Friday, August 7, 2009

Impartial Review of Private Health Insurance Provisions of H.R. 3200

“As the fight in Washington over health care reform continues to dominate public attention and media coverage, most Americans are critical of the way news organizations are explaining key elements of the debate.”

Pew Research Center

If you are longing for an impartial analysis of the proposed legislation for restructuring private health insurance, you need to read this report from the Congressional Research Service. The following appears in the Overview.

Overview of H.R. 3200

This report summarizes the key provisions affecting private health insurance in America’s Affordable Health Choices Act of 2009, found in Division A, as ordered reported by House Committees on Ways and Means and on Education and Labor.1 Division A of H.R. 3200 focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, providing financial assistance to certain individuals, and, in some cases, small employers. In general, H.R. 3200 would include the following:

  • Individuals would be required to maintain health insurance, and employers would be required to either provide insurance or pay into a fund, with penalties/taxes for noncompliance.
  • Several market reforms would be made, such as modified community rating and guaranteed issue and renewal.
  • Both the individual and employer mandates would be linked to acceptable health insurance coverage, which would meet required minimum standards and incorporate the market reforms included in the bill. Acceptable coverage would include
    • coverage under a qualified health benefits plan (QHBP), which could be offered either through the newly created Exchange or outside the Exchange through new employer plans;
    • grandfathered employment based plans;
    • grandfathered nongroup plans; and
    • other coverage, such as Medicare and Medicaid.
  • The Exchange would be established under a new independent federal agency (the Health Choices Administration), headed by a Commissioner. The Exchange would offer private plans alongside a public option.
  • Certain individuals with incomes below 400% of the federal poverty level could qualify for subsidies toward their premium costs and cost-sharing; these subsidies would be available only through the Exchange.
  • In the individual market (the nongroup market), a plan could be grandfathered indefinitely, but only if no changes were made to the terms and conditions of the plan, including benefits and cost-sharing, and premiums were only increased as allowed by statute.
  • This bill would not affect plans covering specific services, such as dental or vision care.
  • Most of these provisions would be effective beginning in 2013.

Read full report.

You can also check out the Kaiser Family Foundation: Side-by-Side Comparison of Major Health Care Reform Proposals

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