Health Reform-ese: we help you decipher the confusing debate

We've put together a brief guide to some of the most frequently used terms and phrases in this year's health reform debate.

Advance care planning consultations – A provision of H.R. 3200 would pay physicians to provide counseling to elderly or terminally ill patients who request the counseling. The provision would pay for one counseling session at least every five years, during which patients could discuss advance care planning, advance directives, living wills, palliative care and hospice and possible life-sustaining treatments for the terminally ill. Critics have dubbed the proposal "death care" and described its intent as "guiding you in how to die."
Related terms: "death care"

"America's Affordable Health Choices Act of 2009" – also known commonly as "H.R. 3200" – is the central piece of health reform legislation moving through Congress. The bill, introduced in the House of Representatives on July 14, 2009, promises to reduce out-of-control costs, encourage competition among insurance plans to improve choices for patients, and expand access to quality, affordable health care for all Americans. Sponsors of the bill promised that it would be deficit neutral and that it would ensure that 97 percent of Americans will be covered by a health care plan that is both affordable and offers quality, standard benefits by 2019. Click here for complete text of the bill or here for a bill summary.
Related terms: "H.R. 3200"

Blue Dog Democrats are comprised of a group of conservative Congressional Democrats who have more centrist voting patterns and who have called for a slower, more measured approach to crafting health reform legislation than the timeline originally set by President Barack Obama.

Budget reconciliation is a Senate procedural tactic that would allow the majority party – in this case the Democrats – to prevent an attempt to block a vote on legislation with a filibuster. The Democrats would need 60 votes to invoke the reconciliation process and break a filibuster. Senate could then pass the bill with a minimum of 50 votes. Read more about budget reconciliation rules.
Related terms: reconciliation

Cooperatives or insurance cooperatives have been proposed in the Senate as an alternative to a proposed government plan or public option. The cooperatives, which would be structured as non-profits and owned by their members, could offer a network of health care providers or contract out for medical services. The concept championed by some Democrats would provide "seed money" for the cooperatives, which would then be sustained by customer premiums. Read news coverage about insurance cooperatives. Read this Commonwealth Fund history of health cooperatives
Related terms: insurance cooperatives

"Death care" – A provision of H.R. 3200 would pay physicians to provide advance care planning consultations to elderly or terminally ill patients who request the counseling. The provision would pay for one counseling session at least every five years, during which patients could discuss advance care planning, advance directives, living wills, palliative care and hospice and possible life-sustaining treatments for the terminally ill. Critics have dubbed the proposal "death care" and described its intent as "guiding you in how to die."
Related terms: advance care planning consultations

Employer mandate – Proposed health reform legislation would require employers to provide health coverage as a benefit to their employees. H.R. 3200 provisions include a requirement that employers with an annual payroll of $400,000 or above would pay at least 72.5 percent of premiums for single-only coverage and 65 percent of family premiums – or pay a penalty: 8 percent of payroll. That penalty would incrementally decrease to a full exemption for businesses with annual payrolls of less than $250,000. Senate legislation includes one option with a mandate for businesses with payrolls exceeding $500,000 annually as well as another option with no "pay or play" mandate and yet another option that exempts businesses with 25 or fewer employees.
Related terms: individual mandate

Employer-sponsored plans currently provide some level of health coverage for approximately 160 million Americans. Employer-sponsored health plans are more likely to be provided by larger companies; in fact, an estimated 99 percent of companies with 200 or more workers offer health benefits, according to recent testimony in Congress. However, the plans face rapidly escalating premiums – up 119 percent since 1998 – and even at larger firms, up to 21 percent of workers may not be eligible for coverge, even it it's offered. Health reform legislation proposals in Congress may include an employer mandate, designed to increase participation by employers and by more of their employees.
Related terms: employer mandate

Government committee – H.R. 3200, the 1,017-page bill under consideration in Congress, includes a provision for a 27-member Health Benefits Advisory Committee – more than half of its members appointed by President Obama – that would set standards for the essential benefits that would be required of plans that could be offered through a proposed Health Insurance Exchange.
Related terms: Health Benefits Advisory Committee, Health Choices Administration

