On Monday, Sen. Joe Lieberman (I-CT) warned warned the House and Senate conference committee against significantly altering the compromises in the Senate bill. “This bill as it appears it will emerge from the Senate is delicately balanced,” he said. Sens. Kent Conrad (D-ND) and Max Baucus (D-MT) expressed similar concerns, arguing that to attract the 60 votes to cut off debate in the Senate, the final legislation would “have to be very close to the bill that has been negotiated here. Otherwise you will not get 60 votes in the United States Senate.”
Indeed, while the conferees are unlikely to adopt the House’s public option provisions or loosen the abortion compromise, the conference can strengthen the final legislation by adopting certain provisions from the House health care bill. These changes would improve the regulation of private insurers and provide Americans more affordable coverage and more coverage choices in the period between enactment and full implementation. Some proposals require no new expenditures of funds:
|House Bill ($894 billion/10 years)||Senate Bill ($871 billion/10 years)||Recommendation|
|1. Making Insurance More Affordable||- Expands Medicaid to 150% Federal Poverty Line.
– Offers subsidies to Americans between 150 – 400% FPL on sliding scale; spend 1.5%-12% of income on premiums. Cost-sharing credits are available to individuals and families with incomes up to 400% FPL
|- Expands Medicaid to 133% Federal Poverty Line.
– Offers subsidies to Americans between 133 – 400% FPL on sliding scale; spend 2.8%-9.8% of income on premiums. Cost sharing is only available for individuals and families with incomes between 100-200% FPL.
|Conference report could adopt the House’s Medicaid expansion and use the savings to reduce premium payments and out-of-pocket spending for individuals with incomes between 150% and 200% FPL. The Conferees can also adopt the Senate’s subsidy levels for individuals and families above 250% FPL.|
|2. Greater Oversight Of Insurers||Creates a national exchange but permits states to establish state-based exchanges if they meet national standards and demonstrate the capacity to administer an exchange.||Creates state-based exchanges.||A national exchange would allow the federal government to implement the law uniformly and relieve the states from taking-on additional regulatory functions. Conferees should also consider moving up the implementation year to 2013.|
|3. More Funding For Prevention||Includes $34 billion over 5 years in public health investment, including $15.4 billion for a Prevention and Wellness Trust Fund.||Includes $15 billion over 10 years in public health investment 10 years.||Conference should retain a Prevention and Wellness Trust with a dedicated funding stream that will increase the use of effective preventive services.|
|4. Increase Primary Care Payments To Medicaid Providers||Increases primary care payment rates to Medicare rates.||Does not include this provision||Conferees should increase payments to Medicaid providers to ensure that the expanded population can access a broad network of providers.|
|5. Financing||5.4% surtax on individuals earning more than $500,000, couples earning more than $1 million; Medicare savings.||Excise tax, increases the payroll tax on individuals who earn more than $200,000 and families earning more than $250,000 a year, taxes on insurers, pharmaceuticals, and medical devices, tax on tanning booths; Medicare savings; Medicare Commission||The Conference report should add a piece of the House’s surtax or increase other taxes on higher-income Americans and increase the threshold on the excise tax.|
|6. Employer Responsibility||Large employers who don’t offer coverage would pay a fee equal to 8% of their payroll. This raises $135B/10 yrs.||Large employers who don’t offer coverage would pay a penalty of $750 per full-time employee if any worker receives a subsidy in the exchange. This raises $28 billion/10 yrs.||To prevent employers from dropping coverage, the conferees — rather than adopting the Senate’s policy — should increase the financial obligation of employers and apply it across full and part-time workers.|
|7. Filling The Doughnut Hole||Completely closes the Medicare Part D ‘doughnut hole’ by 2019.||Does not fully close the Medicare Part D ‘doughnut hole.’||The conferees should completely close the doughnut hole using extra dollars from pharmaceutical industry.|
|8. Protecting Older Americans From Higher Premiums||Allows rating variation between 2:1.||Allows rating variation between 3:1.||The House’s rating would make coverage more affordable for older Americans.|
|9. LGBT Equality||Expands pre-tax employer-provided health insurance benefits to heterosexual and same-sex domestic partners||Does not include this provision||Employees with partner health benefits now pay on average $1,069 per year more in taxes than would a married employee with the same coverage. The conference report should make coverage more affordable and equitable by adopting tax equality.|
|10. Retain COBRA Continuation Until Exchanges Are Established||Individuals eligible for COBRA continuation coverage my retain COBRA coverage until the Exchange is established.||No such provision exists.||The House language would ensure greater continuity in care and give Americans the choice of staying on COBRA until they have more affordable choices.|
|11. Tighter Regulations Of High-Risk Pools||Premiums for high risk-pools will be set at no higher than 125% of the prevailing rate for comparable coverage, rates could vary no more than 2:1 due to age. Annual deductibles will be limited to $1,500 for an individual and maximum cost sharing will be limited to $5,000 for individuals.||Premiums could vary no more than 4:1 due to age. Maximum cost sharing will be limited to $5,950 for individuals.||The House language would provide Americans who can’t find coverage in the individual market with more affordable interim coverage.|