WHAT WILL NATIONAL HEALTH REFORM MEAN?

Below is a link to a fairly clear summary of the health care plan passed in the House over the weekend. Additionally, I've posted articles from the US Psychiatric Rehabilitation Association (USPRA) and from the Justice for All Action Network.

As my mother has said, to the average person these reform measures can seem rather confusing. But as you'll see from reading the article, policy wonks, including Andrew Emperato of the American Association of People with Disabilities seems pleased, as do others. His organization crosses many disability areas, including persons having mental health related disabilities and cognitive/developmental disabilities.

I admit that I myself stay so focused on trying to focus on local and state-level accountability that I have had to choose not to focus so much on the federal. I guess I feel that all politics is local, anyway--in otherwords, most all people in Washington start out at very local then state level government. If we do not help THESE officials understand our issues in very meaningful ways, how will they understand our concerns as they climb the legislative or other ladders. (Our hope, for instance, is that Senator Kay Hagan learned a bit from what did or did not work with NC's mental health reform).

But now it is time to come to terms with what is coming from Washington, as it will impact our services at the state and local levels. It is not too late to talk with our Senators and maybe even some in the House of Representatives who will continue to have to address health care--ALL of health care.
________________

PROVISIONS OF THE HOUSE HEALTH CARE BILL
CQ TODAY ONLINE NEWS – HEALTH Nov. 7, 2009

The House voted, 220-215, for Democratic legislation (HR 3962) to remake the nation’s health care system and extend insurance coverage to millions of Americans. The House opened the historic debate with consideration of a manager’s amendment drafted by Democratic leaders as part of a rule (H Res 903) governing floor debate that was adopted 242-192. Here are the key features of the bill being sent to the floor:

COVERAGE REQUIREMENTS
Individual Mandate
• Requires nearly all individuals to obtain health care coverage beginning in 2013.
• Permits individuals to keep their current health plan as a “grandfathered” plan.
• Excludes from the mandate those exempt from filing income tax returns and others who receive a hardship waiver.
• Subjects those who do not obtain coverage to a penalty tax of 2.5 percent of adjusted gross income above a threshold.
Employer Mandate
• Requires employers to offer their employees health care insurance, or make an insurance contribution on their behalf, starting in 2013.
• Exempts firms with payrolls of $500,000 or less.
• Subjects businesses that fail to provide coverage to penalties of up to 8 percent of their payroll.

PURCHASE OF COVERAGE
Health Insurance Exchange
• Creates a federal exchange, to begin operation in 2013, that would allow individuals and small businesses to purchase health insurance from insurers participating in the exchange.
• Allows states to apply to operate their own state-based health insurance exchanges.
Public Option
• Requires the establishment of a public health insurance option within the insurance exchange by 2013.
• Directs the Health and Human Services Department to run the public option and negotiate with providers to determine rates.
• Requires those rates to be no lower than those under Medicare and no higher than the average for private plans.
Additional Options
• Authorizes loans to entities that want to create health insurance cooperatives.
• Permits states to enter into compacts that allow for the sale of insurance across state lines.

AFFORDABILITY
Individual Subsidies
• Provides affordability credits to individuals and families with incomes of up to 400 percent of the federal poverty level.
• Requires that subsidies would be used to reduce premiums and out-of-pocket costs.
Small Businesses
• Provides tax credits for certain small businesses that offer health insurance to their employees.

REQUIREMENTS FOR INSURANCE COMPANIES
Pre-Existing Conditions
• Bars insurance companies from denying or reducing coverage based on pre-existing medical conditions, beginning in 2013.
• Restricts how long insurers can continue to limit coverage for pre-existing conditions until the full ban takes effect.
• Prohibits companies from considering domestic violence a pre-existing condition.
Coverage Caps
• Prohibits annual or lifetime coverage limits.
Premiums
• Limits variations on premiums based on the age of the beneficiary to a ratio of 2-to-1.
• Permits variations on premiums based on geography and family size.
Out-of-Pocket Expenses
• Limits annual out-of-pocket expenses to $5,000 for an individual and $10,000 for a family.
• Guarantees no out-of-pocket costs for preventive care.
Essential Benefits Package
• Requires all qualified health benefits plans to provide coverage that meets or exceeds the standards of an “essential benefits package.”
• Requires an essential benefits package to, at a minimum, cover hospitalization, outpatient hospital and clinic services, professional services of physicians and other health professionals, prescription drugs, rehabilitative services; mental health and substance use disorder services; preventive services, maternity care, well-baby and well-child care, and medical equipment.
• Establishes a Health Benefits Advisory Committee, chaired by the surgeon general, to make recommendations to HHS regarding the details of covered health benefits included in the essential benefits plan.
Antitrust
• Repeals the blanket antitrust exemption for health insurers.