Health Benefits Advisory Committee – H.R. 3200, the 1,017-page bill under consideration in Congress, includes a provision for a 27-member committee – more than half of them appointed by President Obama – that would set standards for the essential benefits that would be required of plans that could be offered through a proposed Health Insurance Exchange.
Related terms: government committee

Health Choices Administration – H.R. 3200 calls for the creation of a federal agency that would oversee provisions of H.R. 3200, including the establishment of health plan benefit standards, establishment and operation of the Health Insurance Exchange, and administration of individual affordability credits or subsidies. The commission's additional responsibilities would include prevention of abuses within the Health Insurance Exchange system.
Related terms: Health Choices Commissioner, Health Insurance Exchange

Health Choices Commissioner – H.R. 3200 calls for the creation of a federal agency called the Health Choices Administration. Overseeing that agency would be the Health Choices Commissioner, an individual appointed by the President to oversee provisions of H.R. 3200, including the establishment of health plan benefit standards, establishment and operation of the Health Insurance Exchange, and administration of individual affordability credits or subsidies. The commissioner's additional responsibilities would include prevention of abuses within the Health Insurance Exchange system.
Related terms: Health Choices Administration, Health Insurance Exchange

Health Insurance Exchange – An exchange mechanism is a key provision of health reform legislation moving through Congress, established to provide a selection of competing providers, each offering different qualified plans. All qualified plans would meet standards established and enforced by the Health Choices Administration. For instance, participating plans would not be allowed to discriminate against applicants based on health history (pre-existing conditions) or future risk. Competition between the plan providers would, in theory, encourage the providers to improve the quality and pricing of offered plans.
Related terms: exchange

H.R. 3200 – also known by its formal title, "America's Affordable Health Choices Act of 2009" – is the central piece of health reform legislation moving through Congress. The bill, introduced in the House of Represenatives on July 14, 2009, promises to reduce out-of-control costs, encourage competition among insurance plans to improve choices for patients, and expand access to quality, affordable health care for all Americans. Sponsors of the bill promised that it would be deficit neutral and that it would ensure that 97 percent of Americans will be covered by a health care plan that is both affordable and offers quality, standard benefits by 2019. Click here for complete text of the bill or here for a bill summary.
Related terms: "America's Affordable Health Choices Act of 2009"

Individual affordability credits – or subsidies – are included in proposed legislation to help ensure the goals of the legislation's individual mandate. Legislation in both House and Senate bills provides premium subsidies on a sliding scale to eligible individuals and families with incomes up to 400 percent of the federal poverty level to help them purchase coverage through the Health Insurance Exchange.
Related terms: subsidies

Individual mandate would require all citizens to have insurance coverage that meets minimum standards set as part of a health insurance exchange, including guaranteed access to affordable coverage, essential benefits and other consumer protections. Various legislative proposals would impose a tax penalty on individuals who do not purchase coverage. The legislation also includes exemptions for financial hardship.
Related terms: employer mandate

Insurance cooperatives have been proposed by centrists in the Senate as an alternative to a proposed government plan or public option. The cooperatives, which would be structured as non-profits and owned by their members, could offer a network of health care providers or contract out for medical services. The concept championed by some Democrats would provide "seed money" for the cooperatives, which would then be sustained by customer premiums. Read more about insurance cooperatives.
Related terms: cooperatives

Non-profit cooperatives or insurance cooperatives have been proposed in the Senate as an alternative to a proposed government plan. The cooperatives, which would be structured as non-profits and owned by their members, could offer a network of health care providers or contract out for medical services. The concept championed by some Democrats would provide "seed money" for the cooperatives, which would then be sustained by customer premiums. Read more about insurance cooperatives.
Related terms: insurance cooperatives, cooperatives

Pre-existing conditions are medical conditions that may result in an insurance company's denial of your application for health insurance coverage. Proposed health reform legislation would prohibit companies from offering plans in a Health Insurance Exchange if the company denied policies based on pre-existing conditions.
Related terms: rescission

Public option – also referred to as a public plan – is a provision within health reform legislation (H.R. 3200) moving through Congress that would create a qualified health benefit plan to compete with other plans that qualify for a national Health Insurance Exchange. The public plan would be subject to the same requirements – regarding benefit levels, provider networks, consumer protections and cost sharing – that would apply to other plans within the Exchange. The legislation stipulates that a public plan would be financed through premium revenues and that initially, provider rades would be set at Medicare rates. After three years, a new process would be imposed to set rates.
Related terms: public plan

