Wednesday, November 4, 2009

Summary of Title III-Subtile A of House Health Bill

Subtitle A—Health Insurance Exchange

Sec. 301. Establishment of Health Insurance Exchange; outline of duties; definitions. Creates a Health Insurance Exchange with the Heath Choices Administration.

Sec. 302. Exchange-eligible individuals and employers. Specifies who is eligible to obtain insurance through the exchange. There is a three year transition period. The first year of the program will be 2013. In that year, individuals without health insurance through an employer will have access to the exchange along with the smallest employers (employers with 25 or less employees.) In 2014, the exchange is expanded to add in employers with 50 or less employees. In 2015 and beyond, the exchange is further expanded to in the larger employers – employers with more than 50 employees.

The section goes on to outline the health benefits programs that will be available on the exchange:
•Qualified health benefits plans, as discussed in earlier.
•Grandfathered programs (programs already in existence prior to the start of the health exchange as discussed in the post covering Title II.
•Part A of Medicare
•Health coverage given to members of the armed forces
•Veterans Administration coverage
•Other coverage such as state high risk pools, so long as they are approved by the Commissioner

Sec. 303. Benefits package levels. Specifies four levels of plans that can be offered in the Exchange: Basic, Enhanced, Premium and Premium Plus. The first three differ in that each additional level lowers cost sharing. The Premium Plus plan offers additional benefits such as dental and vision. The Commissioner oversees the plans offered and must approval future premium increases.

Sec. 304. Contracts for the offering of Exchange-participating health benefits
plans. The Commissioner is given authority to enter into contracts with insurance companies to offer plans in the Exchange. He can also enter into a contract under this subsection with a QHBP offering entity for the offering of health benefits plan with the same benefits in every State so long as such entity is licensed to offer such plan in each State and the benefits meet the applicable requirements in each such State. This would allow insurance companies to sell plans across state lines, i.e., nationally.

Sec. 305. Outreach and enrollment of Exchange-eligible individuals and employers
in Exchange-participating health benefits plan and Sec. 306. Other functions. Allows the Commissioner to advertise the Exchange, define the enrollment process, create enrollment periods and so on. Largely technical.

Sec. 307. Health Insurance Exchange Trust Fund. Establishes a Trust Fund to pay for operation of the Exchange. The Trust Fund is funded from fines/taxes levied on people and companies who fail to meet the requirements of the health insurance mandates for coverage This includes the penalties paid by people who fail to get coverage (mandated coverage), employment taxes levied against companies who elect not to provide health coverage when they are obligated under this law to do so, and certain excise taxes levied against those who fail to meet certain health coverage requirements. These taxes and penalties will be collected by the IRS, and used to reduce the amount the federal treasury has to give the health exchange to operate.

Sec. 308. Optional operation of State-based health insurance exchanges. A state or group of states can set up their own Exchanges with approval of the Commissioner. It a state or group of states set up their own Exchanges, they will not have to participate in the national exchange.

Sec. 309. Interstate health insurance compacts. Effective January 1, 2015, 2 or more States may form Health Care Choice Compacts to facilitate the purchase of individual health insurance coverage across State lines.

Sec. 310. Health insurance cooperatives. Not later than 6 months after 15 the date of the enactment of this Act, the Commissioner, 16 in consultation with the Secretary of the Treasury, shall establish a Consumer Operated and Oriented Plan program under which the Commissioner may make grants and loans for the establishment and initial operation of not-for-profit, member–run health insurance cooperatives that provide insurance through the Health Insurance Exchange or a State-based Health Insurance Exchange

Sec. 311. Retention of DOD and VA authority. This section does not affect DOD or VA authority over armed forces and veterans health plans.

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