Senate Majority Leader Harry Reid (D-NV), Senate Finance Chairman Max Baucus (D-MT), Senate Banking Chairman Chris Dodd (D-CT) and Senate HELP Chairman Tom Harkin (D-IA) have introduced a Manager's Amendment, Senate Amendment 2786, for The Patient Protection and Affordable Care Act, H.R. 3590. (A "Manager's Amendment" is a set of various individual amendments that Senate managers--majority and minority members who manage legislation debates on their respective sides--have agreed to in advance.) According to the Senate Democrats' website, the amendment will move the legislation closer to passage. Senate is slated to have a vote on cloture (ending of debate) on the bill Monday.

In light of the Congressional Budget Office's release of an analysis of the amendment, Senator Reid stated, "This is a good bill that saves lives, saves money and saves Medicare. Our manager's amendment improves upon the existing reforms within this bill and guarantees real choice and competition to keep insurers in check. By creating strong competition, we'll reduce skyrocketing health care costs that stop thousands of Nevadans and millions of Americans from getting the best possible health care. When we pass this bill, we will cultivate a health care system that values quality of care over profits -- ensuring that patients receive the care they need and deserve."

The amendment offers the following provisions:

Accountability in Insurance: the amendment has stronger medical loss ratios where insurers will be required to spend more of premium revenues on clinical services and quality activities, and less on administrative costs. Participation in insurance exchanges would be based on performance in keeping premiums affordable. There is an immediate ban on pre-existing conditions exclusions for children. Insurers will have to protect choice of physicians and access to emergency care. Use of annual limits will be restricted. An internal and external process to appeal denial of coverage will be implemented.

Choice: Health insurance providers will offer plans under the Office of Personnel Management, which oversees health plans for Members of Congress. One plan must be non-profit and plans will be available nationwide. Workers who qualify for an affordability exemption to the individual mandate, but not for tax credits can take an employer contribution and join an exchange plan.

Affordable Health Care: Insurers and health care providers will have to report on their performance to allow patients to make better informed decisions. Small businesses will have a health insurance tax credit in 2010 with expansion of eligibility for the credit, and improving purchasing power for small businesses.

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