PRACTICING MEDICINE
ness;insurancemarketreformsincludingbenefitrestruc-turing, guaranteed issue and renewability and mandatedparticipation in exchanges; mandated state oversight;cost containment includes HIT adoption, increased fraud,waste and abuse detection, quality thresholds forproviders, prevention and wellness focus, and restruc-tured payments to Medicare Advantage plans.
COST:
N/A
PATIENTS’CHOICE ACT OF 2009(S. 1099 / H.R. 2520)
SPONSORS:
Sens. Tom Coburn, MD (R-OK) andRichard Burr (R-NC); Reps. Paul Ryan (R-WI) andDevin Nunes (R-CA)
DESCRIPTION:
Plan that supporters said aims todeliver on the “shared principles of shared principlesof promoting universal access to quality, affordablehealth care, and does so without adding billions ofdollars in new debt or taxes.”
HIGHLIGHTS:
Coverage remains voluntary; allows state-basedhealthinsuranceexchangeswithmandatedbenefitsmatching those enjoyed by Congress members, allowingstatestoautomaticallyenrollindividualsinlow-cost,high-deductible coverage and provide incentives to maintaincoverage; employer tax credit replaced with tax credit forindividualsandfamiliestoprovideincentivesforinsurancecoverage, and supplemental debit card for private healthinsurance costs to families at 200% FPL; integrate low-income families currently eligible for Medicaid into privateinsurance while keeping low-income disabled, children infoster care, cancer and some TB patients and other excep-tions on Medicaid; allow private facilities to compete withVA to care for veterans, and American Indians to accesscare outside Indian Health Services; tax code changes tobenefit those with low-cost, high-deductible plans includ-ing Health Savings Accounts; encourages adoption of HITthrough incentives to hospitals and providers and creationof personal health records and use of health record card;allow providers to form ACOs and receive Medicare bonus-es for improving quality; adopt competitive bidding forMedicareAdvantage;raisePartBandPartDpremiumsforMedicare beneficiaries making more than $170,000 peryear; enhance fraud and abuse efforts in Medicare; adoptmedicalmalpracticereformsincludingindependentpanelsto review and decide cases with court as a second resort;createHealthCareServicesCommissiontosetandenforcestandards for price and quality reporting; develop nationalstrategic prevention plan; lower premiums for Medicarepatients who adopt healthier behaviors.
COST:
Budget-neutral; funding to come from cost-con-tainment and savings through Medicaid changes andelimination of employer tax exclusions.
U.S.NATIONALHEALTHCAREACT(H.R.676)
SPONSOR:
Rep. John Conyers (D-MI)
DESCRIPTION:
Establishes a universal healthcare sys-tem utilizing public financing and non-profit delivery,similar to nationalized health systems in Canada andother industrialized countries.
HIGHLIGHTS:
Creates a national public health insuranceprogram(USHNC)forallU.S.residents,replacingemployercoverage and eliminating Medicare, Medicaid and CHIP –VAandIndianHealthCaretobephasedoutovertime;pro-vides comprehensive benefits including long-term care;individuals not required to pay premiums or cost-sharing;converts to a non-profit healthcare system utilizing onlypublic or not-for-profit institutions; provide global budgetsforhospitalswithmonthlylumpsumsforoperatingexpens-es and salaried staff, and negotiating annual reimburse-ment rates with physicians and other non-institutionalproviders on simplified fee structure or capitation pay-ments; private insurers may offer coverage for benefits notcovered by USHNC; establishes uniform electronic billingandpatientrecordsystems;privatephysicians,clinicsandother participating providers may not be investor-owned;participating providers to meet state quality and licensingguidelines;createsNationalBoardofUniversalQualityandAccess to oversee the system; establish universal stan-dardsofcareincludingstaffing,technology,scopeofwork,bestpracticesandsalarylevels;createUSHNCEmploymentTransition Fund to assist those who lose jobs in the transi-tion to the new system; raises income tax for top five-per-cent of earners, and imposes payroll tax and stock andbond transaction taxes to help fund the program.
COST:
Budget-neutral; savings to come from redirectionof current healthcare dollars, tax increases and new tax.
