House Tri-Committee Health Reform Bill

It was another eventful week for health reform. You only have to turn on CNN or read the blogs for the political ins and outs. On perhaps the less sexy side of things, we have been busy reading the House's new 1,018 page health reform bill, the America's Affordable Health Choices Act of 2009. The bill, released this week, is an updated version of the draft bill issued by the three House committees at the beginning of the month. We have released a new fact sheet, which provides an overview of the bill's provisions as they relate to children and families.

With the caveat that the shelf life of this list may be a few hours given that they are currently marking up the bill, here are some of the most notable changes for children and families (as well as some of the important provisions that were not changed despite enormous pressure to cut back the scale of health reform):

• Keeps Medicaid for everyone up to 133% FPL with 100% federal funding for those newly-eligible. States that have expanded Medicaid above 133% FPL must still maintain coverage.

• Maintains the creation of a national Exchange with a public plan option that provides subsidized coverage for those up to 400% FPL. The new bill modestly increases the premium contribution cap (e.g., families at or below 133% FPL would contribute up to 1.5% or their income, rather than 1%).

• Continues to require coverage of pediatric services in Exchange and employer plans, including oral, mental health, and equipment for children. Adds a new requirement that the coverage be based in part on what is provided by a typical employer plan.

• Still allows CHIP to expire in 2013, but now requires that HHS decide whether a state and Exchange have a good transition process in place before children are moved from CHIP to other coverage. (As with the original bill, it does not extend federal funding past September 30, 2013, nor does it directly guarantee that children will receive comparable coverage when they are moved from CHIP to Exchange plans.)

• Provides stronger "screen and enroll" provisions for Medicaid-eligible individuals initially applying for coverage through the Exchange.

• No longer allows states to let certain Medicaid enrollees shift to the Exchange (Medicaid-eligible childless adults moving from private coverage still can enroll in Exchange).

• Eliminates the asset test for children and most adults in Medicaid and requires 12-month continuous coverage for separate CHIP programs (but this new requirement does not extend to Medicaid).
  

We are continuing to digest this bill, and others.  We will be back in the near future to share our thoughts on how children are faring, and ways we might strengthen some of the bill's to meet the needs of kids.