparisonshopamongprivateandpublicinsurers.privateandpublicinsurers.


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The ExchangeThe Exchange

Theexchange

will

give

you

achoice

of

several

options

while

in

The

exchange

will

give

you

achoice

of

several

options

while

in

manystatestodaythereareNOoptions.manystatestodaythereareNOoptions.

InMOSTstates,includingVirginia,InMOSTstates,includingVirginia, onehealthinsurerhasaonehealthinsurerhasa

marketshare

of

over

50%,

and

inmarket

share

of

over

50%,

and

in at

least

9states,

one

insurer

at

least

9states,

one

insurer

hasamarketshareinexcessof70%.hasamarketshareinexcessof70%.


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Lack of Choice:Lack of Choice:

More Than Half the States in US areMore Than Half the States in US areDominated by 1 InsurerDominated by 1 Insurer


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H.R. 3200: Benefit PackagesH.R. 3200: Benefit Packages

BasicPlanBasicPlanincludes:includes:

Inpatient

&

Outpatient

hospital

services

Inpatient

&

Outpatient

hospital

services

PhysicianservicesincludingequipmentandsuppliesPhysicianservicesincludingequipmentandsupplies

PreventiveandWellnessservicesPreventiveandWellnessservices

Prescriptiondrugs

Prescription

drugs

MaternityservicesMaternityservices

Wellbabyandwellchildvisitsandoralhealth,vision,andheaWellbabyandwellchildvisitsandoralhealth,vision,andhearingservicesringservicesforchildrenforchildren

RehabilitativeservicesRehabilitativeservices

MentalhealthandsubstanceabuseservicesforchildrenandadulMentalhealthandsubstanceabuseservicesforchildrenandadultsts

TheExchangemakesavailablefourtiersofbenefitpackagesfromwhichconsumerscanchoosetobestmeettheirhealthcareneeds.


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H.R. 3200: Benefit PackagesH.R. 3200: Benefit Packages

Eachtierincludesthecoresetofcoveredbenefits,butprovideEachtierincludesthecoresetofcoveredbenefits,butprovide moremoregenerouscostsharingprotectionsthanthebasicplan. Youwillgenerouscostsharingprotectionsthanthebasicplan. Youwill havehavethe

option

to

purchase:

theoptiontopurchase: EnhancedPlan:EnhancedPlan: IncludesthecoresetofcoveredbenefitswithmoreIncludesthecoresetofcoveredbenefitswithmore

generouscostsharingprotectionsthantheBasicplan.generouscostsharingprotectionsthantheBasicplan.

PremiumPlan:PremiumPlan: IncludesthecoresetofcoveredbenefitswithmoreIncludesthecoresetofcoveredbenefitswithmoregenerouscostsharingprotectionsthantheEnhancedplan.generouscostsharingprotectionsthantheEnhancedplan. PremiumPlusPlan:PremiumPlusPlan: Includesthecoresetofcoveredbenefits,themoreIncludesthecoresetofcoveredbenefits,themore

generouscostsharingprotectionsofthePremiumplan,andadditgenerouscostsharingprotectionsofthePremiumplan,andadditionalional

covered

benefits

covered

benefits

(e.g.,vision

and

oral

health

coverage

for

adults,

gym

(e.g.,

vision

and

oral

health

coverage

for

adults,

gym

memberships,etc.)memberships,etc.) thatwillvaryperplan.Inthiscategory,insurersthatwillvaryperplan.Inthiscategory,insurersmustdisclosetheseparatecostoftheadditionalbenefitssocomustdisclosetheseparatecostoftheadditionalbenefitssoconsumersnsumersknowwhattheyknowwhattheyrepayingforandcanchooseamongplansaccordingly.repayingforandcanchooseamongplansaccordingly.


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H.R. 3200: The PublicH.R. 3200: The Public OptionOption

GovernmentGovernmentruninsuranceplansarepopularruninsuranceplansarepopular

andareefficientlyrun.andareefficientlyrun.


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20

RatingofHealthInsurancePlansRatingofHealthInsurancePlansUsing 0 to 10, where 0 is the worst possible and 10 is the bestUsing 0 to 10, where 0 is the worst possible and 10 is the best possible, how would you ratepossible, how would you rateyour health plan?your health plan?

17

14

21

21

28

26

28

40

56

60

51

40

0% 20% 40% 60% 80% 100%

Medicare

Medicare

advantage

Medicaid

Private

Insurance

0 to 6

7 to 8

9 or 10

Prepared

by

the

Office

of

Congressman

Robert

C.

