The discussion draft of the House bill that is circulating on Capitol Hill does not offer specifics on cost or how to finance reforms, but it does offer subsidies for families that go beyond what has proven to be politically palatable in the past. Like the Senate plans, the discussion draft calls for a health insurance exchange (HIE), but unlike the latest Senate Finance Committee draft, calls for a public option in the HIE. The draft states that such a public option will be "financed only by premiums," although the document also mentions "affordability credits" that start at 133% of the federal poverty level and caps out at 400%, which the draft says would be an income of $88,000 for a family of four.
The House bill, as currently envisioned, would also prohibit insurers from barring coverage of pre-existing conditions as well as annual and lifetime caps on benefits. The discussion draft notes that the bill will allow premiums to vary only by "age, geography and family size."
The discussion draft also lists a set of "essential benefits" that are mandatory for any package offered through the HIE, including prevention services with no co-pay, mental health services, and dental and vision coverage for children. The draft also states that individuals who decline to take coverage will be penalized by 2% of gross income beyond an as-yet unspecified income level and that employers who do not provide an in-house plan will have to contribute to the HIE at a rate of 8% of payroll. However, some small businesses may be exempted from this requirement.
The House bill also would expand community health centers and provide for more federal investment in primary care physicians. As for constraining costs, the bill's authors promise to craft "new payment incentives [that] will encourage a decrease in preventable hospital admissions" with a centerpiece of "a complete reform of the flawed physician payment mechanism" under Part B, the sustainable growth rate (SGR) mechanism. The proposed physician payment update will, the authors assert, provide an update "that wipes away the accumulated deficits [under SGR], provides for a fresh start and rewards primary care services, care coordination and efficiency."
As for Medicare fraud, the bill proposes to allow the Centers for Medicare & Medicaid Services to screen providers and suppliers prior to allowing them to bill for Medicare work and "permits designation of certain areas as being at elevated risk of fraud," to allow anti-fraud efforts.
— Mark McCarty, Washington Editor