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Link To H.R. 1 Conference Report Summary

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Here at long last is the conference report version of H.R. 1, the American Recovery and Reinvestment Act.

The House passed one version of the bill by a wide margin. The Senate passed another version Tuesday, but bill supporters there had to struggle to round up enough votes — including 3 votes from Republicans — to get the bill to the floor.

Congressional leaders brought House and Senate negotiators together to hammer out the conference report, or compromise version, behind closed doors.

One key provision of the bill would subsidize laid-off workers’ purchases of Consolidated Omnibus Budget Reconciliation Act health coverage continuation benefits, and others would provide funding for health information technology efforts, wellness programs and treatment comparative effectiveness studies.

Here is a link to “Division B” of the ARRA conference report, which includes health provisions.

The Senate Finance Committee has posted the latest summary here.

Here are some sections of interest to insurers:


Premium Subsidies for COBRA Continuation Coverage for Unemployed Workers. Recession-related job loss threatens health coverage for many families. To help people maintain coverage, the bill provides a 65% subsidy for COBRA continuation premiums for up to 9 months for workers who have been involuntarily terminated, and for their families. This subsidy also applies to health care continuation coverage if required by states for small employers. With COBRA premiums averaging more than $1000 a month, this assistance is vitally important. To qualify for premium assistance, a worker must be involuntarily terminated between September 1, 2008 and December 31, 2009. The subsidy would terminate upon offer of any new employer-sponsored health care coverage or Medicare eligibility. Workers who were involuntarily terminated between September 1, 2008 and enactment, but failed to initially elect COBRA because it was unaffordable, would be given an additional 60 days to elect COBRA and receive the subsidy. To ensure that this assistance is targeted at workers who are most in need, participants must attest that their same year income will not exceed $125,000 for individuals and $250,000 for families. The Joint Committee on Taxation estimates that this provision would help 7 million people maintain their health insurance by providing a vital bridge for workers who have been forced out of their jobs in this recession. This provision is estimated to cost $24.7 billion.

Medicare Payments for Teaching Hospitals. The bill blocks a FY09 Medicare payment reduction to teaching hospitals related to capital payments for indirect medical education (IME). This provision is estimated to cost $191 million.

Medicare Payments to Hospice. The bill blocks FY09 Medicare payment cut to Hospice providers related to a wage index payment add-on. This provision is estimated to cost $134 million.

Medicare Payments to Long Term Care Hospitals. The bill makes technical corrections to the Medicare, Medicaid, and SCHIP Extension Act of 2007 related to Medicare payments for long-term care hospitals. The estimated cost of these provisions is $13 million.

Repeal of Treasury Section 382 Notice. Last year, the Treasury Department issued Notice 2008-83, which liberalized rules in the tax code that are intended to prevent taxpayers that acquire companies from claiming losses that were incurred by the acquired company prior to the taxpayer’s ownership of the company. The bill would repeal this Notice prospectively. This proposal is estimated to raise $6.977 billion over 10 years.

Treatment of Certain Ownership Changes.
The bill would clarify the application of section 382 to certain companies restructuring pursuant to the Emergency Economic Stabilization Act of 2008. This proposal is estimated to cost $3.163 billion over 10 years.


Funding for Health Information Technology (IT) through Medicare and Medicaid Incentives. This bill promotes the use of health information technology (health IT), such as electronic health records, by: requiring the government to take a leadership role to develop standards by 2010 that allow for the nationwide electronic exchange and use of health information to improve quality and coordination of care; investing $19 billion in health information technology infrastructure and Medicare and Medicaid incentives to encourage doctors, hospitals, and other providers to use health IT to electronically exchange patients’ health information; and strengthening Federal privacy and security law to protect identifiable health information from misuse as the health care sector increases use of health IT. If the bill is enacted, approximately 90% of doctors and 70% of hospitals would adopt and use certified electronic health records within the next decade, according to the Congressional Budget Office. In turn, that would save the government more than $12 billion (through reduced spending on Medicare, Medicaid, and other programs) and generate additional savings throughout the health sector through improvements in quality of care, care coordination, and reductions in medical errors and duplicative care. The estimated net cost of this provision is $17.2 billion; in addition, $2 billion for affiliated grants and loans is available through discretionary funding.


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