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Friday, January 15, 2010

Affordability in the health reform bill

Kate Blocher

Staff Writer

The health reform debate is rounding the corner and barreling towards the finish line-signing the bill into law. However, before we reach this momentous end, there are a few more procedural hurdles to overcome. The most daunting of them will be merging the House and Senate bills into a single piece of legislation that will be able to receive a majority vote in both chambers and to be signed into law by President Obama.

Leaders from the House and the Senate will work together to merge the bills in a modified conference. However, this will be no simple task. Both bills contain thousands of provisions, and conference leaders must settle the differences between the bills. The strength of the final product is dependant on where they end up in their negotiations.

In order to truly bring about comprehensive health reform legislation that finally gives all Americans access quality, affordable health care, leaders must pay special attention to the area of affordability. Both the Senate and House bills address the issue of affordability, but each has their strengths and weaknesses.

Affordable premiums and protections from high deductibles, copayments, and coinsurance are integral elements of comprehensive health reform. Looking at the issue of affordable premiums, the Senate legislation does a good job at providing adequate premium subsidies for people with incomes above 250 percent of the federal poverty level. The House legislation is better at providing premium subsidies for people with incomes below 250 percent of poverty. In order to ensure that both low- and middle-income families are provided adequate premium subsidies to purchase insurance in the Exchange, the final legislation should combine the strengths of the House and Senate bills.

In addition to providing more help with the cost of premiums, the insurance people buy should provide affordable access to health services. Contrasting the provisions in the House and Senate bills that will protect people from high cost-sharing (deductibles, copayments, and coinsurance) and limit total annual out-of-pocket costs is a bit more complicated. However, the bottom line is that the final bill should have the strongest protections possible for all people who purchase coverage in the Exchange, with additional cost-sharing subsidies for people below 300 percent of poverty. 

In addition, both the House and Senate call for a Medicaid expansion. The Senate expands eligibility to 133 percent of poverty, while the House expands eligibility to 150 percent of poverty. In this instance, the conference leaders should follow the House's lead. Medicaid provides both protection from high premiums and special out-of-pocket spending protections, which are critically important for low-income populations. In order to adequately protect this lower-income population, the final bill should adopt of the House's Medicaid eligibility level.

Of course, this is just a snapshot of what is sure to be an intense debate, but the hope is that the leaders from the House and Senate will merge the best parts of both bills in order to create the strongest possible health reform bill. Stay tuned for more updates as Congress takes the last steps in what has already proven to be an incredible journey towards finally obtaining affordable, quality health care for all!