Bobby ScottSource:2007CAHPSsurveyresults,Dept.ofHealth&HumanServices


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21

Administrative Costs of MedicareAdministrative Costs of Medicare

and Private Insurers, 2007and Private Insurers, 2007

0

5

10

15

20

25

30

P

ercentage

oftotalco

st

Prepared by the Office of Congressman Robert C. Bobby ScottSources: Key Issues in Analyzing Major Health Insurance Proposals, CBO, http://cbo.gov/ftpdocs/99xx/doc9924/12-18-KeyIssues.pdf&PricewaterhouseCoopers Health Research Institute

MedicarePrivateInsurer

Average

UnitedHealthGroup


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22

H.R. 3200: Increased ChoiceH.R. 3200: Increased Choice

Employerscan

NOT

require

their

employees

Employers

can

NOT

require

their

employees

toselectaparticularoptiontoselectaparticularoption privateorprivateor

public.public.


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23

H.R. 3200: Public OptionH.R. 3200: Public Option

ThepublicoptionwillbefinancedbypremiumsandThepublicoptionwillbefinancedbypremiumsand

willnotbesubsidizedbytaxpayerdollars.willnotbesubsidizedbytaxpayerdollars.


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24

H.R. 3200: AffordabilityH.R. 3200: Affordability

ProvidesslidingscaleaffordabilitycreditsforlowProvidesslidingscaleaffordabilitycreditsforlow andmoderateandmoderateincomeindividualsandfamiliesupto400%oftheFederalPovertincomeindividualsandfamiliesupto400%oftheFederalPovertyyLevel(upto$43,320foranindividual;$88,200forafamilyofLevel(upto$43,320foranindividual;$88,200forafamilyoffour)sofour)sothattheymaypurchasehealthinsurance.thattheymaypurchasehealthinsurance.

CapsAnnualOutCapsAnnualOutofofpocketspendingat$5,000foranindividualandpocketspendingat$5,000foranindividualand$10,000forafamily.$10,000forafamily.

LowersCosts

of

prescription

drugs

by

closing

the

Lowers

Costs

of

prescription

drugs

by

closing

the

donut

holedonuthole in

in

MedicarePartMedicarePartD.D.

Medicaidwillbeexpandedtoincludefamilies,adultsandchildrMedicaidwillbeexpandedtoincludefamilies,adultsandchildren, aten, atorbelow133%ofpoverty. (upto$14,400foranindividualandorbelow133%ofpoverty. (upto$14,400foranindividualand$29,300

for

afamily

of

four).

$29,300

for

afamily

of

four).

CompetitionfromtheExchangewilldrivedowncosts.CompetitionfromtheExchangewilldrivedowncosts.

CostCostshifting

because

of

uncompensated

care

will

be

reduced.

shifting

because

of

uncompensated

care

will

be

reduced.


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H.R. 3200: Prevention and WellnessH.R. 3200: Prevention and WellnessThebillalsoprovidesanimportantandoverduefocusonpreventThebillalsoprovidesanimportantandoverduefocusonpreventionandionandwellnessservicestoensurethatpeoplecangethealthyandstaywellnessservicestoensurethatpeoplecangethealthyandstay healthy.healthy.

ExpansionofCommunityHealthCenters.ExpansionofCommunityHealthCenters.

ProhibitionofcostProhibitionofcostsharingforpreventiveservices(NoCosharingforpreventiveservices(NoCoPays).Pays).

SupportforcommunitySupportforcommunitybasedprogramswhichdeliverpreventionandbasedprogramswhichdeliverpreventionandwellness

services.

wellness

services.

Targethealthdisparities.Targethealthdisparities.

FundstostrengthenstateandlocalpublichealthdepartmentsanFundstostrengthenstateandlocalpublichealthdepartmentsandd

programs.

programs.


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H.R. 3200:H.R. 3200:

Workforce InvestmentsWorkforce Investments

IncreasessupportfortheNationalHealthServiceCorps.IncreasessupportfortheNationalHealthServiceCorps.

ProvidesfundingtosupportprimarycaretrainingprogramsProvidesfundingtosupportprimarycaretrainingprogramsandbuildacademiccapacityinprimarycare.andbuildacademiccapacityinprimarycare.

Expandseducation,practice,andretentionprogramsforExpandseducation,practice,andretentionprogramsfornurses.nurses.

