Baucus Outlines Plan for Health Care Reform

November 13, 2008 (PLANSPONSOR.com) - U.S. Senator Max Baucus (D-Montana) has provided an 89-page "Call to Action" to reform the American health care system.

The report is a proposal announced by Baucus, Senate Finance Committee Chairman, on Wednesday (See Baucus Announces Proposal for Universal Health Care ). In a press release, Baucus said the goals of his plan are to achieve universal coverage, reduce health care costs, and improve the quality of care our system provides.

Under Baucus' plan, once quality, affordable care is accessible to all Americans, it will be an individual responsibility to have health insurance. Baucus' proposal includes a one-stop insurance marketplace and limited expansions of public programs to help individuals achieve coverage.

Building a Marketplace

According to the "Call to Action" report, the foundation of Baucus' plan is the creation of a nationwide insurance pool called the Health Insurance Exchange - a marketplace where Americans could easily compare and purchase the plans of their choice. Private insurers offering coverage through the Exchange would be precluded from discrimination based on pre-existing conditions.

Premium subsidies would be available to qualifying families and small businesses. Baucus expects that the vast majority of American employers would continue to provide coverage as a competitive benefit to attract employees, so those who already have health coverage could choose to keep what they have.

While the Exchange is being created, the report says the Baucus plan would make health care coverage immediately available to Americans aged 55 to 64 through a Medicare buy-in, and it would begin to phase-out the current two-year waiting period for Medicare coverage for individuals with disabilities. The plan would provide every American living below the poverty level with access to Medicaid, and would also ensure that all states use the State Children's Health Insurance Program (CHIP) to cover children at or below 250% of the Federal poverty level. Finally, the Baucus plan also calls for additional Indian Health Service (IHS) funding.

A Focus on Wellness

The Baucus report says the new system would immediately focus on prevention and wellness, rather than on illness and treatment. Those who are uninsured would be given a "RightChoices" card that guarantees access to recommended preventive care, including services like a health risk assessment, physical exam, immunizations, and age and gender-appropriate cancer screenings recommended by the U.S. Preventive Services Task Force. Current Medicare, Medicaid, and CHIP beneficiaries would receive recommended preventive services with little or no co-payment.

Individuals without private coverage and not eligible or enrolled in a public health coverage program, but whose RightChoices screening detected and diagnosed one or more of the most common, costly chronic conditions, would qualify to receive treatment on a temporary basis until viable coverage options are available under the Health Insurance Exchange. Preventive services would be covered by all insurance options offered through the Exchange.