- To provide affordable, quality health care for all Americans...
The implication is that health care is not affordable and of poor quality for some Americans so it is unsatisfactory for most Americans.
- ...and reduce the growth in health care spending,...
The presumption is that the growth in health care spending is unreasonable when compared with, say, the cost of purchasing a new automobile or cell phone service. There is no examination of what those costs are covering... which may be significantly better diagnosis and treatment than was available just a few years ago.
The chart below [click on image for larger size] shows the annual versus cumulative projected deficit for the implementation of this bill [original from The Wall Street Journal and here]
- and for other purposes.
Now, that is clearly vague and leads to a certain paranoia among those who may have a basic distrust of the government's ability to manage a health care system... like the Veteran's Administration, for example... or mandate-driven Medicaid programs that are crippling states' budgets.
This is a clear example of legislators not listening to their constituents, not being part of the drafting of a bill, and not being capable of understanding the contents and nature of the bill that will force a significant change on our society, increase the total cost of health care, reduce the personal freedom of Americans, and create a huge governmental bureaucracy... where all those "health care" jobs are going to be.
The following is basically a preamble to the legislation. You can read the full bill here. Good luck with that, but it's everything you want to know. Just get yourself at least two top-notch lawyers to interpret it for you.
One other thing, by the way, among the contentious issues is concerning providing health care to illegal aliens. One side says they will be covered; the other side says not. Here is the wording:
SEC. 246. NO FEDERAL PAYMENT FOR UNDOCUMENTEDOkay, that's clearly ambiguous. They can't get affordability credits, but does that imply they can get coverage... just not some credits? See the problem? And since the program will be run at a deficit or covered by tax increases on law-abiding taxpayers, isn't that a subsidy for illegal aliens?
5 Nothing in this subtitle shall allow Federal payments
6 for affordability credits on behalf of individuals who are
7 not lawfully present in the United States.
Here is the start of the bill text beginning at page 4:
1 DIVISION A—AFFORDABLEand on and on and on before you get to the actual contents....
2 HEALTH CARE CHOICES
3 SEC. 100. PURPOSE; TABLE OF CONTENTS OF DIVISION;
4 GENERAL DEFINITIONS.
5 (a) PURPOSE.—
6 (1) IN GENERAL.—The purpose of this division
7 is to provide affordable, quality health care for all
8 Americans and reduce the growth in health care
10 (2) BUILDING ON CURRENT SYSTEM.—This di11
vision achieves this purpose by building on what
1 works in today’s health care system, while repairing
2 the aspects that are broken.
3 (3) INSURANCE REFORMS.—This division—
4 (A) enacts strong insurance market re5
6 (B) creates a new Health Insurance Ex7
change, with a public health insurance option
8 alongside private plans;
9 (C) includes sliding scale affordability
10 credits; and
11 (D) initiates shared responsibility among
12 workers, employers, and the government;
13 so that all Americans have coverage of essential
14 health benefits.
15 (4) HEALTH DELIVERY REFORM.—This division
16 institutes health delivery system reforms both to in
17 crease quality and to reduce growth in health spend
18 ing so that health care becomes more affordable for
19 businesses, families, and government.
20 (b) TABLE OF CONTENTS OF DIVISION.—The table
21 of contents of this division is as follows:Sec. 100. Purpose; table of contents of division; general definitions.1 (c) GENERAL DEFINITIONS.—Except as otherwise
TITLE I—PROTECTIONS AND STANDARDS FOR QUALIFIED
HEALTH BENEFITS PLANS
Subtitle A—General Standards
Sec. 101. Requirements reforming health insurance marketplace.
Sec. 102. Protecting the choice to keep current coverage.
Subtitle B—Standards Guaranteeing Access to Affordable Coverage
Sec. 111. Prohibiting pre-existing condition exclusions.
Sec. 112. Guaranteed issue and renewal for insured plans.
Sec. 113. Insurance rating rules.
Sec. 114. Nondiscrimination in benefits; parity in mental health and substance
abuse disorder benefits.