MEDICARE AND MEDICAID
Medicaid Expansion
• Expands eligibility for Medicaid by allowing enrollment for those making up to 150 percent of the poverty level, beginning in 2013.
• Beginning in 2015, states would pay 9 percent of costs associated with the expanded coverage.
• Requires Medicaid to cover newborns during the first 60 days of life.
Prescription Drug Coverage
• Phases out the coverage gap, or “doughnut hole,” for the Medicare prescription drug program by 2019.
• Pays for the cost of eliminating the coverage gap by requiring drug manufacturers to provide rebates.
Medicare Advantage
• Reduces payments under the Medicare Advantage program over a three-year period beginning in 2011.
• Makes the rates for Medicare Advantage the same as those for traditional fee-for-service Medicare by 2014.
• Provides bonus payments to insurance plans in the program that offer high-quality insurance plans in low-cost areas.
CHIP
• Transfers children eligible for coverage under the Children’s Health Insurance Program to either Medicaid or the health insurance exchange in 2014.

REVENUE PROVISIONS
Health Care ‘Surcharge’
• Imposes a tax surcharge of 5.4 percent on adjusted gross income exceeding $500,000 for an individual or $1 million for a joint return.
• Does not index the surcharge for inflation, meaning it would apply to more taxayers as inflation affects income levels.
• Raises an estimated $460.5 billion through FY2019.
Excise Tax
• Imposes a 2.5 percent excise tax on the sale or lease of medical devices.
• Raises an estimated $20 billion over 10 years.
Health Savings Accounts
• Limits contributions to health flexible savings accounts to $2,500 per year, indexed to inflation. Increases the penalty for non-health related distributions for health savings accounts.
• Raises an estimated $14.6 billion over 10 years.
Reporting Requirements
• Requires payments to corporations to be reported.
• Raises an estimated $17 billion over 10 years.
Economic Substance Doctrine
• Codifies into law the judicial economic substance doctrine that governs questionable transactions made solely for tax purposes.
• Raises an estimated $5.7 billion over 10 years.
Tax Treaty Benefits
• Limits certain tax treaty benefits
• Raises an estimated $7.5 billion over 10 years.
Biofuel Tax Credit
• Limits eligibility for a tax credit for cellulosic biofuels to block paper producers from claiming the credit for making “black liquor,” a manufacturing by-product

HOT BUTTON ISSUES
Abortion
• Prohibits the use of federal funds to provide abortions, except in cases of rape, incest or danger to the mother’s life.
• Prohibits individuals who receive affordability credits from purchasing a plan that provides elective abortions. Individuals could purchase with their own funds plans that cover elective abortions.

Immigration
• Bars illegal immigrants from receiving federal subsidies to purchase health insurance.
• Does not explicitly bar illegal immigrants from participating in exchanges to purchase health insurance with their own money.

Medical Malpractice
• Provides incentive payments to states that enact new laws providing alternatives to traditional medical malpractice litigations, but not if the laws limit attorney fees or impose caps on damages.
• As modified, the bill stipulates that it would not pre-empt or modify the application of any existing state law that limits attorneys’ fees or caps damages, that it would not impair state authority to establish or implement such laws.

Source: CQ Today Online News
---------------

Disability Coalition Applauds Health Care Legislation That Expands Coverage For People With Disabilities

HEALTH CARE REFORM ONE OF 12 ITEMS ON COALITIONA AGENDA

(Washington D.C.) -- The Justice for All Action Network (JFAAN), a coalition of disability-led organizations and allies, applauds health care legislation passed by the U.S. House of Representatives. Passed Saturday in a House vote, the legislation increases the number of people with disabilities covered by health care and increases service options for people with disabilities.

Key points of the legislation supported by JFAAN include: expanding coverage to millions of people currently uninsured; a provision that makes it illegal for insurance companies to deny coverage based upon pre-existing conditions; and the inclusion of the CLASS ACT and the Community First Choice Option (CFC).

"People with disabilities have much at stake as health care reform gets one step closer to passage," said Andrew Imparato, President and CEO of the American Association of People with Disabilities. "A good barometer of the new system that emerges from health reform will be the extent to which it works well for people when they need it the most--whether people with disabilities and chronic health conditions can obtain acute care and long-term services and supports without incurring financial hardship or being forced into a nursing home or other institution."

Under the current system of health care, people with disabilities have no legal protection if they are denied coverage based upon their disability. “With this bill, people with disabilities who have been denied because of pre-existing conditions will have a legal right to coverage,” said Gary Arnold of Little People of America.

