This morning, Sen. Ben Nelson (D-NE) announced at a press conference that he plans to vote for cloture on the current Senate health care bill. His announcement secured Sen. Harry Reid's long sought-after 60th vote to end a Republican filibuster against health insurance reform.
Click here for the full text of the Manager's Amendment [pdf]
Click here for the CBO score of the Manager's Amendment [pdf]
Sen. Reid's office released a rundown of what's included in the manager's amendment. Excerpts are below:
- Quality of care in Medicare. Seniors will benefit when additional health care providers are reimbursed by Medicare for the quality of care they deliver, not the quantity of services they provide.
- Accountability for excessive rate increases. A health insurer's participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded - a powerful incentive to keep premiums affordable.
- Immediate ban on pre-existing condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of pre-existing conditions for children.
- Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care.
- Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014. (Editor's note: This appears to be closing the loophole we noted last week, here.)
- Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.
- Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice.
- Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.
- Vulnerable populations. A range of new programs will tackle diseases such as cancer, diabetes, and children's congenital heart disease, will improve the Indian Health System, and will provide support for pregnant teens and victims of domestic violence.
- Community Health Centers. A substantial investment in Community Health Centers will provide funding to expand access to health care in communities where it is most needed
- Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits - or else pay rebates to policyholders. These stricter limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans.
- Revised abortion language, including state opt-out of abortion coverage (Ed. note: For more in-depth coverage, visit RH Reality Check's blog.)
