Hr3200cs - Citizen Sponsored Health Care Reform Bill

Citizen Sponsored Health Care Reform Bill HR3200CS – A CITIZEN SPONSORED COMMON SENSE HEALTH CARE REFORM BILL HR3200CS – A NEW HEALTH CARE REFORM BILL WHERE THE ‘CS’ STANDS FOR CITIZEN SPONSORED AND COMMON SENSE ARTICLE 1. A Health Care Reform Bill By Citizens, For Citizens ARTICLE 2. Bill Highlights ARTICLE 3. How is Insurance Accessed and Purchased? ARTICLE 4. What are the Insurance Reforms? ARTICLE 4.1. Risk Categories & Assessments ARTICLE 4.2. Risk Mitigation ARTICLE 4.3. Family Clinics vs. Emergency Rooms ARTICLE 4.4. Insurance Premiums ARTICLE 4.5. Three Way Free Market Competition ARTICLE 4.6. Electronic Medical Records ARTICLE 4.7. Tort and Transparency Reforms ARTICLE 5. Conclusion If you would like to participate in the crafting of this bill (become a Citizen Sponsor) call or email the following contact: Philip Tympanick 11 Suzette Circle Millville, MA 01529 508-876-9357 [email protected] There is no charge or fee to become a Citizen Sponsor REVISION HISTORY 2009-10-07 – 1.0 – Initial Revision

ARTICLE 1. A Health Care Reform Bill By Citizens, For Citizens The purpose of the HR3200CS bill is to put the crafting of health care reforms into the hands of those that will be most affected by the bill, that being the citizens. A reasonable question is, if “we the people” are going to have to live with the health care reforms, then why don’t “we the people” simply write the bill ourselves and hand our bill to Congress? The purpose of this bill is to address the most obvious reforms in our health care system that a) make the most sense, and b) will deliver the highest return. Return is defined as that which either reduces cost without sacrificing quality, or increases quality without increasing costs. ARTICLE 2. Bill Highlights The plan will be delivered in five pages and with no legalese. The highlights of the plan are as follows: 1. 2. 3. 4. 5. 6. 7. 8.

All US Citizens are eligible and encouraged, not mandated, to participate A private, market-based solution that reduces cost while improving the supply and the quality of services by introducing three-way competition (think Las Vegas). Control given to patients making them more responsible for their own health care decisions and less dependent on bureaucrats in HR departments and government agencies. Insurance portability across jobs and during unemployment Covers pre-existing and new conditions and ensures nobody can be denied coverage Wellness Incentives are provided Minimal Government Involvement providing subsidies only to the poor and disabled. Medicare and Medicaid are left “as is” and will not be affected in any way.

ARTICLE 3. How is Insurance Accessed and Purchased? Under HR3200CS all legal US citizens would be responsible for acquiring their own private health care insurance for themselves and their families, and the private insurance premiums would be paid for from one of the following sources: 1.

2.

3. 4.

Employer Provided Before Tax Health Care Savings Account – Each full-time employee receives a tax-exempt monthly payment into the savings account for the purposes of buying privately accessible health care insurance. Having a personal health care savings account ensures portability of coverage across employers and jobs. Unemployment Insurance — A portion of Unemployment Insurance would go to fund this savings account in the event an individual becomes unemployed. That amount would be separate from the employer funds and would be inaccessible until such time as the individual files for unemployment benefits. Immediately upon filing they would have access to these additional funds, as well as any residual funds in their private account. Individuals – A person could pay for their insurance just like home, life or auto on a monthly basis and insurance policies could be purchased over multiple year terms (e.g. 5, 10 ,20 years) Government Subsidies – For all that qualify including part-time workers, those with expired unemployment benefits, and those with disabilities that do not allow them to work either full or part time.

ARTICLE 4. What are the Insurance Reforms? Under HR3200CS all state provisions that deny or disrupt nation-wide competition in any way will be outlawed and private insurance regulations will be rewritten to facilitate private insurers selling health insurance policies nation wide. This means that each provider will be able to compete in every state in the country and each insurer must cover residents in all parts of the state and must share an equal majority of high-risk patients across a pool based on pre-existing or high-risk categories. ARTICLE 4.1. Risk Categories & Assessments Common Sense Health Categories will be defined using a graded system (think of high school) with grades falling between A & F with A being the least risky patient, and F being the most risky patient. The department of Health and Human Services and other appropriate agencies, patient advocacy groups, insurers and providers will be responsible for defining the particulars behind each of the categories. The category a person falls into would not necessarily affect the

