"[The GOP has] to understand that when they repeal health care, that senior citizens will pay more for prescription drugs, young people will lose their health care coverage, and once again, we'll have pre-existing conditions that keep women and children and others from getting access to health care when they need it.  And they're also going to have the problem that this health care bill, signed by President Obama, saves $100 billion in the first ten years and a trillion dollars in the second ten years.  So they're going to have to pay for those changes when they go back to their so-called common sense ideas.  The fact of the matter is this health care bill works."

“Not since the explosive years of the civil rights movement and the hard-fought debut of government-supported health care for the elderly and poor have so many big things -- love them or hate them -- been done so quickly.

“Gridlock? It may feel that way. But that's not the story of the 111th Congress -- not the story history will remember.”

"These state-based exchanges, a key foundation of the new healthcare law, are to become the central Internet-based marketplace for consumers who do not get health benefits at work.

"By 2019, about 24 million Americans are expected to shop for coverage on the exchanges, choosing among health plans offering a variety of benefits that meet basic government standards."

"Gov. Arnold Schwarzenegger made California the first state to create an insurance exchange under new federal health care reform as he ended the bill signing period Thursday by also approving bills addressing topics ranging from kindergarten to foster care."
...

"The state's landmark health care legislation sets up an oversight board for an insurance exchange that will let consumers comparison-shop for coverage. Other bills in the package bar insurers from denying coverage to children because of a pre-existing condition and let young adults stay on their parents' health care plans until they turn 26."

“'California families and small businesses are being crushed by health costs and dwindling benefits,' said U.S. Rep. George Miller (D-CA), chair of the House Education and Labor Committee. 'The health exchange law signed by Gov. Schwarzenegger will ensure that insurance companies compete in an open and transparent marketplace, putting consumers in the driver’s seat, thereby driving down costs and making coverage more predictable.'"

“These critics seem to believe that any oversight of the insurance industry is too much, and that consumers would be better off in a system where they have few rights or protections.”

…

“The Affordable Care Act is bringing some basic fairness to our health insurance market. So when I learned that a handful of insurers around the country are blaming their significant rate increases on the new law—even though the facts show that the impact of the law on premiums is small, just 1% to 2% declining over time—I let them know that we'd be closely reviewing their rate hikes.

It’s understandable that some insurance companies and their allies don't welcome this change. They've made large profits from the status quo. And it's not surprising—though still disappointing—that House Republicans have recently pledged to repeal the Affordable Care Act and get rid of these new consumer protections.

“If critics really want to go back to the days when insurance companies ran wild with no accountability, they should have the courage to say so openly instead of hiding behind distracting attacks. In the meantime, we're going to keep standing up for American families and small business owners who deserve a system that works for them.”

“He highlighted some new reforms that take effect at the six-month mark Thursday, including new coverage for preventive care and young adults being able to stay on their parents' health care plans until age 26.

“‘I thank you from the bottom of my heart,’ one woman present, Norma Byrne of Vineland, N.J., told the president, explaining she was benefiting from the law's provisions that are closing the prescription drug coverage gap in Medicare.”

 “Violet can still see the doctor. Violet can still be in the hospital for two weeks if she needs to for them to stop her seizures. Violet is going to be ok because of this.”

“For 23-year-old Gino Romiti, Thursday will be a day to celebrate.

“Six months after passage of the federal health reform law, major provisions will kick in that supporters say will make it easier for Americans to get and keep health insurance, including young people like Romiti.

“Romiti has taken a semester off school and is working at a clothing store in Walnut Creek that does not provide health insurance. He has been on his father's policy, but would have soon lost that coverage because he is not a student.

“That will change beginning Thursday, however, when he and other young people can remain on their parents' policies up to age 26.”

Up until now, insurance companies had been able to retroactively cancel your policy when you became sick, if you or your employer had made an unintentional mistake on your paperwork.

Under the new law, health plans are now prohibited from rescinding coverage except in cases involving fraud or an intentional misrepresentation of facts. Due to pressure from Democrats in Congress and the Obama Administration, insurers agreed to begin implementing this protection early, this spring; so rescissions are now a thing of the past. This protection applies to all health plans.

"Approximately 10,700 people’s coverage, whose coverage is dropped each year because they get sick or make a technical mistake on their application, will be protected under the new law." (White House) 

Each year, thousands of children who were either born with or develop a costly medical condition are denied coverage by insurers. Research has shown that, compared to those with insurance, children who are uninsured are less likely to get critical preventive care including immunizations and well-baby checkups. That leaves them twice as likely to miss school and at much greater risk of hospitalization for avoidable conditions.

The new law prohibits insurance plans both from denying coverage and limiting benefits for children based on a pre-existing condition. This protection applies to all health plans, except “grandfathered” plans in the individual market. These protections will be extended to Americans of all ages starting in 2014.

"Up to 72,000 uninsured children are expected to gain coverage by banning insurers from refusing them coverage due to a pre-existing condition. Coverage for up to 90,000 children will no longer exclude benefits because of a pre-existing condition."  (White House) 

Young people are the most likely to be uninsured – with currently one in three young people having no health coverage. One reason is that young people are less likely to be offered coverage through their jobs.

Under the new law, insurance companies are required to allow young people up to their 26th birthday to remain on their parents’ insurance plan, at the parent’s choice. This provision applies to all health plans. (For employer plans, only those young people not eligible for their own employer coverage receive the benefit, until 2014.) Learn more about the young adults insurance policy. 

"Up to 2.4 million young adults, up to 1.8 million who are uninsured and nearly 600,000 who purchase coverage in the individual market, could gain coverage through their parents." (White House)

Millions of Americans who suffer from costly medical conditions are in danger of having their health insurance coverage vanish when the costs of their treatment hit lifetime limits. These limits can cause the loss of coverage at the very moment when patients need it most. Over 100 million Americans have coverage that imposes such lifetime limits. The new law prohibits the use of lifetime limits in all health plans.

"Up to 20,400 people who typically hit their lifetime limits on the dollar amount that can be spent on coverage, along with the nearly 102 million enrollees who have policies with lifetime limits, will no longer have to worry about hitting their benefits caps." (White House)

Even more aggressive than lifetime limits are annual dollar limits on what an insurance company will pay for health care. Annual limits are less common than lifetime limits – but 19% of individual market plans and 14% of small employer plans currently use them.

The new law phases out the use of annual limits over the next three years. For plan years beginning on September 23, 2010, the minimum level for the annual limit will be set at $750,000. This minimum is raised to $1.25 million in a year and $2 million in two years. In 2014, all annual limits are prohibited. The protection applies to all plans, except “grandfathered” plans in the individual market.

"By 2013, up to 3,500 people will gain coverage as a result of the ban on annual limits that insurers impose on nearly 18 million people today." (White House)

Today, too many Americans do not get the high-quality preventive care they need to stay healthy, avoid or delay the onset of disease, and lead productive lives. Nationally, Americans use preventive services at about half the recommended rate.

Under the new law, insurance companies must cover recommended preventive services, including mammograms, colonoscopies, immunizations, and pre-natal and new baby care, without charging deductibles, co-payments or co-insurance. Learn more about preventive care benefits.

"Up to 88 million people will have access to preventive care with no out of pocket costs." (White House)

Today, if your health plan tells you it won’t cover a treatment your doctor recommends, or it refuses to pay the bill for your child’s last trip to the emergency room, you may not know where to turn. Most plans have a process that lets you appeal the decision within the plan through an “internal appeal” – but there’s no guarantee that the process will be swift and objective. Moreover, if you lose your internal appeal, you may not be able to ask for an “external appeal” to an independent reviewer.

The new law guarantees the right to an “internal appeal.” Also, insurance companies will be prohibited from denying coverage for needed care without a chance to appeal to an independent third party. Learn more about appealing health plan decisions.

"Up to 88 million people will benefit from the new appeals process provisions by 2013." (White House)

Being able to choose and keep your doctor is highly valued by Americans. Yet, insurance companies don’t always make it easy to see the provider you choose. One survey found that three-fourths of the OB-GYNs reported that patients needed to return to their primary care physicians for permission to get follow-up care.

The new law: 1) guarantees you get to choose your primary care doctor; 2) allows you to choose a pediatrician as your child’s primary care doctor; and 3) gives women the right to see an OB-GYN without having to obtain a referral first.

"Up to 88 million people will benefit from the provision that protects primary care provider choice by 2013." (White House)

Many insurers charge unreasonably high cost-sharing for emergency care by an out-of-network provider. This can mean financial hardship if you get sick or injured when you are away from home.

The new law makes emergency services more accessible to consumers. Health plans will not be able to charge higher cost-sharing for emergency services that are obtained out of a plan’s network.

"Up to 88 million people will benefit from this provision." (White House)

“Healthcare providers would be subject to new screening measures based on their level of risk to federal health programs, under new proposed regulations released by the Centers for Medicare and Medicaid Services. The fraud, waste and abuse prevention measures were called for in the new healthcare reform law.

