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The Baucus Bill: What the Plans Must Offer

From pages 17-18:

All plans must provide preventive and primary care, emergency services, hospitalization, physician services, outpatient services, day surgery and related anesthesia, diagnostic imaging and screenings (including x-rays), maternity and newborn care, pediatric services (including dental and vision), medical/surgical care, prescription drugs, radiation and chemotherapy, and mental health and substance abuse services that at least meet minimum standards set by Federal and state laws. In addition, plans could charge no cost-sharing (e.g., deductibles, co-payments) for preventive care services, except in cases where value-based insurance design is used. Plans could also not include lifetime limits on coverage or annual limits on any benefits. Any insurer that rates on tobacco use must also provide coverage for comprehensive tobacco cessation programs including counseling and pharmacotherapy (prescription and non-prescription).

The plans, in other words, have to offer comprehensive coverage. This is much better than what many people get now. But given the insufficiency of the total funding, the question is how much cost-sharing is allowed in these plans. More on that in a moment.

By Ezra Klein  |  September 16, 2009; 12:47 PM ET
Categories:  Health Reform  
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Next: The Baucus Bill: Affordability

Comments

The cost sharing is key though, right? If we're talking about high-deductible plans, then we're not talking about good value.

Posted by: eRobin1 | September 16, 2009 1:24 PM | Report abuse

Why should I have to get a plan that offers maternity or newborn care, if I'm a single male who doesn't plan to get anyone pregnant? Is this for all plans listed? If so it will simply increase costs for young people while deceasing costs for the elderly (the generational transfer of wealth continues).

Posted by: ChicagoIndependant | September 16, 2009 2:07 PM | Report abuse

Glad there is a window for lots of cost sharing, even if they rule out the high deductible plans. Now if they could just add a rule forcing published pricing...we could actually pursue affordable health care.

Posted by: staticvars | September 16, 2009 3:58 PM | Report abuse

you people are NOT reading this right.
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In addition, plans could charge no cost-sharing (e.g., deductibles, co-payments) for preventive care services, except in cases where value-based insurance design is used.

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preventative care ONLY can't be subject to the deductible (HSA's already have first dollar coverage for preventative care). All other services can be done that way. HSA's will survive and continue to thrive because they are an example of how you can keep costs in line.

Posted by: visionbrkr | September 16, 2009 4:04 PM | Report abuse

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