Health Care Reform
We have watched the current health care system in our country become increasingly dysfunctional. It has grown into a system pockmarked with inequities, overutilization and uncertainty. It is a system that doesn’t benefit from the cost savings that could be realized from a risk pool that includes every American. Today, the system is made up of wildly different programs, costs, and outcomes across our country.
In fact the American health care system has become our country’s biggest domestic crisis.
When I first entered politics as a Washington state legislator, I was committed to all I could do to bring about a national health care system that would provide coverage for everyone. It was during my campaign for Governor in 1972 that I gave my first speech declaring my support for a single-payer health care system. I worked in the legislature for a universal health care system for Washington State hoping that it could be replicated across the country, eventually creating a national system much in the same way that the Canadian system was first developed.
I still believe that a single-payer model is the ideal solution, the most effective way to achieve both cost control and universal coverage. There can be no question that America’s employer-based system is failing.
This year, rather than establishing a single-payer system, Congress has designed a less desirable model that would more tightly regulate private insurance companies, much in the same way that we do with utility companies. I know that the current bill is far from perfect and will require continued efforts to adjust and improve it in the years to come. We should celebrate the passage of the current health care reform bill as a first step in a long journey to develop the functional, universal health care system that the people in our country deserve.
Containing Health Care Costs
One of the encouraging components of the current health care reform bill is the establishment of insurance exchanges at the state level as part of the American health care system.
The purpose of an exchange is to pool as many people together as possible to help leverage the most affordable options. A national insurance exchange would have given the federal government enormous bargaining power with the insurance industry to ensure lower premium costs for consumers.
Facts About The Patient Protection and Affordable Care Act
The new Health Care Reform Act will provide thirty-one million Americans with health care coverage they currently do not have. All Americans will see immediate benefits from the new legislation. Factual information about the new landmark legislation:
- • Small Business Tax Credits
Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. Effective beginning for calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)
- • Begins to Close the Medicare Part D Donut Hole
Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand‐name drugs in the donut hole; also completely closes the donut hole by 2020.)
- • Free Preventive Care Under Medicare
Eliminates co‐payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.
- • Help For Early Retirees
Creates a temporary re‐insurance program (until the Exchanges are available) to help offset the costs of expensive premiums for employers and retirees for health benefits for retirees age 55‐64. Effective 90 days after enactment.
- • Ends Rescission
Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.
- • No Discrimination for Children with Pre-existing Conditions
Prohibits new health plans in all markets plus grandfathered group health plans from denying coverage to children with pre‐existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)
- • Bans Lifetime Limits on Coverage
Prohibits health insurance companies from placing lifetime caps on coverage. Effective 6 months after enactment.
- • Bans Restrictive Annual Limits on Coverage
Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all new plans and grandfathered group health plans.)
- • Free Preventive Care Under New Private Plans
Requires new private plans to cover preventive services with no co‐payments and with preventive services being exempt from deductibles. Effective 6 months after enactment.
- • New Independent Appeals Process
Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective 6 months after enactment.
- • Ensuring Value for Premium Payments
Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
- • Immediate Help for the Uninsured Until Exchange is Available (Interim High-Risk Pool)
Provides immediate access to affordable insurance for Americans who are uninsured because of a pre‐existing condition ‐ through a temporary subsidized high‐risk pool. Effective 90 days after enactment.
- • Extends Coverage for Young People up to 26th Birthday Through Parents' Insurance
Tightly restricts the use of annual limits to ensure access to needed care in all new plans and grandfathered group health plans. These tight restrictions will be defined by HHS. Effective 6 months after enactment.
- • Community Health Centers
Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2010.
- • Increasing Number of Primary Care Doctors
Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals. Effective beginning in fiscal year 2010.
- • Prohibiting Discrimination Based on Salary
Prohibits group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.
- • Health Insurance Consumer Information
Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in FY 2010.
- • Creates new, voluntary, public Long-Term Care Insurance Program
Creates a long‐term care insurance program to be financed by voluntary payroll deductions to provide home and community-based services to adults who become functionally disabled. Effective on January 1, 2011.