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A few notes on the House “Affordable Health Care for America Act”

Many media outlets have hit the highlights of the House health care bill unveiled yesterday, so I want to point out a few interesting tidbits as I’m reading through the bill.

The legislation is posted online, by the way, well before any scheduled floor vote.

One great item is the immediate help the health care bill will provide to uninsured individuals and families. It would establish a national high risk pool — or contract with organizations like Inclusive Health, our state’s high risk pool — to immediately provide health insurance.

To qualify individuals must have gone 6-months without health insurance, not including COBRA, or have insurance coverage that is more expensive than is available in the risk pool.

Many of the insurance market reforms would also apply. You could not be denied coverage for age or medical history. Premiums can vary according to age but not by more than 2 to 1. Maximum out-of-pocket limits are set at $5,000 for an individual and $10,000 for a family. No lifetime limits are allowed.

If the House bill passes enrollment in the high risk pools will begin Jan. 1, 2010.

Most reporters covering the roll out of the bill noted that the “robust” public option was excluded. A public option that ties provider reimbursement rates to Medicare is no longer in any bill, which effectively kills the idea for now. There are still reasons for including a public option and the objections — especially the objections from insurance companies — are now moot.

Reimbursing providers a bit more than Medicare would have made the public option affordable compared to private insurance. It would have forced private insurance companies to compete on services and benefits while maintaining reasonable premiums. By paying negotiated rates Congress is ditching an important tool for reforming our health care system.

Another interesting policy is the prohibition against mandating abortion as part of a minimum benefits package. One concern raised by anti-abortion activists this summer was that health reform would mandate abortions. The worry was that when the Department of Health & Human Services set standards for what insurance companies must cover it would require the inclusion of abortion services. The House bill ensures that some insurance policies will cover abortions and some will not.

So how will the minimum benefit levels be set? HHS will survey the benefits covered by employer-sponsored plans to create a reasonable and comprehensive package.

The House bill includes an employer-mandate to provide coverage to employees. Businesses with payrolls in excess of $500,000 are exempt. Businesses with annual payrolls in excess of $750,000 that do not provide insurance would pay the full penalty of 6 percent of payroll. Almost all businesses with payrolls of $500,000 or more currently provide health coverage.

Additionally, the House bill asks HHS to complete a small business hardship study. If the employer-mandate is particularly onerous on some types of businesses then Congress will consider enacting a hardship exemption.

The final surprising note I will add is that that House bill expands Medicaid to 150 percent of the federal poverty level. Most thought Congress would set the rate at 133 percent of poverty. The increase is a welcome change that will give more low-income families immediate access to coverage.

One Comment


  1. hsr0601

    November 1, 2009 at 12:35 am

    I realize the unique innovation of a pay for value program and IT infrastructure combined is destined to turn the volume into high-end service and call into competition for quality in both public and private arena.

    For that reason, I still think a robust public option is intact and sound.

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