“The screening measures include database and licensure checks, unscheduled or unannounced site visits, even criminal background checks and fingerprinting for the highest-risk providers and suppliers to Medicare, Medicaid and the Children's Health Insurance Program. The proposed rule, which will be open for comment for 60 days, also establishes the criteria for six-month enrollment moratoriums to combat fraud and on payment suspensions during pending fraud investigations.”

…

“Improper payments cost federal health programs about $55 billion a year. The White House piggy-backed off the announcement to make the case that defunding healthcare reform, as some Republicans in Congress are advocating, would increase fraud.”

“But if some opponents of health reform in Congress get their way, these common sense rules will be stopped dead in their tracks.

“Opponents are threatening to defund the Affordable Care Act, which would effectively handicap implementation and enforcement of these new rules that would help crack down on criminals and protect seniors.

“This is just one example of the consequences of defunding the Affordable Care Act and one of the many reasons why we can’t afford to roll back the new law. If opponents of reform get their way, new anti-fraud policies aren’t the only provisions that will be prevented from moving forward.”

“The reasons for the rise to 50.7 million, or 16.7%, from 46.3 million uninsured, or 15.4%, were many: workers losing their jobs in the recession, companies dropping employee health insurance benefits, families going without coverage to cut costs. Driving much of the increase, however, was the rising cost of medical care; a Kaiser Family Foundation report shows workers now pay 47% more than they did in 2005 for family health coverage, while employers pay 20% more.”

“Among the new provisions of the health law that take effect later this month is a ban on something most people don't even know they have — a lifetime limit on benefits covered by their health insurance.

“Starting late next week, new health plans or plans that are renewed, won't be able to cap the dollar amount of benefits they cover. No more yearly caps either, though those limits will be phased out over three years, disappearing entirely in 2014.

“The change apply even to health plans that don't have to abide by some new rules because they were ‘grandfathered’ under the health law.”
…

“Until now, many people with expensive chronic conditions simply considered it their lot in life to have to change jobs every couple of years in order to maintain coverage.

“Take Edward Burke, of Palm Harbor, Florida. Burke, who has hemophilia, and has ‘capped out,’ as those with chronic conditions call it, twice in the past seven years. ‘I would have capped out four or five times,’ he says, but for the fact that the industry he works in, home health care, had been going through a series of mergers and acquisitions. So every time his company was bought and changed names, he was lucky enough to start with new health insurance — and a new lifetime limit.

“Burke estimates he spends about $900,000 per year on factor VIII, which replaces a clotting factor he lacks. That makes chewing through a lifetime limit of even several million dollars a matter of when, not if.”

“For many years, Ric and Jill Lathrop held their breath when the annual open enrollment period for their health insurance plan rolled around. Their two boys, now 12 and 14, have severe hemophilia, and each needs twice-weekly injections of a blood clotting replacement factor that costs roughly $250,000 per person per year. The couple lived in fear that their health plan would put a lifetime limit on their benefits.

“In 2005, that's what happened. The Oshkosh, Wis., hospital where Ric Lathrop worked as an MRI technician instituted a $2 million lifetime cap on benefits for the entire family. Rather than wait for their benefits to run out, the Lathrop family relocated to Illinois, where Ric Lathrop got a job at a hospital in Peoria; along with the job came insurance without lifetime limits.

“If that coverage had changed, the Lathrops might have had to move again . . . and maybe again. But the federal health-care overhaul makes further wandering unnecessary. Starting Sept. 23, the new law requires that when health plans renew their coverage for the coming year, they eliminate lifetime limits on coverage.

"It gives us a lot of reassurance to know our kids can have more freedom," says Jill Lathrop.”

• Requiring plans to allow young people up to their 26th birthday to remain on their parents’ insurance policy.
• Banning all health plans from dropping people from coverage when they get sick.
• Providing immediate access to insurance for Americans who are uninsured because of a pre‐existing condition. —This program is already in effect.
  

The Affordable Care Act (ACA) will reduce health insurance costs for small businesses and increase coverage beginning this year, according to two reports released today.

Both a Commonwealth Fund report and an analysis by the RAND Corporation concluded that the new health reform law will help small business owners offer insurance because of tax credits and lower administrative costs of coverage available through a new insurance marketplace, the Exchange.

“The ACA will provide both immediate and long-term relief for millions of small businesses that have long struggled to provide health insurance to their workers and who are now coping with a severely weakened economy,” the Commonwealth Fund report concluded.

Small businesses often face difficulties in securing affordable coverage for their employees as the result of higher administrative costs and insufficient bargaining power as compared to larger companies. The RAND Corporation found that the new health reform law will increase the number of small businesses offering health insurance coverage “by aggregating employees of small firms into a single risk pool, exchanges will reduce year-to-year variance in premiums and may increase bargaining power and reduce administrative spending per enrollee.”

RAND estimates that that the percentage of workers receiving insurance through their job will increase from 84.6 percent to 94.6 percent once reform is fully implemented. The largest factor in this expansion is from more small businesses being able to offer coverage – rising from 60 percent to nearly 86 percent after reform.

According to the Commonwealth Fund, small businesses spend up to 18 percent more in premiums than larger firms do for the same insurance policy. In addition, when workers in small business have to shop for coverage themselves, nearly 70 percent of these workers give up because they found it difficult or impossible to navigate the individual market. More than 16 million employees work in small businesses will be eligible for a tax credit to provide health coverage over up to 2014 as the result of health reform law.

The Affordable Care Act provides specific benefits to assist small businesses and their workers to secure quality and affordable health insurance coverage. Beginning this year, many small businesses will be eligible for a tax credit for providing health coverage to their employees. When health reform comes into full effect in 2014, small businesses and their employees will be able to benefit from the creation of the health insurance exchange, a new marketplace that will help to drive down high administrative costs and end the worst insurance industry practices.

“In these tough economic times, it is difficult for employers to keep up with skyrocketing health care costs for employees and retirees. Many Americans who retire before they are eligible for Medicare see their life savings disappear because of medical bills and exorbitant rates in the individual health insurance market… The Affordable Care Act’s Early Retiree Reinsurance Program will make it a little easier for employers to provide high-quality health benefits to their retirees as we work to put in place market reforms to lower costs for all.”

"As I have often said, slowing the rate of health care cost growth is the single most important action we can take to reduce our long-term fiscal shortfall. The report confirms that the enactment and successful implementation of the Affordable Care Act is a key step toward a healthier fiscal future:

• First, CBO reiterates that the Affordable Care Act will reduce the deficit by more than $100 billion in the current decade and more than $1 trillion in the decade after that — which represents the most deficit reduction enacted since the 1990s.
• Second, the report demonstrates the importance of successfully implementing the Affordable Care Act.  The report includes a scenario in which a number of the Affordable Care Act’s cost-saving measures are curtailed by Congress at the end of this decade and, not surprisingly, not implementing the Act results in significantly higher deficits.  Historically, Congress has generally stood by its enacted health care savings — which is also what statutory Pay-As-You-Go requires and our fiscal trajectory demands.  Nonetheless, in showing the results of this backward step, the report highlights why the Affordable Care Act is such an important step forward."
  

The nonprofit foundation, which is separate from health insurer Kaiser Permanente, said recent premium hikes for individual coverage averaged 20%. Some customers were able to switch plans and pay less so people paying on their own actually wound up paying 13% more on average.

That hike tops last year's average 5% annual increase for employer-sponsored family coverage and almost unchanged premiums for employer-sponsored single coverage, though foundation Vice President Gary Claxton said the comparisons come with qualifications.

The Affordable Care Act will help address this problem and strengthen the health insurance system for everyone. The law starts by helping to prevent unreasonable premium increases by requiring insurance companies to publicly justify unreasonable increases. Companies will also have to spend more of your premium dollars on medical claims, not salaries and overhead. If insurance companies raise rates too high between now and 2014, they could be excluded from the new health insurance exchanges and lose access to millions of new customers. And we are encouraging states to crack down on premium hikes and providing states with $250 million in grants to do so.

Americans are already starting to see the benefits of health care reform. The new law requires health insurance companies — starting in September — to end their most indefensible practice: rescinding coverage after a policyholder gets sick. In recent days insurers and their trade association have rushed to announce that they will end rescissions immediately.

That is very good news for the thousands of people who each year pay their premiums but lose their coverage just when they are likely to run up big medical bills.

...

The insurers were wise to short-circuit the criticisms and end rescissions now. This follows a recent agreement by many companies to start letting dependents stay on their parents’ policies until age 26, which isn’t required until September. Under pressure from the White House, the industry has also agreed to cover children with pre-existing medical conditions as soon as new rules are issued.

Many of the other major provisions of reform don’t kick in until 2014, but it is already changing the behavior of insurers. That means more security for many Americans who might otherwise find insurance unaffordable or unavailable.

WellPoint Inc. said it would revise its request for steep rate hikes in California's individual market, after a state regulator said it found flaws in the company's application.

The proposed premium increases by the company's Anthem Blue Cross unit would have affected more than 700,000 consumers, who would have seen their rates go up by as much as 39%.

