Promising to continue to push for health care reform, President Obama released a revised reform plan this week, urging House and Senate to take up and complete work on the measure.
 
Faced with loss of a 60-vote block in the Senate and growing public unease concerning health reform efforts, the president may be looking at the use of budget reconciliation to get the final bill through Congress.

The administration’s most recent plan is comprised essentially of the bill that has already cleared the Senate, plus a package of adjustments that are being negotiated.  Under budget reconciliation, the House would adopt the Senate bill, then a second bill with making modifications to the first.  The Senate could then adopt the second House bill on a simple majority vote. 

While the Administration’s latest proposal seeks to reduce the fiscal impacts upon states and providers, it remains to be seen if the House modification bill would soften Senate-approved cuts in disproportionate share payments and Medicare update factor reductions.
 
Key to President Obama’s plan are provisions to make health insurance more affordable by reducing premium costs and making health insurance markets more competitive, at the same time reducing the fiscal impact upon the federal budget.  Other measures include:

• Ending discrimination against patients with pre-existing conditions.
• Closing the Medicare prescription drug “donut hole” coverage gap.
• Strengthening provisions to fight fraud and abuse in Medicare and Medicaid.
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans.
• Improving insurance protections for consumers.
• Improving insurance protections for consumers and creating a new Health Insurance Rate Authority to provide Federal assistance and oversight to States in conducting reviews of unreasonable rate increases and other unfair practices of insurance plans.
• Increasing the threshold for the excise tax on the most expensive health plans from $23,000 for a family plan to $27,500 and starting it in 2018 for all plans.

While the administration’s proposal increases the threshold for the excise tax on expensive health plans from $23,000 to $27,500, it pushes start of the tax on all plans out to 2018.

Other provisions that could end up in the House measure include increased Medicaid reimbursement for physicians, health savings accounts in the insurance exchange, increased subsidies for purchase of coverage by moderate-income families and individuals, and modifying the employer mandate as adopted in the Senate bill.