Sanders' Health Reform Amendments

The following amendments have been introduced by Sen. Bernie Sanders, a member of the Senate health committee, to amend the Patient Protection and Affordable Care Act. 

1.     National Single Payer system to replace Exchanges, Mandates and Subsidies

This amendment would establish a single-payer system that would provide health insurance for every person legally residing in the United States.  The single payer system would be regulated and funded by the federal government, through a payroll tax and an income tax, but would be administered by the states.  This amendment would not be a complete substitute; it would leave in place most of the provisions in the quality, prevention, and workforce titles of the Senate bill.  Its contents are modeled on Sanders' American Health Security Act of 2009 (S. 703).

2.     Strengthening the Public Option

This amendment would strengthen the public option by (a) striking the provision allowing states to opt out of the public option, ensuring its availability in all 50 states; and (b) providing that the public option would reimburse providers at Medicare rates plus 5 percent - as proposed in House and scored by the Congressional Budget Office as saving the federal government $110 billion.

3.      Expanding Eligibility for Subsidies to Anyone lacking Affordable, Quality Coverage

This amendment would allow employees offered employer sponsored insurance (ESI) to receive subsidies for which they would otherwise qualify in the exchange if the ESI offered by their employer is inadequate (less comprehensive/valuable than Essential Health Benefits offered in the exchange).  Under the bill as written, they are only eligible to receive subsidies in the exchange if their coverage is unaffordable (more than 9.8 percent of their income), regardless of its adequacy.

4.     Remove the tax on high cost employer-sponsored health coverage

This amendment would eliminate the tax on high value insurance plans, to be offset by a tax on high income individuals (similar to that in the House version of the bill) to begin in 2010. 

5.  Technical Fixes to Waivers for State Innovation

This amendment would (a) move the start date of waiver effectiveness to 2014 (from 2017); (b) revise the language for calculating payments to states so that initial payments can be based on reasonable estimates; and (c) clarify that the Secretary can deny a request for continuation under Sec 1332(e) only if the Secretary finds, in writing, that the state plan has failed to meet the requirements under 1332 (b).

6.      Begin the Exchanges, Subsidies and Medicaid expansion on January 1, 2012. 

This amendment would move up the start date from January 1, 2014, to January 1, 2012 - including exchanges, subsidies, and Medicaid expansion.  It would also move to January 1, 2012, the dates of:  the end of the high risk special pool, when the Secretary will look at premium increases, when early retiree benefits would begin, the Health Insurance Portability and Accountability Act changes, penalties for insurance companies not meeting standards, reinsurance, and Federal Medical Assistance Percentage reimbursement.  It does not affect the dates for quality reporting by physicians and hospitals, benchmarks, bonuses, penalties, demonstration projects, or evaluations.

7.     Expand Medicaid Eligibility to the levels in the House bill. 

This amendment would increase the levels of Medicaid eligibility to the levels in the House bill (150 percent the federal poverty level).

8.     Add Dental and Vision as part of Essential Health Benefits

This amendment would specifically include dental and vision in the essential health benefits section under ambulatory services, similar to the specific inclusion under pediatric services.

9.     Require all employer sponsored insurance plans to provide at least Essential Health Benefits and conform to premium variation limits by 2019.

This amendment would be similar to the House requirement that all employer sponsored insurance plans provide benefits at least as comprehensive as the exchange essential health benefits by no later than 5 years after implementation of the exchanges.

10.      Cap Executive Pay for exchange-participating insurers at $1 million

This amendment would require that exchange-participating insurance companies cap executive annual compensation at $1 million.

11.     Ethical Licensing Requirements for Generics

This amendment would ensure that rules for the approval of generic pharmaceutical products would not require violations of medical ethics in the testing of products in humans.