Concerns Over Health Care Reform Proposal

The hearing of the House Education and Labor Committee, led by Representative George Miller (D-CA), brought together experts to discuss the Tri-Committee draft proposal for health care reform. The witnesses raised concerns over the adequacy of coverage, the high rate of denial of cost-effective care, and the complexity of the appeal process. The discussion highlighted the need for change in the current health care system, but emphasized the importance of designing reforms systematically and consistently.

Key Takeaways:

• Representative Thompson expressed his concern over the high rate of denial of cost-effective care under Medicare Part A and Medicare Part B, which he believes is a result of the complexity of the appeal process.
• The Tri-Committee draft legislation permits varied and unlimited types of remedies, including punitive and compensatory damages, for plans sold through the exchange.
• The existing law provides that private plans in the exchange would be treated as private plans, and public plans would be treated as public plans, with separate standards for remedies.
• Ms. Wcislo mentioned that in Massachusetts, the unemployed can access health insurance through the Connector, a three-month or six-month transitional period to find employment or other coverage.
• Representative Miller stated that the committees will make decisions on the application of remedies and the treatment of likes, rather than creating a new level of exposure.
• The high cost of COBRA insurance, up to $1,200 per month, was mentioned as a challenge for many unemployed individuals.
• The hearing highlighted the need for consumer protections, including prompt and available appeals programs and standards for prompt payment of claims.

Statistics:

• The rate of denial of cost-effective care under Medicare Part A and Medicare Part B was not provided in the testimony.
• 48 states have different coverage decisions made by private insurers.
• 10 months is the length of time it took for Ms. Pollitz's daughter to get herclaim paid.
• $1,200 is the estimated monthly cost of COBRA insurance.

Sources:

• Federal News Service, Inc., Ste. 500, 1000 Vermont Avenue NW, Washington, DC 20005 USA
• "Hearing of the House Education and Labor Committee: The Tri-Committee Draft Proposal for Health Care Reform" (Transcript)