Summary & Analysis of H.R.3200 - America's Affordable Health Choices Act of 2009

What I have thus far... a work in progress...



1. Insurer can't vary the premium with/in a risk group
[Title 1, Sub A, Section 102.a.3]
--> and that means..?

2. Terms & Conditions cannot change
-This only applies to the transition period
[Title 1, Sub A, section 102.a.2]

3. Pre-exisiting medical condition exclusions are prohibited
[Title 1, Sub B, Section 111]

4. Insured plans are guaranteed renewal
[Title 1, Sub B, Section 112]

5. Insurance Rate Rules
Rates may vary by age [2x lowest], by area, and family composition
[Title 1, Sub B, Section 113.a.1-3]

6. Nondiscrimination
In all bemefits. Mental Health & Substance abuse shall be offered to all based on marketplace rules.
This means that coverage must be equal to that of their competitor's.
[Title 1, Sub B, Section 114.a&b]

7. Choice of Coverage:
Non-Exchange-Participating Health Benefits Plans
Exchange-Participating Health Benefits Plans
Continuation of Offering of Seperate Excepted Benefits Coverage
[Tital 1, Sub C, Section 121.b.1-3]

8. Essential Benefits Package Defined
-Provides payment for medical items
-Limits cost-sharing for items
-Does impose annual/lifetime limited coverage
-Is equivalent to average employer-sponsored coverage
[Title 1, Sub C, Section 122.a.1-5]

9. Minimum Services
-Hospitalization
-Outpatient Hospital Clinical Services
-Medical professionals coverage
-Necessary services, equipment, & supplies
-Prescription drugs
-Rehabilitation
-Preventitve Services (vaccines) recommended w/ Grade A or B
-Maternity care
-Baby & childcare, vision, hearing, & related items
[Title, Sub C, Section 122.b.1-10]

10. Cost-sharing & Minimum Actuarial Value
-No Cost-sharing for preventive services
-Annual Limitation
---$5,000 for an individual, $10,000 for a family
(to be raised according to the CPI to the nearest $100)
---Copayments for all plan levels are preferable to coinsurance
-Minimum Actuarial Value
---Insurance to cover apporximately 70% of the full actuarial value of provided benefits
[Title 1, Sub C, Section 122.2c-3b]

11. Health Benefits Advisory Committee
-To recommend covered benefits & essential, enhanced premium plans
-Chair shall be the Surgeon General
-Membership:
- 9 members who are not Federal Employees nor appointed by POTUS
- 9 members appointed by the Comptroller General in a process similiar to the Medicare Payment Advisory Commission
- As many members, not to exceed 8, who are Federal employees as POTUS appoints
-Terms:
- 3-year, staggard terms
-Participation:
- Membership reflects providers, consumers, employers, labor, insurers, exports in finance, counter-discrimination experts, disability reps, relevant gov't agencies, @ < 1 practicing physician or health expert/child health issues
-Duties:
-Recomendations on Benefits, etc
-Begin offering recomendations 1 year after passage, or earlier
-Public input= Advisory Committee to allow input

[Title 1, Sub C, Section 123.a1-5 through b4]

12. Levels of Cost-sharing:
-Enhanced Plan: 85% of value
-Premium Plan: 95% of value
[Title 1, Sub C, Section 123.b5.a-b]

13.