With those changes, Senator Ben Nelson of Nebraska announced his support for the health reform proposal. This means that barring a surprise, the Senate Democrats have the 60 votes necessary to pass the bill off the floor and into conference committee. Given the wide ideological spectrum in the Democratic Party, this is a significant feat–and a bill that is necessarily a compromise.
We’ve been following the action on our Twitter account, at www.twitter.com/healthaccess.
Here’s a list from Senator Reid’s office of the components of the manager’s amendment, with editorial comments from HCAN’s Blog:
* Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits – or else pay rebates to policyholders. These stricter limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans. (Ed note: Reportedly, these require group insurance plans to pay 85% of premiums to health care, and individual plans to pay 80%. These would go into effect in 2011. In 2012, the ratios would be based on the average medical loss ratio in the Exchange.)
* Accountability for excessive rate increases. A health insurer’s participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded – a powerful incentive to keep premiums affordable.
* Immediate ban on pre-existing condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of pre-existing conditions for children.
Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care.
* Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014.
* Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.
* Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice. (Ed note: At least two plans will have to be offered, one of which must be non-profit. OPM can negotiate medical loss ratio, profits, premiums and other terms.)
* Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.
* Children’s health. Support will be extended for the Children’s Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage.
* Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.
* Revised abortion language, including state opt-out of abortion coverage (Ed note: details here)
More commentary to come…