Congress is currently working on legislation to reform our health care system, expand coverage, and lower costs for all Americans. As an issue that affects every single American, health insurance reform can be a controversial topic- and many people have passionate opinions on the subject. I’ve put together this report to offer you information on what Congress is considering, what my priorities include, and what I am working to achieve as this debate moves forward. As always, I welcome your opinion as I continue my deliberations on this important issue.
-Congressman Patrick J. Murphy
Learn More About Health Insurance Reform
What does our health care system look like today?
Most Americans have health insurance, they’re mostly happy with it, and our country has the best health care providers and medical facilities in the world. What’s the problem?
The bottom line is that families are paying far too much for the care they need. Currently, over 62% of bankruptcies in this country result from medical costs, and most of these bankruptcies happen to individuals who have insurance.
Health insurance costs continue to skyrocket. Premiums have doubled over the past 10 years, rising 3 times faster than wages. The average Pennsylvania family will pay over $13,600 in premiums this year and these costs are projected to increase 60% over the next 10 years.
More than 45 million Americans have no health insurance, which limits their access to care. Most of the uninsured can’t afford coverage because they don’t get it through their employer, they’ve lost their job, or they have a pre-existing condition. This only drives up costs for those who have insurance. Families pay the hidden cost of an extra $1,100 in their premium to offset the cost of doctors having to treat the uninsured.
The number of uninsured is steadily rising. Every day, 510 Pennsylvanians – and 14,000 individuals across the country – lose their health insurance through no fault of their own. Millions of Americans worry about losing their coverage if they lose their job. Many of these folks will then be denied coverage when they try to buy it in the individual market because of a pre-existing condition- anything from cancer to allergies.
What should health insurance reform include?
I believe health insurance reform should have three major goals:
A cost-savings-first strategy
There are currently over 45 million uninsured Americans who use emergency rooms as their doctors’ offices. Taxpayers are picking up the tab. Getting these folks covered on the front end will reduce the overall cost of health insurance for all Americans. We also must reduce inefficiencies in our current system, crack down on health insurance fraud, and invest in prevention and wellness.
Ensuring access to quality care
Every American deserves access to the same quality health care choices that I’ve been lucky enough to have, first as a service member in the military, and now as a member of Congress. I believe that reform must provide American citizens access to quality and affordable health care options.
Protecting choice
If you like what you have, you keep it. Period. I support health insurance reform that offers quality, affordable coverage choices and puts you and your family– not the insurance company CEOs – in the driver’s seat.
What's in the plan that Congress is currently considering?
The legislation that Congress is considering- while it changes every day- includes the following:
Insurance companies will no longer be able to deny coverage to someone because of a pre-existing condition he or she had years ago.
The House bill establishes annual caps on out-of-pocket expenses, which would help reduce the financial strain that medical costs place on families. A health insurance exchange will be created to serve as a marketplace that allows consumers to compare coverage options in an easy to understand format and purchase the plan that best suits their needs.
We’ll all be required to have health insurance, but affordability credits will be provided to ensure that coverage is accessible for those not receiving it from their job. This assistance will be given to those with incomes under 400% of the federal poverty level- or about $88,000 for a family of four.
Employers will be required either to provide their employees with coverage or pay into an insurance fund. Small businesses with payrolls under $500,000 – about 86% of small businesses- would be exempt. Small businesses employing fewer than 26 people that provide coverage will receive a tax credit to help cover the cost.
Medicare and Medicaid would continue to cover our seniors and low-income Americans. The House bill eliminates the donut hole in Medicare’s prescription drug benefit.
Health insurance reform cuts Medicare benefits and takes away choices for millions of seniors.
Fact: America’s Affordable Health Choices Act includes several key provisions that improve Medicare benefits and health care for seniors, including the following:
Closes the Donut Hole in the Medicare Prescription Drug Plan – ensuring that millions of seniors will save hundreds of dollars on their prescription drugs by filling in the “donut hole” – the gap where drug costs are not reimbursed at certain levels – in the Medicare prescription drug benefit.
Strengthens Medicare, upon which millions of seniors rely – preserving all of the choices of doctors and hospitals in Medicare that seniors enjoy now and value highly.
Provides a permanent fix to Medicare payments to doctors – ensuring that seniors can keep the doctor they have now by ensuring that doctors in Medicare receive fair and appropriate reimbursements for their services, rather than facing steep cuts in payments.
Improves Medicare benefits for seniors, including eliminating co-payments and deductibles for preventive services under Medicare.
Limits cost-sharing requirements in Medicare Advantage plans to the amount charged for the same services in traditional Medicare coverage.
Improves the low-income subsidy programs in Medicare, such as by increasing asset limits for programs that help Medicare beneficiaries pay premiums and cost-sharing.
