The House released its health care reform bill today and will begin three simultaneous committee markups on different provisions later this week. Video of Waxman’s statement, courtesy of TPM.

You can access House Committee summaries and the actual text at the House Education and Labor Committee site. Help us read through the bill.

First impression from the summaries: it’s an excellent reform package, with lots of very worthwhile features. But we’ll be looking through the details in the next few days.

General Health Care Features:
A. Up to 97 percent of Americans will be covered with federal health care and/or health insurance.

B. Medicaid coverage will be improved and be expanded to allow people up to 133 percent of the federal poverty level. The Feds will pick up the added costs, not states.

C. Uninsured people with incomes above that 133 percent of fed poverty level (FPL) will receive federal credits (subsidies) to help purchase insurance in a new federal insurance Exchange. The feds will build the exchange, but states/regions can take over their regional operations if/when they’re ready.

D. A national health insurance plan ("public option") will be one of the plans available in the exchange to individuals and small businesses that don’t have insurance, with eligibility to others expanded over 3-4 years. It starts with Medicare rates for three years.

E. There will be new federal standards specifying the coverage that all plans, public and private, must include — basic care, mental health, preventive, dental and vision (for kids).

F. A stronger federal advisory (regulatory) group, headed by the Surgeon General, will define the minimum standards. The feds will also promote new payment incentives to providers that will, over time, lower costs of health care.

G. Individual mandate to acquire insurance, with hardship exemptions for low income.

H. Employer mandates, based on "play" (provide insurance at work) or "pay" (8 percent) contribution to fund expanded coverage for the uninsured. Small businsses with payrolls less than $250,000 are exempt, but the contribution is phased in up to 8 percent.

I. Improves Medicare in several ways: It phases out the drug "doughnut hole," eliminates some co-pays, reforms the payment structure, and upgrades coverage.

J. There will be a cap on the total payments you’re required to make yourself — no more than 1.5% of income for those with the lowest income and phasing up to no more
than 11% of income for those at 400% of poverty, which means about $4,000 for them. [This probably needs to be lower.]

K. Objectionable insurance practices will be outlawed: rescission, prior condition exclusion, undue discrimination in premiums. [more details later]

Particularly noteworthy are the descriptions of how the bill will bring costs under control. In addition to using the public plan as a reform model to put competitive pressure on private insurers, the bill addresses the incentive problems described by Gawande and others:

1. Modernization and improvement of Medicare. The bill implements major delivery system reform in Medicare to reward efficient provision of health care, rolling out innovative concepts such as accountable care organizations, medical homes, and bundling of acute and post-acute provider payments. New payment incentives aim to decrease preventable hospital readmissions, expanding this policy over time to recognize that physicians and post-acute providers also play an important role in avoiding readmissions. The bill improves the Medicare Part D program by creating new consumer protections for Medicare Advantage Plans, eliminating the “donut hole” and improving low-income subsidy programs, so that Medicare is affordable for all seniors and other eligible individuals. A centerpiece of the proposal is a complete reform of the flawed physician payment mechanism in Medicare (the so-called sustainable growth rate or “SGR” formula), with an update that wipes away accumulated deficits, provides for a fresh start, and rewards primary care services, care coordination and efficiency.

2. Innovation and delivery reform through the public health insurance option. The public health insurance option will be empowered to implement innovative delivery reform initiatives so that it is a nimble purchaser of health care and gets more value for each health care dollar. It will expand upon the experiments put forth in Medicare and be provided the flexibility to implement value-based purchasing, accountable care organizations, medical homes, and bundled payments. These features will ensure the public option is a leader in efficient delivery of quality care, spurring competition with private plans.

3. Improving payment accuracy and eliminating overpayments. The bill eliminates overpayments to Medicare Advantage plans and improves payment accuracy for numerous other providers, following recommendations by the Medicare Payment Advisory Commission and the President. These steps will extend Medicare Trust Fund solvency, and put Medicare on stronger financialfooting for the future.

In other words, the bill seeks significant cost savings not only in the Medicare structure but, by using the Public Plan as a model for reforms, encourages cost efficiencies in the private industry as well.

Additional links to the Bill are here.

Update: The Bill’s features phase in starting next year and continue to 2018. Ways and Means Committee summarizes the schedule.

Per Ezra Klein: here’s the surtax measures:

If I’m reading this correctly, about half is paid for through $500 billion or so in savings from Medicare and Medicaid. The rest comes from a surtax on the richest 1.5 percent. The surtax is 1 percent on income between $350,000 and $500,000; 1.5 percent on income between $500,000 and $1,000,000; and 5.4 percent in income above $1,000,000. The surtax can vary if the bill is less or more expensive than initially anticipated.

Jonathan Cohn, House Bill looks good so far.
Ezra Klein, House releases bill, incomplete CBO Score = $1 trillion over 10 years.
Ryan Grim, summarizes the CBO $1 trillion cost estimate
Scarecrow, Background post on revenue issues and tradeoffs here.