Yesterday, House Democrats finally unveiled their comprehensive health care overhaul legislation, including details on how they intend to pay for it. For the most part, the $1 trillion-plus plan would be paid for through a surtax on upper incomes (families with adjusted gross incomes of more than $350,000) and by more than $500 billion in savings from Medicare over 10 years.
On the Medicare side, some providers would see their Medicare payouts cut directly (with Medicare Advantage seeing a $156 billion reduction). And in other areas, Medicare would “bundle” payments for a number of related services, with the goal of providing better, less costly care for patients. Currently, Medicare typically reimburses providers for every procedure or test they do.
Prevention and wellness measures of the bill include:
- Expansion of Community Health Centers;
- Prohibition of cost-sharing for preventive services;
- Creation of community-based programs to deliver prevention and wellness services;
- A focus on community-based programs and new data collection efforts to better identify and address racial, ethnic, regional and other health disparities;
- Funding to strengthen state, local, tribal and territorial public health departments and programs.
The bill expands the health care workforce through:
- Increased funding for the National Health Service Corp;
- More training of primary care doctors and an expansion of the pipeline of individuals going into health professions, including primary care, nursing and public health;
- Greater support for workforce diversity;
- Expansion of scholarships and loans for individuals in needed professions and shortage areas;
- Encouragement of training of primary care physicians by taking steps to increase physician training outside the hospital, where most primary care is delivered, and redistributes unfilled graduate medical education residency slots for purposes of training more primary care physicians. The proposal also improves accountability for graduate medical education funding to ensure that physicians are trained with the skills needed to practice health care in the 21st century.