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What Stays, What Goes in Health Reform?

Janice Simmons, for HealthLeaders Media, January 28, 2010

In his State of the Union address on Wednesday night, President Obama made clear that current healthcare reform efforts won't become a distant memory.

He urged Congress to "not walk away from reform—not now ... when we are so close," he said. Instead, now is the time to "let us find a way to come together and finish the job for the American people."

To accomplish this goal, both Senate Majority Leader Harry Reid (D-NV) and House Speaker Nancy Pelosi (D-CA) have been saying over the past week that rather than rush to pass a healthcare reform bill care, they have been deliberately slowing the process.

In an interview on Wednesday with the journal Politico, Pelosi provided some insight of how the House at least will pursue healthcare reform: Promote a two-track approach in Congress in which easier-to-pass incremental changes would be made now and comprehensive reform would come later.

Pelosi added she thought it was "possible to have comprehensive healthcare reform as we go forward." However, she suggested at the same time, that it could be on another track "where some things can just be passed outside of that legislation," Pelosi said in the interview. "We'll be doing both."

If the two-track approach is taken, the provisions that closely mirror provisions both in the House and the Senate bills would go first.

These provisions could include:

  • Provide affordable credits to individuals with salaries up to 400% of the federal poverty level.

  • Provide small employers (with no more than 25 employees) and average annual wages less than $50,000 with a tax credit when they purchase employee health insurance.

  • Establish a temporary reinsurance program for employers providing health insurance coverage to retirees over age 55 who are not eligible for Medicare.

  • Require a guarantee issue and renewability by allowing rating variations based on age, premium rating area, and family enrollment.

  • Create a temporary national high risk pool to provide health coverage for individuals with pre existing medical conditions.

  • Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage.

  • Prohibit insurers from rescinding coverage except in cases of fraud.

  • Establish a Medicare value based purchasing program to pay hospitals based on performance or quality measures.

  • Simplify health insurance administration by adopting standards for financial and administrative transactions.

 

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