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Letter to Senators and members of Congress
After you've read the letter, click here to sign on!
Right now Senate and House leaders are deliberating on the final health care reform bill. There are many positive elements in both the Senate and House bill, and unfortunately several needed reforms that were excluded, but we need one last push to make sure that the best components from each of these bills and additional reforms make it into the final proposal. This still includes a public option, as indicated in the list below.
We ask your organization to do two things today: 1) please sign on to the letter below and show your support for the best possible components of reform in the final bill and 2) forward this request to your network of organizations and urge them to sign on as well.We will then send the signed letter to the Illinois congressional delegation and to our U.S. Senators.
Dear Member of Congress,
We, the undersigned, believe the following issues must be addressed in the final health care reform proposal:
Affordability. Both bills require most Americans to have insurance. Even with subsidies, some people could pay up to 20 percent of their income for health care. The final bill must ensure families aren't required to spend more than they can handle. We need the strongest parts of both the House and the Senate bills to ensure all families can afford coverage. This means including the following five provisions in the merged bill:
Larger Medicaid expansion from the House bill: The House bill expands Medicaid to households with income up to 150 percent of the federal poverty level (FPL) instead of 133 percent FPL as in the Senate, and it guarantees a full Medicaid benefits package rather than the scaled-down one in the Senate bill. Because Medicaid typically does not charge premiums, this expansion assures affordable coverage for very low-income households. Since offering Medicaid costs less than providing subsidies, the larger expansion from the House bill saves more money than the smaller Senate Medicaid expansion.
More affordable subsidies and out-of-pocket caps for families earning up to 250 percent FPL from the House bill: A family of three earning $27,465 would pay 50 percent more for premiums under the Senate bill than under the House bill. That same family would not spend more than 4 percent of their income on out-of-pocket costs in the House bill, compared to 14 percent of their income the Senate bill.
More affordable subsidies and out-of-pocket caps for families earning more than 250 percent FPL from the Senate bill: For example, a family of three earning $73,240 would pay almost 20 percent less for premiums under the Senate bill than under the House. That same family could also spend up to 11 percent in the Senate bill, compared with 14 percent of their income on out-of-pocket costs in the House bill
Plans with the higher actuarial values from the House bill: Higher actuarial values translate to lower out-of-pocket costs for average enrollees. The House bill provides plans with more reasonable out-of-pocket costs for enrollees at all income levels with average medical expenses than the Senate bill.
Protect workers from income cuts due to reduction in hours: The Senate bill creates a steep cliff at 30 hours worked per week below which employers are not required to contribute at all to the costs of coverage for their employees who receive assistance in the exchange. The House bill does not. The final bill should include a pro-rate contribution by employers for part-time workers, similar to the approach taken in the HELP Committee bill.
Financing:
Health care should not be paid for with a tax on health benefits. We want to move away from the Senate's excise tax and towards the House's millionaires tax.
Employers must be asked to provide good health coverage for their employees so health care is affordable at work. We want a robust Employer Mandate.
Insurance Regulations:
No annual & lifetime limits
Rating Factors
Age rating should be the same for everyone:
House version is 2:1 -- Senate has 3:1
Health status rating - remove.
Use the House medical loss ratio of 85 percent across the board. Better yet, this ratio should be 90 percent across the board.
Exchange as an active purchaser. Have the exchange be national and not state by state. A national exchange with a strong regulation enforcer instead of state-based exchanges with weak local insurance commissioners is needed.
Make insurers as transparent as possible.
Hold insurance companies to the same anti-trust laws as other companies. Right now, insurance companies are exempt from laws designed to prevent monopolies and price gouging. The House bill would repeal the anti trust exemption for health insurers and fix this, the Senate bill does not.
Make all insurance companies on the exchange to offer at least one precisely designed high quality insurance plan. This will allow true apple-to-apple comparisons, and make it harder for insurance companies to game the system.
Give Americans the choice of a public option. Congress should model the final bill after the House version, which contains a national public option—the key to real competition, greater choice, and lower costs.
Protect women's health care. Both bills impose dangerous new restrictions on women's reproductive health care. While the House version is worse, neither provision can be in the final bill.
Move up state waiver for innovation to 2014 and add ERISA waiver. The state waiver for innovation is a good idea, but having it start in 2017 creates a bureaucratic nightmare of putting in place one reform only to replace it a few years later. We need to fix our system now, not have states start working toward a real solution a decade from now.
Move up the start date of reform to as soon as possible. Three years is too long!
Allow undocumented immigrants to buy health insurance with their own money on the new exchange.
Increase Medicaid reimbursement payments to primary care, family docs and others that provide services to Medicaid recipients. House bill does this, Senate bill does not.
Make all legal immigrants eligible for all public health care programs, removing the five-year bar.
Early Treatment for HIV Act (ETHA) included in the House not in the Senate. Policy brief (pdf).
Protect the integrity of the CHIP Program. The Senate bill would preserve the program and would extend federal financing through 2015, two years past its expiration date under current law. The House bill, by contract, would end CHIP and redirect the millions of children either to Medicaid (new expansion program) or to new health insurance exchanges where moderate-income Americans would be able to buy private coverage using new federal subsidies to help offset the cost. Without additional protections thousands of children will fall through the cracks.
Add early Medicare buy-in.
Allow for drug re-importation so Americans can get cheaper drugs from Canada or Europe.
Click here to sign on!
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