The main House health bill — H.R. 3962, the Affordable Health Care for America Act — has arrived.
House Democratic leaders say the 1,990-page AHCAA bill, introduced by Rep. John Dingell, D-Mich., would increase the percentage of U.S. residents with health coverage to 96%, from 83% today, at a cost of about $894 billion over 10 years.
House Speaker Nancy Pelosi, D-Calif., and other House leaders created H.R. 3962 by combining and revising three other health bills developed by the House Education and Labor, Energy and Commerce, and Ways and Means committees.
The bill would create a Health Insurance Exchange system that individuals could use to buy health insurance from private insurers and government-run plans.
The bill also would provide incentives for the creation of nonprofit, state-based health insurance cooperatives, and it would explicitly ensure that insurance agents can continue to offer all products sold through the exchange system.
House leaders expect the bill to come up for debate on the House floor next week.
WHERE THE JUICY PARTS ARE
Health insurers have lobbied hard against congressional health bill provisions that would create new government-run health plans and a new government-run long term care insurance program.
In H.R. 3962, the public health insurance option section starts on page 211, and the Community Living Assistance Services and Supports Act LTC program section starts on page 1,213.
The public option plans would have to negotiate their own rates with providers, rather than using the ultra-low Medicare rates. Doctors and hospitals had argued that letting the government plan use Medicare rates would depress already low reimbursement rates even further, and insurers had complained that providers would make up for ultra-low public plan reimbursement rates by trying to jack up the fees privately insured patients pay.
Health agents have lobbied hard to ensure that, if the government does create a system of health insurance exchanges to bring consumers and plans closer together, agents could still have a role to play.
House leaders have kept an amendment adopted previously that would keep agents in the game. On page 191, the bill states that nothing in the “health insurance exchange related provisions” section of the bill “shall be construed to affect the role of enrollment agents and brokers under State law, including with regard to the enrollment of individuals and employers in qualified health benefit plans including the public health insurance option.”
Health insurers have supported the idea that the government needs to require most people to have health coverage to reduce the risk of offering coverage on a guaranteed-issue, mostly community-rated basis.
H.R. 3962 has a “shared responsibility” section that would take effect in 2013 and covers both individuals and employers.
The individual responsibility section starts on page 296. It would impose a “tax on individuals without acceptable health care coverage.” For affected individuals, the tax would equal a maximum of the cost of the average health insurance premium or 2.5% of a taxpayer’s adjusted gross income for the year.
The individual responsibility provision has exclusions for non-resident aliens, individuals living outside the United States and individuals who seek a religious exemption from coverage requirements.
The employer responsibility section, which starts on page 308, would impose a tax equal to 8% of employee wages on employers over a minimum size that failed to provide health coverage. The payroll tax would be lower for employers with $500,000 to $750,000 in payroll, and 0% for employers with less than $500,000 in payroll costs.
Before the coverage mandates kicked in, a temporary government program would insure people turned down by private insurers because of medical problems.
Health insurers and medical malpractice insurers have been trying to ward efforts to end their access to the McCarran-Ferguson Act insurance antitrust exemption. In H.R. 3962, an exemption repeal provision starts on page 150. The provision states that nothing contained in McCarran-Ferguson “shall modify, impair, or supersede the operation of any of the antitrust laws with respect to price fixing, market allocation, or monopolization (or attempting to monopolize)” by health insurers or medical malpractice insurers.
But the provision, based on H.R. 3596, the House Judiciary Committee’s health antitrust exemption repeal bill, includes an amendment introduced by Rep. Dan Lungren, R-Calif., that states that repeal provision would not apply to collecting historical loss data; determinining a loss development factor; “performing actuarial services, if doing so does not involve a restraint of trade”; or the information or rate-setting activities of a state insurance regulator or other state regulator.
OTHER BILL PROVISONS:
H.R. 3962 would:
- Forbid plans from basing premiums or denials of care on factors such as pre-existing conditions, race, or gender.
- Limit use of age rating.
- Cap patients’ out-of-pocket expenses.
- Require health plans for children to cover dental, hearing and vision care.
- Require health plans offered through the exchange system, and, eventually, employer plans, to cover preventive care at no cost to the patient.
- Close the Medicare Part D prescription drug program “doughnut hole” — the coverage gap that enrollees experience when coverage for routine prescription expenses has run out but catastrophic coverage has not yet kicked in.
- Provide “affordability credits” to help individuals and families who meet income requirements pay their health insurance premiums, and provide health insurance subsidies for small businesses.