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Two House Committees Approve Health Care Reform Bill; Another Begins a Multiweek Mark-Up

This week, the House Education and Labor and Ways and Means Committees each approved versions of the America’s Affordable Health Choices Act of 2009 (H.R. 3200); the House Energy and Commerce Committee began its mark-up on July 16. The Senate Health, Education, Labor, and Pensions Committee approved its version of health care reform (as-yet-unnumbered) on July 15 (see The Source, 7/17/09).

Among other provisions, the bill would create a health insurance exchange (p. 72) where small business employers (10 or fewer employees in year one, 20 or fewer in year two) and individuals could compare and purchase a health insurance plan; among the available options, a public plan option would become available in 2013. All of the health insurance plans available through the health insurance exchange would be required to cover all individuals, regardless of health status, and would be prohibited from charging higher rates based on gender or preexisting conditions; premium costs could vary based on age, family size, and/or geographic location. With few exceptions, all individuals would be required to purchase health insurance. Likewise, all businesses would be required to provide health insurance for their employees or pay eight percent of payroll as a penalty; businesses with payrolls below $250,000 would be exempt from this requirement.

Families with incomes below 400 percent of the federal poverty line ($88,200 for a family of four in 2009) would be eligible for financial assistance to purchase health insurance coverage. Individuals and families with incomes at or below 133 percent of the federal poverty line ($29,327 for a family of four in 2009) would be eligible for Medicaid.

The bill would impose a health care surcharge on certain higher income households. Family households with incomes between $350,000 and $500,000 would be subject to a surcharge of one percent of income; those with incomes between $500,000 and $1 million would be subject to a surcharge of 1.5 percent of income, and families with earnings in excess of $1 million would be subject to a surtax of 5.4 percent.

A minimum package of benefits would be required of all health insurance plans participating in the health insurance exchange. All plans would be required to provide parity between mental health, substance abuse, and physical benefits. The bill would require insurance plans to cover preventive care that received an “A” or “B” rating in the current recommendations of the United States Preventive Services Task Force; maternity care; and well baby care and child care until age 21. The bill also would authorize $50 million for FY2010 and “such sums as may be necessary” for FY2011-2014 for school-based health clinics, with special emphasis on establishing such facilities in medically underserved areas.

The bill also would incorporate the provisions of H.R. 2667, the Early Support for Families Act (see The Source, 6/12/09). Section 1904 (p.838) of H.R. 3200 would provide $1.8 billion over 10 years for grants to states, tribes, and territories to establish or expand voluntary home visitation programs for pregnant women and for families with young children.

House Education and Labor Committee

On July 17, the House Education and Labor Committee approved, 26-22, H.R. 3200. The committee held a hearing on an earlier version of the bill on June 23 (see The Source, 6/26/09).  

During debate on the measure, the committee adopted, by voice vote, a manager’s amendment by Chair George Miller (D-CA) that would, among other provisions, create an employer wellness grant program to reward employers who establish or strengthen a workplace wellness program; prohibit insurance companies from changing the coverage or costs of a health plan mid-year, unless the costs are lowered and/or the coverage is increased; and allow families with health insurance costs in excess of 11 percent of family income to be eligible for financial assistance in purchasing health insurance through the health insurance exchange. 

On July 16, the committee adopted the following amendments:

l        an amendment by Rep. Dina Titus (D-NV) that would increase the size of small businesses that can choose to enter the health insurance exchange from 10 employees to 15 in the first year and 20 employees to 25 in the second year, 28-19;

l        an amendment by Rep. Bobby Scott (D-VA) that would expand coverage of healthy baby and child care to include early screening, diagnostic, and treatment services for children under 21 years old, 30-17; and

l        an amendment by Rep. Jared Polis (D-CO) to clarify data collection provisions to include sexual orientation, race, disability or socioeconomic status, language, and other geographic settings to be considered in studies of disparities in health care, by voice vote.

The same day, the committee defeated the following amendments:

l        an amendment by Rep. John Kline (R-MN) to strike the provisions related to a public health plan option, 15-28; and

l        an amendment by Rep. Peter Hoekstra (R-MI) to require that if the national unemployment rate equals or exceeds eight percent for two consecutive months, the employer mandate provisions would be automatically suspended, by voice vote.

House Ways and Means Committee

On July 17, the House Ways and Means Committee approved, 23-18, its version of H.R. 3200.

During debate on the measure, the committee adopted, by voice vote, a manager’s amendment by Chair Charlie Rangel (D-NY) that would, among other provisions, offset $8.2 billion over 10 years in new health care costs by discontinuing the use of tax-advantaged flexible spending accounts, health reimbursement accounts, and health savings accounts for purchasing over-the-counter medications.

The committee defeated the following amendments:

l        an amendment by Rep. Paul Ryan (R-WI) to eliminate the public plan option, 15-25;

l        an amendment by Rep. Dean Heller (R-NV) to require members of Congress and their dependents to enroll in the public plan option, 18-21;

l        an amendment by Rep. Wally Herger (R-CA) to prohibit the Centers for Medicare and Medicaid Services from using federally funded clinical comparative effectiveness research data to make coverage determinations on the basis of cost, 15-26;

l        an amendment by Rep. Sam Johnson (R-TX) to strike the section of the bill that would require employers with payrolls greater than $250,000 to provide health insurance for employees or pay an eight percent payroll tax, 15-25;

l        a second amendment by Rep. Johnson to prohibit the bill from requiring health insurance providers to cover abortion services, except in cases of life endangerment rape, or incest, 18-23;

l        an amendment by Rep. Eric Cantor (R-VA) to prohibit any funding in the bill from being used to pay for abortion services, except in cases of life endangerment, rape, or incest, 19-22;

l        an amendment by Rep. John Linder (R-GA) to strike a section of the bill that would make federal grants to states that provide home visitation programs to families with young children and families expecting children, by voice vote;

l        an amendment by Rep. Kevin Brady (R-TX) to repeal the public health insurance plan if the secretary of Health and Human Services determines, based on data collected, that national five-year cancer survival rates for breast, prostate, and lung cancer for enrollees in the public health insurance option are worse than the corresponding average survival rates for enrollees in other health benefit plans, 15-25.

House Energy and Commerce Committee

On July 16, the House Energy and Commerce Committee began its markup of H.R. 3200; the mark-up is expected to continue through July 22.

At press time, the committee was considering a manager’s amendment by Chair Henry Waxman (D-CA) that would, among other provisions, authorize the Prevention Task Force at $30 million annually for FY2010-2014 and $35 million annually for FY2015-2019; specify that the Task Force on Clinical Preventive Services include individuals with expertise in health disparities and a representative from the National Center on Minority Health and Health Disparities; and clarify that school-based health clinics would be required to comport with all federal, state, and local laws.

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