skip to main content

Senate Begins Debate on Health Care Reform Bill

This week, the Senate began its consideration of H.R. 3590, the Patient Protection and Affordable Care Act. The House passed H.R. 3962, the Affordable Health Care for America Act on November 7 (see The Source, 11/6/09).

Sponsored by Sen. Harry Reid (D-NV), the bill is intended to provide all Americans with access to quality, affordable health care while reducing health care costs. Click here for a detailed summary of H.R. 3590 and here for a section-by-section analysis of the bill.

According to the detailed summary, the measure would provide up to $5 billion to establish a temporary insurance program for uninsured individuals with pre-existing health conditions. By 2014, states would establish health benefit exchanges to help individuals and small businesses obtain insurance coverage. Tax credits to purchase insurance coverage would be available to individuals with incomes between 100 and 400 percent of the federal poverty line ($22,050 for a family of four in 2009). Details on how the tax credits would be calculated can be found on p. 2 of the detailed summary. In order to qualify for such a tax credit, individuals would have to be ineligible for employer-provided insurance or any form of public insurance coverage.

The American Health Benefit Exchange program would replace the temporary insurance program once it is operational in 2014. The exchange would prohibit insurance companies from denying coverage to individuals because of evidence of domestic violence, genetic information, and other pre-existing health conditions.

By 2014, individuals would be required to maintain health insurance or otherwise pay a penalty of $95 in 2014, $350 in 2015, $750 in 2016, and indexed after 2016. For individuals under age 18, the penalty would be one-half the amount for adults. “Religious objectors, those who cannot afford coverage, taxpayers with incomes less than 100 percent of the federal poverty line (FPL) [$44,100 for a family of four], Indian tribe members, those who receive a hardship waiver, individuals not lawfully present, incarcerated individuals, and those not covered for less than three months” would be exempt from this requirement.

Employers with more than 200 employees would be required to provide their employees with insurance coverage. Employers that have at least 50 employees and do not provide coverage but have at least one employee who receives an affordability tax credit would have to pay $750 per full time employee.

The bill would authorize the secretary of the Department of Health and Human Services (HHS) to create a national public option insurance program, the Community Health Insurance Option. However, the Senate bill, unlike its House counterpart, would allow states to opt out of the public option. The bill also would permit states to expand eligibility for Medicaid as early as January 2001. Children, parents, and childless adults who currently are not eligible for Medicaid but have family incomes up to 133 percent of the FPL would be eligible for Medicaid beginning in January 2014.

The Senate bill also contains an essential benefits package, which would require all insurance plans to cover preventive services and immunizations recommended by the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention, as well as certain services for children recommended by the Health Resources and Services Administration.

Abortion

Under the bill, abortion would not be a mandated benefit within the essential benefits package. Instead, health plans would determine whether to cover no abortions, abortions only in the instances of rape, incest, or to protect the life of the mother, or to cover all abortion services. In any case, the secretary would not be permitted to provide coverage for abortions other than those allowed by the Hyde amendment in the public option unless the “secretary 1) is in compliance with provisions prohibiting the use of federal funds to pay for abortions (beyond those allowed by [the] Hyde [amendment]); 2) guarantees that, according to three different accounting standards, no federal funds will be used; 3) and takes necessary steps to ensure that the United States does not bear the insurance risk for abortions that do not meet the Hyde exceptions in the public plan.” The bill would require that abortions currently permitted by the Hyde amendment be covered in the public option to the same extent they are under Medicaid.

The secretary also would ensure that each state exchange would have at least one plan that provides coverage beyond the restrictions placed by the Hyde amendment and at least one plan that does not provide coverage beyond the Hyde amendment. Affordability tax credits or cost-sharing credits could not be used to pay for abortions beyond those permitted by the Hyde amendment.

Maternal and Child Health Provisions

The measure would provide funding to states, tribes, and territories to develop and implement material, infant, and early childhood visitation models targeted at reducing infant and maternal mortality.

In addition, support services for women suffering from postpartum depression and psychosis, as well as for research into the causes, diagnoses, and treatment of postpartum depression and psychosis would be provided.

The legislation would provide $75 million annually through FY2014 for Personal Responsibility Education grants for programs to educate adolescents about abstinence and contraception, innovative teen pregnancy prevention programs for high-risk, vulnerable, and culturally underrepresented populations, grants to Indian tribes and tribal organizations, and research, training, and technical assistance.

The bill would restore $50 million annually through FY2014 for abstinence education.

Other Provisions

The Patient Protection and Affordability Care Act also would authorize new programs to increase access to preventive care and services. Such services would include, among other provisions, requiring Medicaid coverage of smoking cessation programs for pregnant women.

Services provided by free-standing birth centers would be covered under H.R. 3590. States also would have the option of covering family planning services and supplies, including medical diagnostic and treatment services.

The bill also would establish offices on women’s health at various federal agencies “to improve prevention, treatment, and research for women in health programs” and would amend the Fair Labor Standards Act (P.L. 75-718) to require employers to provide time and a place for breastfeeding mothers to express milk. Employers with fewer than 50 employees would be exempt from this requirement.

Amendments

The Senate adopted, 61-39, an amendment by Sen. Barbara Mikulski (D-MD) to provide access to preventive services for women by eliminating or minimizing copayments and high deductibles for services, such as mammograms, Pap smears, and screenings for colorectal cancers. An amendment by Sen. David Vitter (R-LA) to prevent the U.S. Preventive Services Task Force recommendations on breast cancer screening from restricting women’s access to mammograms was incorporated into Sen. Mikulski’s amendment, by unanimous consent.

The Senate is expected to continue its consideration of the measure next week.