A summary of HR 3200

America's Affordable Health Choices Act of 2009

Introduction

This is Fifth Freedom’s summary of HR 3200, America's Affordable Health Choices Act of 2009. While there are other health care reform bills beingdiscussed, HR 3200 is the one that has been the focus of the majority of the debate, both inCongress and in the media. Unfortunately, as the bill is very long, many people debating its merits have never actually read it. So, in an attempt to explain the content of the bill and the intent of Congress, we have created this brief, nonpartisan summary. The only way to have intelligent, honest debate is to examine the actual facts.

Pleasenote that this bill is over 1,000 pages of very complex text. If asection of this summary is of interest to you, you may wish to refer to the original bill toread the complete text. You can read any section of the bill at Thomas.gov. If you are interested in this issue, you may wish to contact your representatives in Congress with your opinion. You can locate your representatives’ contact information here.

Also,it should be noted that Fifth Freedom is a not-for-profitorganization that strives at all times to be non-partisan. FifthFreedom takes no official position on health care reform. Thisdocument is provided for information purposes only, and does notexpress or imply support for any particular political party,politician, candidate for office, or piece of legislation.

This summary is also available as a .pdf file, which you can download by clicking here.

America'sAffordable Health Choices Act of 2009

Sponsor:Representative John Dingell [D-MI]

Co-Sponsors:Representatives Robert Andrews [D-NJ], Dale Kildee [D-MI], CarolynMaloney [D-NY], George Miller [D-CA], Frank Pallone [D-NJ], CharlesRangel [D-NY], Fortney Stark [D-CA], Henry Waxman [D-CA]

Purposes:

Thisbill is not designed to create a single-payer health care system. Itwill not transform American health care into a Canadian or Britishsystem. Rather, it would reform the current system by attempting tomake health insurance and health care in general more affordable.

Thisbill…

1. Establishes a mandate (mandatory order or requirement) for most legalUnited States residents to have heath insurance.


2. Prohibits pre-existing condition exclusions.


3. Prohibits charging different premiums, except for reasons of age,geographic area, or family vs. individual plans.


4. Prohibits cancellation of coverage except for evidence of fraud.


5. Limits annual out-of-pocket expenses to $5,000 per year for anindividual and $10,000 per year for a family.


6. Includes a public health insurance option to compete with privateinsurance.


7. Establishes a Health Insurance Exchange (HIE) within a proposedHealth Choices Administration, to provide individuals and employersaccess to health insurance coverage choices. The HIE would contractwith various insurers to offer benefit plans at competitive prices,by establishing a risk-pooling mechanism. This will allowindividuals and small companies to band together to bargain for lowerrates.


8. Provides a tax credit for low-income individuals and families to helppay insurance premiums.


9. Requires employers with payroll costs over $250,000 that are usingthe HIE to provide health insurance.


10. Provides for a tax on individuals without health insurance andemployers that do not provide the required health insurance.


11. Provides for a tax on individuals with adjusted gross incomeexceeding $350,000.


12. Reduces Medicare payments to hospitals with excessive re-admissions.


13. Establishes a Center for Comparative Effectiveness Research, whichwould analyze cost variances for similar treatments across thecountry.


14. Further expands Medicaid eligibility and scope of covered preventiveservices, for lower-income individuals and families.


15. Increases Medicaid payments to physicians for primary care.


16. Requires the Secretary of Health and Human Services (HHS) to developquality measures for the delivery of health care services in theUnited States.


17. Establishes the Health Benefits Advisory Committee chaired by theSurgeon General.

DIVISIONA

TitleI

Oldindividual insurance plans will be “grandfathered” in –If you want to keep your old individual plan and its terms, you can. After five years, all new plans must comply with the terms in thisbill, which includes participating in the Health Insurance Exchangein Title II.

Theseterms include:

PROHIBITINGPRE-EXISTING CONDITION EXCLUSIONS.

