View From Washington

Health Reform Jumps Huge Hurtle in the House

By Brent Ewig, MHS
Director of Public Policy & Government Affairs, AMCHP   

Late in the evening of Saturday November 7, the U.S. House of Representatives narrowly passed H.R. 3962, the "Affordable Health Care for America Act.” Detailed summaries are available from Congress here and from the non-partisan Kaiser Family Foundation here. And while these resources are comprehensive, I’m sure you are asking what specifically is in this bill for maternal and child health? 

The short answer is - a lot. The bill takes a giant step forward in providing affordable coverage to an estimated 36 million currently uninsured people, including millions of children and women of childbearing age. It also takes steps to stabilize coverage for those currently insured by making several reforms to the insurance market. 

The bill includes a package of insurance reforms that promote both continuity of coverage and affordability by ending increases in premiums or denials of care based on pre-existing conditions, race, or gender; eliminates co-pays for preventive care, caps out-of-pocket expenses, and guarantees catastrophic coverage that protects every American family from medical bankruptcy.  

There are extensive additional reforms, and while the price tag is significant – slightly over $1 trillion over ten years – the Congressional Budget Office has indicated that the bill is fully paid for and would result in a net reduction in federal budget deficits of $104 billion over the 2010–2019 period. 

The bill also is not perfect and certainly reflects the many trade-offs inherent in attracting the majority of votes needed for passage. Two of the biggest catches at this point center on the eventual costs to states due to the expansion of Medicaid eligibility to 150 percent of poverty. For the first two years the federal government will assume full costs of this expansion for newly eligible populations, with a required match after that. The bill also requires Medicaid payment rates to increase to Medicare levels, with full federal financing for the first two years but 10 percent required state match after that. The future cost shift to states is an important factor that is being negotiated intensely and needs to be watched carefully.  

Additionally, the bill proposes that most children currently eligible for CHIP would move into plans offered through the new exchange which could mean that after 2014 currently CHIP eligible children would likely have a slightly reduced benefits package and less cost-sharing protections then available under current CHIP programs. Beyond these two sticking points, the bill includes several important and relatively non-controversial MCH-related provisions, including:

·         Creation of a new Public Health Investment Fund that would generate close to $10 billion per year in mandatory funding above current appropriations levels to support a range of public health programs. At full implementation, this includes $1.6 billion annually for “Delivery of Community-Based Prevention and Wellness Services”; $1.3 billion for “Core Public Health Infrastructure and Activities for State and Local Health Departments”; approximately $1.1 billion for Health Workforce Training and Development; $300 million for Prevention Research; $4 billion to support community health centers; and $350 million per year for “Core Public Health Infrastructure and Activities for CDC.” 

·         Creation of a new grant program to states for quality home visitation programs for families with young children and families expecting children, starting at $50 million a year, growing to $250 million in the fifth year. The bill also allows optional state Medicaid coverage for nurse home visiting services.  

·         Creation of a $1.2 billion grant program to states (over five years) to support expansion of medical homes. 

·         Finally, plans participating in the exchange must include standardized, comprehensive and quality health care benefits that include physician services, hospitalization, prescription drugs, rehabilitative services, mental health and substance use, preventive services recommended by U.S. Preventive Health Services Task Force, vaccines recommended by CDC, maternity benefits, well baby and well child care, and oral health, vision and hearing services for children under 21.  

It is important to stress that while House passage clears a huge hurtle, the Senate still needs to release and pass their bill. Then a conference committee needs to take place to resolve the expected substantial differences between the passed House and expected Senate versions. So the process is still fluid, there is much hard work ahead, and final passage is not assured. Still, the House action is a major step forward on the road to reform, and AMCHP will continue to advocate for our priorities on your behalf.