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Making a Good Bill Even Better

Nancy-Ann DeParle, Director of the White House Office of Health Reform, discusses today's changes to the Senate health insurance reform bill.

Congress has been working hard for months to shape health insurance reform legislation that will bring down costs, expand coverage, increase accountability for insurers, and attack our mounting deficit. We got good news today on all those fronts, as fresh statements of support from the Small Business Majority, the American Cancer Society, and the American Diabetes Association amongst others make clear.

We learned today from the Congressional Budget Office that this bill will reduce the deficit by $132 billion over the first decade, and more than $1 trillion in the decade after that. That makes it the biggest deficit-reduction effort in over a decade. All while expanding coverage to 30 million more Americans.

But bringing down the deficit and expanding coverage are only part of what insurance reform will do. And today the Senate introduced a package of changes to their bill that will make critical progress in ensuring competition, providing affordable choices, and holding the insurance companies accountable. These improvements were bundled together in what’s called a manager’s amendment – and here are some of the highlights:

  • Penalizing insurers for unfair rate hikes. If insurers who arbitrarily jack up rates before the exchanges come online, they won’t be allowed to participate in them – they’ll miss the opportunity to compete for millions of new customers. That creates a strong incentive to keep premiums low before the exchanges are up and running in 2014.
  • Making sure your money goes toward care, not administrative costs. Insurers will be required to spend a greater portion of your premium on the care you receive, rather than administrative costs or salaries. And if they don’t, they’ll have to pay you a rebate.
  • Ending discrimination based on pre-existing conditions. Once the exchanges are open in 2014, insurance companies will no longer be able to deny you coverage because you have a pre-existing condition. In the meantime, the legislation immediately creates a high-risk pool where adults with pre-existing conditions can purchase affordable coverage. And for families with kids, the news is even better: insurers will immediately be prohibited from denying coverage to kids with pre-existing conditions. Period.
  • Protecting your access to care. Lifetime limits on benefits will be banned right away.
  • Annual limits will also be banned once the exchanges are up and running. The manager’s amendment ensures that in the meantime, the use of annual limits will be tightly restricted until we can do away with this unfair practice entirely.
  • More help for small business. The bill now includes additional help for small businesses. The health insurance tax credit for small businesses will now start in 2010, eligibility for the credit will be expanded, and small businesses will see improved purchasing power to make sure employees are getting good coverage at a good value.
  • Choice and competition. Insurers will now offer multi-state plans under the supervision of the Office of Personnel Management. That means more choice and more competition in your state.
  • Focusing on quality, not quantity. Health care providers will be reimbursed by Medicare for the quality of care, not just the quantity of tests and treatments. Shifting the way we reimburse for care is one of the most important things we can do to rein in spiraling health care costs – and it means a renewed focus on what’s best for the patient.

All told, it’s been a landmark day in the health insurance reform effort. There’s a lot more hard work to be done, and we’re confident that the Senate and House will continue to work hard to get this bill across the finish line and to the President’s desk. For the millions of Americans who don’t have coverage, for those who are struggling with costs or being mistreated by their insurance company, every day counts. It’s time for us to deliver.

UPDATE: The statements of support continue to roll in, here's a sample:

American Diabetes Association (ADA):  “The Bill Makes Health Care More Accessible And Affordable…We Urge You To Advance The Patient Protection And Affordable Care Act...”  In a letter to U.S. Senators, the American Diabetes Association (ADA) wrote, “On behalf of the nearly 24 million Americans with diabetes and the 57 million more with pre-diabetes, we thank you for your tireless commitment to reforming our nation’s health system.  We understand the tremendous amount work that has gone into H.R. 3590, the Patient Protection and Affordable Care Act and are grateful for your efforts.  The progress that has been made thus far has brought us closer than ever to achieving the goals of health reform. Specifically, the bill makes health care more accessible and affordable  to the millions of Americans who are currently uninsured and underinsured, including those with diabetes who have been denied coverage or charged exorbitant amounts due to their preexisting condition. The bill also includes many important provisions in terms of prevention, insurance reform, and the delivery of quality and affordable health care. These are but a few of the long overdue improvements to our broken healthcare system…We urge you to advance the Patient Protection and Affordable Care Act and look forward to working with you and members of the House of Representatives in Conference to make certain that our country receives a final Health care package that will make a real and positive difference in the lives of people with diabetes.  [American Diabetes Association Letter to U.S. Senate, 12/19/09]

American Cancer Society (ACS):  Health Reform Bill’s Provisions Banning Coverage Limits Would “Afford Patients With Serious Health Conditions The Strong Financial Protections They Deserve…We Thank The White House And Senate Leaders For Hearings [Our] Concerns.”  In a statement, the American Cancer Society (ACS) said, "We are enormously pleased that the manager's amendment bans annual coverage limits after 2014 and ensures that any annual limits in plans issued before then are set high enough to cover essential health benefits for patients. That language, coupled with the amendment's immediate ban on lifetime coverage limits, would afford patients with serious health conditions the strong financial protections they deserve in the face of major medical expenses. We thank the White House and Senate leaders for hearing the concerns of cancer patients and strongly strengthening these important provisions."  [American Cancer Society Statement, 12/19/09]