Aqualified health benefits plan may not impose any pre-existingcondition or otherwise impose any limit or condition on the coverageunder the plan with respect to an individual or dependent based onany health status-related factors in relation to the individual ordependent.

GUARANTEEDISSUE AND RENEWAL FOR INSURED PLANS.

Exceptfor cases of fraud or not paying premiums, insurers may not cancel aplan.

INSURANCERATING RULES.

Insurersmay only charge individuals different rates for premiums due to ageand geography. The youngest people covered under the plan may becharged no less than half as much as the oldest people covered underthe plan. Insurers may charge more for family plans than forindividual plans.

MINIMUMSERVICES TO BE COVERED.

• Hospitalization.

• Outpatient hospital and outpatient clinic services, including emergency department services.

• Professional services of physicians and other health professionals. (Includes fees related to services, supplies, office use, etc.)

• Prescription drugs.

• Rehabilitative and habilitative services.

• Mental health and substance use disorder services.

• Preventive services

• Maternity care.

• Well baby and well child care and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.

Copayments(“Cost Sharing”)

Costsharing shall be limited to $5000 a year for individuals and $10,000a year for families. There shall be no cost sharing for preventativecare, “well baby” care, and child care.

TitleII

Establishesthe “Health Insurance Exchange” (HIE). The HIE“facilitate[s] access of individuals and employers, through atransparent process, to a variety of choices of affordable, qualityhealth insurance coverage, including a public health insuranceoption.”

Defines“Acceptable Coverage” as one of the following:

1. QUALIFIED HEALTH BENEFITS PLAN COVERAGE- Coverage under aqualified health benefits plan as defined in Title I.
2. GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENTGROUP HEALTH PLAN- Coverage under a grandfathered health insurancecoverage or under a current group health plan.
3. MEDICARE
4. MEDICAID
5. MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE
6. VA- Coverage under the veteran’s health care program
7. OTHER COVERAGE- Such other health benefits coverage, such as aState health benefits risk pool, as the Commissioner, in coordinationwith the Secretary of the Treasury, recognizes for purposes of thisparagraph.

Individualswho do not obtain or purchase such “acceptable coverage”will pay fines.

TheCommissioner of the HIE establishes what benefits are available underall participating health insurance plans.

Individualsmaking less than 400% of the federal poverty level are eligible for“affordable premium credits,” assistance with insurancepremium fees. Individuals will have to pay a portion of the premiumequal to a percentage of their income, and the credits will pay thebalance.

Individualsmaking 150% or less of the federal poverty level (FPL) will have topay a portion of the premium equal to 3% of their income. Individuals making 350% to 400% of FPL will have to pay 11% of theirincome. (Forone person, FPL is $10,830. For two, $14,570. For family of four,$22,050. )

Eligibilityfor credits may be determined by state Medicaid offices. Individualsapplying for these credits will automatically be checked for Medicaideligibility. If they are eligible, they will be automaticallyenrolled instead of being given credits.

Establishesthe Public Health Insurance Option. Premiums will vary by the samerules for private insurance – geography, age, and individualvs. family plans. Two billion dollars is set aside for the firstyear’s insurance claims.

TitleIV

Moreon the taxes to be paid by individuals without “acceptablehealth care coverage.”

Ordainedministers will be exempt from these fines.

Ingeneral, employers will pay fines equal to 8% of their payrollfor not participating in health care coverage.

1. 1 percent of so much of the modified adjusted gross income of thetaxpayer as exceeds $350,000 but does not exceed $500,000
2. 1.5 percent of so much of the modified adjusted gross income of thetaxpayer as exceeds $500,000 but does not exceed $1,000,000, and
3. 5.4 percent of so much of the modified adjusted gross income of thetaxpayer as exceeds $1,000,000.

AfterDecember 31, 2012, this surcharge will double.

Clausescontaining exemptions for large corporations and foreigncorporations.

DIVISIONB – Medicaid and Medicare improvements

TitleI

Changesin Medicare Part D coverage limits and out-of-pocket thresholds toeliminate the “coverage gap”.

