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Congressional Democrats have unveiled the final changes to a sweeping healthcare overhaul they hope will clear the U.S. House of Representatives on Sunday.
Democrats are using a two-step process that involves the House approving the Senate-passed version of the bill and passing the proposed final changes. The Senate must act on the changes before President Barack Obama can sign them into law. Here are key provisions of the legislation including the proposed changes.
The legislation would require substantial insurance market reforms that would bar insurers from excluding people for pre-existing conditions and prevent them from arbitrarily dropping policy holders.
Insurance exchanges would be created where small businesses and individuals without employer-sponsored coverage would be able to shop for coverage. Plans offered on the exchange would have to meet minimum benefit requirements.
The proposed changes would allow dependent children to remain on their parents’ health policies until age 26.
The Senate bill requires insurers to spend at least 85 cents of every premium dollar on medical care in small group markets and 80 cents in large group markets. The proposed changes also would require Medicare Advantage insurers to spend at least 85 percent of revenues on medical care.
Individuals would be required to obtain health insurance. Those who fail to purchase coverage would face fines of up to 2.5 percent of income by 2016.
Firms with more than 50 workers who do not offer medical coverage could face fines of $2,000 per full-time employee.
Federal subsidies would be provided to help people with incomes up to 400 percent of the poverty level purchase coverage on the exchange. Proposed changes would sweeten those subsidies for lower income people.
Medicaid, the government healthcare program for the poor, would be available to everyone with incomes up to 133 percent of the poverty level, which stood at $10,830 for an individual and $22,050, for a family of four. Many states have eligibility requirements below those levels.
The proposed changes would get rid of a special deal to help Nebraska pay for the expanded coverage and boost aid to all states.
The final proposal makes some adjustments to the revenue measures in the Senate-passed bill.
The Senate bill included a 40 percent excise tax on high-cost health insurance plans. The proposed changes would delay implementation of the tax until 2018 instead of 2013. The tax would kick in on plans costing $10,200 for individuals and $27,500 for family coverage. A higher threshold is allowed for plans covering mostly women, older workers and retirees as well as those in high-risk professions.
The bill calls for raising the payroll taxes for Medicare, the government health insurance plan for the elderly, to 2.35 percent from the current 1.45 percent for individuals earning $200,000 or more and for couples earning $250,000 or more. The proposed changes would apply the tax to some investment income as well for those high-income groups.
The bill would impose fees on medical device manufacturers, insurance providers and brand name pharmaceuticals. The proposed changes would delay implementation of those fees.
MEDICARE
The legislation would freeze payments to insurers that provide coverage to Medicare patients in 2011 and begin reducing the subsidy in 2012.
It would also gradually close the gap in drug coverage for Medicare beneficiaries by 2020. Those who enter the coverage gap, the so-called doughnut hole, in 2010 will get a $250 rebate. In 2011 they would get a 50 percent discount on brand-name drugs.
(Reporting by Donna Smith; Editing by Eric Beech)