Today’s column begins my earnest attempt to unpack the specific components of H.R. 3200, the Majority’s 1,017 page health care legislation. As of today, this legislation has been cleared by the three committees of jurisdiction in the U.S. House of Representatives. Congress will be out of session for the month of August, and when we reconvene after Labor Day, I am hopeful that an engaged and informed public will have helped raise the level of discourse and debate on this critical issue.
I will set aside my editorial comment for a later date. Acknowledging the challenge of providing information that is both comprehensive yet digestible, I will likely exclude hundreds of specific provisions. I will include a number of parenthetical references to specific page numbers, which can be found in this most recent version of the legislative text.
Today’s column will attempt to summarize the first 71 pages of the legislation: the regulatory changes to the health insurance market. Here we go…
Regulatory changes to the private health insurance market; the creation of a national health insurance exchange; the creation of a public plan option; subsidies to help individuals pay for insurance; individual and employer mandates.
Numerous changes in the programs’ reimbursement rates, procedures covered, and eligibility requirements.
Increased funding for community health centers, workforce development, wellness programs, and a host of additional new initiatives.
Sections 101 & 102 (pages 14-19) – Sets new requirements for employment-based health plans and health insurance coverage, allowing for a five-year grace period for plans to adjust to the new standards set. Existing individual health insurance plans can be preserved, or “grandfathered” in, but the creation of any new insurance plan or changes to existing plans, must meet the standards established by this legislation.
Here are the coverage requirements for “qualified health benefit plans”:
- Sections 111 (19) – Qualified health benefit plans may not exclude an individual based on pre-existing conditions or an individual’s health status.
- Section 112 (20) – Individuals cannot be denied health insurance (requires “guaranteed issue”). Requires the renewal of insurance policies, and rescissions are “prohibited except in cases of fraud."
- Section 113 (21) – Limits the degree of variation on age, geographic area, and family size on premium rates charged.
- Section 114 (23) – Provides authority to the Health Choices Commissioner to set non-discrimination rules, and applies mental parity laws to qualified health benefit plans.
- Section 115 (24) – Qualified health benefit plans must meet provider network adequacy standards set by the Health Choices Commissioner
- Section 116 (24) – Qualified health benefit plans must meet a specified medical loss ratio as defined by the Health Choices Commissioner
Here are the benefit requirements for “qualified health benefit plans”:
- Sections 121 & 122 (25-30) – A newly established Benefits Advisory Committee will recommend a minimum benefit standard, to be adopted by the Secretary of Health and Human Services, which all qualified plans must adhere to. Any plan operating outside of the Exchange need to offer at least an essential benefits package consisting of ten categories of services: hospitalization; outpatient hospital and clinic services; physician services; durable medical equipment; prescription drugs; rehabilitative and habilitative services; mental health services; preventive services; maternity benefits; and well child care for children under 21 years old.
- Section 123 (30) – Establishes a “Health Benefits Advisory Committee to recommend covered benefits and essential, enhanced, and premium plans.” The Advisory Committee would be chaired by the Surgeon General and include members appointed by the President, the Comptroller General, and representatives of relevant federal agencies.
A number of consumer protections are listed in Sections 131 through 137, which would be established by the Health Choice Commissioner. These requirements include the following: uniform marketing standards by health insurers; grievance and appeals mechanisms; information transparency and plan disclosure; prompt claims payment; and more.
As discussed in the sections above, Section 141 (41) establishes “as an independent agency in the executive branch of the Government, a Health Choices Administration,” lead by a “Health Choices Commissioner who shall be appointed by the President, by and with the advice and consent of the Senate.”
According to Section 142 (42-46), The Health Choices Commissioner is tasked with the following primary functions: establishment of qualified plan standards, establishment and operation of the Health Insurance Exchange; administration of affordability credits; and additional functions as laid out within the bill. The Health Choice Commissioner is granted enforcement authority to impose sanctions and suspend enrollment of a plan.
There are a number of additional requirements and miscellaneous provisions in the final sections of Title I (49-71), including clarification that the bill does not supersede COBRA or HIPAA, unless their requirements prevent the application of one of the requirements above.
This concludes the summary of Title I of Division A of the legislation, bringing us to page 72 of the legislation. Next week, I will outline the rest of Title I, including the creation of the Health Insurance Exchange and the Public Health Insurance Option.
Congressman Paul Ryan serves Wisconsin’s 1st Congressional District. To contact him by phone in Washington, D.C., call (202) 225-3031. Or visit Paul Ryan at www.house.gov/ryan