House Tri-Committee Reform Bill --- What would this version of health reform mean for patients?

This week the House committees continue their mark-ups of the healthcare overhaul bill, called the America's Affordable Health Choices Act , introduced last week. The mark-up process is critical as there are many provisions still being debated for inclusion. For example, the House bill released last week does not yet include a biosimilars provision but one is expected to be added during the mark-up process.

So, how would this version of health reform impact patient access?

· Near-universal access to health care (expected to cover 97% of all Americans) is the signature piece of this bill

· Includes an individual coverage mandate and an employer coverage mandate

· Creates a new Health Insurance Exchange for families and small employers to identify and select health insurance from a range of options; the exchange would include a government-run plan option in addition to private payer options which has been one of the most debated concerns

· Creates a defined “essential benefits package” that includes coverage of many preventative services and creates the minimum coverage for all plans in addition to creating a cap on out-of-pocket costs

· Subsidies to individuals and families are limited and some do not begin immediately

· Medicare eligibles that have selected Medicare Advantage (instead of traditional Medicare) might see a change in plan offerings in the future as the government reduces payer incentives for these plans.

· The bill includes some changes to Medicare Part D that would reduce patient copays during the “donut hole”

· The bill also includes some technical changes to Medicare such as correcting a flaw in physician reimbursement

Of course one of the biggest areas of concern for this bill is how to fund universal coverage and this bill includes a mix of cost-cutting initiatives along with new revenues including a tax surcharge for households over $350,000.