(Reuters) - Here are major provisions of the U.S. House of Representatives’ healthcare plan introduced by Democratic leaders on Tuesday.
NEW INSURANCE EXCHANGE, MARKET REFORMS
* Creates an insurance exchange through which individuals and small businesses could shop among private companies and a new government-run plan for insurance policies. States may offer their own exchange or join with other states to create an exchange.
* Creates a government health plan that would be offered through the exchange and compete with insurance companies.
* Both the exchanges and the new government health insurance would start in 2013.
* Creates an independent agency, the Health Choices Administration, within the White House to work with states to oversee the proposed new health insurance exchange and set benefit standards.
* Insurers would be barred from excluding coverage for those with pre-existing medical conditions.
* Higher penalties for insurers that give false information to Medicare.
* Congressional aides said about 9 million people would be insured by the public plan, with 21 million insured by private companies in the exchange by 2019.
* Another 164 million would be insured through their employers.
* Employers would be required to offer health benefits to workers or pay a tax based on payroll. Exemptions and tax credits would be available for small businesses.
* Legal U.S. residents be would be required to enroll in health insurance or face an income tax penalty of 2.5 percent. The bill would allow some exemptions.
* Government subsidies provided for premiums and cost-sharing on a sliding scale up to 400 percent of poverty.
* Taxes on wealthy would raise $544 billion over ten years.
* Additional tax of 1 percent on income for couples above $350,000, 1.5 percent above $500,000, 5.4 percent over $1 million.
* Triggers a higher rates in 2013 of 2.0 percent for those above $350,000 income and 3 percent for those above $500,000.
MEDICARE AND MEDICAID
* Medicare Advantage plans, private insurers who operate Medicare plans in some areas, would have a “quality performance score” starting in 2010.
* Medicare Advantage plans would face reporting requirements for quality of care by 2013.
* Quality assessments may include hospital readmission rates, patient mortality after surgery, survival for patients with chronic diseases.
* Government would publish “medical loss ratios” of Medicare Advantage plans.
* Expands Medicaid health care for the poor and long-term disabled to all non-elderly with incomes up to 133 percent of the federal poverty level.
* Newborns without insurance would automatically be enrolled in Medicaid for 60 days while their eligibility is decided.
* Medicaid payment rates would increase.
* Drug companies would be required to give rebates for medicines to Medicare and Medicaid patients.
* New measures to close the gap in drug coverage in Medicare.
* With an eye toward saving money, a new center would be set up to study the comparative effectiveness of various treatments to help consumers and payers make healthcare decisions “that improve quality and value.”
* Center would research the effectiveness of drugs, medical tests, surgical procedures and other medical treatments.
* Center would have the power to collect data, both published and unpublished, to study medical treatments.
* New commission of healthcare companies, drug companies, patients, and others would oversee the center’s work.
* Congressional Budget Office estimates ten-year cost at $1.04 trillion.
Reporting by Jackie Frank and Donna Smith
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