Affordable Health Care for America Act
October 29, 2009
On October 29, Members of Congress introduced the Affordable Health Care for America Act (H.R. 3962), a massive health reform bill designed to “provide affordable, quality health care for all Americans and reduce the growth in health care spending.” The bill combines three health care reform proposals previously considered by the House and includes a public option for health insurance. Physician participation in this public option would be voluntary and payments would be based on negotiated rates and the private insurance market.
The Affordable Health care for America Act differs from prior House health reform bills in a few significant ways:
- H.R. 3962 would establish an Institute of Medicine (IOM). The IOM would conduct two studies and make recommendations to CMS, based on their findings, on how to fix the Medicare payment system regarding geographic variations as well as changing the system to reward value and quality. CMS will implement all IOM recommendations unless they are disapproved by Congress.
- The new bill would establish a Center for Medicare Innovation to empower CMS to pursue additional payment and delivery system reforms.
- This legislation proposes to reduce the Medicare Part D coverage gap by $500 and institute a 50% discount for brand-name drugs for eligible participants. (This coverage gap, also known as the Medicare Part D “donut hole” is the difference between the initial coverage limit and the minimum expenditures required to qualify for catastrophic coverage as defined by Medicare.) This provision would be effective in 2010 and proposes to phase out the Part D donut hole entirely by 2019.
- The House bill requires the Secretary of Health and Human Services to negotiate drug prices on behalf of Medicare beneficiaries.