Computerizes medical records so seniors won’t have to take the same test over and over, or relay their entire medical history to a new doctor every time they change providers.
That’s why the AARP is supports reform and this provision, stating “We are pleased by the House TriCommittee’s health insurance reform bill, which makes important strides towards making sure that every American has access to affordable, quality health care choices… [t]hose of our members in Medicare pay close to 30% of their incomes on out-of-pocket expenses and they deserve relief, especially in the prescription drug doughnut hole, where they get no benefit while paying premiums. This bill would make great strides for all of our members and their families.”
Does this bill somehow mandate euthanasia for seniors?
Myth:
Congress would make end-of-life counseling sessions mandatory for Medicare beneficiaries. These seniors would be required to attend these counseling sessions where their doctors will tell them how to end their life sooner.
Fact: No. This provision offers, as a voluntary benefit under Medicare, coverage for the cost of patients voluntarily speaking with their doctors about their values and preferences regarding end-of-life care. This provision, endorsed by the AARP, empowers older Americans to make choices on this critical issue. These are deeply personal decisions that take thoughtful consideration, and this provision ensures that Medicare compensates doctors for their time.
Advance planning consultations are not mandatory; this benefit is completely voluntary. The provision merely provides coverage under Medicare so that patients may have this conversation once every five years if and only if he or she wants to make his or her wishes known to a doctor. If desired, patients may have consultations more frequently if they are chronically ill or if their health status changes.
There is no mandate in the bill to complete an advance care directive or living will. If a patient chooses to complete an advance directive or order for life-sustaining treatment, these documents will help articulate a full range of treatment preferences, from full and aggressive treatment to limited, comfort care only. Patients that choose to create these documents can customize them so that their wishes are reflected appropriately.
There are no government-chosen professionals involved. The legislation simply allows Medicare to pay for a conversation between patients and their doctors.
This provision is one of the reasons why trusted senior groups such as the AARP are supporting this measure, and health care reform in general. In a statement, AARP Executive Vice President John Rother wrote: “This measure would allow Medicare to pay doctors for taking the time to talk with individuals about difficult end-of-life care decisions. It would help provide people with better information on the positives and negatives—both physical and financial—that different treatments can mean for them and their families…This measure would not only help people make the best decisions for themselves, but also better ensure that their wishes are followed… To suggest otherwise is a gross, and even cruel, distortion—especially for any family that has been forced to make the difficult decisions on care for loved ones approaching the end of their lives.”
Will reform use taxpayer dollars to fund abortion?
Myth:
Health insurance reform will allow taxpayer dollars to fund abortion.
Fact: The House health insurance reform bill contains a provision that explicitly prohibits the use of federal funds for abortion coverage. The Hyde amendment has prohibited public money from going toward abortion services for 30 years - except in cases of rape, incest, or the life of the pregnant woman is in danger - and this bill carries on that tradition.
Does this bill cover illegal immigrants?
Myth:
Health insurance reform will allow taxpayer dollars to fund coverage for illegal immigrants.
Fact: This is false. Federal subsidies will be available to help middle and low-income families afford health care coverage. However, Section 246 of the House bill explicitly prohibits federal assistance to anyone not lawfully present in the United States.
Does this bill exclude members of Congress?
Myth:
Members of Congress are not allowed to sign up for the public health insurance option.
Fact: Under the House bill, a quality public option will be one choice among other private options in a national Health Insurance Exchange. Members of Congress would be eligible for the public option and Congressman Murphy has said he will sign up for it.
Will reform prevent private insurance companies from enrolling new beneficiaries?
Myth:
Health insurance reform will prevent private insurance companies from enrolling new participants.
Fact: This misinterpretation stems from Section 102 of the bill, which protects individuals’ right to choose to keep their current coverage. Private plans can absolutely continue to enroll people.
This provision states that insurance plans must meet certain standards of coverage, ensuring that people can get the care they need. Plans that are currently in existence will be grandfathered in, allowing people with individual coverage to keep whatever they have now if they like it. After several years, people looking to get coverage in the individual market will still be able to buy any private insurance they want with whatever benefits they want – it will just be done through a health insurance exchange that allows people to easily compare the price and covered services of the different available options.
Health insurance reform will build on what works in Medicare while improving benefits, empowering seniors and extending the solvency of a program that million of seniors rely upon for the medical care they need.
Unfortunately, some of the most cruel distortions and scare tactics about reform have been aimed directly at seniors. In fact, as the AARP’s own healthcare analysts have said, health insurance reform will improve, not harm, Medicare as well as seniors’ access to quality, affordable care.
So as a senior, what’s in health insurance reform for you?
You will get more benefits and you will get better benefits.
