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President's Proposal on Health Reform

The White House has released a revised health care proposal designed to spur action in Congress and draw Republicans to engage in negotiations to revive the prospects for an agreement this year. This proposal comes in advance of a summit with bipartisan congressional leaders set for Thursday, February 25, 2010, at Blair House. At this point it is uncertain whether or not this new proposal can get health care reform legislation back on track. The full scope of this effort will not come to light until well after the summit, although early reaction is not positive.

Details of the President's proposal can be viewed at the following Web sites:

http://www.whitehouse.gov/health-care-meeting/proposal

http://www.whitehouse.gov/sites/default/files/summary-presidents-proposal.pdf

First it is important to note that the President's proposal builds on the bill that passed the Senate on December 22, 2009. Therefore, in viewing the material on the White House Web site, it should be noted that it is only intended to highlight changes to the Senate-passed bill. In a call with White House staff, it was made clear that if a provision is in the Senate-passed bill but is not mentioned in the White House proposal, it is assumed to be in the President's proposal. In effect, this new White House proposal is the Senate passed bill with changes that fall into several categories:

1) agreements that had been reached between the House and Senate in negotiations that were halted after the Massachusetts Senate election,
2) rejection of the Senate proposals that had drawn public opposition (higher Medicaid match for Nebraska), and
3) Republican proposals that the White House has accepted in order to promote bipartisan discussions.

NAMI Priorities

NAMI sent a letter of support for the Senate passed bill. This support was grounded in provisions in the Senate bill consistent with key NAMI priorities for health care reform including:

  • Inclusion of mental health benefits in the basic benefits package of all health plans offered through the Exchange and a requirement for all plans to adhere to the 2008 federal parity law,
  • Insurance market reforms including a ban on pre-existing condition exclusions and guaranteed issue and renewal,
  • Expansion of Medicaid eligibility for single adults up to 133% of the federal poverty level (FPL),
  • Expanded access to primary and preventive care,
  • Improvements to Medicare Part D including strengthened formulary protections,
  • Authorization for a new Medicaid demonstration program for emergency inpatient psychiatric care, and
  • Strong protections and enhanced oversight for Comparative Effectiveness Research (CER).

In addition, the President's plan also incorporates the following changes to the Senate-passed bill:

  • Higher federal Medicaid match rates for states for the cost of expanding eligibility for new populations (childless adults up to 133% of FPL),
  • New long-term solvency requirements for the CLASS Act provisions for long-term care insurance,
  • Expanded tax credits for insurance coverage for middle class families who will be required to purchase coverage,
  • Completely fill the Medicare Part D coverage gap (the "doughnut hole") by 2020,
  • New tax credits for small businesses, and
  • A new "Health Insurance Rate Authority" to provide federal oversight of insurance premium increases.

Finally, the President's proposal includes a range of proposals that have been put forward by congressional Republicans, most relating to "waste, fraud and abuse." While most of these relate to enhanced sanctions for fraudulent claims and promotion of databases to promote quality, there is a provision to strengthen federal oversight of Community Mental Health Centers. This provision is Section 265 of the Medical Rights and Reform Act of 2009 (HR 3970), Rep. Mark Kirk's legislation to combat health care fraud. The provision grants the HHS Secretary new authority to impose federal standards on CMHCs. NAMI has supported a similar provision in the House bill sponsored by Rep. Doris Matsui for new federal standards for "Federally Qualified Behavioral Health Centers."

The White House is making an aggressive effort to revive the President's top domestic priority.


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