Investsin

health

information

technology

to

improve

Invests

in

health

information

technology

to

improve

coordinationofcare,promoteefficiency,avoidmistakes,andcoordinationofcare,promoteefficiency,avoidmistakes,andimproveoutcomes.improveoutcomes.


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H.R. 3200:H.R. 3200:

Shared ResponsibilityShared Responsibility LargeEmployersLargeEmployerswillberesponsibleforwillberesponsiblefor 72.5%ofyourhealth72.5%ofyourhealth

insurancepremium(65% forafamilypolicy)iftheyofferhealtinsurancepremium(65% forafamilypolicy)iftheyofferhealthh

coverage.

Theemployer

may

choose

to

optcoverage.

The

employer

may

choose

to

opt

out

of

coverage

and

pay

out

of

coverage

and

pay

a8%surchargesothattheiremployeescanpurchaseinsurancea8%surchargesothattheiremployeescanpurchaseinsurancethroughtheExchange.throughtheExchange.

SmallBusinessesSmallBusinesses withanannualpayrollupto$250,000whoofferwithanannualpayrollupto$250,000whoofferhealth

insurance

to

their

employees

will

be

eligible

for

atax

chealth

insurance

to

their

employees

will

be

eligible

for

atax

credit

up

redit

up

to50%oftheirhealthcarecosts.Iftheychoosenottoprovideto50%oftheirhealthcarecosts.Iftheychoosenottoprovidecoveragetheywillbeexemptfromthehealthcaresurcharge.coveragetheywillbeexemptfromthehealthcaresurcharge.

Allothersmallbusinesswithanannualpayrollabove$250,000Allothersmallbusinesswithanannualpayrollabove$250,000

who

choose

not

to

provide

health

coverage

will

be

required

to

who

choose

not

to

provide

health

coverage

will

be

required

to

paythesurchargeonagraduatedscaleof2%paythesurchargeonagraduatedscaleof2% 8%.8%.

IndividualsIndividualswiththehelpofaffordabilitycreditswiththehelpofaffordabilitycredits willberequiredtowillberequiredtopurchasehealthinsurance,exceptincasesofhardshiporreligipurchasehealthinsurance,exceptincasesofhardshiporreligiousousexemption.exemption.


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H.R.3200isdeficitneutralandH.R.3200isdeficitneutralandwillbecompletelypaidforoverwillbecompletelypaidforover

tenyears.tenyears.


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29

Paying for Health Care ReformPaying for Health Care Reform

$110

$100

$102

$544

$156

Eliminating Overpayments

to Private Medicare

Advantage Plans

Medicare Productivity

Improvements

Dual Enrollee Rebate &

Prescription Drug Savings

Other Savings (ie:

Promoting Coordinated

Care)

Surchage Paid by

Wealthiest 1.2%

In Billions of Dollars

Prepared by the Office of Congressman Robert C. Bobby ScottSource: Committee on Ways and Means, Paying for Health Reform


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$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

Surcharge Estate TaxRepeal

Iraq &Afghanistan

ExtendingBush Tax Cuts

Clinton 10 yrSurplus

CumulativeBush OverSpending

Surcharge Compared to other

Government SpendingIn Billions of Dollars

Prepared by the Office of Congressman Robert C. Bobby Scott

Sources: Congressional Research Service, The Cost of Iraq, Afghanistan, and Other Global War on Terror Operations Since 9/11;Congressional ResearchService, Estate and Gift Tax Revenues: Past and Projected in 2009; &Congressional Budget Office.


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H.R. 3200 will provide significantH.R. 3200 will provide significant

benefits for the 3benefits for the 3rdrd CongressionalCongressionalDistrict of VirginiaDistrict of Virginia

14,200smallbusinesses14,200smallbusinesses couldreceivetaxcreditstoprovidecouldreceivetaxcreditstoprovidecoveragetotheiremployees.coveragetotheiremployees. 6,200seniors6,200seniorswouldavoidthedonutholeinMedicarePartD.wouldavoidthedonutholeinMedicarePartD. 1,4701,470 familiesfamilies couldescapebankruptcyeachyearduetocouldescapebankruptcyeachyeardueto

unaffordablehealthcarecosts.unaffordablehealthcarecosts.

HealthcareproviderswouldreceivepaymentforHealthcareproviderswouldreceivepaymentfor$85million$85million ininuncompensated

care

each

year.uncompensated

care

each

year.

73,000uninsuredindividuals73,000uninsuredindividuals wouldgainaccesstohighwouldgainaccesstohighquality,quality,affordablehealthinsurance.affordablehealthinsurance.

hr 3200: health care reform, in short form

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