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7 Items You Didn’t Know Were In The Senate Health Bill

Posted Dec 30 2009 6:23pm


Pay attention: The “Patient Protection and Affordable Care Act” — better known as the Senate health care overhaul bill — is chock full of interesting but little publicized provisions affecting consumers.

1. Nursing mothers get a break
This provision was inserted by Sen. Jeff Merkley, D-Ore., who in June introduced the Breastfeeding Promotion Act. Merkley is promoting breast-feeding partly as a way to cut health costs. He cites studies showing breast-fed children have a lower rate of disease and illness in their lifetime.

2. Learning to be an adult
Being a teenager is tough. The Senate wants to help with a provision allocating $400 million from 2010 to 2015 to help teens make the transition to adulthood.

The money goes to states primarily to set up sex education programs. But the money can also be used for “adult preparation” programs that promote “positive self esteem, relationship dynamics, friendships, dating, romantic involvement, marriage and family interaction.”

3. Retiree health benefits
The Senate bill includes a provision designed to ease out-of-pocket costs for retirees who are under 65 but who still get health insurance from their former employer. The bill would create a temporary “reinsurance” program under which the government would pick up 80 percent of some high-cost insurance claims filed by retirees. Employers would use the savings only to make retirees’ coverage more affordable by reducing their share of premiums or other costs. The Senate bill would set aside $5 billion for the program; the House-passed bill, which has a similar provision, has a $10 billion pot. The proposal has wide support among employer groups and labor unions.

4. Promoting use of bone density scans
The Senate bill is trying to boost payments, which have dropped by more than half since 2006, for a bone test known as dual energy X-ray absorptiometry (DXA) or bone densitometry. And those cuts have made it more difficult for patients to get access to the test, especially in physicians’ offices and clinics, according to the National Osteoporosis Foundation. The Senate bill would increase rates to 70 percent of what Medicare paid in 2006.

5. Setting ER prices
Hospitals would have to limit how much they charge low-income uninsured emergency patients to the lowest amount they receive from insured patients for the same services.

A 2007 study published in the journal Health Affairs showed that many “uninsured and other ’self-pay’ patients for hospital services” were often charged “2 1/2 times what most health insurers actually paid and more than three times the hospital’s Medicare-allowable costs.” The study by Gerard Anderson of Johns Hopkins University also found the “gaps between rates charged to self-pay patients and those charged to other payers are much wider than they were in the mid-1980s.”

6. Singing the blues
Non-profit Blue Cross and Blue Shield health plans would have to spend at least 85 cents of every premium dollar on health services or forfeit their special federal tax deductions. The Congressional Budget Office estimates this provision in the Senate bill would cost the Blues’ plans about $400 million over the next decade.

Historically, Blue Cross and Blue Shield plans received a tax-preferred status because they were created to provide a more significant “community benefit” than other insurance companies. But the Blues have come under increasing scrutiny from state and federal lawmakers and consumer watchdog groups for charging high rates, racking up profits (revenues over expenses) and paying top executives no differently than their for-profit insurance counterparts.

Several Blues’ plans converted to for-profits in the past 15 years. Of the 39 Blue Cross and Blue Shield plans nationwide, 24 are now non-profit.

7. Transparency in drug pricing
Pharmaceutical benefit managers are a critical part of the nation’s health care system. Administering drug plans for more than 210 million insured Americans, they negotiate discounts on prescription drugs with retail pharmacies and wholesalers and also get rebates from drug makers.

At the urging of Sen. Maria Cantwell, D-Wash., the Senate Finance Committee inserted language into its health bill that would force the benefit managers, known as PBMs, to disclose details of those negotiations — including how much of the savings were passed on to consumers.

Source: Kaiser Foundation

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