The new law also aims eventually to improve health insurance for everyone. By now you have probably read or heard about big changes like the rules that will require insurers to cover everyone who applies, regardless of health status, and forbid them from dropping people when they get sick.

You may not yet be aware, though, of another notable improvement to insurance, a change that could save a consumer or family hundreds of dollars a year. Under the new law, insurers must offer preventive services — like immunizations, cancer screenings and checkups — to consumers as part of the insurance policy, at no additional out-of-pocket charge.

The idea is that healthy Americans will be less costly Americans.

“This is transformative,” says Helen Darling, president of the National Business Group on Health, a nonprofit organization for large employers. “We’re moving from an insurance model that was based on treating illness and injury, to a model that’s focused on improving an individual’s health and identifying risk factors.”

The trend toward offering free preventive care has been gaining steam for a decade among large companies that provide employee health benefits. “Employers recognize that if they want to control costs, they have to persuade their workers to be healthier, including their children,” Ms. Darling said.

Three out of four large companies now offer free preventive health services to their workers, according to a 2009 survey by Mercer, a benefits consulting firm. Smaller employers, though, and individual health plans have been less likely to offer free care of any type.

President Barack Obama signed into law the last piece of his mammoth plan to overhaul health care Tuesday and, with the same pen strokes, achieved a far-reaching change in the way most Americas help pay the cost of a college education.

Both the health care provisions and revamping the loan program for college students were sandwiched into a single piece of legislation — the budget-reconciliation bill approved last week by the House and Senate.

President Obama signed important and welcome changes to the nation's campus loan program. The reforms should save the country billions and give more students a crack at a college degree.

Why it took so long is a minor scandal. Since the 1970s, federal money was doled out to banks to lend to students. In practice, though, the banks collected a healthy fee and fobbed off the bad loans to the government. It was a no-lose deal for these lenders.

But it endured, largely through fierce lobbying from lenders such as Sallie Mae. This year, the dam broke. The Senate and House voted to put Washington in charge of the loans, a shift estimated to save $68 billion over 10 years. That will allow loan limits to rise slightly, expand Pell Grants to defray tuition bills for needy students and invest $2 billion in community colleges.

But the changes didn't come easily, despite the sustained and gallant efforts of Rep. George Miller, D-Martinez.

Pelosi vigorously clapped back at the crowd as camera flashes popped. When Obama later singled Pelosi out, calling her "amazing," the crowd jumped to its feet again. (Rep. George Miller (D-Calif.) got a standing ovation, too).

Lots of Democrats can point to lots of different moments when they think the health care bill was brought back from the brink of collapse.

But for a number of senior House Democrats, the crucial turning point was a meeting the night of March 9 in the offices of Speaker Nancy Pelosi. It was supposed to be a strategy session with Senate Democratic leaders about the budget reconciliation procedure that Democrats were planning to use to make final changes to the health care bill and push them through the Senate on a simple majority vote.

Instead, the session focused entirely on the question of whether to include another of President Obama’s top legislative priorities — a sweeping overhaul of federal student loan programs — in the reconciliation package.

The budget resolution approved by Congress last spring provided for completing both major health care legislation and major education legislation through reconciliation, which adjusts federal policy to meet specific goals for reducing the deficit.

A trio of House leaders — Representatives James E. Clyburn, the Democratic whip; George Miller, the chairman of the Education and Labor Committee; and Xavier Becerra of California, the vice chairman of the Democratic caucus — argued strenuously in favor of including the education proposal.

...

Although overshadowed by the larger health care fight, the inclusion of the education bill may have been a decisive factor, especially at a time when House Democrats were exceedingly distrustful of their Senate colleagues and were essentially being forced against their better judgment to approve the Senate’s health care bill as the base law to which they would later make changes.

The student loan overhaul was very popular in the House. And because it would save tens of billions of taxpayer dollars by ending subsidies to private commercial banks, it offered a purely populist message at a time when public anger at Wall Street is running high and many liberals were disappointed that the health care bill would not include a public option, or government-run insurance plan.

Mr. Clyburn, who as the whip is the party’s main vote-counter, argued forcefully that the student loan measure would help generate support for the health care package.

...

For some Democrats, the student loan plan is the hidden triumph in the health care fight, and the late-night meeting earlier this month was the crucial moment. “It was an fascinating conversation about what the Democratic Party represented,” one Democrat said.

“Members of Congress have a clear choice,” Mr. Miller said in a floor speech on Sunday night. We can side with the American people by making health insurance and college more affordable and accessible, while creating millions of jobs and reducing the deficit. Or we can side with the insurance companies and the banks. That’s it. That’s the choice. I’m siding with the American people.”

If Congress makes the right call this week, students and taxpayers will win out.

In the coming days, the House and Senate will take a critical up or down vote on historic health insurance reforms. Tied to them will be the most significant reform of our federal student loan program in a generation. It will make federal aid more effective and cost-efficient for students, families, and taxpayers, without increasing the deficit.

Congress should support both measures.

Our bill is good for taxpayers. It would eliminate these needless subsidies and instead have the government initiate student loans, as it does today, and private banks service them. Consider that the government now funds 88 percent of all federal student loan volume. There's simply no reason to keep giving banks a handout.

Our bill is good for students. The federal government has already proved to be a more reliable lender for students in the midst of economic instability. All of the savings generated from switching to direct lending will go to help students pay for college and reduce our deficit.

Our bill is good for jobs. It would preserve private-sector jobs by allowing banks to compete for loan servicing contracts - and could even bring overseas jobs back home. Unlike loans made by banks, direct government loans must be serviced by U.S. workers.

If reform is defeated, it seems likely that most of the proposed experiments designed to cut costs — first within Medicare and then throughout the rest of the health care system — will die as well. The legislation needs to be passed to establish a structure to force continuing improvement over the years. That is the best chance of restraining soaring medical costs that threaten the solvency of families, businesses and the federal government.

Any change as big as this is bound to cause anxiety. Republicans have happily fanned those fears with talk of “dangerous experiments” on the “best health care system in the world.” The fact is that the health care system is broken for far too many Americans. And the country cannot afford the status quo.

• Provides financial credits to make premiums and cost sharing more affordable for those who today simply cannot afford coverage and care.
• Expands Medicaid to cover those with the lowest income.
• Eliminates job lock and support a more mobile economy and entrepreneurship by ensuring continuous access to comprehensive, affordable coverage regardless of where you work or live, and regardless of your age and health status.
• Enacts real insurance reforms that will allow more people access to insurance and force insurance companies to compete on cost and quality rather than their current strategy of cherry picking only the healthy and young.
• Establishes shared responsibility among individuals, employers and the government so that all contribute to and benefit from a new system that guarantees quality, affordable coverage for all.
  

• Creates a new health insurance marketplace, called an Exchange, that will allow consumers to choose a health insurance plan that best meets their needs.  Ensures everyone has a place to access health care, including when they lose a job, as they age, or get sick.
• Requires insurers to cover essential benefits, including prevention and well child care, so that people know insurance will cover the items and services they need.
• Protects and improves Medicare by filling fill the Republican Medicare prescription drug donut hole, so that seniors will no longer be forced to pay the full cost of their medications during the current coverage gap.  And it makes additional improvements to Medicare to encourage the efficient delivery of high quality, well-coordinated care, eliminate waste, fraud and abuse, and extend Medicare solvency by more than nine years.
  

• Focusing spending on the highest needs;
• Ensuring that the reforms contain substantial proposals to reform care delivery and winnow fat from the system, while expanding access and care coordination; that includes payments to reward high quality care in Medicare, while improving benefits;
• Limiting growth in health spending;  and
• Identifying appropriate revenues to finance the remaining costs.
  

• In the decade after 2019, CBO projects that health reform reduces the deficit by as much as one-half of one percent of the national economy.
• That means deficit reduction of up to one trillion dollars or more.

• The President's proposal will provide $5 billion in immediate federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions. This provision is effective 90 days after enactment, and coverage under this program will continue until new Exchanges are operational in 2014.

• The President's proposal makes an immediate and substantial investment in Community Health Centers to provide the funding needed to expand access to health care in communities where it is needed most. This $11 billion investment begins in 2010 and extends for five years.

• The President's proposal eliminates pre-existing condition exclusions for all Americans beginning in 2014, when the Exchanges are operational. Recognizing the special vulnerability of children, the plan prohibits health insurers from excluding coverage of pre-existing conditions for children, effective six months after enactment and applying to all new plans.

• The President's proposal will create immediate access to re-insurance for employer health plans providing coverage for early retirees, effective 90 days after enactment. This re-insurance will help protect coverage while reducing premiums for employers and retirees.

• The President's proposal begins to fill the “donut hole” by giving seniors a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010.

• The President's proposal will offer tax credits to small businesses beginning in 2010 to make employee coverage more affordable.
• Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage; later, when Exchanges are operational, tax credits will be up to 50 percent of premiums. The full credit will be available to firms with 10 or fewer employees with average annual wages of $25,000, while firms with up to 25 or fewer employees and average annual wages of up to $50,000 will also be eligible for the credit.
  

