Insurance and employer groups are talking about the lack of cost control provisions in H.R. 3590, the Patient Protection and Affordable Care Act bill, which passed by a 219-212 vote at 10:48 p.m. Sunday in the House.
H.R. 3590 is the same bill that the Senate passed early on Christmas Eve a few months back, and it now is awaiting the signature of President Obama.
House members also voted 220-211 at 11:36 p.m. to pass H.R. 4872, the Reconciliation Act of 2010. The Senate still must approve that bill, but it would revise and extend many provisions of H.R. 3590. Senate leaders have told House leaders that they have the votes to pass H.R. 4872 using a special budget reconciliation process.
Under normal Senate rules, bills need 60 votes to pass. Budget reconciliation measures need just 51 votes.
Some Republican lawmakers said during floor debate that they or colleagues would try to block implementation of H.R. 3590 — and of H.R. 4872, if H.R. 4872 becomes law — by turning to the courts for relief.
H.R. 3590 and H.R. 4872 passed with no Republican support; 34 Democrats voted against H.R. 3590, and 33 voted against H.R. 4872.
Democrats were jubilant about winning the H.R. 3590 battle and getting H.R. 4872 to the Senate.
“This is what change looks like,” Obama said during an appearance shortly after the vote on H.R. 3590 took place.
“I know this wasn’t an easy vote for a lot of people,” Obama said. “But it was the right vote.”
House Majority Leader Steny Hoyer, D-Md., smiled at the reporters at a press conference on Capitol Hill. “For all of you who pursued all of us: We had the votes,” Hoyer said.
Insurance say they still have concerns the current versions of the bills.
“The access expansions are a significant step forward” Karen Ignagni, president of America’s Health Insurance Plans, Washington, says in a statement about the health bills. “But this legislation will exacerbate the health care costs crisis facing many working families and small businesses.”
The bill “does little to stem the skyrocketing cost of health care and will be financed on the backs of small business during one of the most delicate financial periods in American history,” says Robert Rusbuldt, president of the Independent Insurance Agents and Brokers of America, Alexandria, Va..
WHAT’S IN H.R. 3590?
H.R. 3590 — the PPACA bill that the Senate passed late on Christmas Eve — is on track to become law whether or not the Senate approves H.R. 4872.
A detailed summary of H.R. 3590 and H.R. 4872 provisions posted by the Henry J. Kaiser Family Foundation, Menlo Park, Calif.
The final version of H.R. 3590 would:
- Enact the Community Living Assistance Services and Supports Act long long term care benefits program.
- Require insurers selling in the individual market, in the small group market and through the exchange system to sell coverage on a guaranteed issue and guaranteed renewable basis. Plans could base rating variations only on age, family use, tobacco use and location, and the rates for the oldest insureds could be only 3 times higher than the rates for the youngest insureds. Rates for tobacco users could be only 50% higher than the rates for non-tobacco users.
- Create a new health insurance exchange system that individuals and employers with up to 100 employees could use to buy subsidized health coverage, and 4 “tiers” of coverage, ranging from catastrophic plans to platinum plans.
- Create a new system of nonprofit health insurance co-ops.
- Permit states to form multi-state health insurance compacts, to create multi-state markets for health insurance.
- Create a health insurance tax credit for employers with 25 or fewer employees and average annual wages of less than $50,000.
- Impose penalties on employers with more than 50 employees that fail to provide health coverage and on inidividuals with incomes over a minimum income threshold who fail to have health coverage.
- Require employers with more than 200 employees to enroll employees in health plans automatically.
- Impose a $750 per-employee penalty on employers with more than 50 employees that fail to provide health coverage.
- Impose minimum medical loss ratios that are similar to those in H.R. 3590: 85% for group plans with more than 100 participants; 80% for small group plans; and 85% for Medicare Advantage plans.
- Impose a 40% “Cadillac plan” excise tax on insurers that sell relatively expensive health plans. Insurers now would pay the tax when they sold plans that cost more than $8,500 for individuals and $23,000 for families.
- Tighten health savings account and flexible savings account reimbursement rules. Individuals could not use account funds to pay for over-the-counter medications unless the medications were prescribed by doctors.