The New Health Dialogue

We're still digesting 25 pages of CBO analysis and 150 pages of legislative language, and we can't say we've mastered all the details of the Reconciliation language, but with a little help from our PDF search function and some smart Hill staffers, here's some of what we've learned:

Changes in Medicare (particularly stopping overpayment to Medicare Advantage managed care plans) will add at least nine years to the Medicare trust fund.

Medicaid will pay more to primary care doctors. As we have noted before, Jonathan Cohn, and Kevin Sack have all written about why this is so important, particularly as the health reform legislation will expand Medicaid.

The donut hole (for Medicare patients with high prescription drug costs) will shrink with 50 percent discounts on brand name drugs starting in 2011. Even before that, this year, anyone on Medicare who hits the coverage gap will get a $250 rebate.

Coverage will be more affordable for low income people -- (It's in Title I for those of you who want the detailed schedules).

Current funding for the State children's Health Program will be maintained through fiscal 2015.

Delays the "Cadillac tax" on high cost insurance plans until 2018 and raises the threshold ($10,200 for individual plans, $27,500 for families).

The Nebraska "Cornhusker" deal, as expected is gone. As is the special break for Florida Medicare Advantage.

Adult children (up to age 26) can stay on their parents' health insurance policy. (They don't have to wait until 2014 for this. They can't be on parents' plan if they have an option of getting coverage through their job.)

Consumer protections (no discriminating on pre-existing conditions, caps. etc) will apply to group plans as well as plans offered in the new exchanges. The Senate bill had grandfathered the group plans (where some of these practices aren't as common as in the individual and small group market.)

We haven't found any new language about alternative dispute resolution in medical malpractice -- even though President Obama has voiced support. Probably didn't fit into the strict reconciliation-deficit reduction rules. Also not included (because of the reconciliation rules) is Sen. Dianne Feinstein's idea about expanded federal review of insurance premium increases and Sen. Tom Coburn's super-popular idea about "mystery patients" aiming to detect medical fraud. We expect that these ideas may re-emerge in other legislative contexts in the future.