• The President's proposal will establish standards for insurance overhead and require public disclosure to ensure that enrollees get value for their premium dollars. The Managers’ Amendment tightened these standards, requiring plans in the individual and small group market to spend 80 percent of premium dollars on clinical services and quality activities, and 85 percent for plans in the large group market. Health insurance plans that do not meet these thresholds will provide rebates to their policyholders. This provision takes effect in 2011 and applies to all plans, including grandfathered plans, with the exception of self-insured plans.

• The President's proposal protects patients’ choice of doctors by allowing plan members to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before and woman sees an ob-gyn, and ensuring access to emergency care. This provision takes effect six months after enactment and applies to all new plans.

• The President's proposal will require insurers to permit children to stay on family policies until age 26. This provision takes effect six months after enactment and applies to all plans for young adults who are not offered qualified coverage elsewhere. 

• The President's proposal will require coverage of prevention and wellness benefits and exempt these benefits from deductibles and other cost-sharing requirements in public and private insurance coverage. This provision takes effect six months after enactment and applies to all new plans and all plans in 2018.
• Beginning on January 1, 2011, Medicare beneficiaries will receive a free, annual wellness visit and will have all cost-sharing waived for prevention services.
  

• The President's proposal will prohibit insurers from imposing lifetime limits on benefits. This provision takes effect six months after enactment and applies to all plans.

• The President's proposal will tightly restrict insurance companies’ use of annual limits to ensure access to needed care, effective six months after enactment for all new health plans. These tight restrictions will be defined by the Secretary of Health and Human Services. When the Exchanges are operational, the use of annual limits will be banned for all plans in 2014.

• The President's proposal will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact. This provision takes effect six months after enactment and applies to all plans.

• The President's proposal will prohibit group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. This provision takes effect six months after enactment and applies to all group health plans in 2014.

• The President's proposal will enable creation of a new website to provide information on and facilitate informed consumer choice of insurance options.

• The President's proposal will provide assistance to States in establishing offices of health insurance consumer assistance or health insurance ombudsman programs to assist individuals with the filing of complaints and appeals, enrollment in a health plan, and, eventually, to assist consumers with resolving problems with tax credit eligibility. This provision is effective beginning with fiscal year 2010.

• Access to Affordable Coverage for the Uninsured with Pre-existing Conditions
• Access to Quality Care for Vulnerable Populations 
• No Pre-existing Coverage Exclusions for Children 
• Re-insurance for Retiree Health Benefit Plans 
• Closing the Coverage Gap in the Medicare (Part D) Drug Benefit 
• Small Business Tax Credits 
• Ensuring Value for Premium Payments 
• Patient Protections 
• Extension of Dependent Coverage for Young Adults 
• Free Prevention Benefits 
• No Lifetime Limits on Coverage 
• Restricted Annual Limits on Coverage 
• Protection from Rescissions of Existing Coverage 
• Prohibits Discrimination Based on Salary 
• Public Access to Comparable Information on Insurance Options 
• Health Insurance Consumer Information 

• Beginning in 2014, annual limits and restrictions on pre-existing conditions and other decision-making based on health status would be banned. Meaningful health reform absolutely requires that pre-existing condition exclusions be outlawed – Americans should be able to get coverage regardless of their health conditions.
• Lifetime caps on benefits would be banned immediately.
• Young adults could stay on their parent’s insurance until age 26.
• Limitations are placed on insurers rating based on age and illness.
• Insurers must cover lifesaving preventative benefits and eliminate the cost sharing when accessing these benefits. 
• Administrative simplification requirements significantly reduce the red tape, and thereby reduce cost.
• Appeals standards are created to protect consumers. 
• HHS and the states would immediately begin to review and if necessary disapprove insurance company premium increases.
• In 2014, Health Insurance Exchanges are created that provide the opportunity for people to comparison shop for coverage that meets their needs.  The Exchanges can negotiate with insurers to protect consumers and ensure that they get the most value for their dollars.  Plans in these exchanges will be required to cover an essential benefits package and meet consumer protection requirements.  
  

• 56 million Americans who currently have insurance are subject to pre-existing condition restrictions that limit their insurance coverage because of their health history
• Almost 13 million individuals were denied coverage due to pre-existing conditions in the previous three years
• More than 1/3 of individuals seeking insurance are denied, charged higher premiums or offered limited coverage due to pre-existing conditions.
• Almost any condition can be considered a pre-existing condition – Blue Shield of CA considers adoption, AIDS, anemia, arthritis, back sprain, breast implants, cleft palate, infertility treatments, kidney stones, pregnancy, sleep apnea, ulcers, and varicose veins as possible pre-existing conditions.
• Young adults are the largest group of the uninsured in the U.S – more than one in four Americans (13 million) between the ages of 18-26 are uninsured, representing 30 percent of the uninsured.
• More than half of Americans in employer-sponsored coverage (approximately 90 million) are subject to an annual or lifetime limit.  As a result of meeting a lifetime limit cap, approximately 20,000 to 25,000 people with employer-sponsored plans were effectively uncovered and de facto uninsured in 2009.
  

• The combined profits for the top five insurance companies -- UnitedHealth Group Inc., WellPoint Inc., Aetna Inc., Humana Inc., and Cigna Corp. -- hit new highs in 2009 – $12.2 billion in 2009, an increase of $4.4 billion or 56 percent from 2008, with Cigna Corp. reporting a profit increase of 346 percent.   Yet 2.7 million Americans lost their private health insurance in 2009, with four of the five companies showing losses in private enrollment.
• Profits for the ten largest insurance companies increased 250 percent between 2000 and 2009, ten times faster than inflation. 
• Anthem Blue Cross of California recently tried to increase individual market premiums by up to 39 percent.  Anthem of Connecticut is requesting an increase of 24 percent and Anthem of Maine has requested 23 percent premium increases.  In addition, Blue Cross of Michigan has requested a premium increase of up to 56 percent and Blue Cross of Oregon has requested a 20 percent premium increase.
  

• Require insurers to disclose and justify their premium increases
• Require them to actually pay out more of your premium dollar in health benefits instead of using those funds for administration, executive compensation and profits
• And when reform is fully implemented, insurers whose rates have gone up too much can be limited from participating in the new coverage arrangements.
  

• Attacking fraud, abuse and waste in an unprecedented fashion
• Simplifying the bewildering array of insurance paperwork that patients, doctors and nurses have to deal with
• Developing innovative payment systems that will “bend the curve” by rewarding the efficient delivery of high quality, well coordinated, care.   
• And at the same time – improving – not cutting – benefits – in particular, filling the “donut hole” in Medicare drug benefits and ensuring continued access to the doctors that seniors know and trust.  
  

• Providing subsidies for premiums and cost sharing for those who can least afford coverage
• Requiring insurers to limit annual and lifetime expenses for those who need care the most
• Setting up exchanges where plans have to compete for business on price and quality, rather than simply cherry picking healthy people in order to turn a profit. 

• It makes insurance more affordable by providing one of the largest tax cuts for health care in history – reducing premium costs and helping over 31 million Americans afford health care.
• It sets up a new competitive health insurance market -- giving millions of Americans the exact same insurance choices that members of Congress have.
  
• It brings greater accountability by laying out commonsense rules of the road to keep premiums down and prevent insurance industry abuses and denial of care.
  
• It will end discrimination against Americans with pre-existing conditions.
  
• It reduces the deficit by $100 billion over the next ten years by cutting government overspending and reining in waste, fraud and abuse.

• It eliminates several “special deals” including the arrangement made for Nebraska;
  
• It includes a series of measures proposed by Republicans to eliminate waste, fraud and abuse;
  
• It includes a new provision to prevent arbitrary rate hikes like the recent 39 percent increase in California.
  

• "Reducing the Growing Backlog of Contested Mine Safety Cases," on Tuesday, February 23.
• "H.R. 4330, the All Students Achieving through Reform Act of 2009," on Wednesday, February 24.
  

The purpose of insurance is to spread risk as widely as possible, at the lowest cost for everyone in the insurance pool. That's exactly what health bills currently stalled in Congress would do by requiring everyone to buy coverage, and helping lower-income people afford the premiums. Costs would be stabilized; everyone would be protected.

In exchange for millions of new customers, insurance companies agreed to quit doing many of the things that make people hate them, such as refusing to cover people with pre-existing conditions and limiting coverage in ways that can bankrupt people when they become seriously ill. Having a larger, more stable group of customers would also reduce the need for abrupt and massive premium hikes.

Health reform legislation would also set up online exchanges where individuals and small businesses could buy policies. The medical insurance market would become more competitive: Companies couldn't turn applicants down, so it would be easier to jump to a different insurer if one hiked rates exorbitantly.

Further, the measures would require insurers to spend at least 80% of their premium income on paying claims, instead of on administrative and marketing costs. California's requirement is now 70%.