TitleII

Astudy will be conducted to examine how Medicare service providers uselanguage services, and the best ways to fund these services. This section appearsto exclude ASL. “The terms ‘interpreting’ and‘interpretation’ mean the transmission of a spokenmessage from one language into another”.

Medicarecoverage for meeting with your doctor once every 5 years to discuss“advanced care” – i.e., end of life planning. Includes discussing hospice care, living wills, etc. This appearsto be the section that has people scared about euthanasia, but thereis no mention of it here or anywhere else in the bill.

TitleIII

Establishmentand funding for the “medical home pilot program”,patient-centered, community-based medical care. After five years,outcomes will be evaluated, and the program may be re-funded.

Partialcoverage for mental health services, including individual therapy,and marriage counseling and family counseling.

Federalgovernment taking over the regulation of hospital construction andexpansion.

TitleIV

Establishesthe Center for Comparative Effectiveness Research, an organizationthat will research and compare the outcomes, effectiveness, andappropriateness of health care services and procedures.

Thegovernment at large will collect everyone’s health care datathrough this Center. However, dissemination of this research shall“not include any data that the dissemination of which wouldviolate the privacy of research participants”.

Importantly,the section notes that “Nothing in this section shall beconstrued to permit the Commission or the Center to mandate coverage,reimbursement, or other policies for any public or private payer.” This appears to mean that the Center has no authority to use itsresearch to dictate what kinds of services or treatments insurancecompanies must cover.

TitleVI

Adds$100 million in funding to the Social Security Administration for“fighting fraud and abuse”.

Createsnew and/or increases current penalties for submitting falseinformation in provider applications, private claims, Medicaremarketing violations, and other areas.

TitleVII

Increasesthe number of people eligible for Medicaid.

Bigreductions in Medicaid DSH payments - Total Federal payments to allStates reduced by $1,500,000,000 in fiscal year 2017, $2,500,000,000in fiscal year 2018, and $6,000,000,000 in fiscal year 2019.

Reducespayments to hospitals for readmissions.

Eliminationof Medicare coverage gap by gradually increasing coverage limit anddecreasing out-of-pocket spending.

Dropscoverage of stop smoking drugs from outpatient coverage.

Coveragefor family planning services, except for individuals who arepregnant. This appears to mean that there will be no federal fundingfor abortions.

TitleVIII

Setsaside $300 million for 2010-12 for the Health Care ComparativeEffectiveness Research Trust Fund, and $375 million for each yearthereafter. For 2013 and after, this shall be covered by anadditional tax of $2.00 per year per person.

Establishesa tax on “plan sponsors” of self-insured health plans of$2.00 per year per person covered under the plan. “Plansponsor” refers to employers, employer organizations, etc.

The$2.00 per person is the default amount for the “fair share percapita” of the Health Comparative Effectiveness Research TrustFund’s expenses. Should these expenses be higher, theSecretary of Health and Human Services is assigned the job ofcalculating the new fair share per capita. This calculation will bemade using the health care figures from the Consumer Price Index.

TitleIX

Removessome provisions from the Social Security Act related to the Trustees’annual report to the President, and presidential oversight ofMedicaid. The Trustees are no longer required to report thefinancial state of the Medicaid Trust Fund and its projected growthor shortfalls, and the President is no longer required to submitcorrective legislation to Congress in the event of a shortfall.

Establishesa program to administer and funding for “voluntary homevisitation for families with young children and families expectingchildren.” The program shall be designed to reduce child abuseand neglect, and to provide parents information about parentingtechniques and child development, etc.

DIVISIONC – Public Health and Workforce Development

TitleII

Establishesthe Public Health Investment Fund. This fund will be used to fundcommunity health centers, the National Health Service Corps Program,the National Health Service Corps Scholarship and Loan RepaymentPrograms, primary care loan funds, primary care education, nursingworkforce development, The National Center for Health Statistics, andThe Agency for Healthcare Research and Quality.

