The following is a summary of the House’s revised “America’s Affordable Health Choices Act” as compiled by SIIA’s Government Relations Staff:

 · Insurance Market Reforms (applicable to self-insured plans):

· Prohibits the application of preexisting conditions

· Guaranteed issue

· Rating rules

· Minimum government-defined “essential” benefits package

· Prohibition of cost-sharing for preventative services

· Requiring fair marketing practices

· Requiring fair grievance and appeals mechanisms

· Requiring information transparency and plan disclosure

· Timely payment of claims

· National Health Insurance Exchange:

· National insurance exchange comprised of government-run and private plans

· Open to all individuals and eventually all businesses

· Plans required to offer government-mandated benefits

· Government-Run Insurance Plan:

· Government-run and subsidized plan as a National Exchange option

· Provide government-mandated benefits

· Tax-payer subsidized funding for initial administrative costs – advantage over private plans

· Governmentally “negotiated” provider reimbursement rates – likely still significantly lower than what private plans would be charged

· Individual Coverage Mandate:

· Individuals required to obtain government-approved healthcare coverage

· Non-compliance penalty – 2.5% of income

· Employer Coverage Mandate:

· Mandates that employers offer their employees healthcare coverage – full-time and part-time employees

· Government-defined “acceptable coverage”

· Mandates minimum premium cost-sharing – 72.5% for individual coverage, 65% for family coverage

· Non-compliance penalty – up to 6% of payroll for businesses under $750,000 in payroll, 8% for businesses above $750,000 in payroll

· Amends ERISA to require the Secretary of Labor to conduct regular plan audits and “conduct investigations” to “discover non-compliance” with the mandate

· Subsidies:

· Provides for subsidies for low-income workers and small businesses

· Subsidies only allowed to be used to purchase coverage through the exchange

· Partial repeal of anti-trust exemption for commercial insurance companies:

· Commercial insurance carriers could be prosecuted for “price-fixing, bid-rigging or market allocations”

· Creation of CO-OPs

· State-based

· Non-profit

· Self-sustaining

· Tax on Self-Insured Health Plans:

· Per-capita tax on all self-insured health plans to fund the proposed Comparative Effectiveness Research Trust Fund – A government-controlled entity tasked with determining what treatments are not acceptable for insurance coverage

· Mandated Self-Insurance Health Plan Study to Determine:

· Types of employers by characteristics that self-insure verses full-insure

· The similarities and differences between self-insured and fully-insured plans

· The financial solvency and reserve levels of self-insured plans

· The risk of self-insured plans not being able to pay obligations

· Rating rules that encourage adverse selection or encourage small and mid-size employers to self-insure

· Requires a report to be submitted by the newly-created Health Choices Commissioner to make RECOMMENDATIONS TO ENSURE AGAINST INCENTIVES FOR SMALL AND MID-SIZE EMPLOYERS TO SELF-INSURE

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This entry was posted by Adam V. Russo on Thursday, October 29th, 2009 at 4:27 pm and is filed under Health Care Legislation. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.