Health Care Reform Comparative

HEALTH CARE REFORM AND THE YOUTH Young people make up a disproportionate percentage of those without health insurance: 15% of the population, but 30% of the uninsured. Yet as a generation, young adults are more civically engaged than ever before in community service, in seeking public office, and at the polls. Health care is one of our top priorities. The time for reform is now – and we want our voices to be heard. The Roosevelt Institute Campus Network Health Care Center has carefully researched the three bills currently being considered in both the Senate and the House of Representatives. Through the lens of the most compelling priorities for young Americans, the center has identified if each bill meets the criteria necessary to actually make a difference in the lives of young Americans. The final health care bill will look different from each of the current options. However, we need to recognize which bills have the most innovative components to address the issues of young people and ensure that they are incorporated into any final bill.

Our generation. Our voice. Our take on health care reform.

1. Young adults can remain on parentʼs insurance until age 26 Currently, young adults are dropped from their parentʼs insurance at age 23 if they are pursuing higher education; non-college youth are dropped at age 19. Given the current economic state, it is unreasonable to expect young people in entry-level jobs to receive employer-based coverage – especially when only 53% of young adults are eligible for the health insurance offered by their employers. It is equally unreasonable to assume that they can command an income that can cover skyrocketing insurance premiums in addition to basic living expenses.

House Tri-Committee Bill No provision

Senate HELP Bill Sec 2709- Extension of Dependent Coverage: The Senate HELP bill extends coverage to young adults on their parentʼs insurance to the age of 26

Senate Finance Bill No provision

2. Viable, affordable choices for health coverage, including a public option The term “public option” has recently become more polarizing than informative, and it can vary in effectiveness and cost reduction based upon its provisions. To save the most money and cover the most people, a public option needs to be tied to Medicare rates for the first three years as described in the House bill and proposed in the Rockefeller amendment in the Senate Finance Committee. The CBO has stated that negotiated rates would mean a reduction in savings by $85 billion and 500,000 fewer people covered. Also, it should be noted that often “the exchange” is cited as a source of saving, but cannot stand alone as an effective market without the strength of the public option, and thus on its own would be a poor means of reform.

House Tri-Committee Bill

Senate HELP Bill

Sec 221: Establishment and administration of a public health insurance option to be offered through the Health Insurance Exchange with rates initially set at Medicare rates

Sec 3116- Establishment of a community health insurance option (public option) accessed through the American Health Benefit Gateways

Senate Finance Bill Subtitle E- Creation of Health Care Cooperatives Create a CO-OP program to foster the creation of a nonprofit member-run health insurance company

3. Health education for youth in the community and at the university level Not all colleges have the means and capacity to provide and require insurance for all students, but they can do what they do best: educate. Young people cannot we lead healthy lifestyles intuitively, and health education is considered one of the most effective forms of preventative care. Funding should be allocated to educational programs both at colleges and in the community so that Americans can take advantage of the newly established benefits of reform. Funding should also be increased to National Health Service Corps to increase engagement of youth in health careers, like primary care physicians.

House Tri-Committee Bill

Senate HELP Bill

No education provision

No education provision

Sec. 2201 National Health Service Corps

Sec. 427 Funding for National Health Service Corps

Senate Finance Bill No education provision

4. Sufficient subsidies to make health care affordable for all There is little point to reform if health insurance remains unaffordable to the vast majority of Americans of both low- and middle-incomes. Without adequate subsidies, insurance will still be out of reach for most. Decreasing the number of uninsured people increases affordability for all in decreasing “safety net” expenses reflected in high premiums of the insured.

House Tri-Committee Bill Premium subsidies to individuals and families with incomes up to 400% FPL, paying no more than 11% income

Senate HELP Bill Premium subsidies to individuals and families with incomes up to 400% FPL, paying no more than 12.5% income

Senate Finance Bill Subtitle C- Disclosure to carry out health insurance exchange subsidies Premium subsidies to individuals and families with incomes up to 400% FPL, paying no more than 12% income

5. Automatic enrollment into SCHIP and Medicaid Many people qualify for SCHIP and Medicaid but are not enrolled. Available tax information could be used to automatically enroll those who qualify into these programs, reducing bureaucracy and increasing coverage of some of the most disadvantaged of society, including the 2/3 of uninsured children who already qualify for these programs who are not enrolled.

House Tri-Committee Bill SEC. 205. Outreach and enrollment of exchangeeligible individuals and employers in exchangebenefiting health benefits plan

Senate HELP Bill SEC. 3204. Enrollment and un-enrollment requirements

Senate Finance Bill Subtitle D- Shared responsibility- automatic enrollment and alternatives

6. Prohibit the unfair and discriminatory increase of premiums for young women We are a generation that embraces diversity and strives for equality. Yet in 38 states it is legal for women to be charged higher premiums based on gender alone. In California, women pay up to 39% more than men for similar individual policies that exclude maternity benefits. The bottom line is that women pay more. The Senate HELP bill takes the biggest step by establishing a committee and information center to focus on womenʼs health issues, but we could do far more to establish true equity.

House Tri-Committee Bill

Senate HELP Bill

Title XXXI, subtitle C Representative from Office on Womenʼs Health on clinical prevention stakeholders board and there will be a member of the Prevention Task Force with his or her expertise in womenʼs health

Sec 229- Health and human services office on womenʼs health: Establishes a Deputy Assistant Secretary for Womenʼs Health, a committee, and a National Womenʼs Information Center to spread health information and keep private and public sector insurance in ethical practices

Senate Finance Bill No provision

7. Increase youth access to preventative medicine Young adults need access to actual health care- not “sick care.” An emergency care plan with a $3,000 deductible from the Finance Senate Committee is unacceptable for young adults. Despite claims by some, we are not invincible nor do we claim to be. Preventative care such as check-ups, testing, and vaccines should be deemed necessary and be made affordable and accessible to young adults. Preventative care is essential in the detection and management of chronic disease and the prevention of disease progression, and ultimately brings down costs and increases quality of health. Moreover, a $3000 deductible is unreasonable to expect from those at the bottom rung of the employment ladder.

House Tri-Committee Bill

Senate HELP Bill

Increase Medicare and Medicaid coverage of preventative services to 100%

Create a prevention and public health investment fund to expand and sustain funding for prevention and public health programs

Create task forces on Clinical Preventive Services and Community Preventive Services to develop, update, and disseminate evidencedbased recommendations on the use of clinical and community prevention services

Encourage employers to provide wellness programs by conducting targeted educational campaign Create a temporary Right Choices Program to provide uninsured adults with access to preventive services Award competitive grants to state and local governments and community-based organizations to implement and evaluate proven community preventive health activities to reduce chronic disease rates and address health disparities

Senate Finance Bill Subtitle D- Shared Responsibility- “young invincible plan” Permit employers to offer employees rewards of up to 30% of the cost of coverage for participating in a wellness program Allow insurers to vary premium rates based on tobacco use Prohibit insurance plans from charging cost-sharing for preventive services.