H.R. 3590 is called the Patient Protection and Affordable Care Act. The bill was sponsored by Congressman Charles Rangel from New York. Congress passed the bill into law on December 24, 2009. While many Americans held strong opinions about the bill as it was being debated, there was a lot of false information as to what the bill actually contained. Now that the bill has passed, and is available for viewing on the Library of Congress' website, Thomas.gov, it is important to know what the law does and does not say. This article addresses Title I, Subtitle D, Parts I and II, of the Patient Protection and Affordable Care Act of 2009.
H.R. 3590 Title I, Subtitle D, Part I: Defining the Essential Health Benefits of "Qualified Health Plans"
Sec. 1301 under Title I, Subtitle D states that a "qualified" health plan provides "essential" health benefits. Within what is called a gold or a silver level, the federal government requires that there be at least one plan option to choose from. The gold level will cost more than the silver level, but will cover more.
Sec. 1302 says that these "qualified health plans" must provide essential health benefits and limit cost-sharing. Essential health benefits include emergencies, hospital stays, pregnancy and newborn care, mental health, drug and alcohol rehabilitation, prescription drugs, disease prevention, well patient care, chronic disease treatment, and pediatric care. Children will also receive vision and dental care through all federally "qualified health plans." Individuals under the age of 30 have the option of limited catastrophic coverage.
The government healthcare plan benefits will be equal to what typical employer-based plans offer. The public will be able to have a say on what these health benefits should include. Beginning in 2014, there will be a limit placed on how much the health insurance premiums will cost for each individual. There will also be limits placed on the deductible for small businesses.
Abortion Coverage under Obama's Health Care Plan
Title I, Subtitle D, Sec. 1303 details the rules regarding abortion coverage. First, individual states may elect to prohibit abortion coverage in federal "qualified health plans" offered in these states. Second, federal funds may not be used for abortion services. Finally, separate accounts must be set up to pay for abortion services out-of-pocket by the individual requesting these services. No qualified health plan provider will be allowed to discriminate against any health care provider or health care facility because of a conviction or a refusal to provide abortions, pay for them, or make referrals for them.
Sec. 1304 defines the terms used in Title I.H.R. 3590, Title I, Subtitle D, Part II: "American Health Benefit Exchanges" and Insurance Competition
The Patient Protection and Affordable Care Act requires, under Sec. 1311, that every state set up an American Health Benefit Exchange. This exchange will make it easier for people to buy a quality health care plan. There will also be a new Small Business Health Options Program, with the acronym "SHOP Exchange." The SHOP Exchange is designed to help small business owners to enroll their employees in federally qualified health plans offered in their individual states.
Sec. 1311 also states that the Department of Health and Human Services will set up a certification process to "qualify" health insurance plans under this Act. In order to become certified to be a qualified health plan, it must meet market requirements outlined in the Act and offer a choice of providers.
American Health Benefit Exchanges must either be state government agencies or non-profit organizations. Only federally certified qualified health plans will be offered. All health plan providers who seek to be federally certified must submit written justification for premium increases before doing so. States are required to offer additional health benefits, but the cost of these additional benefits must come out of the state budget. There will be an Exchange office in every geographical district of a certain size. Employers get to choose a level of coverage for their employees, and employees may choose any qualified health plan within that level.
Members of Congress, Large Employers and Exchange Accountability Under H.R. 3590
Members of Congress and their staff are restricted to health plans created under the Patient Protection and Affordable Care Act or offered through a state Exchange program. Large employers may join an Exchange after 2017.
Sec. 1313 details the accountability requirements for Exchanges. They are required to account for every activity, receipt and expense, and will report to the Secretary of Health and Human Services annually. Actions will be taken to reduce fraud and abuse. The Comptroller General will conduct ongoing studies of Exchange activities and enrollees.
Source:
Thomas.gov, Library of Congress: "Bill Summary and Status, 111th Congress (2009-2010), H.R. 3590 CRS Summary"
Donna Pravel - Donna Earnest Pravel is the owner and senior editor of www.Heart of Texas Copywriting Solutions.com.
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