Small Business Majority:  “It’s Clear That [Senators] Have Heard The Voices Of Small Business Owners…Many Of The Recently Proposed Amendments Contribute To An Overall Bill That Will Be Even More Helpful To Small Business Owners And The Self-Employed.”  In a letter to Senate Majority Leader Reid, Small Business Majority CEO John Arensmeyer wrote, “We appreciate the tremendous amount of work that you and your colleagues in the Senate have put into crafting the Patient Protection and Affordable Care Act so that it will both meet its original goals and gain enough support for passage. Although the necessary compromises have been disappointing and frustrating for some, it’s clear that you and your fellow senators have heard the voices of small business owners, who so desperately need relief from an unfair, overly expensive health insurance system. Many of the recently proposed amendments contribute to an overall bill that will be even more helpful to small business owners and the self-employed. Small Business Majority will continue to support the effort to bring this measure to the Senate floor for a final vote and passage…Again, thank you for your continuing hard work on this vital issue. You can count on Small Business Majority to work to get this bill to conference committee and ensure that final legislation is passed that meets the needs of America’s small businesses and the economy.”  [Small Business Majority Letter to Senate Majority Leader Reid, 12/19/09]

Doctors For America: “We Wish To Express Our Support For Senate Passage Of The Patient Protection And Affordable Care Act…[It] Represents A Historic Step Toward Improving The Health Care System For Us And Our Patients.”  In a letter to Senate Majority Leader Reid, Doctors For America President Vivek Murphy wrote, “On behalf of Doctors for America and its 16,000 physician and medical student members across all 50 states who are committed to building a better health care system for our patients, we wish to express our support for Senate passage of the Patient Protection and Affordable Care Act. This landmark piece of legislation provides increased access to affordable health coverage, implements market reforms to protect our patients, invests in the primary care physician workforce and public health system, and begins to reform the payment and delivery systems so doctors can focus on providing high quality care for our patients…As doctors and medical students, we see the urgent need to fix our broken health care system first hand every day – which is why a majority of physicians support health reform this year. We are fighting to ensure that all Americans receive access to high quality care - the kind of care that we, as physicians, want for our patients. While we know that this legislation will not fix all the problems of our broken health care system, the Patient Protection and Affordable Care Act represents a historic step toward improving the health care system for us and our patients.”  [Doctors For America Letter to U.S. Senate, 12/19/09]

Community Catalyst: “We Strongly Encourage Passage Of The Bill Because We Believe It Will Positively Impact The Lives Of Millions Of Americans.”  In a statement, Community Catalyst said, “Today, the U.S. Senate has brought us even closer to the finish line of passing landmark health reform legislation that will improve access to quality affordable health care for millions of Americans.  As a national advocacy organization actively working in more than 40 states to ensure consumers have a strong voice in improving America’s health care system, we are very pleased 60 Senators from states where we have focused our efforts have pledged their support for the Patient Protection and Affordable Care Act. We thank these Senators for hearing the concerns of consumers across the country and allowing this important process to move forward. The Manager’s amendment released today builds on the strengths of the bill through critical consumer protections such as programs to contain health costs and make insurance policies more affordable, greater accountability from health insurance companies, improved choice and competition, and better access to quality affordable health care for vulnerable populations.  We strongly encourage passage of the bill because we believe it will positively impact the lives of millions of Americans.  As the only national consumer organization that has on-the-ground experience implementing comprehensive health reform at the state level, Community Catalyst understands the benefits of this bill and the important ongoing role consumer advocates will need to play to ensure its success. We encourage the Senate to pass this critical legislation, and to continue to work with the House to ensure that all Americans have access to quality health-care they can afford.”  [Community Catalyst Press Releaee, 12/19/09]

National Hospice and Palliative Care Organization (NHPCO): “We Applaud [The Senate’s] Recognition Of The Importance Of Preserving Quality, Compassionate And Cost-Efficient End-Of-Life Care.”   In a letter, the National Hospice And Palliative Care Organization (NHPC) wrote, “On behalf of hospice and palliative care providers and the more than 1.5 million patients, and their families, served by hospice each year, the National Hospice and Palliative Care Organization (NHPCO) would like to express our strong support for the national effort to enact health care reform. We acknowledge the enormity and complexity of the task facing Congress, and we applaud your recognition of the importance of preserving quality, compassionate and cost efficient end-of-life care as a critical component to the nation’s health infrastructure.” [National Hospice and Palliative Care Organization letter, 12/19/09]

Nancy-Ann DeParle is the Director of the White House Office of Health Reform.