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Health Insurance Reforms in the House Version

House Poised to Debate Health Reform Bill Following Introduction of H.R. 3962

November 02, 2009

At an October 29 press conference, House leaders announced the release of legislative language for H.R. 3962, the “America’s Affordable Health Choices Act.” This 1,990-page bill is expected to be considered on the House floor late this week.

An AHIP statement on the House bill can be found by clicking here. While the precise timing of House floor action is uncertain, House leaders reaffirmed last week that, before voting on the bill, members will have 72 hours to review the legislative language and a yet-to-be-released manager’s amendment that will make additional changes. House Majority Leader Steny Hoyer (D-MD) said last Thursday that he expects the manager’s amendment to be released today and that the bill could be considered on the House floor as early as this Thursday. Over the past 24 hours, however, there have been indications that this timeframe is likely to be pushed back. Leader Hoyer has notified members that, if necessary, the House may be in session on the weekend of November 7-8 and on the following Monday and Tuesday.

The following are key elements of the House bill that was introduced last week:

Insurance Market Reforms (2010): Beginning in 2010, the following reforms would take effect:

  • an 85% minimum would be set for medical loss ratios, with rebates required for plans that do not meet this requirement;
  • rescissions would be allowed only when fraud occurs and would be subject to independent review;
  • plans would be required to justify premium increases in an annual review process that would be conducted by the HHS Secretary in conjunction with the states;
  • the “look-back” period that applies for purposes of determining whether a person has preexisting conditions would be reduced from six months to 30 days and the timeframe during which a plan can exclude coverage for the preexisting conditions of new enrollees would be reduced from 12 months to three months;
  • individuals through age 26 who are not otherwise covered would be allowed to remain on their parent’s health coverage at their parent’s discretion; and
  • lifetime limits would be prohibited.

Insurance Market Reforms (2013): Beginning in 2013, additional reforms would take effect: guaranteed issue and renewal, no preexisting condition exclusions, no premium variation based on health status or gender, and premium variation based only on age (no more than 2:1), geography, and family size.

Government-Run Plan: Beginning in 2013, a government-run health insurance plan would be established and offered through the newly created health insurance exchange. The Secretary would negotiate payment rates with health care providers. Medicare providers would be presumed to participate in the government plan unless they opt out.

Health Insurance Exchange: Individuals without coverage and small employers would be eligible to purchase coverage through a newly established health insurance exchange. The exchange would be administered by a Health Choices Commissioner who would have wide-ranging authority, including setting standards for participating plans, auditing and sanctioning participating plans, enforcing insurance market reforms, and collecting data for quality improvement and other activities.

Interstate Health Insurance Compacts: Beginning in 2015, two or more states could facilitate the purchase of individual health insurance coverage across state lines. The NAIC would develop model guidelines for the creation of such compacts.

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November 2, 2009 - Posted by | Federal Government, healthcare | , ,

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