Tonight, with support from Rep. Betty Sutton (D-OH), the House passed H.R. 3590, the Patient Protection and Affordable Care Act, as well as H.R. 4872, the Reconciliation Act of 2010. Rep. Sutton (D-OH) released the following statement on the passage of this important reconciliation measure:
"Every year 45,000 people in this country die because they do not have health insurance coverage, and in this great nation it should not be that way. And, on this day, in this moment, we have been called to stand up and vote to put an end to that sad reality.
"This is the moment when we will finally take the long-overdue step of ending the unconscionable practices of the insurance companies, who through their greed and disregard have enjoyed record profits even as American families have suffered, sometimes fatally because of their actions.
"I support this legislation because it will put a stop to the discriminatory practices by insurance companies that deny care based on pre-existing conditions and impose outrageous premium increases on American families. I support this legislation because it will cap out-of- pocket expenses that insurance companies impose on our constituents forcing many into bankruptcy when they or their children are stricken by illness or injury. I support this legislation because it is a vote to stop insurance companies from inflicting lifetime caps on people who have paid for insurance, only to find that it was not there for them when they needed it most. I support this legislation, because it will strengthen the solvency of Medicare, lower drug costs and close the donut hole for our seniors, and has the support of the AARP.
"This legislation will make health insurance more affordable and accessible for small businesses and individuals. This legislation will finally curb the perpetual, skyrocketing costs of health care that have been drowning far too many American families for far too long. This measure will reduce our deficit by more than $1.3 trillion in the next two decades.
"I support this legislation because within the 13th District of Ohio, which I am so honored to serve, it will improve coverage for 420,000 of my constituents with health insurance. It will give tax credits and other assistance to up to 154,000 families and 13,200 small businesses to help them afford coverage. It will improve Medicare for 107,000 beneficiaries, including closing the donut hole. It will extend coverage to 33,500 uninsured residents of the 13th District. It will guarantee that 9,000 residents with pre-existing conditions can obtain coverage. It will protect 1,700 families from bankruptcy due to unaffordable health care costs. It will allow 45,000 young adults to obtain coverage on their parents' insurance plans. It will help support 3 community health centers in the 13th District and reduce the cost of uncompensated care for hospitals and other health care providers by $34 million annually.
"For all of these reasons, this is the day, this is the moment, and I am honored to support this health care measure."
The Benefits of Health Care Reform in the 13th Congressional District of Ohio include:
Affordable High-Quality Health Care for the Middle Class
Essential health insurance reforms. Approximately 65% of the district (420,000 residents) receives health care coverage from an employer or through policies purchased on the individual market. Under the legislation, individuals with insurance can keep the coverage they have now, and it will get better. The insurance reforms in the bill prohibit annual and lifetime limits, eliminate rescissions for individuals who become ill while insured, ban coverage denials for pre-existing conditions, and reduce the cost of preventive care. To rein in soaring insurance costs, the reforms also limit the amount insurance companies can spend on administrative expenses, profits, and other overhead.
Historic health care tax cuts. Those who do not receive health care coverage through their employer will be able to purchase coverage at group rates through the new health insurance exchange. To make this insurance affordable, the legislation contains the largest middle-class tax cut for health care in history, providing middle class families with incomes up to $88,000 for a family of four with tax credits to help pay for coverage in the exchange. For a family of four making $50,000, the average tax credit will be approximately $5,800. There are 154,000 households in the district that could qualify for these credits if they purchase health insurance through the exchange or, in the case of households with incomes below 133% of poverty, receive coverage through Medicaid.
Coverage for individuals with pre-existing conditions. There are 9,000 uninsured individuals in the district who have pre-existing medical conditions like cancer, heart disease, and diabetes. Under the bill's insurance reforms, they cannot be denied affordable coverage.
Financial security for families. There were 1,700 health care-related bankruptcies in the district in 2008, caused primarily by the health care costs not covered by insurance. The bill caps annual out-of-pocket costs at $6,200 for individuals and $12,400 for families who purchase insurance through the exchange or who are insured by small businesses. It also eliminates annual and lifetime limits on all insurance coverage. These reforms ensure that no family will have to face financial ruin because of high health care costs.
Security for Seniors
Improving Medicare. There are 107,000 Medicare beneficiaries in the district. The legislation improves their benefits by providing free preventive and wellness care, improving primary and coordinated care, and enhancing nursing home care. The bill also strengthens the Medicare Trust Fund, extending its solvency from 2017 to 2026.
Closing the Part D donut hole. Each year, 8,500 Medicare beneficiaries in the district enter the Part D donut hole and are forced to pay the full cost of their prescription drugs. Under the bill, these beneficiaries will receive a $250 rebate in 2010, 50% discounts on brand name drugs beginning in 2011, and complete closure of the donut hole within a decade. A typical beneficiary who enters the donut hole will see savings of over $700 in 2011 and over $3,000 by 2020.
New Coverage Options for Young Adults
New lower-cost health care options for young adults. The legislation will allow young adults to remain on their parents' policies until they turn 26. There are 45,000 young adults in the district who could benefit from this option. For individuals under age 30, the bill creates new, inexpensive policies that allow them to obtain protection from catastrophic health care costs.
Help for Small Businesses
Helping small businesses obtain health insurance. Under the legislation, small businesses with 100 employees or less will be able to join the health insurance exchange, benefiting from group rates and a greater choice of insurers. There are 15,100 small businesses in the district that could benefit from this provision.
