| Plan |
American Benefits Council Ten Prescriptions for Reforming Health Care Quality, Cost and Coverage | |
| Date |
January 2009 | |
| Overall Approach |
Ten principles for employer-based health care reform, including an individual mandate | |
| Universal Coverage |
Yes | |
| Guaranteed Coverage |
Yes | |
| Portability |
Not addressed | |
| Voluntary Employer-Based System |
Yes | |
| New Programs |
Establishes a system to connect individuals to appropriate sources of health care coverage if they fail to make a coverage decision on their
own
Establish a federal minimum benefit standard | |
| Expansion of Existing Public Programs/Federal Law |
Builds federal reform solutions on a single set of rules to avoid state or local regulation of employer group health plans
Sets a federal minimum eligibility standard for Medicaid of income levels below 100 percent of the federal poverty level | |
| Insurance Pool |
Every state required to establish a high risk pool plan that provides coverage that meets or exceeds the new federal minimum coverage standard. | |
| State Responsibility |
Requires state to expand outreach to enroll individuals who are currently eligible for coverage under public programs
Every state required to establish a high risk pool plan that provides coverage that meets or exceeds the new federal minimum coverage standard
Requires at least one basic benefit plan exempt from additional state benefit mandates in the individual insurance market be available in all states | |
| Individual Mandate |
Establish a federal obligation for all Americans to obtain at least a minimum level of health coverage. | |
| Employer Mandate |
None | |
| Private Insurance Mandates |
Premiums for coverage offered under state high risk pool plans subject to federal rating restrictions
At least one basic health plan that meets the federal minimum coverage standard be available in the individual market in every state. | |
| Individual Subsidies |
Provide income-based premium subsidies.
Require subsidy payments be applied to employer-sponsored coverage when available. | |
| Individual Vouchers |
Yes | |
| Employer Subsidies |
Provide employer incentives to offer coverage that meets the minimum benefit standard
Subsidize employer-sponsored plans for individuals also eligible for coverage under Medicaid or SCHIP | |
| Individual Plan/Provider Choice |
Yes | |
| National Health Board |
No | |
| Tax Changes |
Maintain the ability of employers to deduct their expenses for health coverage to employees.
Allow employees to pay their share of health insurance premiums on a pre-tax basis.
Provide comparable tax preferences for coverage purchased in the individual insurance market.
Improve tax preferences for retiree health insurance
Permit pre-tax payments of retiree health premiums from a defined benefit or defined contribution retirement plan
Permit employees age 50 or older to designate a limited amount of their 401(k) catch-up contributions to a retiree medical sub-account for future pre-tax payments for retiree health coverage;
Lower the health savings account (HSA) catch-up contribution age from 55 to 50 and permit tax-free distributions from these accounts for retiree health premiums before age 65
Allow all employers to use Voluntary Employees' Beneficiary Associations (VEBA) to pre-fund retiree health without taxing VEBA earnings | |
| Premium/Co-Pay/Deductible |
Not addressed | |
| Health Quality Improvement |
Adopt and implement a nationwide interoperable health information technology network
Provide safe harbor protections for health care providers and payers for decisions and practices that are evidenced-based
Promote personal wellness and ownership for maintaining a healthy lifestyle
Increase participation in chronic disease management programs
Develop a clear regulatory pathway for bio-generic (or bio-similar) drugs
Expand the understanding and availability of appropriate end-of-life care options
Develop cost measures based on episodes of care rather than unit prices for components of care services
Transform the current payment system from a procedure-based, fee- for-service system to a value-based system
Expand the practice of nonpayment for serious preventable medical errors
Establish a national entity to significantly increase the capacity for comparative research on clinical and cost effectiveness of medical technology and services | |
| Information Technology / Electronic Medical Records |
Adopt and implement a nationwide interoperable health information technology network by a date certain. | |
| Individual Responsibility for Health and Lifestyle |
Yes | |
| Preventive care |
Not specifically addressed | |
| Transparency |
Support more informed health care decisions by consumers through the development of better information tools.
Equip health care providers with comparative clinical performance information to support continuous improvement in patient care.
Increase consumer engagement in health care decision- making through greater use of "consumer-directed" plans | |
| Drug Reimportation |
Not addressed | |
| Medicare Rx Drug Price Negotiation |
Not addressed | |
| Medical Personnel Education |
Not addressed | |
| Mental Health Parity |
Not addressed | |
| Other Provisions |
Allow employers to pre-fund retiree health costs using Voluntary Employees' Beneficiary Associations (VEBAs) | |
| Cost |
Not addressed | |
| Cost Containment |
Enact medical liability reform legislation
Establish a national review process to examine existing and proposed state and federal benefit mandates | |
| Financing |
Not addressed | |
| Source |
"Condition Critical: Ten Prescriptions for Reforming Health Care Quality, Cost and Coverage," American Benefits Council, January 2009 | |