price they pay for insurance. The category assessment would only be used to spread risk across pools of people in similar categories across insurance providers as per section 4.2 The primary care physicians will deliver a rating for each of their active patients. Those who do not have a primary care physician will go to special family clinics as defined in sub-section 4.3 to have a health care assessment (physical) done. All assessments must be updated every five years for each patient. ARTICLE 4.2. Risk Mitigation Every insurer operating across the nation will have to take on a proportionate amount of A, B, C, D, & F patients. Consequently, each of the insurers will be incented to help patients move from the most risky, to the least risky pools by promoting and supporting wellness programs and other initiatives that promote physical fitness, proper diet and nutrition. ARTICLE 4.3. Family Clinics vs. Emergency Rooms Though many family clinics exist in the country today, they typically deviate in staffing, equipment, and consequently delivery capabilities. That being said, all new and existing family clinics will be AMA certified to have the following minimal capabilities guaranteeing that any clinic can perform the following basic services:

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Category Assessments or what we traditionally think of as physicals

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Basic Out Patient Services by Nurse Practitioners

Flu Shots and Inoculations Basic Diagnostic and Treatment Services by Nurse Practitioners e.g. Minor infections and Illnesses e.g. Treatment of Contusions & Abrasions and Rashes

The expansion of the network of family clinics should begin to ease the burden on emergency rooms, deliver more convenient and timely care to patients, and will enable the system to service a large number of patients at a significantly lower cost. ARTICLE 4.4. Insurance Premiums Each insurance provider will participate in a free market to price the premiums for each category of patient or insured client. Insurers will be required to offer health premium credits for people that move from higher risk categories to lower risk categories incenting their customers to get healthy and stay healthy. This is better known as the wellness provision. In addition, providers will have the option of structuring a menu of options that consumers can choose from in each of the health care categories. Consumers will choose which options and feature they want. For example, co-pays vs. no copays, deductible amounts etc. ARTICLE 4.5. Three Way Free Market Competition The health care delivery system will be set up to promote competition across each leg of the three-leg health care stool. Said another way, providers, insurers and patients will all compete for one another. This will ensure a proper balance is struck between all three constituents such that:

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Providers can leverage market forces to ensure the right balance is struck between quality for their patients and profitability for themselves

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Insurers can leverage market forces to ensure the right balance is struck between the quality of their product offerings and profitability for themselves

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Consumers can leverage market forces to ensure the right balance is struck between quality of coverage and its cost.

The best example of this three-pronged competitive model can be found in the gaming industry in Las Vegas. Think of the casinos as the insurers, the acts and entertainers as the health care providers, and the guests as the patients. Here, everyone is competing for each other, and the result is that every consumer can find something they’ll both enjoy, and can afford. Likewise, the better casinos and the entertainers are able to make a comfortable profit while the worst go out of business. Furthermore, under natural market conditions this competition leads to more and better casinos being built (insurance competition), more higher quality acts and entertainment to be established (doctors opening higher quality practices and more of them), and guests getting more bang for their buck (patients receiving higher quality at a lower

cost). Competition amongst insurers alone, while helpful, would not provide the same optimal outcome as competition amongst all the parties involved in the system. The premise of this three-way competition reform is to get the consumer more involved in their own health care insurance and provider decisions. In doing so, they will tend to make better decisions for themselves, while at the same time drive down costs across the health care network due to the resulting increase in competition. What’s done in Vegas ought not stay in Vegas! ARTICLE 4.6. Electronic Medical Records Every health care provider will have access to patient medical records electronically, and strict laws and penalties will be enacted to prevent the misuse of such information. Sharing of medical records will only be allowed between providers, their patients, and insurers and any leak of information to the general public without the patient’s permission will be a felony. ARTICLE 4.7. Tort and Transparency Reforms Tort reforms to include limits on damages, and any other provisions needed that will incent more practices to open, remain open, and will ensure that good providers stay in business, while poor providers are weeded out. This reform will also come with patient-centric aids to help patients subjectively measure and monitor doctor and provider performance. These would include web-sites where patients can review doctor’s, insurers, and providing facility’s performance records. ARTICLE 5. Conclusion HR3200CS was purposely designed to be a framework document, and while many questions and issues will need to be discussed and debated around this framework, the primary purpose of this document was to put forth, to the people and our legislators, a simple, readable, health care proposal that can be understood by everyone, and in turn, can begin to “move the needle” towards bi-partisan solution to health care reform.