Public plan – also referred to as a public option – is a provision within health reform legislation (H.R. 3200) moving through Congress that would create a qualified health benefit plan to compete with other plans that qualify for a national Health Insurance Exchange. The public plan would be subject to the same requirements – regarding benefit levels, provider networks, consumer protections and cost sharing – that would apply to other plans within the Exchange. The legislation stipulates that a public plan would be financed through premium revenues and that initially, provider rades would be set at Medicare rates. After three years, a new process would be imposed to set rates.
Related terms: public option

Rationing – actually the threat of rationing – is one of the most powerful arguments leveled against proposals for an expanded government control of the U.S. health care system. Critics of such expanded control – which might take the form of a public plan or public option – argue that in order to control costs in a revamped system, the government would have to restrict (or ration) care, by refusing to pay for certain procedures or medication or by putting limits on care for the elderly or terminally ill. Some proponents of increased government control argue that health care is already, in effect, rationed in the United States, as consumers are limited in their ability to get adequate health insurance – and health care – by rapidly climbing health care costs.
Related terms: public plan, public option

Reconciliation or budget reconciliation is a Senate procedural tact that would allow the majority party – in this case the Democrats – to prevent an attempt to block a vote on legislation with a filibuster. The Democrats would need 60 votes to invoke the reconciliation process and break a filibuster. Senate could then pass the bill with a minimum of 50 votes. Read more about budget reconciliation rules.
Related terms: budget reconciliation

Rescission is a controversial insurance industry practice that has come under fire as an unfair tactic used to deny coverage to policy holders. If you've been a victim of rescission, your insurance company has received a claim from you, and then – after reviewing your application and medical history for undisclosed conditions or inconsistencies – has cancelled your policy at a point when you needed it most. (So if an agent tries to "help" you by omitting any of your health history, they're likely just trying to close the sale.
Related terms: pre-existing conditions

Single-payer system is a health care system in which one entity – a single payer – collects all health care fees and pays for all health care costs. Proponents of a single-payer system argue that because there are fewer entities involved in the health care system, the system can avoid an enormous amount of administrative waste. Instead, all health care health care providers in a single-payer system would bill one entity for their services. Within a single-payer system, all citizens would receive high-quality, comprehensive medical care PLUS the freedom to choose providers. Paperwork would be dramatically reduced with the elimination of bills, co-pays and deductibles. A single-payer system – like the system in Canada – is NOT socialized medicine. Read here for a comparison of single-payer and socialized medicine. Read more about the difference between a single-payer system and socialized medicine. Current health proposals moving through Congress are NEITHER single-payer nor socialized medicine solutions.
Related terms: socialized medicine, universal health care

Socialized medicine is, by definition, a health care system in which the government owns and operates health care facilities and employs the health care professionals, thus also paying for all health care services. Examples abroad include the British National Health Service, and national health systems in countries such as Finland and Spain, but NOT including Canada's Medicare system (which is publicly funded but which does not own all of the health facilities). Closer to home, the Veterans Health Administration is, as one author points out, "actually socialized medicine, where the government owns the hospitals and employs the doctors." Read more about the difference between a single-payer system and socialized medicine. Current health proposals moving through Congress are NEITHER single-payer nor socialized medicine.
Related terms: single-payer system, universal health care

Subsidies – or individual affordability credits – are included in proposed legislation to help ensure the goals of the legislation's individual mandate. Legislation in both House and Senate bills provides premium subsidies on a sliding scale to eligible individuals and families with incomes up to 400 percent of the federal poverty level to help them purchase coverage through the Health Insurance Exchange.
Related terms: employer subsidies, individual affordability credits, individual subsidies

Waiting periods are among the fears vocalized by opponents of single-payer health care systems. Critics of single-payer systems in countries such as Canada cite lengthy waits for some elective surgeries. Proponents of single-payer systems note that a high percentage of Americans already are being unable to obtain medical care – including medication, testing and treatment – because of costs, while a much smaller percentage of residents in single-payer systems report that costs had limited their access to care.
Related terms: rationing, single-payer system