NATIONALHEALTH INSURANCE ACT(H.R. 15)
SPONSOR:
Rep. John Dingell (D-MI)
DESCRIPTION:
Also known as “expanded andimproved Medicare for all,” the proposal is anothersingle-payer healthcare system that would allowpatients to choose their doctors and hospitals.
HIGHLIGHTS:
Creates a national health insurance pro-gram (NHIP) for eligible individuals with no payment ofpremiums; requires states to administer as well as pro-vide care for those not meeting eligibility requirements;coverage is comprehensive, except for long-term care;Medicare continues but may be phased out, new pro-gram covers services Medicare does not; required studyof cost-control mechanisms, including impact of med-ical malpractice and liability claims; administratorsrequired to promote quality and health system perform-ance between providers, public health centers and edu-cational and research institutions; disease, disabilityand premature death prevention and wellness empha-sized; grants for training benefit administrators.
COST:
Financed through 5% value-added tax on cer-tain transactions.
EMPOWERING PATIENTS FIRST ACT(H.R. 3400)
SPONSOR:
Rep. Tom Price (R-GA)
DESCRIPTION:
Plan that emphasizes patient controland choice through tax incentives for insurance pur-chasing, encouraging states to assist consumers withpre-existing conditions, and promoting the employer-based insurance system.
HIGHLIGHTS:
No requirement for coverage; allows incometax deduction of premiums for individual insurance plans;refundable tax credits for individuals and families below300% FPL to buy insurance on the individual market;establishes Association Health Plans and IndividualMembership Associations offering insurance; state high-risk pools or reinsurance to cover people with pre-existinghealth conditions; states required to provide coverage for90% of children in families at below 200% FPL as a con-dition for expanding child eligibility to 300% FPL; requirestates to provide premium assistance for Medicaid andCHIP enrollees with access to employer-sponsored insur-ance,andvoucherstoMedicaid-andCHIP-eligiblesforpur-chasing private insurance; allows employers to automati-callyenrollindividualsinthelowest-costgrouphealthplanas long as they can opt out, offer defined contributions forworkerswhopurchasetheirowncoverageontheindividualmarket, and requires them to disclose to employees thetotal amount spent on employee’s health insurance premi-um; small employers get a temporary tax credit to adoptauto-enrollment and contribute to employee private insur-ancecoverage;allowphysicianstodeductcostsofuncom-pensated care required under EMTALA; private insurersallowed to sell across state lines, required to disclose truehealthinsuranceplancoststoemployers;adoptionofmed-ical malpractice reforms and create state health care tri-bunals to review and decide cases, with court as secondoption; reduce Medicaid and Medicare DisproportionateHospital Share (DSH) funds if national uninsured ratedecreases; enhance fraud and abuse efforts in Medicareand Medicaid; reinstate the Medicare Trigger to containcosts; prohibit comparative effectiveness research frombeing used to deny coverage; create a process to developperformance-based quality measures for physician servic-es under Medicare; create a health plan and provider por-tal website to provide standardized information on insur-anceplans,providerpriceandqualitydata;allowpremiumdiscounts/rebatesforindividualswhoadheretohealthpro-motion and disease prevention programs and employercost-sharing based on participation in wellness plans;establish student loan fund for non-profit or osteopathicmedicalschools;upto$50,000loanforgivenessforprimarycare providers serving 3-5 years in medically underservedareas; reform the Medicare SGR rate.
COST:
Funding from cost savings in liability reform,DSH payment reductions, non-defense spending capsand waste, fraud and abuse efforts.
AMERICAN HEALTH SECURITY ACTOF 2009 (S. 703)
SPONSOR:
Sen. Bernie Sanders (I-VT)
DESCRIPTION:
A single-payer healthcare plan provid-ing state-administered coverage to all Americans andlawful residents.
HIGHLIGHTS:
Creates a state-based public health insur-ance program for all U.S. residents, with no premium pay-mentorcost-sharing,replacesemployercoverageandelim-inates Medicare, Medicaid and CHIP, with VA and IndianHealth Service programs remaining independent; compre-hensive coverage to include long-term care with some
34TENNESSEE MEDICINE /
SEPTEMBER 2009
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