Anthem's official explanation for the hikes is that rapid increases in the cost of treatments and greater demand for healthcare services are driving up expenses at an "unprecedented" rate. It also asserts that the recession has prompted many healthy people to give up their insurance, leaving fewer policyholders to cover the cost of caring for a sicklier group. Those are valid complaints, but they don't automatically justify jacking rates up to the roof. In fact, Anthem's rate increases are contributing to the problem by pricing younger, healthier people out of the market for individual policies.

[The bills] would bar insurance companies from cherry-picking customers and denying coverage for preexisting conditions, enabling people to switch insurers easily. The bills also would promote competition and clarity in pricing through a new marketplace for individual policies.

A key voice in the House health insurance legislation negotiations has vowed to keep fighting for the beleaguered bill, decrying what he called a bad strategy of kowtowing to a 60-vote supermajority in the U.S. Senate.

"I think we'll have a bill this year," said Rep. George Miller, D-Martinez, after his feisty and occasionally defiant speech to business and other local leaders Monday morning. "I don't know the exact timetable. There are a lot of discussions going on, but I think we will end up getting the votes."

The imposition of a supermajority hurdle "empowers the weakest people with worst claims," Miller continued.

When lawmakers must have 60 votes in order to debate a bill, Miller said, it foments bad deals such as Nebraska trading its support for an exemption from paying the costs of caring for poor children.

"The minute you to go to majority rule, you become more bipartisan," he said. "The extremes know you don't need them.

Congress is achingly close to passing legislation that would cover most uninsured Americans and provide much more security for all Americans — guaranteeing that if they lose their jobs they will be able to buy affordable policies and can’t be denied coverage because of pre-existing conditions.

If the Democrats quit now, so close to the goal line, the opportunity for large-scale reform could be lost for years. Meanwhile, the number of uninsured, currently more than 46 million, will keep going up and the cost of health care will continue to soar.

• Ensure that 30 to 35 million Americans will have health insurance coverage.
• Prevent insurance companies from discriminating or charging more because of a preexisting condition.
• Prevent insurance companies from dropping coverage during life-saving treatment.
• Ensure that laid-off workers won't lose insurance.
• Eliminate annual or lifetime caps on coverage.
  

• Health insurance reform means you never have to be sick, without a safety net because it offers protections against insurance company discrimination and losing coverage when you get sick.
  
  
• Health insurance reform means you will continue to have access to health insurance even if you lose your job. Find out how that would work with our interactive graphic on health insurance reform.


• Health insurance reform means relief for small businesses and employers as well as jobs for Americans. According to a study by Harvard and USC economists, health insurance reform would save money and boost jobs which is probably why business leaders support health care reform plans.
  


• Health insurance reform means at least 30 million more Americans will finally have health insurance. The uninsured would have access to health insurance plans as soon as the bill becomes law.


• Health insurance reform mean lower drug costs for seniors which explains why seniors and doctors groups have thrown their support behind the health care bill.
  

1. Protections Against Insurance Company Discrimination And Losing Coverage When You Get Sick.  People who have been denied coverage because of a pre‐existing condition will finally have access to affordable coverage. Insurers will no longer be able to drop your coverage when you get sick and are in the middle of treatment.
   
   
2. Insurance Security If You Lose Your Job. Never again will you lose access to insurance if you get laid off or switch jobs.
   
   
3. Relief For Small Businesses And Employers, Jobs For Americans. Small businesses and employers getting crushed by soaring health care costs will see lower costs, allowing them to create as many as 4 million more jobs over the next decade.
   
   
4. No Annual Or Lifetime Limits On Coverage. Never again will you be subject to annual or lifetime limits on what insurance companies will pay, protecting millions of Americans from the threat of medical bankruptcy.
   
   
5. Free Preventive Care. Insurers will be required to offer free preventive care, lowering your out‐of‐pocket expenses and helping ensure that diseases or conditions can be caught early on.
   
   
6. Independent Consumer Advocates And Sunshine On Rate Increases. For the first time, consumers will have independent advocates dedicated to upholding consumer protections, answering their questions, and helping with any problems related to their plans. Insurance companies will be required to disclose their rates to consumers – discouraging them from runaway rate increases.
   
   
7. Lower Drug Costs For Seniors, Lower Premiums For Early Retirees. Seniors who fall into the Medicare Part D donut hole will see lower prescription drug costs as immediate steps are taken to close the donut hole. Employers who cover their early retirees will receive temporary funds to help offset the cost of expensive claims for retirees’ health benefits – lowering premiums and protecting coverage for early retirees.
   
   
8. Better Access And Stronger Protections For Women. Prohibits insurers from charging women more than men for health insurance or discriminating on the basis of domestic violence as a pre‐existing condition. Required maternity services as part of the essential benefits package in the exchange.
   
   
9. Extended Coverage For Young Adults. Young adults will now be able to stay on their parents’ insurance much longer, through their 26th or 27th birthday.
   
   
10. At Least 30 Million More Americans Will Finally Have Health Insurance. Health reform will finally guarantee access to quality, affordable health insurance for 30‐35 million Americans who don’t have coverage today, also eliminating the annual hidden tax of $1,100 that American families pay to cover the cost of the uninsured. While the official health insurance exchanges are being created, a temporary insurance pool will be available for individuals with pre‐existing conditions or chronic illnesses.
    
    

House Speaker Nancy Pelosi and Majority Leader Steny Hoyer officially announced Thursday that the final health care bill will be posted online for 72 hours before the vote.

“The House Democratic Leadership is committed to having the final health insurance reform legislation online for 72 hours before the House votes, for all Members and the American people to review," the pair said in a statement. "We will continue the transparent process this landmark legislation has had for months.”

• Spent nearly 100 hours in hearings on health reform
• Heard from 181 witnesses (both Democratic and Republican)
• Spent 83 hours in Committee markups
• Considered a total of 239 amendments (both Democratic and Republican); approved 121

• Draft bill was available online for 25 days before H.R. 3200 was introduced
• H.R. 3200 was posted online for 30 days before the first Committee markup
• H.R. 3200 was posted online for 107 days before introducing the merged bill
• Text of the reintroduced bill, H.R. 3962, was posted online on October 29, 2009, 9 days before the Floor vote
• The Democratic leadership made the Manager’s Amendment (introduced November 3, 2009) available online for a full 72 hours before the Floor vote
• The text of H.R. 3962, as passed by the House, has been available online since passage on November 7, 2009
• A side-by-side comparison of key differences between the House-passed and Senate-passed bills has been available online since December 29, 2009.

Think of posting something on line for 3 days as a ‘safety valve’ – a final chance for citizens, media, lawmakers and lobbyists alike to look at the whole package giving everyone one last opportunity to raise questions and concerns about the bill. If readers are in an advocacy mode they have time to mobilize others in support or opposition, and/or take action in whatever form they see fit.

There is no measure more important to debate in the open than health care, and this is a moment when we all need to be champions for public, online disclosure and engage with our government. With 72 hours, the buck can actually stop with citizens the way our Founders intended. We know that Congress do it because congressional leadership has already done so at other critical points in this debate.

This is what real transparency would look like.

Nearly 90% of those polled cite health care costs as a major concern, more than cite taxes, government regulation, labor costs or energy costs.

Without reform, 86% of those polled believe that health care costs will continue to rise in the next five years, and 55% believe it will go up "a lot." If costs continue to rise as expected, nearly 9 out of 10 business leaders expect to raise their employees' deductibles and copayments. Nearly 8 out of 10 expect to cut benefits. And nearly one in three expects to lay off employees.

Over the next 15 years, American businesses would collectively spend $637 billion less on their share of health insurance premiums, and their workers would save a collective $177 billion under the Senate bill. For a typical business with 500 employees, the cost of coverage would be $2.5 million less than it would be otherwise over 15 years. In other words, these reforms will slow the annual growth rate of costs for job-based health care coverage over the next decade and a half from a projected increase of 5.8% to 5.0% per person. For American businesses, these savings will translate directly into higher wages for workers, more money to expand and invest, and a greater ability to succeed in a fiercely competitive global marketplace. For workers, these savings will lead to coverage that is more stable and more secure.

Savings from Reform: 2010 through 2024

	Projected total spending	Projected spending under reform	Total projected reductions in spending from reform
Aggregate spending on employer share of premiums for job-based coverage	$14.55 trillion	$13.91 trillion	$637 billion
Aggregate employee share of premiums for job-based coverage	$4.04 trillion	$3.86 trillion	$177 billion
500-person employer offering coverage	$56.4 million	$53.9 million	$2.5 million

1. It's not a government takeover of health care.
2. It's highly unlikely that your existing coverage is going to cost more under this legislation than it would otherwise over the next 10 years.
3. Relatedly, the legislation is not going to bust the budget.
4. Medicare is not being sacrificed on the altar of coverage expansions for the under-65 folks.

Prices for hundreds of brand-name drugs have soared since the beginning of the decade, especially those that treat depression, infections and heart disease, according to a U.S. government report on Monday.

The nonpartisan General Accountability Office said it found "extraordinary price increases" for 321 brand-name drugs, with prices jumping by 100 percent to 499 percent -- and in a few cases by more than 1,000 percent.

