A Glimpse of What the Final Health Reform Bill Might Look Like – Say Ahhh! A Children’s Health Policy Blog

Right after the question of how the incredibly busy OMB director Peter Orszag managed to find the time for such an exciting personal life, the major topic in D.C. policy
circles is what will be in the final health care bill. For the latest “big pictures” stories,
check out Politico
and the
New York Times
. But, here is
what we’ve been able to glean on issues of particular importance to kids and

On Medicaid. Long-time Medicaid champion, Representative Henry Waxman, Chairman of
the House Energy and Commerce Committee, is pushing hard to address access concerns
in Medicaid by increasing reimbursement rates for primary care services to
Medicare levels. With Medicaid slated to be a cornerstone of health care
reform, the argument is that now is the time to tackle this issue. In the House bill, the initiative was
estimated to cost $57 billion, which means if it is in a final bill, it is quite
possible that it will be in a scaled-back form with a less hefty price tag.

As for the larger question of whether the bill will take Medicaid eligibility to 150
percent of the federal poverty level (House) or 133 percent of the federal
poverty level, we have no good clues. The Senate seems adamantly opposed and the nation’s Governors already are up-in-arms about the fiscal impact on states of Medicaid expansions. On the other hand, it is less expensive
to cover people through Medicaid than Exchange plans and right now, anything
that helps lower the federal cost of health reform is likely to be considered.

On CHIP. It increasingly looks like the final bill may adopt the
Senate’s strategy of continuing CHIP, although nothing is certain at this
stage. Over the weekend, Rebecca Adams with Congressional Quarterly reported
the following: Many analysts expect that some version of the Senate language will
prevail in the final bill. Not only do many child advocacy groups prefer it,
but so do health insurers. Lobbyists for America’s Health Insurance Plans, an
industry trade group, say that shifting people into different programs could be
disruptive and confusing, which could lead to some children ending up
uninsured. And, Mike Lillis of the Washington
Independent just ran a story entitled “Waxman Not Married to CHIP Repeal,” in which he reports that while Waxman strongly favors his approach on
CHIP, he may not insist on it. “I’m not drawing lines in the sand on anything,”
Waxman said.

On Affordability. Consumer advocacy and faith-based groups are pushing hard for
improvements to the subsidy structure for low-income Americans and, in particular, for the final bill to draw on the House’s approach for
people below 250 percent of the federal poverty level. But, no hints are emerging in the
public domain on where this is heading. It will come down to money.(As my kids routinely say to any and all bits of information that I share with them, “obvious.”)

Where do you think these issues are headed? Any clues you’d like to share with the Say Ahhh community?

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