Senate Finance Committee chairman Max Baucus (D-Mont.) and Ranking Member Chuck Grassley (R-Iowa) have released a 61-page report of policy options for covering the uninsured. The proposed policies will be discussed by the committee before it marks up its health reform legislation slated for June. The policy options aim to reform the individual and small group health insurance markets by creating a competitive environment in which health plans compete on price and quality. Insurers would no longer be allowed to bar individuals with pre-existing conditions from qualifying for a policy. All insurers would have to offer coverage in four benefit categories, and all plans would be required to provide primary care and first-dollar coverage for preventive services, emergency services, medical and surgical care, physician services, hospitalization, outpatient services, day surgery, diagnostic imaging and screenings including x-rays, maternity and newborn care, prescription drugs, radiation and chemotherapy, and mental health and substance-abuse services. Plans would not be allowed to set lifetime limits on coverage or annual limits on any benefits.
Individuals with incomes under 400 percent of the poverty level would receive a tax credit to make coverage more affordable. Small businesses with 10 or fewer full-time employees with average employee earnings below $20,000 would get a credit equal to 50 percent of the average total premium cost paid by the employer.
The proposal also includes three alternatives for a public health insurance plan. One is a Medicare-like option that would be administered by HHS. The second would be administered through multiple, regional third-party administrators and a third alternative would be state-run. The policy report also discusses expanding coverage through a reformed and better regulated private market instead of creating a public health insurance option. The policy options also would standardize Medicaid eligibility for all parents, children, and pregnant women below 150 percent of the federal poverty level.
