Democratic House committee leaders have pulled the tent covers off of the 852-page draft of a health care bill.

Lawmakers who appeared today at a press conference held to haul the mammoth draft out before the public include Rep. Charles Rangel, D-N.Y., chairman of the House Ways and Means Committee; Rep. Henry Waxman, D-Calif., chairman of the House Energy and Commerce Committee; and Rep. George Miller, D-Calif., chairman of the House Education and Labor Committee.

The press conference included the heads of those committees’ health subcommittees, along with Rep. John Dingell, D- Mich., chairman emeritus of the Energy and Commerce Committee.

Division A of the bill draft has sections
on topics such as health plan standards; the creation of a national health insurance “exchange,” or buying system; individual responsibility to own health coverage, and employer responsibility to provide coverage; taxation of individuals and employers that fail to meet health coverage responsibility standards; and a small business health coverage expense tax credit.

An affected individual who failed to own “acceptable health care coverage” would have to pay a tax equal to 2% of adjusted gross income over the IRS threshold for determining whether individuals or couples must file tax returns.

“The tax imposed … shall not exceed the applicable national average premium” for health coverage, according to the bill draft.

The bill would provide free coverage for the individuals and families with the lowest incomes, and “affordability credits” for individuals and families with incomes ranging from 133% of the federal poverty level to 400% of the federal poverty level, or about $14,404 to $43,420 for individual, and $29,327 to $88,200 for a family of 4.

An employer that said it would provide health coverage and failed to do so could have to pay a tax of $100 per employee per day from the time when the failure occurred up to the time when the failure was corrected.

An employer that provided coverage also would have to pay at least 72.5% of the premiums for an individual policy for a full-time employee, and 65% of the premiums for a family policy for a full-time employee.

The tax would not apply if an employer exercising reasonable diligence failed to find the error.

An employer that chose not to provide health coverage would have to pay an excise tax equal to 8% of the employees’ wages, according to the draft text.

Health insurers could no longer exclude coverage for pre-existing conditions or reject applicants based on health status information, and there would be restrictions on insurers’ ability to use health status information to set rates. The draft also would prohibit annual and lifetime limits on benefits. Rates adjusted to reflect factors such as applicant age, location and family size could vary only within a range in which the highest rates would be twice as high as the lowest rates.

An advisory committee would develop a package of essential benefits, and that design would include a cap on enrollees’ out-of-pocket expenses for covered services.

Provisions in other divisions of the bill draft would revamp the Medicare physician payment system; seek improvements in basic medical and mental health care services, by promoting treatment effectiveness research, care quality measurement programs and “physician payment sunshine provisions”; and promote community health programs, financial aid programs for individuals seeking careers in health care, and prevention and wellness programs.

A link to copies of summaries, position statements and other documents related to the proosal are available here.

AHIP Responds

America’s Health Insurance Plans, Washington, is reviewing the draft, according to AHIP spokesman Robert Zirkelbach.

“We strongly believe that now is the time for comprehensive, bipartisan health care reform that makes care more affordable, improves quality, and covers all Americans,” Zirkelbach says in a statement.

Health plans like the idea of finding a way to discontinue rating based on health status and to guarantee coverage for pre-existing conditions, but they want to avoid the kinds of unintended consequences that setting up a government-run plan would create, Zirkelbach says.

“A government-run plan would dismantle employer-based coverage, add additional liabilities to the federal budget, and turn back the clock on efforts to improve the quality and safety of patient care,” Zirkelbach says. “A better approach is to pursue reforms that can achieve broad bipartisan support, including strengthening the health care safety net, overhauling existing market rules, promoting shared responsibility, and transforming the delivery system to reward quality and value.”