House Unveils Near-Final Reform Package; Weekend Vote Likely
On Thursday, House Democrats unveiled a near-final version of their health reform package (HR 4872), kicking off a 72-hour review period before the Democratic leadership can call the legislation to a floor vote, the New York Times reports.
The measure combines elements of the Senate health reform bill (HR 3590) with the House's so-called "corrections" bill that would address the concerns of House Democrats with the Senate bill (Herszenhorn/Pear, New York Times, 3/18).
The House Rules Committee posted details of the package online after the Congressional Budget Office earlier in the day issued a cost-and-coverage estimate analysis, which found that the bill would cost $940 billion over 10 years and reduce the federal deficit by $138 billion over 10 years ("44," Washington Post, 3/18).
Below is a list of key proposals and changes included in the final package.
- Coverage mandate: Almost all U.S. residents would be required to obtain health insurance under a mandate rule that would take effect in 2014. The rule includes an exemption for low-income U.S. residents. Individuals whose incomes qualify them to pay taxes must obtain insurance coverage or pay a $325 fine or 2% of their income, whichever is higher, beginning in 2015.
- Dependents: Adult children would be permitted to remain on their parents' health plans up to age 26.
- 'Doughnut hole': The coverage gap in the Medicare prescription drug program would be fully closed. Starting this year, eligible seniors would get a $250 rebate to help cover the cost of their medications. Beginning in 2011, seniors would receive a 50% discount on brand-name medications, the cost of which would be covered by drugmakers. In subsequent years, the discount would expand to cover generic drugs, the cost of which would be covered by the federal government. The discounts are expected to top out at 75% by 2020.
- Insurance industry: New consumer safeguards, scheduled to take effect in 2014, would ban insurers from denying coverage to people with pre-existing medical conditions. Insurers also would be prohibited from setting lifetime dollar limits on health policies.
- Insurance exchange: In place of a public option, state-based insurance exchanges would be established for individuals who do not have access to employer-sponsored coverage. More generous federal subsidies would be offered to individuals whose incomes are between 133% and 400% of the federal poverty level. The subsidies would become less generous in 2019, more in line with those proposed in the Senate bill.
- Medicaid: The so-called "Cornhusker Kickback," under which the federal government would have covered the full cost of a proposed Medicaid expansion in Nebraska, would be eliminated. Instead, the government would provide full matching rates to all states for newly eligible Medicaid recipients for three years. From 2014 through 2016, people with incomes up to 133% of the federal poverty level would be eligible for Medicaid coverage.
- Medicare: Federal payments to Medicare Advantage would be reduced by $132 billion over 10 years, compared with $118 billion over the same period in the Senate bill. As proposed in the Senate bill, a 15-member independent board would be established to make recommendations on ways to curb spending, but the panel would be expected to produce about one-half of the $23 billion in savings proposed in the Senate bill.
- Penalties: Businesses would not be required to provide coverage, but employers with 50 or more workers would be liable for a fine if at least one worker obtains government-subsidized coverage. The fine would be $2,000 for every worker beyond the first 30 employees.
- Taxes: The implementation of an excise tax on high-cost insurance policies -- costing $10,200 annually for individuals or $27,500 annually for families -- would be delayed until 2018. The corrections bill would raise the threshold from those proposed in the Senate bill. To make up for the lost revenue, the corrections bill would raise the Medicare payroll tax on "unearned income," such as investment income -- for individuals whose annual incomes are greater than $200,000 and married couples whose annual incomes are more than $250,000 -- by 0.9% to 3.8% (CQ Today, 3/18; AP/Washington Post, 3/18; Appleby/Carey, Kaiser Health News, 3/18).
The new Medicare payroll tax would generate $210 billion in revenue over 10 years, more than twice as much as the $87 billion under the Senate bill, according to the Congressional Joint Committee on Taxation.
Total revenue from the fees and taxes would amount to $438 billion over 10 years, up from $399 billion in the Senate bill (New York Times, 3/18).
House Rules Panel To Convene Saturday, Key Vote Likely Sunday
According to CongressDaily, a spokesperson for the House Rules Committee confirmed that the panel would convene Saturday for a meeting, during which members are likely to consider use of a special legislative maneuver known as the self-executing rule or "deem and pass" (Edney, CongressDaily, 3/19).
Majority Leader Steny Hoyer (D-Md.) has told House members to prepare to cast votes after 10 a.m. on Saturday and after 2 p.m. on Sunday, The Hill reports.
The deciding vote is expected on Sunday, to comply with lawmakers' requests for a 72-hour review period after the CBO score and bill were released (Allen/Young, The Hill, 3/18).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.