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HR 3200 Is Now HR 3962

03 Nov

It’s already old news that Nancy Pelosi has introduced the House’s final version of health reform legislation. In fact, there’s plenty of buzz about the bill being voted upon this week. That should make an impression on the folks who like to go around muttering about how “Congress never gets anything done.”

The bill, HR 3962 is known as the “Affordable Health Care for Americans Act.” That sounds quaint. I’m sure there’s some faction of Americans out there who would act as though they prefer unaffordable health care, but I think they’re in the very small, stubbornly political minority. Still, before it goes voting on the thing, I figure that perhaps people would like to know just exactly what’s in the bill, especially because it’s now 1,900 pages long, while HR 3200 clocked in at a relatively meager 1,018 pages. Suffice it to say that the bill would do a lot of things, but here are the biggies that most people will care about:

  • Prohibits insurers from denying coverage on the basis of pre-existing conditions
  • Eliminates medical underwriting in favor of community (not experience) rating
  • Limits individuals’ out-of-pocket expenses
  • Eliminates annual and lifetime maximum benefit caps
  • Defines a minimum-level of “essential benefits” that all insurers must meet or exceed
  • Creates a national health insurance exchange to increase transparency and foster competition – this is how individuals would be able to buy affordable coverage, and it may be extended to small–and eventually even large–businesses.
  • Requires employers to “pay or play” (i.e., offer benefits to employees or pay a tax to support the public option) if their payroll exceeds $500,000 a year
  • Give small businesses tax credits if they offer their employees insurance
  • Require all individuals to have insurance coverage or pay a fine equal to 2.5% of their annual adjusted gross income, but not exceeding the average cost of a typical insurance policy
  • Will provide subsidies to low income individuals to help them buy insurance
  • Would extend Medicaid eligibility to all persons earning 150% of the poverty level or below (Current levels vary by state, tend to be much lower, and require individuals to belong to certain categories to be eligible–e.g., pregnant women, children, etc.)
  • Paid for in part by excise taxes on insurers and providers

There are also several pieces of the reform that are set to take place immediately upon passage of the act. This is notable, because previously, many of the most important provisions were not set to be implemented until 2013. In brief, these are the immediate “fixes” that would happen:

  • Insurers would be subject to a “medical loss ratio” of 85%
  • Insurers would be prohibited from the process of “rescission” without appropriate (i.e., fraudulent) cause as determined by a third-party reviewer (That means no more dropped policies because you misspelled something or failed to disclose something minor and unrelated to your current claim)
  • Pre-existing condition exclusions would be virtually eliminated
  • Lifetime benefit caps would be eliminated (Sparing thousands from medical bankruptcy)
  • Children could remain on parent’s insurance policies until age 26
  • COBRA coverage would be extended until the creation of the exchange in 2013
  • A high-risk pool for the uninsured would be created and operated until the exchange is created in 2013 and employers would be sanctioned for “dumping” their employees into this plan
  • Fixes to Medicare Part D would begin eliminating the so-called “donut hole”

Of course, there are many other things that HR 3962 would do, but this is a good start. If you have questions about any particular pieces of the legislation as outlined above, let me know, and I’ll devote a future post to that in much more detail.

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1 Comment

Posted by on November 3, 2009 in Uncategorized

 

One response to “HR 3200 Is Now HR 3962

  1. Michel

    October 3, 2013 at 7:57 pm

    What are the differences between HR 3200 and HR 3962? Please advise? Thank you

     

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