Individualswith student loan debt to medical school can get up to $50,000 repaidby joining the National Health Service Corps Program and serving 20hours a week for two years.

Establishesa similar loan repayment program, Frontline Health Providers LoanRepayment Program, for physicians working in underserved areas or inunderserved fields.

Establishesthe Public Health Workforce Scholarship Program. Individuals in medschool can sign a contract agreeing to serve full-time as a publichealth professional in the Corps for 2 years to get a full 4-yearscholarship.

TitleXXXI

(Thebill skips from Title 2 to Title 31. This must be an error at theGovernment Printing Office, as all sources are like this.)

Establishesand funds the Task Force on Clinical Preventive Services and the TaskForce on Community Preventive Services to research, makerecommendations regarding, and establish a national strategyregarding preventive medicine.

TitleIV

(It skips again)

Establishesand funds the Center for Quality Improvement to identify, develop,evaluate, and implement best practices in the delivery of healthcare.

TitleV

Limitshospitals’ use of group purchasing organizations to buymedications.

Createsa grant program to establish and fund School-Based Health Clinics(SBHC). Preference will be given to SBHCs that have been shown toserve “a high percentage of medically underserved children andadolescents, communities or populations in which children andadolescents have difficulty accessing health and mental healthservices, and communities with high percentages of children andadolescents who are uninsured, underinsured, or eligible formedical assistance under Federal or State health benefits programs. This appears to mean that Congress is predicting there will still besignificant numbers of uninsured people after the bill’sreforms become active.

Establishesand funds a national medical device registry to assist in analyzingthe safety and effectiveness of Class II medical devices that are“implantable, life-supporting, or life-sustaining,” andClass III medical devices.

Deviceclasses are defined in Sec. 513 of the Federal Food, Drug, andCosmetic Act. Class II devices are essentially medical devices thatthe FDA has approved for use, but has limited safety data concerningthem. Class III devices are in the pre-market approval stage becausethe FDA has even less safety data concerning them than they do ClassII devices.

TheRegistry will have access to each device’s “type, model,and serial number or other unique identifier,” and “claimsdata, patient survey data, standardized analytic files that allow forthe pooling and analysis of data from disparate data environments,electronic health records, and any other data deemed appropriate bythe Secretary” of Health and Human Services.

(Forexample, a patient gets a new kind of pacemaker implanted. TheRegistry tracks the patient’s medical data to determine howsafe and effective the new device is. If it works really well, thedevice gets moved up to Class I, which is a device that has beenproven highly effective and very safe. While the bill does containnumerous other provisions for tracking medical data, this appears to be the onlysection where that data would have to be linked to individual people.)

Thereis a rumor that this section of the bill mandates that all Americansreceive a “tracking chip” or some other device. There isnothing even close to that in this section.

Establishesand funds a grant program to award grants to create nursing educationprograms and to create “pipeline to nursing” programs tohelp ancillary health care workers advance their careers by becomingnurses. To be eligible for a grant, the organization must beadministered by a health care employer and a labor union representingthe health care employees. Non-union organizations will not beeligible for these grants.

Thefunds in the grants are to be used for programs that “provideeducation and training to establish nursing career ladders to educateincumbent health care workers to become nurses” and “assistnurses in obtaining advanced degrees and completing specialtytraining or certification programs and to establish incentives fornurses to assume nurse faculty positions on a part-time or full-timebasis.”

Programsmay involve “preparing incumbent workers to return to theclassroom through English-as-a-second language education, GEDeducation, pre-college counseling, college preparation classes, andsupport with entry level college classes that are a prerequisite tonursing.”

Finally,states may have federal health care funding withheld if they do notfollow the dictates of this bill, and force their politicalsubdivisions (counties, cities) to do the same.

FifthFreedom is a not-for-profit organization that strives at all times tobe non-partisan. The content of this document is provided forinformation purposes only, and does not express or imply support forany particular political party, politician, candidate for office, orpiece of legislation. Fifth Freedom takes no official positionregarding health care reform.