Health Reform Demands That Lawmakers Read the Bills

Congress has agreed to step away from its promise to pass expansive health bills before its August recess as the president wanted. It would have bordered on legislative malpractice for the House to have rushed to pass its bill last week as its leadership hoped to do, considering that most members still have not read the 1,017-pager, known as H.R. 3200. John Conyers, chairman of the House Judiciary Committee, during a speech at the National Press Club that can be seen on YouTube, derided members for haranguing their colleagues to read the health bill before voting, saying, "What good is reading the bill if it's a thousand pages and you don't have two days and two lawyers to find out what it means after you read the bill?" Now a slew of negative TV spots are asking lawmakers, "Have you read the bill?" Good idea; maybe the public should, too. The August recess is the perfect time for both legislators and the public to do this required summer reading.

Dr. Bernadine Healy

Reading H.R. 3200 is not like curling up with Harry Potter. But you can download it free from a government website, thomas.loc.gov. I advise everyone to take a stab at it. You will see confirmation that the bill reforms insurance so it can't be canceled or denied for a prior illness and will be widely accessible. But many details cloaked in its off-putting legalspeak bring surprises that should stimulate more public discussion before September, when Congress restarts its reform efforts.

Here are just four things that promise to radically change some people's health experiences—and everyone's relationship with the government—even if you are now among the happily insured.

Health choices commissioner. Congress proposes a new, independent federal agency called the Health Choices Administration, whose commissioner would create standards for insurance that you and some 285 million Americans (15 million would still not be covered) would be required to have. The commissioner would also qualify plans that meet federal requirements and determine which individuals are eligible for subsidies.

The Health Choices Administration would establish and operate the Health Insurance Exchange, where those without coverage would sign up with private insurers or get new government-established public insurance. (The Senate is rumored to have abandoned this option in favor of nonprofit cooperatives seeded with federal money, but its bill isn't finished.)

The commissioner of health choices would ensure that deadbeats who did not seek out insurance would be randomly assigned to an exchange plan or to an expanded version of Medicaid, which the bill provides. The bill anticipates that everyone will walk away with a standardized, electronic health identification card, making it easy for hospital staff to quickly figure out whether an individual is eligible for a specific service with a specific physician at a specific facility.

Health Benefits Advisory Committee. Recommendations for the essential benefits your insurance would cover, which would change with new knowledge and technology, would rest largely with the secretary of health and human services' Health Benefits Advisory Committee. This group of up to 27, more than half of whom would be appointed by the president, would come up with lists of treatments and services that must be covered and set your copayments for any of the covered services. This will be a tough job, as we've already seen during the recent dust-up in Congress over whether a government plan would cover abortions. Imagine battling over those $50,000 drugs for cancer patients.

Defining essential health benefits will figure into the real long-term cost of health reform. With new advances and an aging population, costs could easily swell beyond the trillion dollars the Congressional Budget Office calculates. Or costs—and patients' options—could shrink if the defined essential benefits constrain coverage of more-expensive services. Costs to individuals could in turn rise if they chose to pay on their own.

Federal penalties. The commissioner of health choices would perform random and targeted audits of health plans across the country and fine or shut down any that flunk federal requirements. And American citizens found lacking in federally acceptable insurance would be fined 2.5 percent of their income for that period, up to the cost of the national average premium.

The Internal Revenue Service would assist enforcement by making taxpayers file a new IRS form detailing the status of their family's insurance coverage. To comply with President Obama's promise, those who have insurance they like when the law is implemented would be allowed to keep it for a while, even if it doesn't meet government specs. That does not mean companies could not decide to cancel what are otherwise unacceptable plans.

In the House bill, companies would have to cover workers with federally compliant plans or pay the feds 8 percent of any payroll that exceeds $500,000. All employers would face federal audits and hefty penalties for each day of noncompliance.

Money from the young and the old. One squeeze on the young: H.R. 3200 legislates that they pay premiums that are no less than half of what older people would pay. Now, kids out of school can buy health policies for a small fraction of what their parents can, but that won't be allowed.

Medicare faces the biggest squeeze of all, providing more than a third of the money needed to make reform pay for itself. It's hard to figure that from the bill, which speaks in formulas, so go to CBO.gov, the budget office website, to see the dollars. But the program will still keep giving. The secretary of health and human services is charged with continuing efforts to decrease elders' hospitalization. The focus has been on hospital readmissions within 30 days, but this bill leaves that time open ended. This is no small consideration: Currently, 56 percent of Medicare recipients who need the hospital go back in within one year.

The bill adds a new benefit to Medicare called "advance care planning consultation." Offered free every five years, or more frequently if the patient has a chronic, progressive, life-limiting, or terminal disease or is in a nursing home, it gives beneficiaries information about living wills and a range of end-of-life services like palliative and hospice care. Some might say this is a not-so-subtle response to the fact that Medicare patients consume tens of thousands of dollars during the last six months of life. Saving that money may be hard. As any doctor knows, patients surprise you all the time. Giving up on them calls for pretty sound and well-informed judgment.

And that is what we want of our lawmakers. Before they cast what will be historic votes expected in the fall, I'd suggest that each member take a proctored, multiple-choice test on these bills, with their grades posted on the Web. Those who flunk, step aside.