The White House Blog: Health Care

What's in the Health Care Bill?

On the day that President Obama signed health insurance reform into law, a lot of Americans are researching the final legislation and how it affects them.  As the President helpfully pointed out in his speech earlier today:

Go to our Web site, WhiteHouse.gov; go to the Web sites of major news outlets out there; find out how reform will affect you.  And I’m confident that you will like what you see -- a common-sense approach that maintains the private insurance system but makes it work for everybody; makes it work not just for the insurance companies, but makes it work for you.

So we want to make sure you don’t miss a bunch of health care reform resources on our website:

• Frequently asked questions
• A title-by-title health care reform bill summary
• A list of all recent blog posts about health care
• Links to full text of the health care bill: H.R. 4872 - Health Care and Education Affordability Reconciliation Act of 2010 and an area to submit your comment on the legislation

Today, White House Director of Health Reform Nancy-Ann DeParle sent an email update (you can sign up for them here) outlining key benefits of health reform for individual Americans that take place soon: 

FROM: Nancy-Ann DeParle, The White House
SUBJECT: What Happens Next

Good afternoon,

Since the House of Representatives voted to pass health reform legislation on Sunday night, the legislative process and its political impact have been the focus of all the newspapers and cable TV pundits.

Outside of DC, however, many Americans are trying to cut through the chatter and get to the substance of reform with a simple question: "What does health insurance reform actually mean for me?" To help, we've put together a list of some key benefits every American should know.

Let's start with how health insurance reform will expand and strengthen coverage:

• This year, children with pre-existing conditions can no longer be denied health insurance coverage. Once the new health insurance exchanges begin in the coming years, pre-existing condition discrimination will become a thing of the past for everyone.
• This year, health care plans will allow young people to remain on their parents' insurance policy up until their 26th birthday.
• This year, insurance companies will be banned from dropping people from coverage when they get sick, and they will be banned from implementing lifetime caps on coverage. This year, restrictive annual limits on coverage will be banned for certain plans. Under health insurance reform, Americans will be ensured access to the care they need.
• This year, adults who are uninsured because of pre-existing conditions will have access to affordable insurance through a temporary subsidized high-risk pool.
• In the next fiscal year, the bill increases funding for community health centers, so they can treat nearly double the number of patients over the next five years.
• This year, we'll also establish an independent commission to advise on how best to build the health care workforce and increase the number of nurses, doctors and other professionals to meet our country's needs.  Going forward, we will provide $1.5 billion in funding to support the next generation of doctors, nurses and other primary care practitioners -- on top of a $500 million investment from the American Recovery and Reinvestment Act.

Health insurance reform will also curb some of the worst insurance industry practices and strengthen consumer protections:

• This year, this bill creates a new, independent appeals process that ensures consumers in new private plans have access to an effective process to appeal decisions made by their insurer.
• This year, discrimination based on salary will be outlawed. New group health plans will be prohibited from establishing any eligibility rules for health care coverage that discriminate in favor of higher-wage employees.
• Beginning this fiscal year, this bill provides funding to states to help establish offices of health insurance consumer assistance in order to help individuals in the process of filing complaints or appeals against insurance companies.
• Starting January 1, 2011, insurers in the individual and small group market will be required to spend 80 percent of their premium dollars on medical services. Insurers in the large group market will be required to spend 85 percent of their premium dollars on medical services. Any insurers who don't meet those thresholds will be required to provide rebates to their policyholders.
• Starting in 2011, this bill helps states require insurance companies to submit justification for requested premium increases. Any company with excessive or unjustified premium increases may not be able to participate in the new health insurance exchanges.

Reform immediately begins to lower health care costs for American families and small businesses:

• This year, small businesses that choose to offer coverage will begin to receive tax credits of up to 35 percent of premiums to help make employee coverage more affordable.
• This year, new private plans will be required to provide free preventive care: no co-payments and no deductibles for preventive services. And beginning January 1, 2011, Medicare will do the same.
• This year, this bill will provide help for early retirees by creating a temporary re-insurance program to help offset the costs of expensive premiums for employers and retirees age 55-64.
• This year, this bill starts to close the Medicare Part D 'donut hole' by providing a $250 rebate to Medicare beneficiaries who hit the gap in prescription drug coverage. And beginning in 2011, the bill institutes a 50% discount on prescription drugs in the 'donut hole.'

Thank you,

Nancy-Ann DeParle
Director, White House Office of Health Reform

A Historic Livestream

This afternoon President Obama will sign the most significant health insurance reform bill this country has seen in decades, expanding coverage to millions of Americans and putting an end to the worst practices of insurance companies.

