And now we go to debate

The Senate made history Saturday evening at 8 PM, November 21, 2009. It voted to open debate on H.R. 3590, its $848 billion healthcare reform bill. The final vote was 60-39, with all Democrats and Independents voting in the affirmative. The bill includes important consumer protections, a (very weak) “public option,” and many provisions vital to the nursing profession. To allow debate on this legislation clearly represents a movement toward much-needed, comprehensive and meaningful reform for our nation’s healthcare system.

The key provisions of the 1,300 pages of “legal speak” in the Patient Protection and Affordable Care Act would:

• reduce the federal deficit by $130 billion over the 2010-2019 period
• cover about 31 million Americans who are presently uninsured
• raise the percentage of Americans with healthcare coverage from 83% to 94%
• slow Medicare’s annual growth rate to 6%, from the 8% rate it has experienced since 1990
• allow states to opt out of offering citizens an opportunity to buy into a public health care plan. A Medicare-like public plan will offer four levels of care: basic, enhanced, premium, and premium-plus. The four levels are differentiated mainly by costs covered, which range from 60% to 90%.
• The public plan will be offered along with myriad private plans via a state-based insurance exchange. For the first few years, only small businesses, the uninsured, and self-employed persons will be able to purchase policies from the exchange.

The bill does not contain an employer mandate. However, businesses that don’t provide coverage to employees will be assessed a flat fee for each employee who buys insurance via the exchange.

Like the House bill, the Senate bill reforms for-profit practices by mandating that private insurers:

• are required to accept all applicants
• may not charge higher premiums because a person becomes ill
• may not use preexisting conditions to limit or refuse coverage
• allow parents’ insurance to cover their children until age 26
• may not require a lifetime cap on coverage expenditures.

H.R. 3590 is a decent start, but once it goes to debate, there’s no telling what will happen. Only one thing is certain—the various vested interests will be pushing hard to amend the legislation to benefit themselves!