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Obama Signs H.R. 1

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President Obama has signed H.R. 1, the American Recovery and Reinvestment Act, a bill that includes health benefits subsidies for laid-off workers, health information technology standards and privacy provisions, and funding for efforts to study the effectiveness of various medical treatments.

Members of the House voted 246-183 to pass the bill Friday afternoon.

Members of the Senate passed the bill by a 60-38 vote late in the evening. Senate supporters had to wait for Sen. Sherrod Brown-D-Ohio, to fly back from his mother’s funeral to get the final vote needed to get the bill through the Senate.

The bill received no Republican votes in the House and only 3 Republican votes in the Senate.

Drafts and even detailed descriptions of the conference report — a compromise version of the bill that combines the House and Senate versions — were scarce last week.

The House Rules Committee now has posted links to copies of the text of the conference report and “joint explanatory statements” concerning the conference report here.

Earlier, the House passed a version of the bill would have subsidized 65% of the cost of laid-off workers continuing Consolidated Omnibus Budget Reconciliation Act health coverage continuation benefits. The Senate passed a bill that included a 50% subsidy.

The version that Obama signed provides a 65% subsidy for up to 9 months.

According to the authors of a “joint explanatory statement” that accompanies the final version of ARRA:

The program is mandatory for employers required to offer COBRA continuation health coverage. Eligible individuals must have a qualifying event between September 1, 2008 and December 31, 2009, and must have been terminated involuntarily. Firms providing COBRA benefits will be able to allow those electing COBRA to choose from other insurance options at the time of the qualifying event, and firms will be able to contribute to the individual portion of the premium. (Lastly, the benefit phases out for single taxpayers with modified adjusted gross incomes betwecn $125,000 and $145,000 ($250,000 and $290,000 for joint filers) for the taxable year….

… if COBRA subsidy exceeds payroll taxes, employers will be reimbursed directly through a program established by the Department of Trcasury. COBRA continuation health coverage for this purpose includes not only coverage that applies to private, nongovernmental employers with 20 or more employees but also coverage rules that apply to Federal and State and local governmental employers pursuant to Federal law, and to State law mandates that apply to small employers (employers with less than 20 employees) and other employers not covered by Federal law, provided that such State law mandates require an employer or other entity to offer comparable continuation health coverage.

Lawmakers note in the explanatory statement that the Internal Revenue Service must adopt regulations to implement the COBRA subsidy provision and prevent abuse.

The IRS must try to keep individuals from claiming the subsidy while eligible for other group coverage, either through a spouse or through a new employer, lawmakers write.

The final version of the bill includes a long section dealing with health information technology and health data privacy.

The provision defines some accidental releases of personal health information as a breach of the privacy rules, but a technical change states that the accidental releases of information will not count as violations if the individuals who see the information have authorization to see other personal health information at the same facility, lawmakers write in the joint explanatory statement.

The definition of “personal health record” in the provision does not include the kinds of records managed by or primarily for life insurance companies, lawmakers write.

“By extension, a life insurance company would not be considered a PHR vendor under this subtitle,” lawmakers write.

The health data provision will require covered entities to notify individuals of breaches of their personal health information, and to notify the secretary of Health and Human Services and “prominent media outlets” if more than 500 individuals in an area are affected.

The comparative effectiveness section of ARRA provides $1.1 billion in funding that federal agencies can use to compare the costs and benefits of different types of health care treatments.

America’s Health Insurance Plans, Washington, has welcomed congressional passage of H.R. 1.

“This legislation means health security for millions of low-income families and workers going through a job transition,” AHIP President Karen Ignagni says in the statement. “The health IT provisions in this bill will improve health care quality and safety, strengthen privacy protections, and preserve patients’ access to health plans’ care coordination and disease management programs. The investment in comparative effectiveness will yield vital information on the safety and effectiveness of medical treatments and technologies, empowering patients and doctors to make better informed health care decisions.”

Policymakers should build on the momentum in the bill by introducing reforms that ensure that all Americans have access to high-quality, affordable health care, Ignagni says.


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