H.R. 3200, Part I

There's a lot of bitching these days about health care. Most of it is the idiotic rambling of morons who couldn't pour piss out of a boot if the instructions were written on the heel. Some of it actually addresses concerns over cost, feasibility, and how such a program would operate. While the Senate continues to write their bill, the House already has one on hand, H.R. 3200. Many people are complaining that their Representatives haven't read the bill (ignore anyone claiming their Senator hasn't read H.R. 3200, they are a member of the group of above-mentioned morons), but many laypeople have not read the bill either. Well, for your convenience and education, I will be summarizing the ~1,040 page bill, in parts.

A BILL To provide affordable, quality health care for all Americans, and reduce the growth in health care spending, and for other purposes.

DIVISION A: Affordable Health Care Choices, Title I - Protections and Standards for Qualified Health Benefits Plans

Subtitle A - General Standards

Sec. 101: Requirement Reforming Health Insurance Marketplace
Upon the enforcment of the bill, in order for a plan to be a qualified it must meet requirements relating to affordability, essential benefits, and consumer protection. A person is enrolled in an employment-based plan if that person benefits or participates in a plan as defined by the Employee Retirement Income Security Act of 1974. Individual health insurance coverage and group health insurance coverage is defined by the Public Heath Service Act.

Sec. 102: Protecting the Choice to Keep Current Coverage
Insurance will be grandfathered in if the first day of coverage is not after this bill is enforced. Dependents may enroll into the grandfathered insurance plan after enforcement. The provider must not change any terms or conditions, and may not alter premiums unless such a change is made for all policy-holders in the same risk group at the same rate.

Employment-based plans in effect before enforcement have a five-year grace period to meet the requirements relating to affordability, essential benefits, and consumer protection. During the grace period, those plans will be considered acceptable. Exceptions to this include plans that adhere to section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009, excepted benefits in section 733(c) of the Employee Retirement Income Security Act of 1974, and other limited benefits as determined by a commission. However, any coverage that extends only to those exceptions will be regarded as unacceptable.

Individual coverage offered after enforcement may only be offered through the exchange-market program. Excepted benefits are not included in the definition of health care coverage, and need only be available in the exchange and offered at a separate price from insurance coverage.

Subtitle B - Standards Guaranteeing Access to Affordable Coverage

Sec. 111: Prohibiting Pre-Existing Condition Exclusions
Qualified plans may not impose any pre-existing condition exclusion. Limitation of coverage based on health-related factors is prohibited.

Sec. 112: Guaranteed Issue and Renewal for Insured Plans
Employers and individuals will be guaranteed availability and renewal of their plans unless payment of premiums have not been received. In that case, the issuer must notify the holder of lapsed payment and provide a grace period for the holder to make such payments. Coverage may not be cut off except in cases of fraud.

Sec. 113: Insurance Rating Rules
Premium rates for a qualified plan may not vary except in consideration of age, area, and family enrollment.

Health and Human Services and Labor will conduct a study of large-group insurance and self-insured employer markets. This study will examine what types of employers self-insure or use group insurance, the similarities and differences between those plans, how solvent those self-insured employers are, the risk of self-insured employers not being able to pay obligations, and the effect of rating rules in determining choice of insurance plan. This report will make recommendations to prevent adverse selection in insurance plans to the detriment of employees.

Sec. 114: Nondiscrimination in Benefits; Parity in Mental Health and Substance Abuse Disorder Benefits
Qualified plans may not discriminate in health benefit or benefit structures. Benefits dealing with mental illness or substance abuse disorders shall not be discriminated against either in the individual or large group market.

Sec. 115: Ensuring Adequacy of Provider Networks
Qualified plans using a provider network will meet standards to provide access to items and services and provide transparancy in the cost difference between in-network and out-of-network coverage.

Sec. 116: Ensuring Value and Lower Premiums
Qualified plans must meet a medical loss ratio as determined by the commission. Plans that do not meet set ratio in a year must offer rebates to their enrollees to meet that ratio. This ratio will be based on definitions and methodologies determined by HHS.


More later.