Close the “Donut Hole” in the Medicare Prescription Drug Plan. This ensures that millions of seniors will be protected from spending thousands of dollars on prescription drugs when they fall into the Medicare “donut hole.” In the 8th District of Pennsylvania alone, 11,200 seniors would avoid facing these staggeringly high out of pocket costs.
Provide a 50% discount for brand-name drugs used by Part D beneficiaries in the “donut hole,” until the coverage gap is completely eliminated.
Free preventive care. Reform will end any cost-sharing for preventive services under Medicare to help keep you healthy, putting our focus not just on treating the sick but on keeping people healthy, too.
More affordable premiums thanks to a two-year freeze on premiums.
You can continue to see your own doctor when you need them. The quality of care will improve.
More time with your primary care doctor. Reform will improve payments to primary care doctors, meaning that you’ll get more time with your primary care doctor who can get to know you better, make sure you’re on the right medications, and getting the tests and specialty care you need.
Preserving your access to the doctors you see now. Reform will provide a permanent fix to Medicare payments and eliminate the steep cuts in feeds that doctors had faced, so they can continue to care for Medicare patients
Medicare’s finances will be improved, fraud and abuse will be reduced, and its solvency extended.
The improvements made to Medicare, including efforts to reduce fraud in the program, will strengthen the integrity of the program. We know that Medicare is in a dire financial system and reform is needed to avoid the program going broke. Doing nothing is simply not an option for our seniors.
That’s why the AARP supports reform, stating “We are pleased by the House TriCommittee’s health care reform bill … [t]hose of our members in Medicare pay close to 30% of their incomes on out-of-pocket expenses and they deserve relief, especially in the prescription drug doughnut hole, where they get no benefit while paying premiums. This bill would make great strides for all of our members and their families.”
How does this bill affect small businesses?
What’s the current situation with small businesses and health insurance?
Employers want to do the right thing by their workers and ensure that they have health insurance, but skyrocketing costs often prevent them from doing so. This country has the best health care providers and medical facilities in the world, but small businesses simply spend far too much to cover their employees, putting them at a major competitive disadvantage.
The number of small businesses able to offer health insurance to their employees is dropping rapidly. In 2008, 38% of small companies offered health insurance, compared with 41% in 2007 and 61% in 1993. This decrease in coverage in health insurance costs for small firms have increased 129% over the last eight years.
How are small businesses treated in the plan that Congress is currently considering?
The House bill would require some employers either to provide their workers with health insurance or pay a percentage of their payroll into an insurance pool. The employees not offered insurance by their employer would then purchase a plan with assistance from that pool. Most of these employees (in families with incomes of up to $88,000 for a family of four) would receive assistance to help them pay for their premiums.
To help small businesses cover their employees, those with 25 employees or fewer would be eligible for a tax credit.
Businesses with payrolls under $500,000 would be exempt from the requirement to provide coverage.
Roughly 170 million Americans have private health insurance coverage through their employers, and the number of individuals receiving employer-provided health insurance would actually increase by several million people under this plan.
What am I working on to improve health insurance reform?
I’m fighting to include two of my bills in health insurance reform legislation:
IMPROVE Act
The IMPROVE Act (Improving Medicare and Medicaid Reimbursement Policy through Oversight and Efficiency) is a bipartisan bill that would crack down on health care fraud, which drains $60 billion in taxpayer money out of our system each year. Working with Sen. Mel Martinez, the former head of the Republican Party, this bill would require that Medicare and Medicaid pay their providers and suppliers using direct deposit. Right now, individuals looking to scam the system can take their reimbursement checks and cash them at a check-cashing store without having to establish a bank account, provide verification of their business, or show identification. The IMPROVE Act - which has been endorsed by the National District Attorneys Association and the AARP - would close this check-cashing laundering loophole. It provides law enforcement an important tool to crack down on fraud and protect taxpayer dollars.
CHIA Act
The CHIA Act (Children’s Health Insurance Improvement Act) has been incorporated into the House health insurance reform bill. CHIA would expand health care access to over 300,000 middle-class kids. Currently, some states have waiting periods that require kids to remain uninsured for a certain number of months before qualifying for SCHIP. This bill would exempt from these waiting periods kids who lost coverage when a parent was laid off, kids in families that were paying over 10% of income toward health care costs, and kids who are under the age of two. I was proud to work with my Republican colleague from across the state, Rep. Tim Murphy, on this piece of legislation that protects some of our most vulnerable citizens.
Read more about all my legislative work on health care issues
In order to properly reform our health insurance system we need to keep what works and fix what doesn’t. If you’ve had trouble affording or keeping health insurance, or if you are happy and have had good experiences with your health insurance, I’d like to hear your stories. Please click here if you’d like to share.
How will the health insurance reform bill affect you?
