In the USA, the Democrats have introduced a 1018-page healthcare-reform bill that will create a public health insurance option, require individuals to hold some level of health insurance and levy fees against employers that do not offer insurance. Members from both parties on the Senate Health Committee have agreed it, taking a big step toward President Barack Obama's goal for a health overhaul that he wants to get through Senate before August.
With minor changes as the legislation progresses, this is likely to be the future of US healthcare for the next decade. It may well affect the supply of outbound US medical tourism; if it works as President Obama hopes, the need to go overseas for medical treatment will undoubtedly fall. The reforms will affect any agency or hospital negotiating with insurers, employers or benefit plans. The plans make no provision for overseas treatment, for any state system paying overseas hospitals, or for including medical tourism in either the basic benefit package or government plan.
Key points of the plan for US healthcare:
• A system of health insurance exchanges through which individuals and small businesses can shop for insurance among private insurers and a new government-run plan. States may offer their own exchange or join with other states to create an exchange. It may be expanded to include large employers.
• A committee will recommend an essential benefits package including preventive services, mental health services, oral heath and vision for children; and out-of pocket costs will be capped. The new benefit package will be the basic benefit package offered in the exchanges and will become the minimum quality standard for employer plans.
• A government health plan will be offered through the exchanges and will compete with insurance companies.
• Proposes that both the exchanges and the new government health insurance start by 2013.
• An independent agency, the Health Choices Administration, will work with states to oversee the proposed new health insurance exchanges and set benefit standards.
• Insurers will be barred from excluding coverage for those with pre-existing medical conditions.
• 9 million people will be insured by the public plan, with 21 million insured by private companies in the exchange by 2019. Another 164 million will be insured through their employers.
• Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payroll under $250,000 annually will be exempt.
• Individuals must have insurance, enforced through tax penalty with hardship waivers. The penalty is 2.5 percent of income.
• Government subsidies for premiums and cost sharing on a sliding scale up to 400 percent.
• Private insurers who operate Medicare plans will have a quality performance score from 2010, and reporting requirements on quality of care by 2013.
• Expands Medicaid health care for the poor and long-term disabled to all non-elderly with incomes up to 133 percent of the federal poverty level. Medicaid payment rates will increase.
• A new centre will be set up to study the comparative effectiveness of various treatments to help consumers and payers make healthcare decisions that improve quality and value. This will research the effectiveness of drugs, medical tests, surgical procedures and other medical treatments. It will have the power to collect data, both published and unpublished, and to study medical treatments.
• 94 percent of non-elderly residents (those not covered by Medicare, which starts at age 65) will be covered, compared with 81 percent now. Nearly half of the 17 million non-elderly residents who remain uninsured are calculated to be illegal immigrants who obviously cannot travel overseas for medical care.
Even if the legislation does not reduce the number of American medical tourists, anyone offering medical tourism services to US healthcare consumers, insured individuals, insurance companies or employers needs to watch these developments closely.
