The House and Senate have each passed health care reform legislation. What is the status of CHADD's 13 principles?
On August 13, CHADD issued 13 principles to consider in health care reform. On October 15, CHADD and five national sister organizations (AACAP, ASA, CABF, MHA, and NAMI) issued five principles to consider. The five are a merged and consistent statement with the previous thirteen.
CHADD's 13 principles and their legislative status:
1. Provide health care coverage for all Americans.
Health care coverage is greatly expanded in both bills. The Congressional Budget Office (CBO) anticipates 94% coverage in the Senate bill and 96% insurance coverage in the House bill once the bills are fully implemented.
The Senate bill expands Medicaid mandatory eligibility to 133% of the federal poverty level, while the House bill expands mandatory eligibility to 150%. Both bills create a "National High Risk Pool," the Senate bill for uninsured people denied coverage due to a pre-existing condition, the House bill for the insured and those denied coverage due to a pre-existing condition. These pools would terminate upon the enactment of "insurance exchanges."
The Senate bill would establish state-based health insurance exchanges for individuals and small businesses by 2014. The House bill would establish a National Health Insurance Exchange for those uninsured without Medicare and Medicaid coverage and for small employers. Data is inconsistent over the true extent of coverage.
Both bills require individual mandates to have insurance (2013 in the House, 2014 in the Senate) and non-small employer mandates to offer insurance. There is much debate on whether these coverage options are "affordable."
2. Require "parity" for mental health assessment and treatment, including prohibiting non-discrimination between health conditions.
The Senate non-discrimination requirement, including health status, medical condition, and disability, becomes effective 2014. The House bill includes mental health and substance abuse parity requirement and authorizes a Health Choice Commission to define the extent of the non-discrimination requirement. The Senate bill also requires mental health parity. It is covered as part of the essential health benefits package, but the language is not as clear as the House bill in terms of parity.
3. Prohibit discrimination on the basis of pre-existing conditions.
The Senate prohibition begins immediately for children and the prohibition becomes effective in 2014. The House bill reduces the "look back" period from 6 months to 30 days and the prohibition becomes effective in 2013.
4. Prohibit health plans terminating coverage when people become seriously ill or when they are treated for long-term chronic conditions and eliminate lifetime conditions.
"Rescissions," the practice of terminating health plan coverage, is prohibited, 2011 in the Senate bill and July 1, 2010 in the House bill. The House bill prohibits lifetime limits in 2010; the Senate bill contains a variety of approaches, 2011-2014.
