Exactly how much do we really know?


I better question may be: How much info do you really wish to know?

There is a synopsis from the Kaiser Foundation that breaks down the 1000 page HR 3200 House bill into a more readable format.

And ... at the following link an interactive side-by-side comparison engine that compares the twelve (12) leading comprehensive reform proposals across a number of key characteristics and plan components :

You can choose an individual plan to read or the side-by-side comparisons of each plan if you so choose.


www.kff.org/healthreform/sidebyside.cfm



Here is the "Pooling Mechanism" for creating the "Exchanges" and "Public Option" as an example of one of the characteristics of the HR 3200 House bill:

*  Create a National Health Insurance Exchange, through which individuals and employers (phasing-in eligibility for employers starting with smallest employers) can purchase qualified insurance, including from private health plans and the public health insurance option.

    * Restrict access to coverage through the Exchange to individuals who are not enrolled in qualified or grandfathered employer or individual coverage, Medicare, Medicaid (with some exceptions), TRICARE, or VA coverage (with some exceptions). [E&C Committee amendment: Permit members of the armed forces and those with coverage through TRICARE or the VA to enroll in a health benefits plan offered through the Exchange.]

    * Create a new public health insurance option to be offered through the Health Insurance Exchange that must meet the same requirements as private plans regarding benefit levels, provider networks, consumer protections, and cost-sharing. Require the public plan to offer basic, enhanced, and premium plans, and permit it to offer premium plus plans. Finance the costs of the public plan through revenues from premiums. For the first three years, set provider payment rates in the public plan at Medicare rates and allow bonus payments of 5% for providers that participate in both Medicare and the public plan and for pediatricians and other providers that don't typically participate in Medicare. In subsequent years, permit the Secretary to establish a process for setting rates. [E&C Committee amendment: Require the public health insurance option to negotiate rates with providers so that the rates are not lower than Medicare rates and not higher than the average rates paid by other qualified health benefit plan offering entities.] Health care providers participating in Medicare are considered participating providers in the public plan unless they opt out. Permit the public plan to develop innovative payment mechanisms, including medical home and other care management payments, value-based purchasing, bundling of services, differential payment rates, performance based payments, or partial capitation and modify cost sharing and payment rates to encourage use of high-value services. [E&C Committee amendment: Clarify that the public health insurance option must meet the same requirements as other plans relating to guarantee issue and renewability, insurance rating rules, network adequacy, and transparency of information.] [E&C Committee amendment: Require the public health insurance option to adopt a prescription drug formulary.]

    * Create four benefit categories of plans to be offered through the Exchange:

          o Basic plan includes essential benefits package and covers 70% of the benefit costs of the plan;
          o Enhanced plan includes essential benefits package, reduced cost sharing compared to the basic plan, and covers 85% of benefit costs of the plan;
          o Premium plan includes essential benefits package with reduced cost sharing compared to the enhanced plan and covers 95% of the benefit costs of the plan;
          o Premium plus plan is a premium plan that provides additional benefits, such as oral health and vision care.

    * Require guarantee issue and renewability; allow rating variation based only on age (limited to 2 to 1 ratio), premium rating area, and family enrollment; and limit the medical loss ratio to a specified percentage.

    * Require plans participating in the Exchange to be state licensed, report data as required, implement affordability credits, meet network adequacy standards, provide culturally and linguistically appropriate services, contract with essential community providers, and participate in risk pooling. Require participating plans to offer one basic plan for each service area and permit them to offer additional plans. [E&C Committee amendment: Require plans to provide information related to end-of-life planning to individuals and provide the option to establish advance directives and physician's order for life sustaining treatment.]

    * Require risk adjustment of participating Exchange plans.

    * Provide information to consumers to enable them to choose among plans in the Exchange, including establishing a telephone hotline and maintaining a website and provide information on open enrollment periods and how to enroll.

    * [E&C Committee amendment: Prohibit plans participating in the Exchange from discriminating against any provider because of a willingness or unwillingness to provide abortions.]

    * [E&C Committee amendment: Facilitate the establishment of non-for-profit, member-run health insurance cooperatives to provide insurance through the Exchange.]

    * Allow states to operate state-based exchanges if they demonstrate the capacity to meet the requirements for administering the exchange.

	-OGD-