Tax credits for small businesses. Small businesses with 25 employees or less and average wages of less than $50,000 will qualify for tax credits of up to 50% of the costs of providing health insurance. There are up to 13,200 small businesses in the district that could qualify for these credits.
Coverage for the Uninsured
Coverage of the uninsured. The Legislation would extend coverage to 95% of all Americans. If this level of coverage is reached in the district, between 33,500 residents who currently do not have health insurance will receive coverage.
Relieving the burden of uncompensated care. In 2008, health care providers in the district provided uncompensated care to individuals who lacked insurance coverage and were unable to pay their bills. Under the legislation, these costs of uncompensated care will be $34 million.
Supporting community health centers. There are 3 community health centers in the district that provide health care to the poor and medically underserved. Nationwide, the legislation would provide $11 billion in new funding for these centers. If the community health centers in the district receive the average level of support, the 3 centers will receive $3.9 million in new assistance.
No deficit spending. The cost of health care reform under the legislation is fully paid for, in large part by eliminating waste, fraud, abuse, and excessive profits for private insurers. The legislation will reduce the deficit by $130 billion over the next 10 years, and by about $1.2 trillion over the second decade.
This analysis is based upon the following sources: the U.S. Census (data on insurance rates, small businesses, and young adult population); the Centers for Medicare and Medicaid Services (data on Medicare and Part D enrollment); the Department of Health and Human Services (data on health care related bankruptcies, uncompensated care, and pre-existing conditions); the Health Resources and Services Administration (data on community health centers); and the Congressional Budget Office (estimates of the percentage of citizens with health insurance coverage under health care reform legislation).
Key provisions that will take effect immediately under the legislative package the House passed today (the Senate health bill as amended by the reconciliation bill). The reconciliation bill is based largely on the improvements put forward by the President's proposal - moving toward the House bill in certain critical areas.
1. SMALL BUSINESS TAX CREDITS -- Offers tax credits to small businesses to make employee coverage more affordable. Tax credits of up to 35 percent of premiums will be immediately available to firms that choose to offer coverage. Effective beginning for calendar year 2010. (Beginning in 2014, the small business tax credits will cover 50 percent of premiums.)
2. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE -- Provides a $250 rebate to Medicare beneficiaries who hit the donut hole in 2010. Effective for calendar year 2010. (Beginning in 2011, institutes a 50% discount on brand-name drugs in the donut hole; also completely closes the donut hole by 2020.)
3. FREE PREVENTIVE CARE UNDER MEDICARE -- Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program. Effective beginning January 1, 2011.
4. HELP FOR EARLY RETIREES -- Creates a temporary re-insurance program (until the Exchanges are available) to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64. Effective 90 days after enactment
5. ENDS RESCISSIONS -- Bans insurance companies from dropping people from coverage when they get sick. Effective 6 months after enactment.
6. NO DISCRIMINATON AGAINST CHILDREN WITH PRE-EXISTING CONDITIONS -- Prohibits health insurers from denying coverage to children with pre-existing conditions. Effective 6 months after enactment. (Beginning in 2014, this prohibition would apply to all persons.)
7. BANS LIFETIME LIMITS ON COVERAGE -- Prohibits health insurance companies from placing lifetime caps on coverage. Effective 6 months after enactment.
8. BANS RESTRICTIVE ANNUAL LIMITS ON COVERAGE -- Tightly restricts new plans' use of annual limits to ensure access to needed care. These tight restrictions will be defined by HHS. Effective 6 months after enactment. (Beginning in 2014, the use of any annual limits would be prohibited for all plans.)
9. FREE PREVENTIVE CARE UNDER NEW PRIVATE PLANS -- Requires new private plans to cover preventive services with no co-payments and with preventive services being exempt from deductibles. Effective 6 months after enactment. (Beginning in 2018, this requirement applies to all plans.)
10. NEW, INDEPENDENT APPEALS PROCESS -- Ensures consumers in new plans have access to an effective internal and external appeals process to appeal decisions by their health insurance plan. Effective 6 months after enactment.
11. ENSURING VALUE FOR PREMIUM PAYMENTS -- Requires plans in the individual and small group market to spend 80 percent of premium dollars on medical services, and plans in the large group market to spend 85 percent. Insurers that do not meet these thresholds must provide rebates to policyholders. Effective on January 1, 2011.
12. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) -- Provides immediate access to insurance for Americans who are uninsured because of a pre-existing condition - through a temporary high-risk pool. Effective 90 days after enactment.
13. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 26TH BIRTHDAY THROUGH PARENTS' INSURANCE - Requires health plans to allow young people up to their 26th birthday to remain on their parents' insurance policy, at the parents' choice. Effective 6 months after enactment.
14. COMMUNITY HEALTH CENTERS -- Increases funding for Community Health Centers to allow for nearly a doubling of the number of patients seen by the centers over the next 5 years. Effective beginning in fiscal year 2010.
15. INCREASING NUMBER OF PRIMARY CARE DOCTORS -- Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals. Effective beginning in fiscal year 2010.
16. PROHIBITING DISCRIMINATION BASED ON SALARY -- Prohibits new group health plans from establishing any eligibility rules for health care coverage that have the effect of discriminating in favor of higher wage employees. Effective 6 months after enactment.
17. HEALTH INSURANCE CONSUMER INFORMATION -- Provides aid to states in establishing offices of health insurance consumer assistance in order to help individuals with the filing of complaints and appeals. Effective beginning in FY 2010.
18. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM -- Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled. Effective on January 1, 2011.