HR3962, Affordable Health Care for America Act

Summary

The Affordable Health Care for America Act provides quality affordable health care for all Americans and controls health care cost growth. CBO estimates that it will provide coverage to 96% of Americans, that it does so under the $900 billion threshold outlined by President Obama, and that it reduces the deficit within the budget window and beyond.

Key provisions of the legislation include:
COVERAGE AND CHOICE | AFFORDABILITY | SHARED RESPONSIBILITY | PREVENTION, WELLNESS AND PUBLIC HEALTH | WORKFORCE INVESTMENTS | CONTROLLING COSTS


COVERAGE AND CHOICE: The bill builds on what works in today’s health care system and fixes the parts that are broken. It protects current coverage – allowing individuals to keep the insurance they have if they like it – and preserves choice of doctors, hospitals, and health plans. It does this by:

•    Implementing immediate reforms to provide affordable coverage for those who can’t get health insurance today because of pre-existing
•    Creating a Health Insurance Exchange for individuals and small businesses to comparison shop among private and public insurers, including new health-insurance co-ops.
•    Establishing a Public Health Insurance Option to offers consumers a new choice in many areas of the country dominated by just one or two private insurers today.
•    Guaranteeing coverage and reforming insurance market to protect consumers from discrimination due to health status.
•    Establish Essential benefits that include preventive services with no cost-sharing, mental health services, oral health and vision for children, and caps on the amount of money a person or family spends on covered services in a year.
•    Ending the Antitrust Exemption for Health Insurers to increase competition in the insurance marketplace.

 

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AFFORDABILITY: To ensure that all Americans have affordable health coverage the bill:

•    Provides sliding scale affordability credits for low- and moderate- income individuals and families.
•    Caps annual out-of-pocket spending at a maximum of $5,000 per individual and $10,000 per family to prevent bankruptcies from medical expenses.
•    Drivies down insurance costs by increasing competition while expanding consumer choice with a health insurance exchange, public option, and co-ops.
•    Expands Medicaid to individuals and families with incomes at or below 150% percent of the federal poverty level.
•    Improves Medicare by filling the prescription-drug donut hole, eliminating cost-sharing for preventive services, increasing access to primary care providers, and more.

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SHARED RESPONSIBILITY: The bill creates shared responsibility among individuals, employers and government to ensure that all Americans have affordable coverage of essential health benefits.
•    Individual responsibility. Except in cases of hardship, once market reforms and affordability credits are in effect, individuals will be responsible for obtaining and maintaining health insurance coverage.
•    Employer responsibility. Employers that choose to contribute will pay an amount based on a percent of their payroll. Employers that choose to offer coverage must meet minimum benefit and contribution requirements specified in the proposal.
•    Assistance for small employers. Recognizing the special needs of small businesses, the smallest businesses (payroll that does not exceed $500,000) are exempt from the employer responsibility requirement.
•    Government responsibility. The government is responsible for ensuring that every American can afford quality health insurance, through the new affordability credits, insurance reforms, consumer protections, and improvements to Medicare and Medicaid.

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PREVENTION, WELLNESS AND PUBLIC HEALTH: Prevention and wellness measures of the bill include:
•    Increasing funding for community health centers to allow the creation of new centers.
•    Prohibiting cost-sharing for preventive services in Medicare, Medicaid and essential benefits packages.
•    Establishing new programs to to deliver prevention and wellness services at the community level.
•    Supporting grants to small businesses that promote wellness programs.
•    Creating a dedicated funding source to support research on clinical and community preventive health services.
•    Starting new data collection efforts to address racial, ethnic, regional and other health disparities.
•    Making new investments to strengthen state, local, tribal and territorial public health programs.

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WORKFORCE INVESTMENTS: The bill expands the health care workforce through:
•    Improving programs targeted on training primary care doctors and other health professionals
•    Greater support for workforce diversity programs that the nation’s health workforce reflects the population it serves.
•    Expanding scholarships and loan repayment programs for individuals in needed health professions and areas.

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CONTROLLING COSTS:  The bill reduces the deficit and will reduce the growth in health care spending in a numerous ways.
•    Implementing major delivery system reform in Medicare to reward efficient health care and decrease preventable hospital readmissions.
•    Creating new consumer protections for Medicare Advantage Plans, eliminating the “donut hole” and improving low-income subsidy programs.
•    Empowering the public health insurance option to implement innovative delivery reform initiatives that make it get more value for each health care dollar.
•    Eliminating overpayments to Medicare Advantage plans and improving payment accuracy for numerous other providers, putting Medicare on stronger financial footing for the future.
•    Creating new tools to combat waste, fraud and abuse within the entire health care system.
•    Simplifying the paperwork burden that adds tremendous costs and hassles for patients, providers, and businesses today.

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