House Democrats Tuesday unveiled their new 1,018-page Tri-Committee healthcare reform bill that includes a health insurance exchange, public policy option, individual and employer "pay or play" provisions, and a surtax on upper incomes.
How much the bill will cost, though, is still not known: While the Congressional Budget Office released a preliminary analysis on Tuesday, it noted that more time was needed to review updated language included in the just-released bill. Mark-up will begin on the measure in the three committees—Energy and Commerce, Ways and Means, and Education and Labor—on Thursday; Wednesday will be reserved for opening statements from committee members.
In introducing the bill, House Speaker Nancy Pelosi (D-CA) called the measure "a starting point" that addresses costs, individual choice, and quality issues. "Inaction is not an option for us. That is why we are still on schedule to do what we have planned, to vote on this legislation before we leave for the August recess."
"We are trying to achieve a number of different objectives, but holding down the costs in healthcare is certainly, by far, our number one objective," said House Energy and Commerce Chairman Henry Waxman (D-CA). "The system is unsustainable. We cannot continue to put more and more money into healthcare—especially when you recognize that this country spends more money on healthcare than any other Western industrialized nation."
Not surprisingly, GOP members—who just saw copies of the new bill themselves on Tuesday—were vocal in their opposition. Rep. Roy Blunt (R-MO), chairman of the Republican Health Care Solutions Group, said the bill would eliminate jobs, raise taxes, limit access to healthcare, "and lead to a government takeover of healthcare." He proposed offering an amendment that would require all federal officials to enroll in the public insurance plan "if it was such a good deal for the American people."
Rep. Joe Barton (D-TX), the ranking minority member on Energy and Commerce, argued that hurrying to approve a bill before the July 31 recess was a mistake because "healthcare is too big an issue to rush." He predicted that the votes would not be there in the end to approve the bill because of its various taxes, mandates, and the push to "eliminate physician owned hospitals, which in those states that allow them have been chosen as an efficient way to get healthcare."
Paying for the reform likely will be the challenge. House Democrats currently seek raising about $544 billion over the next 10 years with a graduated surtax on the incomes of wealthier families and individuals. As proposed now, the plan would mean that:
- Joint filers with adjusted annual gross incomes between $350,000 and $500,000, and individual taxpayers with adjusted gross incomes between $280,000 and $400,000, would pay an additional 1% income tax.
- Joint filers making between $500,000 and $1 million and individual filers making between $400,000 and $800,000 would pay an additional 1.5% income tax.
- Joint filers making more than $1 million and individuals making more than $800,000 would pay an additional 5.4% income tax.
To provide coverage and choice and expand healthcare coverage, the newly drafted bill calls for:
- Creating a health insurance exchange that would permit individuals and small employers to shop and select among private and public insurers for coverage.
- Establishing a public health insurance option that would be subject "to the same market reforms and consumer protections" as other private plans in the exchange; it would be self sustaining—financed only by its premiums.
- Creating guaranteed coverage and insurance market reforms to prevent insurers from refusing to sell or renew policies because of an individual's health status or from excluding coverage of treatments for pre existing health conditions.
- Developing a benefit package based on "standards set in the law" by a new independent advisory committee staffed by practicing providers and healthcare experts and chaired by the U.S. surgeon general.
The bill calls for "shared responsibility"—or requiring all American to get coverage or pay a penalty by:
- Giving employers an option to provide coverage or pay the government a fee based on 8% of their payroll.
- Requiring individuals to obtain coverage or pay a fee equivalent to 2% of their adjusted gross income (except in cases where hardship is indicated).
- Exempting small businesses with payrolls under $250,000 from the fee, but phased in for employers with payrolls above that level.
For the healthcare workforce, the new bill calls for:
- Increasing the National Health Service Corp to reach more underserved areas.
- Promoting more training of primary care physicians and "expansion of the pipeline" of those going into primary care, nursing, and public health.
- Redistributing unfilled graduate medical education residency slots for the training of more primary care physicians.
There is additional focus on controlling costs by:
- Encouraging innovation through accountable care organizations, medical homes, and bundling of acute and post acute provider payments.
- Preventing waste, fraud, and abuse.
- Promoting administrative simplification through reducing paperwork.