To aid the incoming 111th Congress and Obama Administration, the Congressional Budget Office (CBO) released a 235-page report outlining 115 budget options for health care reform. The report catalogs most of the hottest legislative ideas on Capitol Hill, with useful background information and scores of costs and savings. Here’s the list of reform ideas in the report:

The Private Health Insurance Market:

  • Foster the Formation of Association Health Plans
  • Allow Individuals to Purchase Non-Group Health Insurance Coverage in Any State
  • Impose a Pay-or-Play Requirement on Large Employers
  • Establish a National High-Risk-Pool Program
  • Establish a National Reinsurance Program to Provide Subsidies to Insurers and Firms for Privately Insured Individuals
  • Require States to Use Community Rating for Small-Group Health Insurance Premiums
  • Create a Voucher Program to Expand Health Insurance Coverage
  • Limit Awards from Medical Malpractice Torts

The Tax Treatment of Health Insurance:

  • Reduce the Tax Exclusion for Employment-Based Health Insurance and the Health Insurance Deduction for Self-Employed Individuals
  • Replace the Income Tax Exclusion for Employment-Based Health Insurance with a Deduction
  • Replace the Income and Payroll Tax Exclusion with a Refundable Credit
  • Allow Self-Employed Workers to Deduct Health Insurance Premiums from Income That Is Subject to Payroll Taxes
  • Expand Eligibility for an “Above-the-Line” Deduction for Health Insurance Premiums
  • Disallow New Contributions to Health Savings Accounts
  • Allow Health Insurance Plans with Coinsurance of at Least 50 Percent to Qualify for the Health Savings Account Tax Preference
  • Levy an Excise Tax on Medigap Plans

Changing the Availability of Health Insurance Through Existing Federal Programs:

  • Raise the Age of Eligibility for Medicare to 67
  • Create a Medicare Buy-In Program for Individuals Ages 62 to 64
  • Eliminate or Reduce Medicare’s 24-Month Waiting Period for Recipients of Social Security Disability Benefits
  • Create a Medicaid Buy-In Program
  • Require States to Adopt Premium Assistance Programs for Medicaid Enrollees
  • Expand Eligibility for Medicaid Family Planning Services
  • Expand Medicaid Eligibility to Include Young Adults with Income Below the Federal Poverty Level
  • Expand Medicaid Eligibility to Include Parents with Income Below the Federal Poverty Level
  • Establish a Medicaid Outreach Program with Mandatory Funds
  • Permanently Extend the Transitional Medical Assistance Provision in Medicaid
  • Allow People and Firms to Buy Health Insurance Plans Through the Federal Employees Health Benefits Program
  • End Enrollment in VA Medical Care for Veterans in Priority Groups 7 and 8
  • Reopen Enrollment for VA Medical Care Among Priority Group 8 Veterans for Five Years

The Quality and Efficiency of Health Care:

  • Bundle Payments for Hospital Care and Post-Acute Care
  • Reduce Medicare Payments to Hospitals with High Readmission Rates
  • Expand the Hospital Quality Incentive Demonstration to All Hospitals
  • Deny Payment Under Medicaid for Certain Hospital-Acquired Conditions
  • Establish Regional Centers of Excellence for Selected Surgical Procedures Covered by Medicare
  • Convert Medicare and Medicaid Disproportionate Share Hospital Payments into a Block Grant
  • Consolidate Medicare and Federal Medicaid Payments for Graduate Medical Education Costs at Teaching Hospitals
  • Allow Physicians to Form Bonus-Eligible Organizations and Receive Performance-Based Payments
  • Pay Primary Care Physicians in Medicare Using a Partial-Capitation System, with Bonuses and Penalties
  • Pay for a Medical Home for Chronically Ill Beneficiaries in Fee-for-Service Medicare
  • Require Medicare Carriers to Provide Information About Peer Profiling to Physicians
  • Require Prior Authorization for Imaging Services Under Medicare
  • Encourage Wider Use of Patient Shared-Decision Aids by Physicians in Medicare
  • Expand Medicare’s Least Costly Alternative Policy to Include Viscosupplements
  • Require Drug and Device Manufacturers to Disclose Their Relationships with Physicians Who Participate in Medicare
  • Fund Research Comparing the Effectiveness of Treatment Options
  • Create Incentives in Medicare for the Adoption of Health Information Technology
  • Require the Use of Health Information Technology as a Condition of Participation in Medicare
  • Support Development of VistA to Meet Standards and Encourage Adoption
  • Sponsor Regional Markets for Health Information Technology

Geographic Variation in Spending for Medicare:

  • Reduce Medicare’s Fees for Physicians in Areas with Unusually High Spending
  • Reduce Medicare’s Payment Rates for Hospitals in Areas with a High Volume of Elective Admissions
  • Reduce Medicare’s Payment Rates Across the Board in High-Spending Areas
  • Impose a Surcharge on Medicare Cost Sharing in High-Cost Areas and Prohibit Medigap Plans from Covering the Surcharge

Paying for Medicare Services:

