HEALTH INSURANCE REFORM AT A GLANCE

STRONG COST CONTAINMENT MEASURES

TheSenatepassedhealthinsurancereformbillasimprovedbyreconciliationcontainsaseriesof strongcostcontainmentmeasures.Indeed,anumberofhealthcareexpertshavepointedoutthatthis billincludeseveryseriouscostcuttingproposalthathasbeenputforward.Withoutcontrollinghealth carecosts,familieswillcontinuetobeburdenedwithhigherpremiums,businesseswillbeforcedto dropcoverageorlayoffworkers,andournationalandstatebudgetswillbefiscallyunsustainable. Thislegislationisfiscallyresponsibleensuringnotonlythatitisfullypaidforbutthatitbendsthe costcurveoverthelongterm.TheCongressionalBudgetOffice(CBO)estimatesthatthebillcutsthe deficitby$143billionoverthenext10yearsandby$1.2trillioninthefollowingdecade.CBOalso estimatesthat,forfamilies,premiumsforcomparablecoveragewillbelowerunderreform.

DELIVERY SYSTEM REFORMS/MOVING TOWARD VALUE-BASED PAYMENTS Deliverysystemreformmeansmakingsurethattherightpatientgetstherighttreatmentattheright timeinthemostefficientwaypossible.ThisbillincludesnumerousreformsinMedicarethatwill rewardthevalueofcare,notthevolumeofcare.Thehealthreformbill:

MandatesthattheSecretaryofHHSadoptvaluebasedpurchasingandpaymentmethodsfor Medicarereimbursementsforbothphysiciansandhospitals. Createsincentivestoreducepreventablehospitaladmissions.Underthebill,beginninginFY2013, hospitalpaymentswillbeadjustedbasedonthedollarvalueofeachhospitalspercentageof potentiallypreventableMedicarereadmissions. EncouragestheformationofAccountableCareOrganizations(ACOs)thatallowhospitalsand doctorstoworktogethertomanageandcoordinatecareandprovidesthattheseACOswillreceive ashareofthesavingstheyachieveforMedicare. ProvidesthattheSecretaryofHHSwilldevelopanationalpilotprogramencouraginghospitals, doctors,andpostacuteproviderstocoordinatepatientcareandachievesavingsthroughbundled payments(underwhichonepaymentwouldbemadeforanentireepisodeofcare). CreatesanewdemonstrationprogramforchronicallyillMedicarebeneficiariesthatwilltest paymentincentivesandservicedeliveryusinghomebasedprimarycareteams. CreatesanewCenterforMedicareandMedicaidInnovationthatwillresearch,develop,test,and expandinnovativepaymentanddeliveryarrangements. CRACKING DOWN ON WASTE, FRAUD AND ABUSE Intryingtogethealthcarecostsundercontrol,it'simportantthatweknowwhatwe'repayingfor. Thatmeanscrackingdownonwaste,fraud,andabuse.Thehealthinsurancereformbill:

RequiresHHStoinstituteanewscreeningprocessforallprovidersandsuppliersbeforegranting Medicarebillingprivilege;andprovidesstateswithnewauthoritytoimposescreeningprocedures onMedicaidproviders.

Requiresprovidersandsupplierstoadoptcomplianceprogramsasaconditionofparticipatingin MedicareandMedicaid. EliminateswastefuloverpaymentstoMedicareAdvantageplansthatincreaseprivateplanprofits, notpatientcare. IncreasesfundingfortheHealthCareFraudandAbuseControlFundtofightMedicareand Medicaidfraud. Establishesnewpenaltiesforsubmittingfalsedataonapplications,falseclaimsforpayment,orfor obstructingauditinvestigationsrelatedtoMedicare,Medicaid,andCHIP.

CONTAINING COSTS OVER THE LONG TERM Thereformbillcontainsnewstepstoattempttocontaincostsoverthelongterm,including:

Establishesa15memberIndependentPaymentAdvisoryBoardtopresentCongresswithproposals toslowthegrowthofMedicareandprivatehealthcarespendingandimprovethequalityofcare. Theboardischargedwithdevelopingrecommendationsaboutinnovativewaystobettercontrol costsbothinpublicandprivatehealthprograms,whileensuringthatcareisimproved. Includesarevisedversionoftheexcisetaxonhighcosthealthplans,includingdelayingthe effectivedateofthetaxfrom2013to2018,therebyallowingallhealthplansadditionaltimeto becomemoreefficient,whileatthesametimenotimpairingthetaxsabilitytoslowthegrowthof healthcarecostsoverthelongterm. UTILIZING PREVENTION AND WELLNESS PROGRAMS BenjaminFranklinwasrightAnounceofpreventionisworthapoundofcure.Preventionand wellnessprogramswillhelpAmericanslivelonger,healthierlives,andhelpreducetheneedformore costlytreatmentsofhealthconditionslaterinlife.Thereformbill:

EliminatespatientcopaysforpreventiveservicesinMedicare,Medicaid,andprivateplans. EstablishesaPreventionandPublicHealthInvestmentFundtoprovideanexpandedandsustained nationalinvestmentinpreventionandpublichealth. AuthorizesHHStoawardgrantstoeligibleentitiestopromoteindividualandcommunityhealth andtopreventchronicillness. Fundsresearchinpublichealthservicesandsystemstoexaminebestpreventionpractices.

PROMOTING MARKET COMPETITION ThecreationofHealthInsuranceExchangesandinsurancereformswillpromotehealthycompetitionin themarket,puttingdownwardpressureonprices.Thereformbill:

EstablishesstatebasedHealthInsuranceExchanges,transparentmarketplacesthatreplacetodays dysfunctionalsmallgroupandindividualmarkets,toloweradministrativecostsandprovide incentivestoinsurerstomaintainlowerpremiumsinordertoattractmillionsofExchange enrollees. Includesinsurancereformsandstandardizedbenefitpackagesthatwillrequireinsurerstocompete onthebasisofpriceandquality,notonthebasisofthemedicalunderwritingofsickerpatients. Discouragesexcessivepriceincreasesbyinsurancecompaniesbyrequiringdisclosureand justificationofinsurancerateincreases.Insurerswithexcessivepriceincreasescanbeexcluded fromExchanges,providingastrongincentivetokeeppremiumslow. PREPAREDBYTHEOFFICEOFTHESPEAKER MARCH21,2010