By Jocelyn Guyer

Yesterday, the House of Representatives released a “reconciliation” or “fix it” bill with final changes to the health reform package. With these changes, we can now get a complete picture of what health reform could mean for America’s families and children. The $940 billion package would cover 32 million uninsured people through Exchanges and an expansion of Medicaid, adopt broad-reaching reforms in insurance industry practices, make major new investments in public health, close the Medicare doughnut hole, and reduce the federal deficit (according to the nonpartisan Congressional Budget Office).

As everyone has probably heard by now, even those who would prefer to watch March Madness than the news, the House is heading toward a final vote on Sunday on the compromise package (both the underlying Senate bill and the “fix it” bill) and it is going to be very close. If it passes, the Senate will take up the “fix it” package as early as next week. In a sign of the high stakes, President Obama has canceled a trip to Asia to be present for the final stages of congressional action on health reform.

The final health reform package adheres closely to the structure of the underlying Senate bill and incorporates most of President Obama’s ideas for changes.  For funding, it relies less heavily on an excise tax on high cost health plans and more on Medicare savings. From a child and family health perspective, some of the key provisions include:

• Stronger affordability protections. The final package increases the adequacy of tax credits aimed at helping people purchase coverage through new “health insurance exchanges.” For example, those up to 133% FPL would pay 2% of income and those up to 300% to 400% FPL would pay 9.5%. Cost-sharing assistance also would be stronger than in the Senate bill. Overall, 24 million people are expected to be covered through Exchange plans, 19 million of whom would receive a tax credit for their coverage.

• Expands Medicaid up to 133% of the FPL. The “fix it” bill eliminates the special deal for Nebraska and instead provides all states with an enhanced federal matching rate for people made newly eligible as a result of the Medicaid expansion. This new “super” matching rate is set at 100% in calendar years 2014, 2015, and 2016; 95% in 2017; 94% in 2018; 93% in 2019; and 90% in 2020 and future years. Overall, the federal government is expected to pick up 95% of the cost of the new Medicaid expansions and fully 98% of the cost of covering 32 million more uninsured people.

• More equitable Medicaid financing for leading states. Due to a provision in the reconciliation bill, leading states that already cover adults (both parents and childless adults) up to at least 100% FPL will be treated more equitably. By 2019, these states will receive the same “super” matching rate for childless adults up to 133% FPL as states that never covered them prior to reform. Specifically, each of the “leading” states will see 50% of the gap between its regular Medicaid matching rate and the “super” matching rate addressed in 2014, 60% in 2015, 70% in 2016, 80% in 2017, and 90% in 2018. For example, a “leading” state with a regular matching rate of 60% will receive a matching rate for childless adults of 80% in 2014, 84% in 2015, 88% in  2016, 88% in  2017, 90% in  2018, and 93% in FY 2019.  The states that appear to meet the criteria of a “leading” state include AZ, DC, DE, HI, MA, ME, MN, NY, PA, VT, WA, and WI.

• Higher Medicaid reimbursement rates for primary care. As reform is being launched in 2013 and 2014, states will receive 100% federal funding for the cost of increasing their Medicaid reimbursement rates for primary care services up to Medicare levels. CBO estimates this change will cost the federal government $8.3 billion over 10 years and will have a positive effect on Medicaid reimbursement rates even after 2014.

• Simplified enrollment procedures. Along with maintaining the Senate’s provision requiring “no wrong door enrollment,” the final package simplifies enrollment and allows for better coordination between Medicaid and the Exchange by adopting a uniform definition of income (“modified adjusted gross income”). In place of Medicaid disregards for various types and kinds of income, the final bill calls for using a uniform 5% income disregard. This provision applies to all Medicaid beneficiaries, except for those who also qualify for Medicare, as well as to CHIP.

• Continuation of CHIP. As expected, the final package continues CHIP through 2019, and provides new federal funding for the program from FY 2013 through FY 2015. States are required to maintain their CHIP and Medicaid coverage for children, and will receive a 23-percentage point increase in their CHIP matching rate beginning October 1, 2015.