  • Reduce Annual Updates in Medicare Fee-for-Service Payments to Reflect Expected Productivity Gains
  • Reduce the Update Factor for Hospitals’ Inpatient Operating Payments Under Medicare by 1 Percentage Point
  • Reduce the Update Factor for Payments to Providers of Post-Acute Care Under Medicare by 1 Percentage Point
  • Eliminate Inflation-Related Updates to Medicare’s Payment Rates for Home Health Care for Five Years
  • Reduce the Update Factor for Medicare’s Payments for Skilled Nursing Facilities by 1 Percentage Point
  • Modify the Sustainable Growth Rate Formula for Updating Medicare’s Physician Payment Rates
  • Create Service-Specific Updates for Medicare’s Physician Payment Rates
  • Use the Medicare Economic Index to Update Physician Payment Rates for Evaluation and Management Services and Create Four Service-Specific Updates for Remaining Services
  • Modify the Equipment Utilization Factor for Advanced Imaging in Calculating Physicians’ Fees in Medicare
  • Set the Benchmark for Private Plans in Medicare Equal to Local Per Capita Fee-for-Service Spending
  • Convert Medicare to a Premium Support System
  • Establish Benchmarks for the Medicare Advantage Program Through Competitive Bidding
  • Eliminate the One-Sided Rebasing Process for Establishing Benchmarks for Medicare Advantage Plans
  • Require Manufacturers to Pay a Minimum Rebate on Drugs Covered Under Medicare Part D
  • Establish an Abbreviated Approval Pathway for Follow-On Biologics

Financing and Paying for Services in Medicaid and State Children’s Health Insurance Program:

  • Convert the Federal Share of Medicaid’s Payments for Acute Care Services into an Allotment
  • Remove or Reduce the Floor on Federal Matching Rates for Medicaid Services
  • Equalize Federal Matching Rates for Administrative Functions in Medicaid at 50 Percent
  • Restrict the Allocation to Medicaid of Common Administrative Costs
  • Reduce the Taxes That States Are Allowed to Levy on Medicaid Providers
  • Modify the Amount of the Brand-Name Drug Rebate in the Medicaid Program
  • Apply the Fee-for-Service Medicaid Drug Rebate to Drugs Purchased for Medicaid Managed Care Enrollees
  • Apply the Medicaid Additional Rebate to New Formulations of Existing Drugs
  • Base Medicaid’s Pharmacy Payment Formulas for Brand-Name Drugs on the Average Manufacturer Price
  • Encourage Therapeutic Substitution in Medicaid by Applying Federal Upper Payment Limits to Two Classes of Drugs
  • Eliminate Allotment Caps for the State Children’s Health Insurance Program and Permit States to Expand Coverage up to 400 Percent of the Federal Poverty Level
  • Adjust Funding for the State Children’s Health Insurance Program to Reflect Increases in Health Care Spending and Population Growth

Premiums and Cost Sharing in Federal Health Programs:

  • Replace Medicare’s Current Cost-Sharing Requirements with a Unified Deductible, a Uniform Coinsurance Rate, and a Catastrophic Limit
  • Restrict Medigap Coverage of Medicare’s Cost Sharing
  • Combine Changes to Medicare’s Cost Sharing with Restrictions on Medigap Policies
  • Impose Cost Sharing for the First 20 Days of a Stay in a Skilled Nursing Facility Under Medicare
  • Require a Copayment for Home Health Episodes Covered by Medicare
  • Impose a Deductible and Coinsurance for Clinical Laboratory Services Covered by Medicare
  • Increase the Basic Premium for Medicare Part B to 35 Percent of the Program’s Costs
  • Permanently Extend the Provision That Provides Cost-Sharing Assistance for Qualifying Individuals Under Medicaid
  • Eliminate the Doughnut Hole in Medicare’s Drug Benefit Design
  • Institute a Premium for Higher-Income Enrollees Under Medicare’s Drug Benefit Similar to That Used in Part B
  • Increase the Fraction of Beneficiaries Who Pay an Income-Related Premium for Part B of Medicare
  • Base Federal Retirees’ Health Benefits on Length of Service
  • Adopt a Voucher Plan for the Federal Employees Health Benefits Program
  • Require Federal Employees Health Benefits Plans to Subsidize Premiums for Medicare Part B and Reduce Coverage of Medicare Cost Sharing by an Equivalent Amount
  • Increase Health Care Cost Sharing for Family Members of Active-Duty Military Personnel
  • Introduce Minimum Out-of-Pocket Requirements Under TRICARE For Life
  • Increase Medical Cost Sharing for Military Retirees Who Are Not Yet Eligible for Medicare
  • Require Copayments for Medical Care Provided by the VA to Enrollees Without a Service-Connected Disability

Long-Term Care:

  • Increase States’ Flexibility to Offer Home- and Community-Based Services Through Medicaid State Plan Amendments
  • Make Home and Community-Based Services a Mandatory Benefit Under Medicaid
  • Increase the Federal Matching Rate for Home and Community-Based Services and Decrease the Federal Matching Rate for Nursing Home Services
  • Clarify Medicaid’s Definition of Permissible Asset Transfers
  • Increase the “Look-Back” Period for Transfers of Assets in Medicaid
  • Implement Policies That Encourage the Use of Advance Directives
  • Require Deposits to Individual Accounts for Purchasing Long-Term Care Insurance

Health Behavior and Health Promotion:

  • Impose an Excise Tax on Sugar-Sweetened Beverages
  • Increase the Excise Tax on Cigarettes by One Dollar Per Pack
  • Increase All Taxes on Alcoholic Beverages to $16 Per Proof Gallon
  • Reduce Medicare Payment Rates for Primary Care Physicians Who Do Not Meet Benchmarks for Influenza Vaccination
  • Base Medicare’s Coverage of Preventive Services on Evidence of Effectiveness
  • Closing the Gap Between Medicare’s Spending and Receipts
  • Increase the Payroll Tax Rate for Medicare Hospital Insurance by 1 Percentage Point
  • Limit Growth in Medicare Per Capita Spending to Growth in Per Capita Gross Domestic Product Plus 1 Percentage Point
  • Design an Enforcement Mechanism for the Medicare Funding Warning
  • Set a Savings Target to Reduce Spending for Medicare by 1 Percent
  • Increase Funding for the Health Care Fraud and Abuse Control Program in Medicare and Medicaid