The number of drug price increases more than doubled from 2000 to 2008 with most drugs maintaining their higher prices over time, the investigative arm of Congress said.

• closes the Part D donut hole by $500 in 2010 and eliminates the donut hole entirely by 2019. This protects seniors by ending the gaps in coverage that force them to pay the full cost of their drugs. For patients who are able to switch to lower-cost generic drugs, H.R. 3962 clarifies that Part D plans can offer a free generic prescription fill when a Part D enrollee switches to the generic.
• requires the Secretary of the Department of Health and Human Services (HHS) to negotiate with Part D manufacturers for lower prices, providing new leverage to help control Part D drug price increases.
• requires new transparency in drug pricing for plans in the Exchange that use pharmaceutical benefit managers (PBMs). This will reduce waste, fraud, and abuse and give patients more information about drug prices and spending.

• expands and increases the Medicaid drug rebate, which requires that manufacturers pay a rebate to cover cost increases that exceed the inflation rate. These payments will protect taxpayers from price increases that occur before or after the health care reform legislation goes into effect.
• contains new Part D rebates that help cut the cost of providing drugs for dually eligible and low-income enrollees. These Part D rebates are based on the Medicaid rebates. They will save taxpayers billions of dollars each year.

Wading into the hotly debated issue of whether the legislation is a job creator or a job killer, researchers from the two universities say that the reforms under consideration would slow the rate of cost increases and free up money for companies to raise wages and hire more workers.

Specifically, healthcare savings could be achieved through proposals for greater competition in insurance markets, better coordination of care and shrinking administrative expenses, they said in a report to be released today. With those changes, employers could then reallocate money now spent on ever-growing premiums to other business priorities.

The Harvard-USC economists concluded that industries with high rates of employer-sponsored insurance -- including manufacturing, utilities and financial services -- would see some of the largest employment gains.

"If you have a strong bill that will promote control of healthcare costs, there will be an effect on the number of jobs," said Neeraj Sood, director of international programs at USC's Schaeffer Center for Health Policy and Economics.

• Health reform will create up to 4 million jobs in the next ten years: The paper finds that health care reform could increase the number of jobs in the United States by about 250,000 to 400,000 per year over the coming decade.
• Reform will create jobs across industries: By 2016, reform will create more than 200,000 new jobs in manufacturing and nearly 900,000 jobs in services.

Speaker of the U.S. House of Representatives Nancy Pelosi said on Wednesday that any final U.S. healthcare bill must hold insurance companies accountable and be fiscally responsible.

"We all are committed to the fiscal responsibility that has to accompany this bill," she told reporters after meeting at the White House with President Barack Obama and the chairmen of House committees involved with the bill.

• Pays for the entire cost of the legislation though a combination of savings achieved by making Medicare and Medicaid more efficient – without cutting seniors’ benefits in any way – and  revenue generated from placing a surcharge the top 0.3 percent of all households in the U.S.(married couples with adjusted gross income of over $1,000,000) and other tax measures.
• The Congressional Budget estimates the bill will reduce the deficit by at least $100 billion over ten years.
• Estimates also show the bill will slow the rate of growth of the Medicare program from 6.6 percent annually to 5.3 percent annually.

• Ensure that 30 to 35 million Americans will have health insurance coverage.
• Prevent insurance companies from discriminating or charging more because of a preexisting condition.
• Prevent insurance companies from dropping coverage during life-saving treatment.
• Ensure that laid-off workers won't lose insurance.
• Eliminate annual or lifetime caps on coverage.
  

• News of the Day: If health care bill passes, some changes would start fast
• News of the Day: Sick, without a safety net
  

More money for community health centers. Immediate help for the uninsured. No more lifetime limits on coverage.

Under the health care legislation that's moving through Congress, these and other benefits would take effect quickly and should produce a noticeable impact on consumers, according to many independent analysts and Democrats.

"This would be a substantial package that could probably be quite helpful," said John Holahan, the director of the health policy center at Washington's Urban Institute, a research group.

Paul Ginsburg, the president of the Center for Studying Health System Change, called help for Medicare prescription-drug beneficiaries and people with pre-existing medical conditions "highly visible improvements for individuals already highly aware of the shortcomings of the existing system."

Leaders in the House of Representatives and the Senate are expected to reach agreement on the legislation in the next few weeks, with the aim of having a final bill ready for President Barack Obama's signature later this month.

The two bills have several similar immediate-impact features. Both would bar lifetime limits on coverage, starting six months after the measure is enacted.

They also would expand community health centers, where consumers could go for care, and would require health plans to allow young people, up to age 26 in the Senate bill and 27 in the House bill, to stay on their parents' policies. Age requirements now vary by state.

Both bills provide immediate aid for the uninsured. The Senate would provide $5 billion to help finance a temporary program that would provide coverage to uninsured people with pre-existing conditions, effective 90 days after the bill is signed.

The House bill also would create a temporary insurance program for those who have trouble getting coverage, effective immediately upon passage.

But no one is talking about dropping the kinds of insurance reforms that will open a new chapter in the lives of sick people like him: those with mental illness, heart disease, cancer, diabetes -- chronic ailments that touch almost every family in America. Those patients are the ones most likely to lose coverage because their policies impose lifetime limits, or because they have, in industry parlance, a "preexisting condition."

Their pain may continue, their premiums may be high, their diseases could remain incurable, but the legislation President Obama is expected to sign into law next year will almost certainly ensure they have access to health insurance.

Johnson had hit a wall that affects an estimated 46 million people in America who are without health insurance. In his case, no insurance company would take him because he was already sick, even though his father and his boss were willing to buy him a policy.

The law protects people with preexisting conditions if they are covered by group plans provided by their employers -- people like Johnson's mother. But there are no such protections for those looking to buy individual coverage. More than a third are denied, according to data from the Centers for Disease Control and Prevention.

The [AARP], which has been pushing for a health overhaul for more than a year, had withheld a formal endorsement of any of the healthcare bills being developed by congressional Democrats.

That endorsement was followed by an announcement at about 10 a.m. Pacific time from the American Medical Assn. in which the nation's largest doctors group voiced its support for the measure.

AARP Executive Vice President Nancy LeaMond said today that the group saw the House Democratic bill as the most promising proposal.

...

The AMA's support for the House bill comes ahead of a critical policymaking meeting of its House of Delegates in Houston that begins Saturday. The organization is being asked by some constituencies, at the eleventh hour, to back away from supporting healthcare reform.

"These bills go far beyond what is necessary to fix what is broken with our healthcare system, and they grant the federal government considerable new powers and authority, which could ultimately amount to a complete government takeover of healthcare, and which is anathema to doctors and patients," reads a resolution introduced by the American Assn. of Neurological Surgeons, the American Society of General Surgeons and the American Academy of Facial Plastic and Reconstructive Surgery. The resolution was also supported by AMA delegations from Georgia and Washington, D.C.

One of those states is Massachusetts, which passed health-care reform similar to the one contemplated at the federal level in mid-2006. The major aspects of this reform took place in 2007, notably the introduction of large subsidies for low-income populations, a merged nongroup and small group insurance market, and a mandate on individuals to purchase health insurance. And the results have been an enormous reduction in the cost of nongroup insurance in the state: The average individual premium in the state fell from $8,537 at the end of 2006 to $5,143 in mid-2009, a 40 percent reduction, while the rest of the nation was seeing a 14 percent increase.

• Why is a mandate necessary? [Those without coverage drive up costs for those with coverage]
  
• Will premiums go up or down? [They would go down]
  
• Will there be help? [Yes]
  
• What's affordable? [The House bill provides affordability tax credits for families of 4 up to $88,000]
• Has it been tried? [Yes, successfully]
  
• Which version is more affordable? [The House bill]
  

That's why the most important document House Democrats released when they unveiled their bill last week was a list of 14 benefits that would be created immediately.

These include insurance reforms to ban lifetime limits on coverage and an end to "rescissions," under which insurers abruptly nullify patients' policies after they file claims. One of the most popular reforms in the bill -- barring insurers from denying coverage to those with pre-existing conditions -- wouldn't take effect until later. So the House bill creates an interim high-risk pool to help those who need coverage in the meantime.

There are also particular benefits for Medicare recipients, including an immediate reduction in drug costs, and a very popular provision that would allow parents to keep their children on the family health plan through age 26.

Especially important are new investments in community health centers and in efforts to increase the number of primary care doctors. As millions more people get access to decent care, the system will have to provide more doctors, nurses and facilities to treat them.

"People will be excited about 2013," said Rep. George Miller, chairman of the House Education and Labor Committee, which shares jurisdiction on the health-care bill. "But there are enough benefits between now and then to keep them engaged and to keep them favorably disposed."

Readers of this paper will know that, for much of this year, Congress and President Obama have grappled with one of the most important and complicated issues affecting our nation's economy and our community: health insurance reform.

I am proud to announce that on Thursday we introduced revised legislation that addresses many concerns raised about reform and brings us closer than ever to delivering on the long-held promise of quality and affordable health care for each of us.

