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House Approves Health Care Reform Bill

On November 7, the House passed, 220-215, H.R. 3962, the Affordable Health Care for America Act, after rejecting, 187-247, a motion to recommit by Rep. Eric Cantor (R-VA) to address medical malpractice liability. The bill incorporates aspects of H.R. 3200, the America’s Affordable Health Care Act passed by the Education and Labor, Energy and Commerce, and Ways and Means Committees. The Education and Labor and Ways and Means Committees passed their respective portions of H.R. 3200 on July 17 (see The Source, 7/17/09), while the Energy and Commerce Committee approved its portion of H.R. 3200 on July 31 (see The Source, 7/31/09).

The bill would establish a health insurance exchange from which employers and individuals who are not covered by their employer could purchase insurance coverage. The bill also would establish a public health insurance option within the exchange. Insurance companies would be prohibited from denying coverage to individuals with pre-existing health conditions and from considering domestic violence as a pre-existing health condition.

Individuals would be required to purchase and maintain health insurance for themselves and their families. Those who do not obtain insurance or a hardship waiver would be assessed a penalty equal to 2.5 percent of their modified adjusted gross income. Employers would have the option of covering their employees or contributing funds on their behalf. Employers whose payroll is less than $500,000 would be exempt from this provision.

Essential Benefits Package

According to a section-by-section summary of the bill, H.R. 3962 would require qualified plans within the exchange to meet benefits standards recommended by the Benefits Advisory Committee and adopted by the secretary of Health and Human Services (HHS). Plans outside of the exchange would be required to provide an “essential benefits package.” The benefits package would prohibit cost sharing for preventive care, including well baby, well child care, and mammograms; cap annual out-of-pocket expenses at $5,000 for individuals and $10,000 for families; and include coverage for domestic violence assessment and counseling as part of an individual’s behavioral health or primary care visits. The essential benefits package would include coverage of maternity services; plans outside of the exchange soon would be required to do so as well.

The bill clarifies that it would not preempt state laws pertaining to abortion or change existing federal laws regarding “conscience protections, willingness or refusal to provide abortion, and discrimination on the basis of such willingness or refusal.” Federal, state, and local agencies would be prohibited from discriminating against a provider on the basis of whether she or he provides coverage or refers for abortion services.

During consideration of the bill, the House adopted, 240-194, an amendment by Rep. Bart Stupak (D-MI) to prohibit federal funding to pay for abortion services or cover the costs of insurance plans that include abortion coverage, except in cases of rape, incest, or to protect the life of the mother, and strike provisions in the bill that would have allowed coverage for abortion services in the public option.

The amendment permits individuals in the exchange who receive affordability credits to use their own money to purchase abortion-only riders that cover such services. However, such individuals would be prohibited from purchasing a comprehensive insurance plan that includes abortion services. Individuals in the exchange who do not receive federal subsidies would be able to purchase comprehensive plans that include abortion services. The amendment also clarifies that private insurance plans outside of the exchange still could provide abortion coverage.

Medicaid and the Children’s Health Insurance Program

States would be required to cover non-disabled, childless adults under age 65 who are not eligible for Medicare and have incomes at or below 150 percent of the federal poverty line (FPL) ($16,200 annually for an individual). The federal government would pay 100 percent of the costs of such coverage in 2013 and 2014 and 91 percent in 2015 and beyond.

Children, parents, and individuals with disabilities with incomes at or below 150 percent of the FPL ($33,100 for a family of four) also would be covered, with the federal government paying 100 percent of the costs in 2013 and 2015 and 91 percent in 2015 and beyond. Newborns would be covered up to their first 60 days of life if they are not otherwise covered at birth.

The Affordable Health Care for America Act also would appropriate $40 million for FY2010-2015 to develop measures for the quality of maternity care and other adult care and would authorize $1.235 billion to establish a five-year pilot program to test the medical home concept with Medicaid beneficiaries, including high-risk pregnant women and “medically fragile” children.

States would have the option of providing coverage for home visits to families with a first-time pregnant women or a child under the age of two who is eligible for Medicaid, for family planning services and supplies for low-income women who are not pregnant, and for free-standing birth centers. States would be prohibited from denying coverage for tobacco cessation products.

Other Provisions

The bill would provide increased funding for community health centers by an additional $12 billion over FY2011-2015 and establish a new program to reduce teen pregnancy and sexually transmitted infections.

The bill would reauthorize $70 million in FY2011, $73 million in FY2012, $77 million in FY2013, $81 million in FY2014, and $85 million in FY2015 for the Centers for Disease Control and Prevention’s WISEWOMAN (Well–Integrated Screening and Evaluation for Women Across the Nation) program. The program provides low-income, under- or uninsured women age 40-64 with “the knowledge, skills, and opportunities to improve diet, physical activity, and other lifestyle behaviors to prevent, delay, and control cardiovascular and other chronic diseases.”

The secretary would be encouraged to “expand” and “intensify activities on postpartum conditions,” such as research, epidemiological studies, screening and diagnostic testing, as well as education and information programs. The secretary also would be required to study the benefits of screening for postpartum conditions.

The measure would codify the Office on Women’s Health within HHS, as well as in the director’s offices of the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention, Food and Drug Administration, and the Substance Abuse and Mental Health Services Administration.

The bill also contains provisions to reauthorize the Indian Health Care Improvement Act (P.L. 94-437). The House Energy and Commerce Subcommittee on Health held a hearing on its reauthorization on October 20 (see The Source, 10/23/09).

Other provisions also include insurance coverage for family therapy and marriage counseling services, increased reimbursement rates for nurse-midwives, coverage for culturally and linguistically appropriate medical services, and a pilot program to reduce infant mortality, authorized at $10 million annually for FY2011-2015.

The House rejected, 176-258, a substitute amendment by Republican Leader John Boehner (R-OH) to provide $15 billion for FY2010-2019 and $10 billion for FY2015-2019 to require states to establish a high-risk pool or reinsurance programs in order to guarantee “that all Americans have access to affordable health care,” regardless of pre-existing conditions. Among other provisions, the Boehner amendment would codify the Hyde amendment, which prohibits federal funds from being used to pay for abortion; permit individuals to purchase insurance plans across state lines; and allow small businesses to pool together their resources in order to provide their employees with health insurance.

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