Congressional Research Service (CRS)

Health Reform and the 111th Congress Hinda Chaikind, Specialist in Health Care Financing October 14, 2009 http://opencrs.com/document/R40581/2009-10-14/download/1013/ [full-text, 27 pages]

Summary The health reform debate in the 111th Congress has continued and expanded upon the work begun in the 110th Congress. On November 12, 2008, the Chairman of the Senate Finance Committee, Senator Baucus, released a white paper detailing his principles for health reform. This provided a framework for work within the committee for the 111th Congress. Several bills were introduced when the 111th Congress first convened, and these bills focused on a broad spectrum of approaches to health reform. Most recently, the House and Senate committees of principle jurisdiction on health reform have been formulating their legislation. On July 15, one of the two committees with principle jurisdiction in the Senate, the Committee on Health, Education, Labor, and Pensions, ordered reported S. 1679, the Affordable Health Choices Act. In the House, the principle jurisdiction for health reform is divided among the Committees on Education and Labor, Ways and Means, and Energy and Commerce. Jointly, the committees released for consideration H.R. 3200, America’s Affordable Health Choices Act, on July 14. The Committees on Education and Labor and Ways and Means each ordered reported, as amended, their versions of H.R. 3200 on July 17. The Committee on Energy and Commerce ordered reported its version of H.R. 3200 on July 31, 2009. The Senate Finance Committee ordered reported the Chairman’s mark, as amended, known as America’s Health Future Act of 2009, on October 13.

The health reform bills being considered by the House and Senate committees of principle jurisdiction focus on simultaneously expanding private and public coverage options. Some of the other bills introduced in the 111th Congress take a similar approach to health reform. Additionally, other bills have focused on other solutions, attempting to expand coverage using one of the following approaches:

• Largely replace existing coverage with a national government-provided health insurance program (or a national health service).

• Expand existing public programs for certain individuals.

• Expand privately sponsored coverage.

• Encourage state-based reforms.

• Simultaneously expand private and public coverage options.

This report presents basic background on health insurance that may be useful to legislators considering health insurance reforms. It describes reform approaches and provides brief descriptions of health insurance reform bills introduced in the 111th Congress, as well as some of the general principles currently being considered by the Congress. The potential impact of the various approaches and bills is not analyzed in this report, however. As a result, it does not provide evaluations of how well different bills, once enacted, would meet their objectives. This report will be updated periodically to reflect recent congressional activity in health reform.

Contents Introduction ...............................................................................................................................1 What Is Health Insurance Reform All About? ........................................................................1 Different Objectives ........................................................................................................2 Prioritizing Among Stakeholders .....................................................................................3 Scope of Reform.............................................................................................................3 General Approaches to Health Insurance Reform.........................................................................5 National Government-Provided Health Insurance Program....................................................5 Expand Existing Public Programs for Certain Individuals......................................................6 Expand Privately Sponsored Coverage ..................................................................................7 Expanding Employer-Based Coverage ............................................................................7 Improving Access to Health Insurance in the Individual Market ......................................8 Market Reforms ............................................................................................................10 Encourage State-Based Reforms..........................................................................................12 Simultaneously Expand Private and Public Coverage Options .............................................13 Health Insurance Reform Bills in the 111th Congress .................................................................14 National Government-Provided Health Insurance Program..................................................14 H.R. 15 .........................................................................................................................14 H.R. 676 .......................................................................................................................15 H.R. 1200/S. 703 ..........................................................................................................15 H.R. 2399 .....................................................................................................................15 Expand Privately Sponsored Coverage ................................................................................16 H.R. 198 .......................................................................................................................16 H.R. 502 .......................................................................................................................16 H.R. 879 .......................................................................................................................16 H.R. 1495 .....................................................................................................................16 S. 1324 .........................................................................................................................16 S. 93 .............................................................................................................................17 S. 207 ...........................................................................................................................17 S. 979/H.R. 2360 ..........................................................................................................17 S. 988 ...........................................................................................................................18 Encourage State-Based Reforms..........................................................................................18 H.R. 956 .......................................................................................................................18 S. 898 ...........................................................................................................................18 Simultaneously Expand Private and Public Coverage Options .............................................19 H.R. 109 .......................................................................................................................19 H.R. 193 .......................................................................................................................19 S. 391 ...........................................................................................................................20 H.R. 1321 .....................................................................................................................20 H.R. 3200 .....................................................................................................................20 H.R. 3400 .....................................................................................................................21 H.R. 3438 .....................................................................................................................21 S. 1679 .........................................................................................................................22 Senate Finance Chairman’s Mark, as Amended, America’s Healthy Future Act of 2009 ...........22

Contacts Author Contact Information ......................................................................................................23 Acknowledgments ....................................................................................................................23

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