Watch it live on WhiteHouse.gov:

• 11:15 AM EDT President Obama Signs the Health Insurance Reform Bill in the East Room
• 12:05 PM EDT President Obama delivers remarks on the Health Insurance Reform Bill from the Department of the Interior

This is What Change Looks Like

After a historic vote in the House to send health reform to the President, he speaks to all Americans on the change they will finally see as they are given back control over their own health care:

Good evening, everybody. Tonight, after nearly 100 years of talk and frustration, after decades of trying, and a year of sustained effort and debate, the United States Congress finally declared that America’s workers and America's families and America's small businesses deserve the security of knowing that here, in this country, neither illness nor accident should endanger the dreams they’ve worked a lifetime to achieve.

Tonight, at a time when the pundits said it was no longer possible, we rose above the weight of our politics. We pushed back on the undue influence of special interests. We didn't give in to mistrust or to cynicism or to fear. Instead, we proved that we are still a people capable of doing big things and tackling our biggest challenges. We proved that this government -- a government of the people and by the people -- still works for the people.

I want to thank every member of Congress who stood up tonight with courage and conviction to make health care reform a reality. And I know this wasn’t an easy vote for a lot of people. But it was the right vote. I want to thank Speaker Nancy Pelosi for her extraordinary leadership, and Majority Leader Steny Hoyer and Majority Whip Jim Clyburn for their commitment to getting the job done. I want to thank my outstanding Vice President, Joe Biden, and my wonderful Secretary of Health and Human Services, Kathleen Sebelius, for their fantastic work on this issue. I want to thank the many staffers in Congress, and my own incredible staff in the White House, who have worked tirelessly over the past year with Americans of all walks of life to forge a reform package finally worthy of the people we were sent here to serve.

Today’s vote answers the dreams of so many who have fought for this reform. To every unsung American who took the time to sit down and write a letter or type out an e-mail hoping your voice would be heard -- it has been heard tonight. To the untold numbers who knocked on doors and made phone calls, who organized and mobilized out of a firm conviction that change in this country comes not from the top down, but from the bottom up -- let me reaffirm that conviction: This moment is possible because of you.

Most importantly, today’s vote answers the prayers of every American who has hoped deeply for something to be done about a health care system that works for insurance companies, but not for ordinary people. For most Americans, this debate has never been about abstractions, the fight between right and left, Republican and Democrat -- it’s always been about something far more personal. It’s about every American who knows the shock of opening an envelope to see that their premiums just shot up again when times are already tough enough. It’s about every parent who knows the desperation of trying to cover a child with a chronic illness only to be told “no” again and again and again. It’s about every small business owner forced to choose between insuring employees and staying open for business. They are why we committed ourselves to this cause.

Tonight’s vote is not a victory for any one party -- it's a victory for them. It's a victory for the American people. And it's a victory for common sense.

Now, it probably goes without saying that tonight’s vote will give rise to a frenzy of instant analysis. There will be tallies of Washington winners and losers, predictions about what it means for Democrats and Republicans, for my poll numbers, for my administration. But long after the debate fades away and the prognostication fades away and the dust settles, what will remain standing is not the government-run system some feared, or the status quo that serves the interests of the insurance industry, but a health care system that incorporates ideas from both parties -- a system that works better for the American people.

If you have health insurance, this reform just gave you more control by reining in the worst excesses and abuses of the insurance industry with some of the toughest consumer protections this country has ever known -- so that you are actually getting what you pay for.

If you don’t have insurance, this reform gives you a chance to be a part of a big purchasing pool that will give you choice and competition and cheaper prices for insurance. And it includes the largest health care tax cut for working families and small businesses in history -- so that if you lose your job and you change jobs, start that new business, you’ll finally be able to purchase quality, affordable care and the security and peace of mind that comes with it.

This reform is the right thing to do for our seniors. It makes Medicare stronger and more solvent, extending its life by almost a decade. And it’s the right thing to do for our future. It will reduce our deficit by more than $100 billion over the next decade, and more than $1 trillion in the decade after that.

So this isn’t radical reform. But it is major reform. This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. This is what change looks like.

Now as momentous as this day is, it's not the end of this journey. On Tuesday, the Senate will take up revisions to this legislation that the House has embraced, and these are revisions that have strengthened this law and removed provisions that had no place in it. Some have predicted another siege of parliamentary maneuvering in order to delay adoption of these improvements. I hope that’s not the case. It’s time to bring this debate to a close and begin the hard work of implementing this reform properly on behalf of the American people. This year, and in years to come, we have a solemn responsibility to do it right.

