Insurance Industry Reforms Help Families, Small Businesses, Seniors

WASHINGTON- Today, U.S. Senator Debbie Stabenow, a member of the Senate Finance Committee, voted in favor of the health insurance industry reform proposal. It passed by a margin of 14 to 9.

Senator Stabenow said, “ The America's Healthy Future Act is a long-time coming. This process started over 100 years ago, when President Teddy Roosevelt first called for a national commitment to health care coverage for all Americans. Today, we are one step closer to achieving that goal. This bill stops bad insurance company practices, begins to bring costs down, and closes the gaps in coverage that have left millions of Americans without the health care they need. From pre-natal care, to young-adulthood, through the working years, into retirement, this bill covers every stage of life with quality, affordable health care coverage.”

In the Senate, the proposal will now be merged with the Senate Health, Education, Labor and Pensions Committee’s health insurance reform bill before moving to the floor. Then, after a process of amending and passing the combined package on the Senate floor, the bill will move to a joint House and Senate conference committee. Finally, the House and Senate will vote on the complete legislation before it is sent to the President’s desk to be signed into law.

The Senate Finance Committee proposal passed today includes key initiatives from Senator Stabenow:

• Contributing $5 billion to Early Retiree Coverage - Reimburses employers or insurers for 80 percent of early retiree insurance claims between $15,000 and $90,000. Eligible employers are those who offer coverage for preventative treatments as well as care for high-cost and chronic conditions for retirees aged 55 to 64.

• Allowing States to Negotiate for Lower Cost Coverage - Creates competition in the health insurance market by allowing states to negotiate with insurers for the first time. Using their large purchasing power, states will be able to bargain for high-quality health care coverage at a lower cost for their citizens. This will create a basic health insurance plan for up to 75 percent of the uninsured.

•  Providing Mental Health Coverage- Ensures that health insurance plans in the new insurance exchanges are required to comply with federal law and provide mental health services that are equivalent in coverage to physical health services. Treatment for depression will receive the same coverage as treatment for high blood pressure.

•  Ensuring Dental Coverage-  This Stabenow provision will make sure that dental insurance companies can offer their services to consumers in the new health insurance exchange. Dental insurance won’t take a back seat to primary care or other insurance coverage.

• Improving Hospital Quality - Establishes a national strategy to improve quality and patient safety based on Michigan’s own nationally-recognized Keystone Initiative.

• Investment in Nurse Training - Supports the training of nurses through a new, federally-funded partnership with hospitals and community-based centers.

• Keeping Seniors Safe from Abuse - Protects our nation’s seniors from abuse by assisting nursing homes and long-term care facilities with employee background checks.

•  Eliminates Obstacles to Generic Drugs - Removes barriers to prescribing high quality, lower cost generic medicine. Gives seniors enrolled in Medicare Part D more opportunities to sample affordable generic medicines free of charge. Then, they can determine whether a lower cost generic drug meets their needs just as well as their present brand name option.

•  Guaranteed Family Planning Option- Provides optional reproductive family planning services and supplies as well as related medical diagnosis and treatment services as part of state Medicaid programs.

• High-Quality Foster Care - Ensures that children in foster care can receive specialized medical care for serious mental and behavioral needs.

•  Protecting Our Children-  Directs that children covered by CHIP, known as MI Child in our state, will continue to receive quality coverage as the number of enrollees increases.

•  School-based Health Centers - Helps more children receive health care services from school-based health centers.

The complete package from the Senate Finance Committee:

Stops Insurance Company Bad Practices

•  Prevents insurance companies from denying coverage or hiking up rates for those with pre-existing conditions.

 

•  Stops insurance companies from dropping coverage or reducing benefits for those who get sick.

 

•  Stop insurance companies from charging different premium rates based on gender, health status, family history or occupation.

 

•  Halts insurance company practice of putting limits on how much coverage you can use each year and during your lifetime.  Through this package insurance companies will be required to treat consumers fairly. 

 

•  Requires maternity care and other basic services to be included in health insurance coverage.

 

•  Health insurance companies will no longer receive tax deductions if they give their executives excessive salaries and compensation.

Strengthens Medicare for Our Seniors

• Strengthens Medicare for the Future - Strengthens the Medicare Trust Fund to ensure sustainability for years to come. It also reduces federal spending by making our system more efficient and aggressively targeting waste, fraud and abuse.

• Lowers Prescription Drug Costs - Helps Medicare Part D participants purchase prescription drugs when they hit the coverage gap portion or “donut hole”. Instead of paying 100 percent of their drug cost in the gap, Part D beneficiaries with low to moderate incomes will receive a 50 percent discount on the price of brand-name drugs covered by their plan to help make expensive medicines more affordable.

• Prevention - Eliminates all out-of-pocket costs for recommended preventive care and screenings. Provides seniors with free annual visits under Medicare.  These visits will give seniors a personalized prevention plan to address health risks and chronic health problems and to design a schedule for regular recommended preventive screenings.

•  Better Care for Chronically-Ill Seniors - Gives states incentives to create “health homes” for chronically-ill seniors. A health home would centralize responsibilities to ensure that seniors with multiple health care needs don’t have treatments fall through the cracks. Seniors who choose to participate will receive comprehensive care coordination, transitional care and, if relevant, referral to community-based programs and social services.

Making Comprehensive Health Insurance Affordable for Families and Small Businesses

• Health Insurance Exchanges - Establishes health insurance “exchanges” that provide an easy, efficient place for consumers to compare health insurance plans. Americans will be able to choose from current insurance company plans, non-profit plans, or consumer-owned and oriented plans called CO-Ops. Also, Members of Congress will be required to buy their health insurance through the same exchanges that people in their own states will use, instead of their current Federal Employees Health Benefit plan.

•  Health Care Affordability Tax Credits- Helps more middle-class families and individuals to afford health insurance coverage by providing tax credits to purchase insurance and caps on out-of-pocket expenses.

 

•  Small Business Health Care Affordability Tax Credits - Creates a tax credit for small businesses that offer health insurance to their employees.

Improving Access and Delivery of Health Care Services

•  Hospital Value-Based Purchasing - This proposal will establish a value-based purchasing program for hospitals so that a percentage of a hospital’s payments will be tied to the quality of care it gives to patients on common and high-cost treatments, such as cardiac, surgical and pneumonia care.

 

•  Medicare Home Health Agency and Skilled Nursing Facility Value-Based Purchasing -

Directs the Secretary of Health and Human Services to submit a plan to Congress related to home health providers and skilled nursing facilities suggesting how to increase the quality of care they provide by creating payment incentives in the future.

 

•  Quality Reporting for Other Providers - Sets providers such as long-term care hospitals, inpatient rehabilitation facilities, PPS-exempt cancer hospitals and hospice providers on a path toward increase efficiency by requiring the Secretary of Health and Human Services to begin measuring the quality of health care services they provide.

America’s Healthy Future Act makes it easier for families and small businesses without insurance to purchase health insurance and it increases their choices. People who currently have insurance will benefit from better coverage and new rules that make insurance companies treat them fairly. Senator Stabenow said, “I am pleased to have led the effort to give Michigan families, seniors, small businesses and individuals tax credits that will keep health insurance within their reach.”

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