Rating the House health reform proposal

Jun 25, 2009 12:23 PM

In testimony before the House Education and Labor Committee yesterday, Consumers Union’s senior policy analyst, Bill Vaughan rated the House Tri-Committee Draft Proposal for Health Care Reform on how well it met our criteria for meaningful reform for consumers. As explained in a seven-page editorial in the August Consumer Reports, we’re looking for health reform that:

covers everyone,
makes insurance simple,
provides information on quality of care,
helps employers to offer protection for workers,
rewards good care—not just more procedures,
frees doctors to practice medicine,
and gives you the freedom to choose your plan.

So how does the house proposal rate? Here’s some of what Vaughn told the house committee, including suggestions for what can be improved.

The Tri-Committee proposal will bring us to the goal of affordable, quality dependable health care for all. But we also know that even more savings are possible and can be directed toward spurring breakthrough research if we all work together.

Covers everyone: The House proposal would create a national health insurance exchange that consumers can use to find guaranteed health insurance, regardless of pre-existing conditions. Private plans would compete with the option of a public plan to keep insurance affordable. Subsidies for those making less that 400 percent of the poverty level would expand access to health care to millions of Americans who can’t afford it today.

Makes insurance simple: The national exchange would go along way to simplifying health care. The minimum standard benefit package (and at least 2 distinct, more valuable options,) would have no yearly or lifetime limits. The out-of-pocket catastrophic protection would cover all expenses over $5,000 for individuals, and $10,000 for couples. Those with low-income get even more protection. That would bring financial security and piece of mind, and eliminate the hassle of trying to figure out what is and isn’t covered. The bill also creates a Health Choices Administration and an Insurance Ombudsman as tools to help keep the system uncomplicated.

Provides information on quality: Comparative effectiveness research would inform physicians and patients about which treatments objective science says are the best—and those would be given preference. But if a drug, device, or service does not work for an individual, then that person should be able to try another drug, device, or service without hassle or delay.

The bill has provisions that would pay hospitals less for readmissions due to poor quality of care. It would also establish a new center to set priorities for quality improvement. And it has provisions to make infection rates of hospitals and other facilities public.

Helps employers offer protection for workers: The Health Insurance Exchange would make policies more affordable, and subsidies to small businesses and lower wage firms would make it affordable. Rewards good care—not just more procedures: The bill would increase comprehensive preventive services, and improves Medicare to make such care more affordable. A new Wellness and Prevention Trust Fund would help spur community wellness. Efforts to develop accountable care organizations and medical homes would also help ensure better care coordination.

Frees doctors to practice medicine: The bill has a number of provisions dealing with the medical workforce, graduate medical education, and increasing payments to primary care doctors, all of which should help.

The freedom to choose: Those with good plans can keep what they have. Everyone else can choose between the public and private plans in the exchange.

What can be improved:

 The policies sold through the exchange in each of the three broad categories the bill creates should be made identical so that consumers can shop on the basis of price and quality, not on tiny and confusing differences.

 Reform should require standardization of insurance definitions so consumers can easily compare policies on an apples-to-apples basis.

 It should require insurers to clearly state, in standardized formats, what’s covered and what’s not in every plan offering, and to estimate out-of-pocket costs under typical treatment scenarios.

 The plan should create an insurance information and complaint hotline; compile federal and state data on insurance complaints; and report this data publicly on a Website.

 Consumers should be made fully aware of their rights to register complaints about health plan service, coverage denials, balance-billing and co-pay problems, and be able to appeal coverage denials.

 More should be done to ensure that infection rate and other reported information is made public on a facility-specific basis.

 Better efforts are needed to report medical errors.

 Periodic quality recertification should be required for health care providers, as recommended by the Institutes of Medicine.

 Programs to rate the quality of insurance products and services should be implemented.

Finally, consumers are desperately worried about the high cost of health care. There are some worthy cost-cutting measures in the tri-committee bill, including a public plan option, comparative effectiveness research, form simplification, stepped up fraud prevention efforts, and implementation of MedPAC recommendations, among others. But more are needed to make the health care plan budget neutral.

—Bill Vaughan, Senior policy Analyst, Consumers Union

Read Vaughan’s full testimony* before the House Education and Labor Committee.