New York Times - All Americans would have access to “essential health care benefits,” with no annual or lifetime limits, employers would have to contribute to the cost of coverage and the government would create a new public insurance program under sweeping legislation drafted by Senator Edward M. Kennedy and circulated Friday.
Under the legislation, the government would subsidize premiums for people with incomes up to 500 percent of the poverty level ($110,000 for a family of four), and private insurers would have to pay out a specified percentage of their premium revenues in benefits.
The new government-run program would pay doctors and hospitals at Medicare rates, plus 10 percent.
Mr. Kennedy’s bill would also establish a new insurance program to provide home- and community-based care for 10 million people with severe disabilities.
The bill gives no indication of how Mr. Kennedy would pay for his proposals, other than by requiring contributions by individuals and employers.
Mr. Kennedy, the Massachusetts Democrat and longtime champion of health care for all, has been battling brain cancer. Though the senator has been absent from Congress, he and his staff have prepared legislation for which he hopes to win approval this month from the Committee on Health, Education, Labor and Pensions. He is chairman of the committee.
Anthony Coley, a spokesman for Mr. Kennedy, said the legislative language circulated in Washington on Friday was “a draft of a draft.” Democratic members of the committee “are still actively talking among themselves and their Republican colleagues,” and “there is no final policy,” Mr. Coley said.
As expected, the Kennedy bill, called the American Health Choices Act, is to the left of one being written by the Senate Finance Committee, headed by Senator Max Baucus, Democrat of Montana. Senate Democratic leaders said the two bills would be merged before going to the Senate floor — in July, they hope.
Under the Kennedy bill, individuals would be subject to financial penalties if they did not have health insurance. The Treasury secretary would set the amount of the penalties, at “the minimum practicable amount that can accomplish the goal” of expanding coverage. The penalties would be added to a person’s tax bill and collected by the Internal Revenue Service.
People would be exempt from the penalties if “affordable health care coverage is not available” or if the premium payments would cause “an exceptional financial hardship.” President Obama recommended such a “hardship waiver” this week.
Under Mr. Kennedy’s bill, the secretary of health and human services would establish a panel of experts, the Medical Advisory Council, to recommend a minimum package of insurance benefits. If Congress did not disapprove the recommendations, insurers would generally have to provide the benefits.
The bill stipulates that the “essential benefits” include doctors’ services, hospital care, maternity and newborn care, prescription drugs and mental health and substance abuse services.
Any group health plan or insurance company that provided coverage for children and their parents would have to offer to continue “dependent coverage” for the children through age 26. In effect, young adults could stay on their parents’ policies.
Mr. Kennedy’s bill would also expand Medicaid to cover uninsured people with incomes up to 150 percent of the poverty level ($16,245 for an individual and $33,075 for a family of four). That could open Medicaid to millions of people who do not now qualify.
The bill says that “nothing in this act shall allow federal payments” for illegal immigrants.
Under the bill, the federal government would make grants to the states to establish insurance marketplaces or exchanges. Those entities, known as health benefit gateways, would disseminate information about premiums and benefits and would help people enroll.
The new entities would also act as financial intermediaries, receiving subsidy payments from the government and sending the money to insurance companies. The insurance exchanges would also redistribute money among health insurance plans, from those with a large share of healthy subscribers to those with large numbers of sick people.
To protect consumers, federal officials would establish rules for the marketing of insurance policies. States could enforce tougher standards of their own.
The secretary of health and human services would establish the new government-sponsored plan, which would compete directly with private insurers. Republicans strenuously oppose a government-run plan, but Mr. Obama says it is needed to “keep insurance companies honest.”
Friday, June 05, 2009
The Kennedy Plan
The Kennedy Plan