I am a principal co-author of the bill.

Since three House committees passed a bill this summer, we have worked hard to incorporate changes and improvements suggested by people from across the political spectrum. Our revised bill directly addresses the needs of American families. It will:

• Not increase the deficit.
• Curb out-of-control costs that are bankrupting families and employers.
• Strengthen Medicare for seniors, in part by closing the prescription drug "donut hole" and by making the program sustainable for years to come.
• Protect people against discriminatory insurance company practices. We eliminate so-called "pre-existing" condition denials, stop insurance companies from dropping coverage if you get sick, and establish yearly caps on what you will pay out-of-pocket.
• Keep premiums affordable and insurance companies honest by ensuring competition in the health care marketplace through inclusion of a public consumer option. People in California will be able to choose from multiple private options, such as Blue Shield, Kaiser Permanente and others, or choose a public plan that offers the best quality at the best price -- just as they do on Expedia.
• Offer affordability credits to ensure that low-income and middle-class families can pay for coverage, and ensure that small businesses can actually help cover their employees.

One of the biggest concerns I heard throughout this process was about the bill's cost. Let me be clear: Our reforms are fully paid for and will not increase the federal deficit. In fact, our revised bill will reduce the deficit by at least $30 billion over the next 10 years.

The nonpartisan Congressional Budget Office estimates the cost of our reforms at $894 billion. More than half of this cost will be offset through a combination of savings generated by making Medicare and Medi-Cal more efficient and implementing new technology, but we do not cut services for seniors or low-income individuals. We improve care for people served by these critical programs.

The rest of the bill's costs are paid for by a surcharge on the wealthiest 0.3 percent of U.S. households-- married couples earning over $1 million dollars and individuals earning more than half a million dollars annually.

For the past 70 years, Americans have battled hard for the right to quality, affordable health care. While we still have hard work ahead, next week the House will vote on our truly historic legislation and get us closer than ever to achieving what generations of Americans have been fighting for.

require insurers to allow young people through age 26 to remain on their parents’ policies. It would provide immediate help to people who have been uninsured for several months or denied coverage because of pre-existing conditions. It would speed elimination of a gap in drug coverage for Medicare beneficiaries (the so-called doughnut hole) and would give the government power to negotiate drug prices on behalf of Medicare beneficiaries, a promising way to reduce costs.

The bill would take a long stride toward universal coverage while remaining fiscally responsible.

• If people like their current plans, they will be able to keep them.
• For individuals who aren’t currently covered by their employer, and some small businesses, the proposal will establish a new Health Insurance Exchange where consumers can comparison shop from a menu of affordable, quality health care options that will include private plans, health co-ops, and a new public health insurance option. The public health insurance option will play on a level playing field with private insurers, spurring additional competition.
• This Exchange will create competition based on quality and price that leads to better coverage and care. Patients and doctors will have control over decisions about their health care, instead of insurance companies.

• Every American who receives coverage through the Exchange will have a plan that includes standardized, comprehensive and quality health care benefits.
• It will end increases in premiums or denials of care based on pre-existing conditions, race, or gender, and strictly limit age rating.
• The proposal will also eliminate co-pays for preventive care, and cap out-of-pocket expensesto protects every American from bankruptcy.

• Guarantees that every child in America will have health care coverage that includes dental, hearing and vision benefits.
• Provides better preventive and wellness care. Every health care plan offered through the exchange and by employers after a grace period will cover preventive care at no cost to the patient.
• Increases the health care workforce to ensure that more doctors and nurses are available to provide quality care as more Americans get coverage.
• Strengthens Medicare and Medicaid and closes the Medicare Part D ‘donut hole’ so that seniors and low-income Americans receive better quality of care and see lower prescription drug costs and out-of-pocket expenses.

• Employers can continue offering coverage to workers, and those who choose not to offer coverage contribute a fee of eight percent of payroll.
• All individuals will generally be required to get coverage, either through their employer or the exchange, or pay a penalty of 2.5 percent of income, subject to a hardship exemption.
• The federal government will provide affordability credits, available on a sliding scale for low- and middle-income individuals and families to make premiums affordable and reduce cost-sharing.

• Provides transparency in plans in the Health Exchange so that consumers have the clear, complete information, in plain English, needed to select the plan that best meets their needs.
• Establishes consumer advocacy offices as part of the Exchange in order to protect consumers, answer questions, and assist with any problems related to their plans.
• Simplifies paperwork and other administrative burdens. Patients, doctors, nurses, insurance companies, providers, and employers will all encounter a streamlined, less confusing, more consumer friendly system.
• Increases funding of efforts to reduce waste, fraud and abuse; creates enhanced oversight of Medicare and Medicaid programs.

• Pays for the entire cost of the legislation though a combination of savings achieved by making Medicare and Medicaid more efficient – without cutting seniors’ benefits in any way – and  revenue generated from placing a surcharge the top 0.3 percent of all households in the U.S.(married couples with adjusted gross income of over $1,000,000) and other tax measures.
• The Congressional Budget estimates the bill will reduce the deficit by at least $100 billion over ten years.
• Estimates also show the bill will slow the rate of growth of the Medicare program from 6.6 percent annually to 5.3 percent annually.

The states' reports suggest the biggest impact has been at schools. Twenty-three states that have reported school job numbers said more than 156,000 jobs had been created or saved.

Carol Bingham, director of fiscal policy for the California Department of Education, estimated the stimulus saved about 20,000 teaching positions. But she and others warn that precisely counting saved jobs has proved almost impossible. "It was intended to be a count. The way it was done, I think it's going to end up being an estimate," she said.

Indiana officials reported that the stimulus had created or saved about 13,000 school jobs. Asked whether he had any idea how many layoffs the plan had prevented, state Education Department spokesman Cam Savage replied: "I really don't."

• Guarantee that you will not be denied coverage based on a so-called pre-existing condition
• Limit out-of-pocket expenses to protect families from medical-related bankruptcy
• Make your insurance policy transparent so you know what you’re paying for
• Prevent insurance companies from dropping coverage when you get sick
• Prevent insurance companies from charging people different rates based on gender, health status, or occupation.

The bill, which passed 253 to 171, would allocate about $80 billion over the next decade for new loans, community colleges, school construction and early childhood programs without increasing taxes or adding to the deficit. How? Instead of paying bankers to provide loans for which they bear no real risk, the government would make the loans directly.

Liberals are always accused of spending money without worrying where it comes from, but in this case, costs are covered by making a government program more efficient -- yes, at the expense of bankers.

"We were paying these exorbitant subsidies to bankers who were taking government money, loaning it to somebody else, getting government guarantees that the loans would be paid back, and then taking all these profits," said Rep. George Miller (D-Calif.), the bill's champion. This, he told me, led Congress to ask itself: "Hey, chump, what is it you don't get about what's going on here?" The only knock on the proposal is ideological: that government is "taking over" the student loan program. But it's already a government program. The bill simply eliminates corporate welfare.

This is a classic case of how the Great Ideological Distortion Machine does its mischief: Instead of focusing on how the bill advances values typically regarded as "centrist" -- government efficiency, pay-as-you-go budgeting -- the banks' defenders bury the specifics behind abstract discussions of "big government." Yet I'd venture that middle-of-the-road Americans prefer that their tax money go toward education rather than to padding the profits of financial firms.

Over the past week, I've spoken with Democratic House members, most from highly contested districts, about what happened in their town halls. None would deny polls showing that the health-reform cause lost ground last month, but little of the probing civility that characterized so many of their forums was ever seen on television.

"I think the media coverage has done a disservice by falling for a trick that you'd think experienced media hands wouldn't fall for: of allowing loud voices to distort the debate," said Rep. Mary Jo Kilroy, whose district includes Columbus, Ohio.

At her town halls, she said, "I got serious questions, I got hostile questions, I got questions about how this would work, I got questions about how much it will cost. I also got a lot of comments from people who said it's important for their families and businesses to get health-care reform."

Rep. Frank Kratovil hails from a very conservative district that includes Maryland's Eastern Shore and says it didn't bother him that he was hung in effigy in July by a right-wing group. "As a former prosecutor, I consider that to be mild," he said with a chuckle. The episode, he added, was not at all typical of his town-hall meetings, where "most of the people were there to express legitimate concerns about the bill, wondering about how it was going to impact them" and wanting "to know the truth about some of the things that were being said about the bill."

The most disturbing account came from Rep. David Price of North Carolina, who spoke with a stringer for one of the television networks at a large town-hall meeting he held in Durham.

The stringer said he was one of 10 people around the country assigned to watch such encounters. Price said he was told flatly: "Your meeting doesn't get covered unless it blows up." As it happens, the Durham audience was broadly sympathetic to reform efforts. No "news" there.

Medicare beneficiaries would often have to pay higher premiums for prescription drug coverage, but many would see their total drug spending decline, so they would save money as a result of health legislation moving through the House, the Congressional Budget Office said in a recent report.

