No. But the bill would let employers offer insurance discounts of up to 30% to workers who participate in wellness and fitness programs. It also would require chain restaurants and vending machines to display nutritional information.
How will the reform handle malpractice abuse while still fairly compensating the injured?
There is no malpractice reform in the bill. Instead, the measure would authorize $50 million for state experiments in alternative ways to resolve malpractice claims. The bill would give preference to proposals that are "likely to enhance patient safety by detecting, analyzing and helping to reduce medical errors and adverse events."
Will all employers -- large or small -- be required to provide medical insurance?
The legislation requires employers with more than 50 workers to provide insurance or pay a penalty ($2,000 per employee, with the first 30 workers exempted). The mandate would not apply to employers whose full-time workers are all paid well enough not to qualify for premium subsidies. Employers with more than 50 workers who do offer health insurance, but who have low-wage workers choosing instead to buy federally subsidized policies insurance through new insurance exchanges, would have to pay $3,000 for each worker receiving a subsidy. Small businesses that offer health benefits would get a tax credit.
If so, can employers self-insure?
Yes.
What is the minimum care to be provided under the insurance envisioned by the reform proposal? Am I precluded from buying supplemental care if I am able? Will I be taxed for doing so?
Policies for individuals or small groups would have to meet minimum coverage standards set by the secretary of Health and Human Services. They would have to cover "essential" in-patient, outpatient, emergency, maternity, neonatal, pediatric, mental health, rehabilitative, laboratory and preventive services, as well as some prescription drugs, but could not be broader in scope than the typical employer's plan. The insurance would have to pay for at least 60% of the expected costs of the services it covered, with a tighter limit on out-of-pocket expenses for policyholders with lower incomes.
The coverage requirements would not apply to the market for large groups. Nor would there be any prohibition on or penalty for buying more services than the policy covers, or for buying supplemental policies. However, there would be a tax on high-cost employer-sponsored insurance plans (those priced at more than $10,200 annually for single individuals, with higher thresholds for family coverage, retirees, high-risk jobs and employers with atypical demographics) that insurers would probably pass along to their customers.
How will the reform proposal affect prescription costs and the availability of generics, and who will pay?
Medicare drug benefits would increase through the gradual elimination of the "doughnut hole," which requires patients to pay the full cost of prescriptions between the initial covered amount (currently $2,700) and catastrophic coverage (currently $6,154). This benefit would be financed through the new excise tax on drug makers, whose cost is likely to be passed on to consumers.
Private insurance plans would have to comply with a minimum level of drug benefits set by the secretary of Health and Human Services. To help lower the cost of new biotechnology-produced drugs, the Food and Drug Administration would be authorized to approve generic versions of some biologic medicines. The president's proposal also would bar pharmaceutical companies from paying competitors to keep generic versions of their medicines off the market.
Will taxpayer funds be used to pay for abortions?
The only direct funding would be for cases involving rape, incest or risk to the mother's life. States could bar insurers participating in their exchanges from covering other types of abortions. If they do not, federal subsidies for lower-income individuals could be used to pay part of the cost of policies that covered such procedures. However, insurers would have to allocate the subsidy dollars to non-abortion services, so that customers would technically be paying their own money for the abortion coverage.
Abortion opponents contend that the provision is an accounting gimmick, and that the subsidies shouldn't be permitted to pay for any part of a policy that includes abortion coverage.
Will medical records be available electronically, and if so, how will medical privacy be accommodated?
The reform proposal says little about electronic records. However, the 2009 economic stimulus bill provided more than $19 billion to encourage doctors and hospitals to digitize their paperwork.
How is billing to be done? Co-pays? Deductibles?
The bill attempts to lower administrative costs by standardizing the way providers interact with insurers. It doesn't directly address the record-keeping and billing demands that doctors and hospitals make on patients.
Is there any comparable healthcare system elsewhere in the world?
The U.S. system is unique in its heavy reliance on the private sector. The closest analog might be South Korea, which achieved universal health insurance coverage in the late 1980s largely through private insurance companies. But in 2000 the 139 regional insurers were combined into a single national one, with the government regulating the rates it paid to providers.
