H.R. 3200: "AMERICA'S AFFORDABLE HEALTH CHOICES ACT OF 2009"
By: Dennis E. Merkley
H.R. 3200 is a bill originating in the House of Representatives "[t]o provide affordable, quality health care for all Americans and to reduce the growth in health care spending." H.R. 3200. When the media and Congressmen talk about health care reform, this is the legislation that they are currently referring to. H.R. 3200 is not yet law, and it is still subject to more debate and revision if it is to become a law. The bill as it currently stands is 1,017 pages long. H.R. 3200. This is a long document even when compared to other groundbreaking pieces of legislation. In comparison the Civil Rights Act of 1964 was just over 20 pages in length. Pub. L. 88-352.
The purpose of this article is to provide a brief summary of some of the key provisions of H.R. 3200 and a timeline of when some of the proposed reforms will be put into place, if passed into law in its current form.
Coverage and Choice
A Health Insurance Exchange will be created to act as a marketplace for individuals and employers to comparison shop between private and public insurers. All the plans available through the Health Insurance Exchange will be required to meet minimum coverage requirements proposed by the Health Benefits Advisory Committee, led by the Surgeon General, and approved by the Health and Human Services Department. The basic package will include preventive services with no cost-sharing, mental health services, oral health and vision coverage for children and an out-of-pocket spending limit for individuals and families. One of the options that would be available at the Health Insurance Exchange is a public health insurance option. The goal of the public health insurance option is that it will be self-sustaining, meaning that it will befinanced only by its premiums. H.R. 3200 is not clear on how this goal will be achieved. Private insurance companies would be prohibited from denying health insurance coverage due to an individual's health status. Coverage would no longer be able to be excluded due to a pre-existing health condition. H.R. 3200 would also limit insurance companies' ability to charge higher rates due to health status, gender, or other factors. Premiums could only vary based on age, geography and family size. H.R. 3200 includes a broadly worded provision that prohibits insurance companies from discriminating based on "personal characteristics extraneous to the provision of high quality health care or related services."
Affordability
Low and moderate-income individuals and families would receive credits to assist in the purchase price of health insurance. The decline with income is completely phased out when income reaches 400 percent of the federal poverty level, $43,000 for an individual or $88,000 for a family of four. The Health Insurance Exchange would administer the credits along with other federal and state entities. All new policies would have a cap on annual out-of pocket spending. H.R. 3200 operates on the belief that the Health Insurance Exchange and a public health insurance option would create increased competition that would spur efficiency and transparency. Medicaid would be expanded and the expansion would be federally financed. H.R. 3200 is unclear on how the financing for this fully funded expansion would be made. The bill also seeks to improve issues with Medicare by eliminating cost-sharing for preventive services, improving the low-income subsidy program, and fixing physician payments.
Shared Responsibility
H.R. 3200, if enacted into law, would share responsibility for providing affordable coverage of essential health benefits between individuals, employers, and the government. Individuals would be responsible for obtaining and maintaining health insurance coverage. Individuals that choose not to do so would be obligated to pay a penalty of 2.5 percent of modified adjusted gross income above a specified level. Employers would have the option of providing health insurance coverage for their workers or contributing funds on their behalf. Employers with annual payrolls above $400,000 would have to contribute an amount based on eight percent of their payroll if they choose not to provide coverage. Employers that choose to offer coverage must meet minimum benefit requirements. The government would be given the broad responsibility to ensure that every American can afford quality health insurance.
If passed into law, all aspects of this bill would not immediately be put into place. Instead, the bill would not have its most substantial provisions in place until 2013. Below is a timeline with some of the key dates.
2010
A Health Benefits Advisory Committee would be established. The Committee would be led by the surgeon general and charged with the task of recommending a basic benefits package.
2011
The benefits package recommended by the Health Benefits Advisory Committee would be adopted by the Health and Human Services Department. An increased tax would be levied on upper-income earners. The increased tax would be one percent of modified adjusted gross income exceeding $350,000 going up to 5.4 percent on modified adjusted gross income exceeding $1,000,000.
2012
Low-income seniors would get additional financial assistance with Medicare prescription plans.
2013
The Health Insurance Exchange would open. A government sponsored plan would be available through the Health Insurance Exchange. All plans in the exchange would offer at least basic minimum coverage. Individuals would be required to obtain coverage and employers would be required to offer coverage or face financial penalties. Restrictions would be placed on private insurance companies regarding discrimination and rate increases.
H.R. 3200 is not close to becoming law. This bill will continue to be hotly debated and changed many times before the Senate even votes on it. The bill and the idea of healthcare reform is a large undertaking with many important provisions that were not mentioned in this article. This article is intended as a brief summary of some aspects of H.R. 3200 and the current attempt at healthcare reform. Hopefully this article will be used as a starting point to facilitate discussion on this topic.
The following links were used and relied on heavily in preparation of this article:
http://energycommerce.house.gov/Press_111/20090714/aahca.pdf
http://energycommerce.house.gov/Press_111/20090619/healthcarereform_summary.pdf
http://www.msnbc.msn.com/id/32013032/ns/politics-white_house/
http://www.mag.org/pdfs/hr3200_summary_final_080709.pdf