House Dem's health reform bill under $900 billion
By Paul Beddoe
associate legislative director
Speaker of the House Nancy Pelosi (D-Calif.) announced the introduction of H.R. 3962, the Affordable Health Care for America Act, Oct. 29. The bill would expand health insurance coverage to more than 96 percent of Americans for less than $900 billion over 10 years.
It is largely financed by savings within Medicare and Medicaid, and by a surcharge on individuals with adjusted gross incomes of more than $500,000 and families over $1 million. The threshold for the surcharge is higher under the blended bill than a previous bill, H.R. 3200, considered in the House this past summer.
Beginning in 2013, the bill expands Medicaid to cover everyone under 150 percent of the federal poverty level (FPL), instead of the 133 percent FPL in H.R. 3200. The federal government will cover 100 percent of the cost of expanding coverage in 2013 and 2014, but drop to 91 percent beginning in 2015. The bill also pegs the Medicaid payment rate for primary care to the Medicare rate with 100 percent federal matching rate through 2014, and then reduces the rate to 90 percent in 2015 and beyond.
NACo supports expanding Medicaid and improving reimbursement rates but calls for 100 percent federal financing with a pass-through for counties in states that require them to contribute to the non-federal share.
DSH Is ‘Dissed’
The bill retains the approach to Medicaid Disproportionate Share Hospital funding (DSH) adopted by the House Energy and Commerce Committee, which would reduce funding by $1.5 billion in 2017; $2.5 billion in 2018 and $6 billion in 2019.
It would also require the health and human services secretary to conduct a study on the continued role of Medicaid DSH under health reform, with recommendations, to be completed by the end of 2015. NACo opposes mandatory cuts to Medicaid DSH.
Public Health, Wellness, Jail Inmates
The bill creates a Prevention and Wellness Trust Fund, providing $34 billion in mandatory funding over the next 10 years for programs such as a community-based prevention or child obesity programs. It also establishes a grant program to help small employers create or strengthen workplace wellness programs.
Disappointingly, provisions that would have repealed the Medicaid, Medicare, SCHIP and SSI inmate exception for pretrial inmates were not included.
H.R. 3962 includes the CLASS program that sets up a national, voluntary insurance program — long term care insurance — for purchasing community-living assistance services and support to enable individuals to maintain community residence
Other new provisions:
- training activities to address the unmet needs of children and adults with autism and related developmental disabilities
- new training program for mental and behavioral health professionals, including those specializing in substance abuse counseling and addiction medicine, to promote interdisciplinary training and coordination of the delivery of health care
- grants to strengthen the nation’s emergency room and trauma center capacity
- reauthorizes grant programs to support telehealth networks and telehealth resource centers, including incentives to coordinate telemedicine licensure activities among states, andextends the section 340B outpatient drug discounts to certain rural and other hospitals, including Critical Access Hospitals. A Critical Access Hospital is a hospital that is certified to receive cost-based reimbursement from Medicare.
- requires chain restaurants to put the calorie content of their menu items directly on the menus and to provide other nutritional information available so that consumers can make informed choices about what they eat.
The House’s health reform measure merges the provisions of H.R. 3200, the America’s Affordable Health Choices Act, as amended this summer by the three House committees of jurisdiction with some changes negotiated in the intervening months.
To view a copy of the bill go to: http://docs.house.gov/rules/health/111_ahcaa.pdf
|
