With health care reform coming down to the wire, what seems to be getting lost amid all the shouting is the fact that lawmakers and business groups have reached agreements on a number of health insurance reforms.  While there are still many details to be worked out, there is agreement on some fundamental changes that bode well for all of us. 

If these consensus items become law, insurance companies could no longer drop someone because they fall ill, and people would no longer have to worry about how they could afford care if they lost their job.   No one would be uninsurable because of a pre-existing condition and the number of people without insurance would drop significantly. 

Briefly, here are the areas where there is agreement:

•    No more pre-existing conditions - Health insurers couldn’t refuse to cover people who have a  serious medical problem.
•    Legislation would cap out-of-pocket costs – Many plans already include a cap on out of pocket costs. Legislation would require all plans to have a cap, and the House bill puts that cap at $5,000 for an individual and $10,000 for a family.
•    Subsidies – People with lower incomes would get help buying insurance, based on a sliding scale.
•    Requirement to have insurance – All Americans would have to have insurance or pay a tax penalty.  While conservatives and liberals disagree on this issue, it hasn’t been a major roadblock to reform so far.
•    Preventive care – Nearly everyone in Washington touts the need for greater emphasis on preventive care
•    Health Insurance exchanges – An exchange would be an online marketplace where people could easily compare health insurance plans and choose one that fits their needs.
•    Primary care physicians – Not enough medical students are opting to become primary care physicians.  Federal lawmakers agree government must do more to encourage people to join the medical professions front lines.
•    Payment reform – Doctors and hospitals get paid for the tests and services they perform even if those test and services do little to help patients recover. With reform, Medical professionals would be rewarded based on the outcomes of their care.
•    More Generics – The main reform efforts all include a provision that would allow drug companies to make generic versions of expensive biologic drugs, which include gene therapies.
•    Shrinking the ‘doughnut hole’ – This would reduce the coverage gap in seniors’ drug benefits offered through Medicare Part D.  Drugmakers would reduce the cost of seniors’ drugs by 50 percent for those stuck in the gap between the $2700 annually that Medicare covers and the $6152 cap. 
   
There is still disagreement on what the government’s role should be in offering a health plan to compete against private carriers, what the cost of reform would be, and other issues, such as an employer mandate to provide health insurance to employees.  There are also myths, such as the so-called “death panels” that would determine whether the very old and very sick would receive care, and the myth that undocumented immigrants would receive free insurance and free health care. 

In the final months of 2009, the remaining issues will have to be resolved between Congress and the President before health care reform can become reality. But much has been agreed upon, and for those of us with disabilities for whom health care is life sustaining, that is good news.