What’s In the Final Health Care Reform Bill

The Kaiser Family Foundation has a well-condensed table [pdf] comparing the House, Senate and final bill now being voted on. It lacks the public option. It does contain this, however:

Create the Consumer Operated and Oriented Plan (CO-OP) program to foster the creation of non-profit, member-run health insurance companies in all 50 states and District of Columbia to offer qualified health plans. To be eligible to receive funds, an organization must not be an existing health insurer or sponsored by a state or local government, substantially all of its activities must consist of the issuance of qualified health benefit plans in each state in which it is licensed, governance of the organization must be subject to a majority vote of its members, must operate with a strong consumer focus, and any profits must be
used to lower premiums, improve benefits, or improve the quality of health care delivered to its members. (Appropriate $6 billion to finance the program and award loans and grants to establish CO-OPs by July 1, 2013)

It isn’t a federal level public option. And it isn’t even close to single-payer universal coverage. But, it’s the beginning of the end of the medical insurance industry.

And these protections, blocking the most devilish horseshit the insurance industry has come up with to protect profits (emphasis added by me):

• Prohibit individual and group health plans from placing lifetime limits on the dollar value of coverage and prohibit insurers from rescinding coverage except in cases of fraud. Prohibit pre-existing condition exclusions for children. (Effective six months following enactment) Beginning in January 2014, prohibit individual and group health plans from placing annual limits on the dollar value of coverage. Prior to January 2014, plans may only impose annual limits on coverage as determined by the Secretary.
• Grandfather existing individual and group plans with respect to new benefit standards, but require these grandfathered plans to extend dependent coverage to age 26, prohibit rescissions of coverage, and eliminate waiting periods for coverage of greater than 90 days. Require grandfathered group plans to eliminate lifetime limits on coverage and beginning in 2014, eliminate annual limits
on coverage. Prior to 2014, grandfathered group plans may only impose annual limits as determined by the Secretary. Require grandfathered group plans to eliminate pre- existing condition exclusions for children within six months of enactment and by 2014 for adults. (Effective six months following enactment, except where otherwise specified)
• Impose the same insurance market regulations relating to guarantee issue, premium rating, and prohibitions on pre- existing condition exclusions in the individual market, in the Exchange, and in the smallgroup market. (See new rating and market rules in Creation of insurance pooling mechanism.) (Effective January 1, 2014)
…
• Limit deductibles for health plans in the small group market to $2,000 for individuals and $4,000 for families unless contributions are offered that offset deductible amounts above these limits. This deductible limit will not affect the actuarial value of any plans. (Effective January 1, 2014)
• Limit any waiting periods for coverage to 90 days. (Effective January 1, 2014)
• Create a temporary reinsurance program to collect payments from health insurers in the individual and group markets to provide payments to plans in the individual market that cover high-risk individuals. Finance the reinsurance program through mandatory contributions by health insurers totaling $25 billion over three years. (Effective January 1, 2014 through December 2016)

I’m not thrilled, but it’s genuinely better than what we have now. It’s America. We might be too stupid to succeed. Despite my disappointments of what is not here, I’ll defer to Jonathan Cohn and take what reform I can get:

… I like to think of reform as achieving three broad goals: Making sure anybody can get an affordable insurance policy, shoring up everybody’s coverage so that it provides real economic security, and transforming medical care in order to make it both more effective and less expensive. Those arguments got a lot stronger this week, when the Congressional Budget Office determined that the final reform package—including both the Senate’s health care bill and the proposed amendments to it—would provide coverage to 32 million additional people, strengthen the baseline for coverage, and reduce the federal deficit over time.

But there’s another argument for health care reform, one that is at once more subtle and more sweeping. The disturbing part of our health care system is the financial and physical suffering it causes. But the unjust part of our health care system is the way it distributes that suffering. There are things all of us can do to stay healthy—we can eat right, we can exercise, we can avoid excessive risks. But even when we do the right things, we remain vulnerable.

You can have the perfect diet, jog three miles every day, and wake up one morning to discover you have cancer. So now you face mortal peril. And if, on top of everything else, you can’t pay your medical bills, you face financial ruin, as well.
….
The conservatives protesting on the Capitol lawn Saturday see things differently. Health care reform isn’t about contributing money for the sake of their own security; it’s about having their money taken for the sake of somebody else’s security. When they hear stories of people left bankrupt or sick because of uninsurance, they are more likely to see a lack of personal responsibility and virtue than a lack of good fortune. As my colleague Jonathan Chait has observed, theirs is an extreme version of a view common (although surely not universal) on the right: That individuals can fend for themselves, as long as they are responsible and as long as the government gets out of the way.

There’s obviously a balance to be struck between these two world views. But, broadly speaking, conservative ideas about responsibility and vulnerability have dominated political discussion for most of the last four decades. That will change on Sunday, if health care reform passes. The bill before Congress may be flawed. And the process that produced it may be severely flawed. But it is, nevertheless, an expression of the idea that we—as as society—are not prepared to let people continue to suffer such dire consequences just because they’re unlucky.