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Over the coming weeks and months, the primary business of the United States Congress will be crafting, debating and voting on legislation to reform the nation's health care system. The outcome of this process is likely to have significant impacts on providers of community and public transportation across the country.

If passed, the bills introduced by the House of Representatives and the Senate seek to address health care reform by expanding the size and scope of both the Medicare and Medicaid programs--potentially introducing tens of millions of new participants--while also introducing new measures that attempt to improve their efficiency and effectiveness. These changes could produce substantial numbers of new riders for non-emergency medical transportation services. At the same time, the final legislation is also likely to include requirements, incentives and/or fines to compel all employers--including transportation providers--to offer health insurance to their employees, or support their employees in purchasing coverage on their own. Finally, new consumer protections will likely expand coverage for all individuals by barring restrictions based on age or condition and establishing caps on yearly out-of-pocket costs, potentially increasing the need for medical trips.

When combined, these aspects present the most direct implications for community and public transportation providers of any legislation beyond the authorization our nation's surface transportation legislation. For the benefit of our members and colleagues throughout our industry, we've provided an overview of the current health care reform activity in both the House of Representatives and the Senate, along with the general vision presented by President Obama. We will be monitoring and reporting on this activity closely through our Web site and our free Fast Mail electronic newsletter. You can subscribe to Fast Mail on the front page of our Web site.

House of Representatives: America's Affordable Health Choices Act of 2009

The health care reform legislation produced in the House of Representatives is titled America's Affordable Health Choices Act of 2009. Jointly authored and approved by the House Committees on Education and Labor, Ways and Means, and Energy and Commerce, the Act focuses on providing health coverage for every American while also limiting the growth of health care costs. To that end, it is organized into six key components:

  • improving coverage;
  • making coverage options more affordable;
  • determining responsibility for coverage between individuals, employers and the government;
  • developing initiatives and incentives for improved wellness;
  • encouraging reform of the health care industry;
  • and improving the efficiency and effectiveness of federal health care programs.

As part of this effort, the Community Transportation Association has worked with House leaders to ensure the current provisions supporting non-emergency medical transportation in the current Medicare program are retained in this new legislation. The full text of the legislation is available here (PDF) (1.69 MB) and a summary can be found here (283 KB).

Each component includes numerous provisions to affect the Act's goals. Among these are the establishment of a health insurance exchange for individuals and employers to procure coverage, a public health insurance option, protections against discrimination by insurance providers based on age, long-term afflictions and pre-existing conditions, credits for low- and middle-income workers to purchase insurance, caps on yearly costs incurred by policyholders and improvements to both Medicare and Medicaid to provide better coverage and reduce waste and abuse of the system. Additionally, the Act would mandate all individuals maintain insurance once the exchange markets and public options are established, require employers (except for small businesses) to provide coverage or contribute to the costs of individually-procured plans, and require the federal government to provide universal coverage for all Americans. Investment for the legislation's initiatives would be supported through cost savings from Medicare and Medicaid reforms and a new tax on the wealthiest one percent of taxpayers.

Full details on the plan's financial details can be found here (PDF) (253 KB). Currently, the legislation has been approved by the three House committees and is being readied for a vote by the full House of Representatives.

Senate: America's Healthy Future Act

On Sept. 16, Senator Max Baucus (D-Mont.), Chairman of the Senate Finance Committee, announced a bill he will submit to the Committee for markup, titled the America's Healthy Future Act. Unlike its House counterpart, Baucus' bill would not guarantee universal coverage for all Americans, instead focusing on insuring 95 percent of Americans. Additionally, it also would not include a publically-run health care option, but would instead establish non-profit co-ops to compete with private insurance plans.

The full text of the bill is available here (PDF) (1.19 MB).

Specifically, similar to the House legislation, the Act would establish a mandate for coverage, offer credits for individuals and small businesses to purchase insurance, create protections to prevent denials based on age, long-term afflictions or pre-existing conditions and introduce efficiency and effectiveness provisions to Medicare and Medicaid while also expanding the coverage offered under those programs. Unlike the House proposal, it would not create exchange markets or a public option, require all employers to provide or support coverage, or institute caps on annual out-of-pocket costs to policyholders.

The Senate plan would total an investment of over $850 billion over 10 years, supported by cost savings through Medicare and Medicaid, fees on insurance companies, drug makers, medical device manufacturers and insurers, a 35 percent tax on individual insurance plans of more than $8,000 and family plans over $21,000, and fees for companies not providing coverage. A detailed estimate of the bill's financial structure is available here (PDF) (11 KB). Baucus' bill is scheduled for markup by the Finance Committee on Sept. 22, to be followed by the Committee's deliberation and vote in late September or early October.

President Obama's Vision for Health Care Reform

On Sept. 9, President Obama addressed a joint session of Congress and a national audience on his vision for health care reform. The full text of the President's remarks are available here and a summary version of his plan, Stability and Security for All Americans, can be found here (PDF) (299 KB). The plan sets the benchmarks for what Obama considers essential elements for a plan to be approved by Congress, including providing improved conditions for those who already have coverage, offering insurance for those who don't, and slowing the growth of the costs incurred through the Medicare and Medicaid programs. Both the House and Senate plans are structured to achieve these goals.

As the President and the Executive Branch have no authority to independently craft legislation, the Obama Administration will work with Congressional leaders to ensure the provisions it considers vital are included in the final bill. The President has given no indications on what legislative outcomes--if any--would receive his approval or veto.

Again, we will be monitoring any developments carefully as they develop in the coming days and weeks, and will provide updates through our Web site and Fast Mail. If you would like any additional details on federal health care reform information, feel free to contact Communications Specialist Rich Sampson at or 202.415.9666.

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