Additionally, the long-term care system currently denies the right of people with disabilities to receive services in the most integrated setting, a right recognized by the Americans with Disabilities Act (ADA) and the 1999 Olmstead Supreme Court Ruling. Thousands of people in the United States are forced into nursing homes because supports, like personal assistant services, can only be accessed in institutions. The Justice for All Action Network has advocated to include the CLASS Act and the CFC, which expand optional home and community services, in new healthcare legislation. “The House vote is a good first step as we approach the 20th Anniversary of the ADA. We challenge Congress to finalize a bill that recognizes the civil right of people with disabilities to access to services in their homes,” said Bruce Darling of ADAPT, a grassroots disability rights group.

Healthcare Reform is a key component of 12-point JFAAN Joint Campaign Agenda the coalition has developed that addresses major policy issues of people with intellectual, physical and psychiatric disabilities. Throughout the healthcare debate, JFAAN members have, through outreach, direct action, and negotiation, advocated for health care legislation that includes more long term care choices for people with disabilities.

Created in an effort to build a strong and unified cross-disability movement, the Justice for All Action Network is organized into a steering committee of 13 national consumer-led disability organizations and more than 20 organizational and individual members. The group was formed in the wake of the 2008 Presidential Election.

About the Justice for All Action Network

Mission: The Justice for All Action Network is a national cross-disability coalition, led by disability groups run by persons with disabilities with support from allies, committed to building a strong and unified cross-disability movement so that individuals with disabilities have the power to shape national policies, politics, media, and culture.

Working as a coalition, JFAAN is committed to accomplishing each item on the coalition’s agenda by July 2010, the 20th anniversary of the Americans with Disabilities Act.

Steering Committee Members: ADAPT, American Association of People with Disabilities, American Council of the Blind, Autistic Self Advocacy Network, Hearing Loss Association of America, Little People of America, National Association for the Deaf, National Coalition of Mental Health Consumer Survivor Organizations, National Council on Independent Living, National Federation of the Blind, Not Dead Yet, Self Advocates Becoming Empowered, United Spinal Association.

For more information, contact:

Andy Imparato, American Association of People with Disabilities, 202 521-4301, AImparato@aapd.com; Kelly Buckland, National Council on Independent Living, 202-207-0334, kelly@ncil.org.

__________________________

USPRA PRAISES HOUSE PASSAGE OF THE AFFORDABLE HEALTH CARE FOR AMERICA ACT

Contact:
Jane Porter, Director of Government Relations & Public Affairs
410-789-7054 ext. 105
jporter@uspra.org

Linthicum, MD - November 9, 2009 - USPRA applauds House passage of the Affordable Health Care for America Act (H.R. 3962), landmark legislation that expands health care coverage to 96% of Americans, and improves access to mental health and substance abuse treatment services.

On Oct. 29, House Speaker Nancy Pelosi (D-CA) and House Democratic leaders unveiled their much-anticipated H.R. 3962—the final, reconciled version of a bill that was amended by three different House Committees over the summer. On Saturday, Nov. 7, this historic legislation was passed by the House of Representatives with a vote of 220 to 215.

In summary, H.R. 3962 would require all individuals to have insurance, establish a new health insurance exchange, require most employers to provide insurance, and ban insurance companies from denying coverage because of pre-existing conditions. Moreover, this legislation serves as one, groundbreaking step towards removing the barriers which prevent individuals with mental illnesses from entering the workforce.

USPRA is proud that the final version of this legislation includes numerous provisions we have long advocated. In particular, USPRA is pleased that H.R. 3962:

* Addresses the inclusion of rehabilitative services as a component of the essential benefit package that all qualified plans must provide;
* Expands the Wellstone Domenici parity law to all qualified health plans;
* Establishes a nationwide Medicaid eligibility floor of 150 percent of the Federal Poverty Level for children, pregnant women, and adults, which helps to expand benefits to millions of Americans who are currently uninsured and in low-paying positions;
* Includes the new grant program for substance use disorder and mental health workforce development. $60 million is authorized for each year from FY2011 through FY2015.

According to Congressional Budget Office (CBO) estimates, the bill would cost $894 billion over the next 10 years. But as a result of the tax provisions and spending reductions in the bill, it would actually reduce the national deficit by $104 billion.

USPRA believes that the Affordable Health Care of America Act lays the necessary groundwork to ensure individuals with mental illnesses can exercise their rights of citizenship as members of the community and of society at large. USPRA commends the House for their leadership, vision and ongoing efforts to ensure that mental health remains a priority.

What’s next? While the passage of this legislation is likely to energize the Majority’s health care reform effort, the debate may continue into January. The Senate continues to wait on a score of the merged Finance/HELP bill from the CBO. Once the score is completed, the Senate will take up the legislation; debate on the Senate floor is expected to last at least two weeks. After the Senate passes its version of the health care reform bill, the House and Senate will need to reconcile the two bills. The merged legislation will then be sent to President’s desk for his signature.