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Three Health Reform Ideas That Will Stay, Three That Will Go

Les Masterson, for HealthLeaders Media, November 11, 2009

With the House of Representatives' narrow approval of its health reform bill Saturday, the next stop for the health reform train is the Senate, which will soon begin debating its own plan that was approved by the Senate Finance Committee.

If the Senate's bill is approved—which is probable, but not a slam dunk—the two houses on Capitol Hill will come together to create the final health reform law. (If you need a reminder of the process, Bill can tell you all about it.)

The House passage was praised by many as a landmark achievement, but we're still a long way off. During the next few weeks (or months), legislators will battle for pet reforms while stripping away others.

Here is my prediction for three health reform ideas that will stay and three that will go:

Three that will stay

  • Medicaid expansion.

The final health reform plan will make it easier for poor and lower middle-class Americans to get insurance through Medicaid.

The House bill would allow individuals and families with incomes at or below 150% of the federal poverty level to be eligible for Medicaid. The Senate will probably come up with a not-as-generous level, but the two sides will develop a plan that will allow thousands of new Medicaid beneficiaries.

This will somewhat satisfy those who decry healthcare system access, but won't please doctors, hospitals, or states.

The feds will provide funding in the transition, which may increase Medicaid reimbursement in the near term, but doctors and hospitals will not like having more of its patients covered under state Medicaid programs.

  • More insurance regulations coupled with a watered down individual mandate.

President Barack Obama has made it clear health reform will target health insurance. Obama and the Democrats want more health insurance regulation, including not allowing rejections because of pre-existing conditions or charging higher rates to women (who insurers say cost more to insure than men), or those who are in worse health.

Insurers are OK with those added regulations as long as health reform requires all or most Americans to buy health insurance. The insurance industry wants the mandate because they know it will flood the market with young adults who are historically not interested in health insurance. These new, low-cost members will help pay for the new, sicker members.

  • Insurance exchanges that will allow consumers to compare health plans online.

An insurance exchange will be seen as a compromise to a public plan. The federal government will likely seed billions to states to help them create Web sites, public outreach, and staffing so residents will have an easy one-stop shopping experience for health insurance.

This will likely resemble the Massachusetts Connector Web site, which I wrote about in September.

These Web sites will give states control while satisfying Republicans and conservative Democrats, who will see the exchanges as a way to help consumers buy insurance rather than expanding government-run healthcare.

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