With the passage of the Affordable Health Care for America Act (H.R. 3962) in the House of Representatives this past weekend, women with ovarian cancer and their families may be wondering how this bill will affect their health care coverage. Listed below are some major provisions of the bill. The House bill is not the final Health Reform bill – we will not know what final provisions will be enacted until a joint bill is passed by both Houses.
Most Americans will be required to have insurance
- The bill will require all individuals to have health insurance and will levy a penalty on those without coverage, starting in 2013. Exceptions will be granted for religious or financial reasons.
- Health Insurance Exchanges will be organized. Individuals who do not already receive health insurance through their employer may purchase health insurance through Health Insurance Exchanges. These exchanges will offer insurance plans that include a minimum benefits package and comply with other cost and quality standards.
- Requires coverage for individuals with pre-existing conditions. Additionally, no insurers will be allowed to put annual policy limits or lifetime policy limits into effect or cancel a policy when individuals file expensive claims.
- Insurance Companies prohibited from charging women more based on gender. A practice known as gender rating, where women are often forced to pay higher premiums for the same coverage men receive will be eliminated.
- Eliminates Cost-Sharing for preventive services in Medicare and Medicaid including mammograms and Pap tests.
- Provides wellness grants for small employers to implement a qualified wellness program.
- Employers will have to offer coverage to employees and pay for a majority of the premium costs.
- A national “Health Insurance Exchange” will be created for individuals who do not already receive health insurance through their employer. Additionally, states that comply with federal standards will be eligible to run their own health insurance exchanges. Within the exchanges, insurance plans provided by private companies will be available for purchase, as well as a competing government-run health insurance plan.
- Individuals who currently are uninsured, have expensive coverage through an individual plan, or who work for small businesses may seek a health insurance plan through the Exchange over the next few years.
- Individuals and families can purchase insurance on the exchange if they are not covered by employer-sponsored insurance or if they do not have other federal insurance including Medicare, Medicaid, TRICARE or Veteran Affairs (VA) coverage.
- If a person is a full-time employee receiving coverage through their work, they will not be able to shop for insurance through the Exchange unless their employee-provided coverage accounts for more than 12% of their income. By 2015, the Secretary of Health and Human Services will determine whether employees of large businesses may enter the Exchange.
- Low and middle-income individuals will receive a federal subsidy to enable them to afford their purchase of health insurance. Financial assistance to pay for health insurance will be provided to families with incomes up to 400 percent of the Federal Poverty Level. For example, assistance will be provided to a family of four with an income below $88,200. (Visit the Federal Poverty Guidelines to see more).
- The bill places caps on out-of-pocket spending. Individuals will have annual out-of-pocket spending limits of $5,000 per year, and families will have annual out-of-pocket spending limits of $10,000 per year. Lower-income individuals and families with incomes below 350 percent of the Federal Poverty Level will have lower out-of-pocket limits.
- Small businesses will receive a tax credit to assist them in offering health insurance to their employees.
Changes to Existing Programs
- Medicare Part D Gap will be reduced and eventually eliminated. There will be a $500 reduction in the coverage gap (also known as the Medicare Part D “doughnut hole”). By 2019, the “doughnut hole” will be completely eliminated.
- Provides a discount on brand name drugs purchased through Medicare.
- COBRA coverage may be retained until the exchange is established.
- Provides numerous incentives for coordination of care, enactment of alternative medical liability laws, administrative simplicity and use of comparative effectiveness determinations.
Health care reform is far from over. First, the Senate must pass either this bill or its own bill. Next, a Conference Committee must be formed to combine the House and Senate bills. Then that combined bill must be voted on by both the House and Senate. Once passed, the bill will be signed by the President. Many do not expect the President to sign a health reform bill until February, 2010.
For more on this topic, please see the Ovarian Cancer National Alliance’s Principles of Health Care Reform.