Premiums for drug coverage would rise an average of 5 percent in 2011, beyond the level expected under current law, and the increase would grow to 20 percent in 2019, the budget office said.

“However,” it said, “beneficiaries’ spending on prescription drugs apart from those premiums would fall, on average, as would their overall prescription drug spending (including both premiums and cost-sharing).”

The House bill would require drug companies to provide larger discounts, or rebates, on medications dispensed to low-income people enrolled in both Medicare and Medicaid. It would also require drug makers to provide 50 percent discounts on brand-name drugs in the doughnut hole, until the coverage gap was eliminated.

The budget office said premiums would increase, in part, because Medicare drug plans would have to provide additional coverage, paying some costs that beneficiaries now pay themselves.

“In return for those higher premiums,” Mr. Elmendorf said, “enrollees would receive greater protection against incurring high drug costs. As a result, beneficiaries’ spending on prescription drugs apart from the premiums would decrease, on average. That reduction in cost-sharing would outweigh the increase in premiums, again on average.”

This entirely voluntary plan — that's why it's called an "option" — would bring some cost control to health care by applying government's purchasing power as leverage against medical providers and insurance companies. Yet the idea is cynically cast as a "government takeover of health care" — rhetoric worthy of the Mad Hatter.

The dirty secret of our health care system is that it already is dependent on government or, more precisely, government waste. More than 46% of all medical service in the USA, about $1 trillion annually, is paid for directly by taxpayers. Private insurers cover 42%, and the remainder is paid out of pocket. In addition to what government pays directly, it pumps in more than $200 billion a year in tax subsidies.

If Washington does nothing, this government role will only get a lot bigger as the population ages, providers hike prices and private coverage becomes increasingly unaffordable.

The Washington Post debunked one of the leading myths being peddled by health reform opponents this morning. They took on the misleading claims about end-of-life discussions being forced euthanasia.

Washington Post says:

THE DEBATE over health reform has veered into a peripheral and misleading discussion of whether it includes a scheme to pressure senior citizens into pulling the plug. The most extreme misrepresentation has "death panels," as former Alaska governor Sarah Palin colorfully put it, deciding who is too old or too disabled to merit treatment. This is a distorted interpretation, to say the least. The debate threatens sensible policy on end-of-life discussions and in the separate realm of reforming the health-care system.

 

First: It makes sense for everyone to think about end-of-life issues, and the earlier in life the better. If you want every last heroic measure to be tried to extend your life, you can say so. If you have a different vision, you can spell that out. You will be doing your relatives and yourself a favor if you express yourself while you are still healthy. You can always change your mind.

The Washington Post goes on to discuss the need for end-of-life planning and the cost saving benefits of it. Learn more about the misinformation campaign against the America’s Health Choices Act.

Today’s LA Times editorial called for Americans to refuse the status quo in health care. They explain how while most of cable news has been covering town hall protests recently, while there are daily stories that have gone unnoticed but reveal the need for real health reform.  

LA Times says:

It's too bad the television cameras haven't been trained instead on the Forum in Inglewood, where the Remote Area Medical Foundation opened a temporary clinic this week. The scene makes a compelling case for a health care overhaul, putting a human face on the dry statistics about uninsured and underinsured Americans. People started lining up Monday for a chance to be treated Tuesday by volunteer doctors, dentists, nurses and other health care providers. About 1,500 people were seen that first day; after hundreds more camped out overnight, the clinic ran at full capacity again on Wednesday. It's scheduled to stay eight days before heading to its next stop, a reservation in Utah.

 

The turnout in Inglewood was huge despite the lack of publicity about the clinic, indicating how great the need is for more primary care. These are the people whose first stop for treatment tends to be the emergency room, often after a routine problem has festered long enough to become a complex (and expensive) one. Expanding health insurance to cover this group wouldn't be cheap, but it's a prerequisite to the changes in delivery and payment that will help improve care and control costs.

Remote Area Medical's experience here also illustrates one of the best features of our health care system: the humanitarianism of its professionals. But unless the system is reformed to bring basic health care services to all Americans, far too many will continue to depend on the kindness of strangers.

 

We encourage you to continue read the remainder of the LA Times editorial and learn more about the America’s Health Choices Act.

In this morning’s USA Today editorial, they take on myths that continue to surface about health care reform. On July 31, U.S. Reps. Chris Van Hollen (D-MD) and George Miller (D-CA) released a statement exposing the campaign of misinformation on health care.

USA Today says:

There's an old proverb that says a lie can travel halfway around the world while the truth is still getting its boots on. That's surely true when the lie instills deep personal fears, and lies appear to be in full sprint as the nation's health care debate goes local.

Some August town hall meetings around the country have degenerated into furious shouting matches, driven by outrageous misinformation borne of many sources.

The Internet spreads anonymous chain e-mails to a public that is both vulnerable and gullible. Groups with a financial or ideological interest give the rumors a boost. Talk radio provides an echo chamber for the demonizers. Most outrageously, political leaders who know better and could oppose legislation in a more credible way, engage in their own hyperbole or simply remain silent. One Republican senator, South Carolina's Jim DeMint, simply bypassed the substance of the discussion, saying it was a chance to "break" a popular Democratic president. He has plenty of company that isn't quite as blunt.

We encourage you to continue reading the USA Today editorial and learn more about the America’s Health Choices Act.

• Page 22 of H.R. 3200 requests a study, not an audit, of the effects to which rating rules are likely to cause adverse selection in the large group market and employer self insurance market insurance market. This does not require an audit of ALL employers that self insure

• Nothing in the bill infringes upon you and your doctor’s ability to make medical decisions.  The National Health Benefits Advisory Council is not a “government committee” but is made up of providers, consumer representatives, employers, labor, health insurance issuers, independent experts and representatives of government agencies.  They will make recommendations about minimum standards of care and covered benefits that insurance companies have to offer- ensuring that everyone has a health plan that provides them with adequate coverage. 

• This is a misreading of the text.  This section limits the amount of out-of-pocket costs you will face to $5,000 for an individual and $10,000 (indexed to CPI) for a family for a basic package of care.  This ensures you have access to affordable care and won’t go bankrupt paying for it.

• The Health Choices Commissioner is charged with ensuring insurance plans are meeting regulations and minimum standards as well as administering affordability credits and monitoring the exchange.  Nothing in this section or in the larger bill permits the Health Choices Commissioner to choose your benefits for you

• This is blatantly false.  This section prohibits insurance companies from discriminating against persons when issuing coverage, and has nothing to do with government subsidized coverage to illegal immigrants.  The bill explicitly states that no Federal payments will be used for affordability credits for illegal immigrants.  (P. 143, sec. 246). 

• This section says nothing about a National ID health card, or accessing your personal financial information.  This section promotes administrative simplification- for example being able to look up your insurance coverage and determine how much you will pay and which provider your insurance will accept, at the point of service.  This saves money and gives you, the consumer, information about what you will owe at the front end, rather than being denied or getting a surprise bill from your insurance company weeks after your treatment.
  

• This section encourages the development of standards to encourage electronic payments between providers and insurance companies.  Administrative simplification measures like these save billions of dollars.  Nothing will give the government access to your bank account.

• This section provides a limited reimbursement for participating employment-based private plans for part of the cost of providing health benefits to retirees (age 55-64) and their families.  People who have been forced into early retirement in this age group do not qualify for Medicare and this will help them stay on their employer provided, private insurance plan if their employer wants to participate.  Participation is voluntary. This is for all early retirees, and no language targets the provision towards unions or acorn.

• The bill imposes new regulations on private health care plans that will force them to end unethical practices such as rescissions or denying coverage based on pre-existing conditions.  The Exchange will improve the quality of coverage and increase the affordability of private insurers in the Exchange.
  

• Insurance companies in the Exchange will have to offer a basic benefit packages in every service area.  This package will include basic care such as hospitalization, physician visits, medical equipment, mental health, preventative care, maternity and well baby care, and drugs – services that anyone would expect a real insurance policy to cover.  Private insurers may offer a higher tier of coverage with more benefits that are not mandated by the government if they choose.
  

• No, this determines the minimum standards insurance companies must offer coverage for- it has nothing to do with rationing.  Private plans can offer extra benefits like dental or vision coverage for adults, or other non-covered benefits that are not included in the basic level plan.

• The bill requires plans in the Exchange to offer culturally and linguistic appropriate services.  The U.S. is a diverse country culturally and linguistically.  Many legal residents and citizens of the U.S. speak other languages, and implying that everyone of a different culture in the U.S. is here illegally is intolerant and incorrect.  The bill explicitly states that it will not subsidize coverage for illegal immigrants.  (P. 143, sec. 246). 

• The Health Choices Commissioner will conduct outreach and enrollment activities to educate Exchange-eligible individuals and businesses about enrollment in the new Exchange, which includes many private plans along with the public option.  This includes a toll-free hotline, maintenance of a website, creation of outreach materials, and community locations for enrollment.
  

• This section has nothing to do with seniors or Medicare. It describes the minimum benefits insurance plans must offer under the Exchange.