Senate Democrats

Reid, Baucus, Dodd, Harkin Introduce Manager’s Amendment To Senate Health Reform Bill

Washington, DC— Today, Senate Majority Leader Harry Reid, Senate Finance Chairman Max Baucus, Senate Banking Chairman Chris Dodd and Senate HELP Chairman Tom Harkin introduced the manager’s amendment for The Patient Protection and Affordable Care Act.  The introduction of this amendment moves us closer to final passage of this historic legislation.  This fiscally responsible legislation extends access to quality, affordable health care to millions of Americans. 

The CBO has confirmed that the bill now exceeds our original goals of deficit reduction and preserves our goals of expanded coverage and lower costs:

–      Reduces Deficit by $132 billion in the first decade (up $2 billion from the merged bill)

–      Reduces Deficit by $1.3 trillion in the second decade (up from $650 billion in the merged bill)

–      Expands Coverage to over 94% of Americans under 65 years of age – including over 31 million uninsured

The manager’s amendment to The Patient Protection and Affordable Care Act builds upon the strong bill we already have. It demands greater accountability from health insurance companies while creating more choice and competition for consumers. It implements new programs to further rein in health costs and makes health insurance policies more affordable; and it improves access to quality, affordable health care for children and vulnerable populations.

“This is a good bill that saves lives, saves money and saves Medicare,” said Majority Leader Reid.  “Our manager’s amendment improves upon the existing reforms within this bill and guarantees real choice and competition to keep insurers in check.  By creating strong competition, we’ll reduce skyrocketing health care costs that stop thousands of Nevadans and millions of Americans from getting the best possible health care.  When we pass this bill, we will cultivate a health care system that values quality of care over profits – ensuring that patients receive the care they need and deserve.” 

“This amendment makes a good bill even better – it bolsters efforts to make health care affordable for small businesses, to contain skyrocketing health care costs and to regulate insurance companies so patients, rather than profits, are the priority,” said Chairman Baucus. “Montanans — and all Americans — want to hold insurance companies accountable and they want tax credits to help make their premiums affordable, and that’s exactly what this bill will deliver. It will modernize the health care system, saving money for families, for businesses and for the federal budget. Passing this amendment will bring this country closer than ever to an affordable and accessible health care system.”

“The Senate continues to overcome obstruction and move towards health care reform that will lower costs and increase choice for millions of Americans,” said Chairman Dodd.  “The final bill will reflect the hard work we have done over the past months to develop a broad and strong consensus within our caucus.  It will make health insurance a buyer’s market, not a seller’s market, like it is today.  It will lower costs for everyone, whether you have insurance today or not, and it will save lives.  I look forward to the day, closer than it’s ever been, when the Senate passes this bill into law."

“The manager’s package goes to the heart of health reform’s mission: decrease the number of uninsured, increase access to affordable care and make health insurance companies more accountable,” said Chairman Harkin.  “This bill is a good foundation on which to build, and this amendment strengthens that base.  It will provide more health insurance choices and specifically, improve access to care for children and vulnerable populations and further our prevention efforts.”


This manager’s amendment introduced today makes insurers more accountable, makes health insurance more affordable, improves choice and improves access to quality, affordable health care for children and vulnerable populations.

More Accountability for Insurers

–      Stronger medical loss ratios.  Health insurers will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits – or else pay rebates to policyholders.  These stricter limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans.

–      Accountability for excessive rate increases.  A health insurer’s participation in the Exchanges will depend on its performance.  Insurers that jack up their premiums before the Exchanges begin will be excluded – a powerful incentive to keep premiums affordable. 

–      Immediate ban on pre-existing condition exclusions for children.  Health insurers will be immediately prohibited from excluding coverage of pre-existing conditions for children.

–      Patient protections.  Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care. 

–      Ensuring access to needed care.  The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014.

–      Guaranteed opportunity to appeal coverage denials.  All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.

Creating Choice and Competition

–      Multi-state option.  Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress.  At least one plan must be non-profit, and the plans will be available nationwide.  This will promote competition and choice.

–      Free choice vouchers.  Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.

Making Health Care More Affordable

–      Innovation.  Medicare will be able to test new models and, if successful, implement them via a stronger Innovation Center, Independent Payment Advisory Board, and other authorities. 

–      Transparency.  New requirements will ensure that insurers and health care providers report on their performance, empowering patients to make the best possible decisions. 

–      Small businesses.  A package of improvements include starting the health insurance tax credit in 2010, expanding eligibility for the credit, and improving the purchasing power of small businesses.

Increasing Access to Quality Care for Seniors, Children and Vulnerable Populations

–      Quality of care in Medicare.  Seniors will benefit when additional health care providers are reimbursed by Medicare for the quality of care they deliver, not the quantity of services they provide.

–      Children’s health.  Support will be extended for the Children’s Health Insurance Program and the adoption tax credit.  Foster care children aging out of Medicaid will be able to retain its comprehensive coverage.

–      Community Health Centers.  A substantial investment in Community Health Centers will provide funding to expand access to health care in communities where it is most needed

–      Rural and underserved communities.  Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers. 

–      Vulnerable populations.  A range of new programs will tackle diseases such as cancer, diabetes, and children’s congenital heart disease, will improve the Indian Health System, and will provide support for pregnant teens and victims of domestic violence.

Identifying Alternatives to Litigation

–     Testing new models.  States will be eligible for grants to test alternatives to civil tort litigation that emphasize patient safety, disclosure of health care errors, and early resolution of disputes, with a provision for patients to opt-out of these alternatives at any time.  Alternatives will be evaluated to determine their effectiveness.