Washington, D.C.- Three years and eleven days after first introducing his own legislation to reform the nation's health care system, U.S. Senator Ron Wyden (D-Ore.) joined his Senate colleagues this morning to pass the "Patient Protection and Affordable Care Act," comprehensive health reform legislation that Wyden says lays the foundation for many of the reforms he has long been fighting for.
"We've always known that the path to reforming the nation's health care system was going to be long and it wasn't going to be easy, but this legislation takes a significant step in the right direction," said Wyden. "So while it's important to celebrate how far we've come, let's remember this is only a start. This legislation creates exchanges that we must expand access to. It puts in place insurance market reforms that we have to make certain get enforced and it gives choice and competition a new foothold that we will build on until every American has the power to choose the health insurance that works best for them and their family. I pledge to continue this effort in the days ahead as we work to reconcile this legislation with the House and in the months and years ahead as our legislative effort continues."
In addition to the broader reforms that Wyden had long advocated as part of his bipartisan "Healthy Americans Act," - such as insurance market reforms making it illegal for insurance companies to discriminate on the basis of gender and preexisting conditions and the creation of a health insurance exchange where Americans will be able to shop among competing health insurance plans - several Wyden-authored provisions were passed as part of the final Senate bill:
Free Choice Vouchers: As Wyden said earlier this year "free choice vouchers" will "for the first time…introduce the concept of individual choice to a marketplace where it has long been foreign." Under this provision Americans with employer-provided health benefits who qualify for an affordability exemption to the individual responsibility policy but who do not qualify for tax credits - in other words individuals whose share of their insurance premiums fall between 8 percent and 9.8 percent of their income - will be able to convert their tax-free employer contribution into a "free choice voucher" which they can use to shop on the exchange. CBO says that this provision will expand coverage to Americans who would otherwise go without insurance for far less than what the federal government would spend on tax subsidies. Prior to this amendment being accepted, there was no way for individuals to use their tax-free employer health subsidy to shop for health insurance in the exchange. While it remains the case that most Americans will not be eligible for the free choice voucher, now that it is in the bill, Senator Wyden says that he will work to make more and more Americans and their employers eligible.
Waiver for State Innovation: Originally adopted by the Senate Finance Committee, this Wyden Amendment makes it possible for states to implement their own approaches to covering their residents without an act of Congress. The idea being that what works in Oyster Bay, New York doesn't always work in Coos Bay, Oregon. Similar to a provision in Senator Wyden's Healthy Americans Act, the amendment will allow states to apply for a waiver from the individual mandate or any other requirement of the bill if they can demonstrate that they have another way of meeting federal coverage requirements.
Bonus Payments for High-Quality Medicare Advantage Plans: While health reform initially sought to eliminate payments for all Medicare Advantage plans, Wyden's amendment will preserve payments for high-quality Medicare Advantage plans. Wyden successfully argued that seniors in states like Oregon, where low Medicare reimbursement rates often limit health care options, could not afford to lose the high quality Medicare Advantage plans that they have come to rely on. Wyden's amendment will protect high-quality plans and create incentives for providing high-quality care by increasing payments for Medicare Advantage plans that voluntarily improve their services. The Centers for Medicare and Medicaid Services (CMS) score Medicare Advantage plans on a one to five scale. The best plans fall into the four and five star range. This amendment would boost payment rates by 1 percent to those plans that achieve a rating between four and five stars.
Age rating down to 3:1: The original legislation offered by the Senate Finance Committee set the age rating at 5:1, meaning that insurance companies could charge late-middle-aged Americans as much as five times what they charge younger Americans. (Under the current system there is no limit on how much more an insurance company can charge older Americans.) Wyden's Healthy Americans Act would have made it illegal for insurance companies to charge subscribers more on the basis of age. Fighting for this position Wyden first got the age rating dropped to 4:1 in the revised version of the Senate Finance bill and to 3:1 in the merged Senate legislation. He will continue to fight to end price-discrimination on the basis of age.
Independence at Home: This amendment, based on legislation that Wyden has introduced in the last two Congresses with U.S. Congressman Ed Markey (D-Mass.), will establish a demonstration project to provide personalized, in-home care for Medicare patients suffering from multiple chronic conditions. Under the project, house call teams - similar to those successfully used by the Veterans Administration for decades - will be available to provide one-on-one attention to patients. This personalized approach will cut down the costs and difficulties associated with multiple hospital visits. This amendment specifically targets the 10 percent to 25 percent of Medicare Beneficiaries who account for 66 percent to 85 percent of Medicare spending, drastically reducing the cost of treating patients with multiple chronic conditions while improving the quality of care. It has received widespread support from senior and patient advocacy groups ranging from AARP to the Alzheimer's Foundation of America to the U.S. Public Interest Research Group.
Personalized Medicine: This amendment establishes a demonstration project which Wyden says will give more Americans access to innovative molecular diagnostic tests designed to improve treatment outcomes for life-threatening diseases such as cancer and heart disease. Under current law, if a test is ordered less than 14 days after a beneficiary leaves the hospital, the hospital must bill for the laboratory service. This is problematic as many of these tests are often done by highly specialized labs that do not generally have agreements with an individual hospital. As a result patients have been required to wait to be tested until after the 14 day period is over. This can lead to a delay in diagnosis and treatment for patients. This amendment will create a demonstration project under which labs will be allowed to bill Medicare directly, thus expediting the process and improving outcomes for patients.
People in hospice do not have to give up the prospects of a cure: Under current law, Medicare will not pay for services and treatments after a patient enrolls in hospice care. Believing that Americans should never have to give up the prospects of a cure, Wyden's amendment creates a Medicare Hospice Concurrent Care (HCC) three-year demonstration program that would allow hospice patients to also receive Medicare coverage while in hospice. It would also direct the Secretary of HHS to establish 16 sites across the country - in both rural and urban areas - to examine the effectiveness of this delivery model and its ability to improve patient care, quality of life and cost-effectiveness.
Reduced Hospice Cuts: The original Senate health bill plus regulatory changes would have cut payments to the hospice community by more than 14 percent starting October 1st. Wyden argued that hospice not only saves money but plays a critical role for American families by making it possible for beneficiaries to spend their final days in the comfort of their own home rather than in the hospital. His amendment will ease the impact of funding cuts for hospice care so that these services will remain available to those who need them.
Authorizing the Use of New Technologies that Empower Patients and Their Providers to Get More Value in Accountable Care Organizations: This amendment, which Wyden originally added in the Senate Finance Committee, will move America's health care system into the 21st century by allowing Accountable Care Organizations to use the latest in technology to connect patients and their medical care providers. Innovations such as remote patient monitoring, which reduces the need for face-to-face office visits and allows physicians to use remote sensors to keep track of patients' vital statistics, have been proven to improve outcomes for patients with chronic diseases and cut health care costs.
Longshore Workers Classified as Employees Engaged in High Risk Professions: Wyden fought to have Longshoremen included in the list of high-risk professions whose plans receive a higher exclusion from the insurance excise tax. Sec . 10901 of the manager's amendment extends that protection and guarantees that the higher costs of their health plans - reflecting the higher risk of their profession -- will not be unfairly penalized by the Insurer Excise Tax.