• COVERAGE AND CHOICE
• AFFORDABILITY
• SHARED RESPONSIBILITY
• CONTROLLING COSTS

Coverage and Choice

As is made clear by the title of the legislation, the first thing that the President and the Congress want to convey is that consumers have their choice in health insurance. If somebody likes their current insurance, they can simply keep it. They can also keep their doctor, hospital, and health plan. If they are unhappy, or if they are uninsured or lack sufficient coverage, this legislation will give them a choice to switch.

Health Insurance Exchange
The legislation would create a new, transparent way for individuals and small businesses to shop for health insurance. It will provide an easy way for people to figure out what the best insurance plan is for them.

Public Insurance Option
For the first time in American history, the country will provide an option for all Americans to get government sponsored insurance, similar to Medicare and Medicaid.

Guaranteed Access to Health Care
Another innovation in this bill is the banning of insurance discrimination. After enactment of this law, insurance companies will no longer be allowed to deny insurance to a person due to a preexisting medical condition.

Affordability

One of the biggest health care problems in the country is the cost of insurance. Many families have to pay 20-30% of their paycheck just to get health care coverage. Another major goal of the legislation is to make health care more affordable for all Americans.

A Cap on Out of Pocket Spending
The most common reason for people to declare bankruptcy is health care costs. People who don't have health insurance, or whose insurance is not sufficient for a catastrophic illness or injury, will often suffer more costs than they can afford, and must declare bankruptcy. This legislation would prevent that with a cap on out of pocket costs.

Increased Competition
Due to the legislation including a public option for health insurance, competition for a consumer's health insurance business will drive down prices and increase quality.

Closes the Medicare Part D "Donut Hole"
Under the Medicare prescription drug benefit, (officially called Part D), some costs are covered by Medicare if a consumer spends between $0 and $2,700 and from $6,154 and up on their prescriptions. However, if a patient spends between $2,700 and $6,154 each year, the person will receive zero benefit from the plan. H.R. 3200 closes that "donut hole" and covers patients when they spend between $2,700 and $6,154.

Requirements for Individuals and Employers

To drive insurance costs lower for all Americans, everybody will have to share the responsibility

Individual Responsibility
When this legislation takes effect, every American will be required to carry health insurance. When everybody in the country is covered by insurance, it will lower costs for everybody who has insurance. Currently, if a person does not have insurance and gets sick or injured, they have few options besides visiting the emergency room, which is exponentially more expensive than preventative care. If they are not able to afford the emergency care, that cost gets spread to everybody who has health insurance. If everybody has health care, they will be able to afford the preventative care to solve minor illnesses and injuries before they get to the emergency room level.

Employer Responsibility
Employers will be responsible for either providing health coverage for their employees, or paying into the health care pool instead. The cost of paying is eight percent of the employer's payroll. Small businesses (those with a payroll under $250,000) are exempt from this. With a payroll between $250,000 and $400,000 the cost of paying into the pool will steadily increase from 2% of payroll to 8%. There will also be a new tax credit for small businesses that provide health care for employees.

Cost Controls

The United States pays more for health care than any other country in the world. http://www.kff.org/insurance/snapshot/chcm010307oth.cfm Both in total cost and cost per person, the U.S. spends far more than the next highest spending country. This legislation includes cost controls which will help lower the high cost of health care.

Public Insurance Negotiation
Having a public option in the health care industry will help to drive down costs for everybody. Having a large number of people utilizing a public option will allow for bulk discounts on everything from prescription drugs to MRI scans. Just like the VA does, the new public option will allow for bulk purchasing to reduce costs.

Preventing Waste, Fraud and Abuse
The public insurance will have a wide variety of tools available to ensure that every dollar spent on health care is a legitimate one. All the best practices and safeguards available to the industry will be used to protect taxpayer dollars and lower costs.

Reducing Administrative Costs
One of the runaway costs in the health care industry is administrative costs. Americans' health care dollars go to far more than medicine. Paperwork, CEO salaries, and even lobbying costs all come out of the health care premiums that Americans pay. All of these costs will be reduced or eliminated, allowing more health care dollars to be spent on health care rather than administrative costs.