On Monday, President Obama released his proposal for completing health care reform. The comprehensive plan appears to reflect deliberations in January between House and Senate negotiators working to craft a compromise bill. The proposal is extensive and could serve as a starting point for a budget reconciliation bill (which would need only 50 votes to pass in the Senate). Such a “fix” bill would be passed in conjunction with House passage of the Senate bill.
For an extensive analysis of the bill, read Tim Jost’s two blog posts in Health Affairs. As Jost points out, even though the President has put forth his proposal, this does not exclude Republican ideas from being incorporated into the health care package (indeed, many have been already). Changes can still be made through the reconciliation process or possibly through a separate bipartisan bill. However, as Jost states, this is the only realistic path forward:
The president’s approach of merely putting out reconciliation language is […] politically realistic. It should be clear to everyone that simply starting over with a clean slate is not politically feasible at this point. A year’s work has gone into the pending legislation, and this Congress has neither the time nor the good will to do it all over again.
Here is a very brief summary of the provisions in the President’s proposal:
- No public option
- State exchanges (Senate bill) rather than national (House bill)
- Expands eligibility for Medicaid to 133% of the federal poverty line (House bill was 150%) – 133% FPL is $14,404 for an individual and $29,327 for a family of four
- Premium subsidies closer to the Senate bill (less generous than House bill for those closer to the poverty line)
- Provides states 100% of funding for the Medicaid expansion through 2017, 95% through 2019, and 90% thereafter
- Eliminates Nebraska Senator Ben Nelson’s special “Cornhusker” kickback for his state
- Does not increase Medicaid provider payment rates (which are lower than those for Medicare)
- Provides $11 billion for community health centers over the next five years (Senate bill: $7 billion, House bill: $12 billion)
- Keeps the Senate abortion language
- Subjects existing, “grandfathered,” plans to some of the new regulations (under both the House and Senate bills, existing plans would have been exempt).
- Keeps the Senate’s employer penalties rather than the House’s employer mandate; increases penalties, but exempts more employees
- Keeps the Senate’s tax on “Cadillac” health plans but increases the threshold
- Increases taxes for individuals earning over $200,000 a year and couples earning over $250,000 (more similar to the House bill)
- Eliminates the Medicare prescription drug “donut hole” by 2020 ($250 rebate in 2010, gradual reduction thereafter)
For additional resources on health care reform, visit the Abundant Life health care page.