Nor does this day represent the end of the work that faces our country. The work of revitalizing our economy goes on. The work of promoting private sector job creation goes on. The work of putting American families’ dreams back within reach goes on. And we march on, with renewed confidence, energized by this victory on their behalf.

In the end, what this day represents is another stone firmly laid in the foundation of the American Dream. Tonight, we answered the call of history as so many generations of Americans have before us. When faced with crisis, we did not shrink from our challenge -- we overcame it. We did not avoid our responsibility -- we embraced it. We did not fear our future -- we shaped it.

Thank you, God bless you, and may God bless the United States of America.

Fiscal Realities

We are mere feet from the finish line to passing into law historic, fiscally responsible health insurance reform that will give more choice and security to those with health insurance, provide access to coverage to those without, improve the quality of health care for us all, and provide the most deficit reduction of any bill in over a decade.

With momentum building, it’s no surprise that opponents took to the morning talk shows and the Sunday newspaper op-ed pages in an attempt to undermine one of the signature accomplishments of the legislation under consideration today: the fact that it reduces the deficit by more than $100 billion over the first decade, and more than $1 trillion in the decade after that.

Especially at this late hour, it’s important to get the facts right. So let’s consider their main charges one by one.

First, critics charge that the bill uses 10 years of savings to pay for six years of spending. As I have posted before, if this were what we were doing, then health reform would blow a hole in the deficit after the first decade (or the budget window). Yet, as CBO has made clear again and again and in its final score issued last night, the opposite is true with health reform. In fact, the reform would reduce the deficit by a half percentage point of GDP -- or more than $1 trillion -- over the legislation’s second 10 years.

Second, we have heard that the bill is double counting Medicare savings.  To put on the green eyeshade for a moment, let’s be clear: the bill has been scored by using standard budget accounting – the same methods used for years. And again, CBO confirms that health reform will reduce the deficit over 10 years and over 20 years.

Looking at the budget as a whole, this bill will leave us with less debt over time, and that is what matters.

Third, critics contend that there is no way that savings and revenue adjustments put forward will actually happen.  No one has a crystal ball, but we do know how Congress has acted in the past.   When tough decisions were made in the past about our central benefit programs, these changes have tended to stick. As I have noted before, the Center on Budget and Policy Priorities (CBPP) has studied Medicare savings and found that: "Virtually all of the Medicare cuts enacted in 1990 and 1993, which accounted for a significant portion of the savings in those large deficit-reduction packages, were implemented...And most of the savings enacted in 1997 other than the SGR cuts – nearly four-fifths [emphasis theirs] – were implemented as well." 

Fourth, some have charged that there are hidden costs not being counted in the CBO score. One source is authorizations for discretionary spending for items related to health reform. Authorizations are just that; they are not expenditures, and Congress often does not act on them -- or can do so while cutting elsewhere so the overall amount of discretionary spending doesn’t increase.  The other source for these alleged secret costs is the need to fix the Sustainable Growth Rate (SGR) in Medicare, which otherwise would cut physician payments drastically. An SGR fix, however, is not in this bill -- so adding its costs to the legislation posits a piece of legislation that doesn’t exist. Moreover, and more importantly, the need to address the SGR is a longstanding issue that pre-dates health reform and would be an issue even if Congress didn’t undertake health reform.  Both Democratic and Republican Congresses and Administrations have applied temporary fixes in the past.

This brings me to a final point. Perhaps people are appropriately skeptical about some of these budget figures because over the past decade, budget gimmicks and fiscal irresponsibility became the norm. Massive tax cuts (which weren’t paid for) were passed and were presented as temporary to make them seem less expensive – even as supporters fully intended to make them permanent. New health care entitlements were signed into law without any offsets. Budget windows were manipulated to blind people from true costs. It is truly, and sadly, ironic that the central critics of the fiscal underpinnings of today’s health reform legislation are those who supported these policies --and led the way -- as our country spiraled from surplus down into deep budget deficits.

The legislation before the House represents the most important deficit reduction package that would be enacted in over a decade -- and, perhaps more importantly, represents the first serious piece of legislation that would begin the process of addressing our long-term fiscal imbalance by re-orienting the health system toward quality rather than quantity.  We stand by its CBO score. Later tonight, we expect a majority in Congress to stand by it as well – ushering in, among other things, a new era of fiscal responsibility.

Peter Orszag is the Director of the Office of Management and Budget