Sec. 115. Ensuring adequacy of provider networks.
Sec. 116. Ensuring value and lower premiums.
Subtitle C—Standards Guaranteeing Access to Essential Benefits
Sec. 121. Coverage of essential benefits package.
Sec. 122. Essential benefits package defined.
Sec. 123. Health Benefits Advisory Committee.
Sec. 124. Process for adoption of recommendations; adoption of benefit standards.
Subtitle D—Additional Consumer Protections
Sec. 131. Requiring fair marketing practices by health insurers.
Sec. 132. Requiring fair grievance and appeals mechanisms.
Sec. 133. Requiring information transparency and plan disclosure.
Sec. 134. Application to qualified health benefits plans not offered through the
Health Insurance Exchange.
Sec. 135. Timely payment of claims.
Sec. 136. Standardized rules for coordination and subrogation of benefits.
Sec. 137. Application of administrative simplification.
Sec. 141. Health Choices Administration; Health Choices Commissioner.
Sec. 142. Duties and authority of Commissioner.
Sec. 143. Consultation and coordination.
Sec. 144. Health Insurance Ombudsman.
Subtitle F—Relation to Other Requirements; Miscellaneous
Sec. 151. Relation to other requirements.
Sec. 152. Prohibiting discrimination in health care.
Sec. 153. Whistleblower protection.
Sec. 154. Construction regarding collective bargaining.
Sec. 155. Severability.
Subtitle G—Early Investments
Sec. 161. Ensuring value and lower premiums.
Sec. 162. Ending health insurance rescission abuse.
Sec. 163. Administrative simplification.
Sec. 164. Reinsurance program for retirees.
TITLE II—HEALTH INSURANCE EXCHANGE AND RELATED
Subtitle A—Health Insurance Exchange
Sec. 201. Establishment of Health Insurance Exchange; outline of duties; definitions.
Sec. 202. Exchange-eligible individuals and employers.
Sec. 203. Benefits package levels.
Sec. 204. Contracts for the offering of Exchange-participating health benefits
Sec. 205. Outreach and enrollment of Exchange-eligible individuals and employers
in Exchange-participating health benefits plan.
Sec. 206. Other functions.
Sec. 207. Health Insurance Exchange Trust Fund.
Sec. 208. Optional operation of State-based health insurance exchanges.
Subtitle B—Public Health Insurance Option
Sec. 221. Establishment and administration of a public health insurance option
as an Exchange-qualified health benefits plan.
Sec. 222. Premiums and financing.
Sec. 223. Payment rates for items and services.
Sec. 224. Modernized payment initiatives and delivery system reform.
Sec. 225. Provider participation.
Sec. 226. Application of fraud and abuse provisions.
Subtitle C—Individual Affordability Credits
Sec. 241. Availability through Health Insurance Exchange.
Sec. 242. Affordable credit eligible individual.
Sec. 243. Affordable premium credit.
Sec. 244. Affordability cost-sharing credit.
Sec. 245. Income determinations.
Sec. 246. No Federal payment for undocumented aliens.
TITLE III—SHARED RESPONSIBILITY
Subtitle A—Individual Responsibility
Sec. 301. Individual responsibility.
Subtitle B—Employer Responsibility
PART 1—HEALTH COVERAGE PARTICIPATION REQUIREMENTS
Sec. 311. Health coverage participation requirements.
Sec. 312. Employer responsibility to contribute towards employee and dependent
Sec. 313. Employer contributions in lieu of coverage.
Sec. 314. Authority related to improper steering.
PART 2—SATISFACTION OF HEALTH COVERAGE PARTICIPATION
Sec. 321. Satisfaction of health coverage participation requirements under the
Employee Retirement Income Security Act of 1974.
Sec. 322. Satisfaction of health coverage participation requirements under the
Internal Revenue Code of 1986.
Sec. 323. Satisfaction of health coverage participation requirements under the
Public Health Service Act.
Sec. 324. Additional rules relating to health coverage participation requirements.
TITLE IV—AMENDMENTS TO INTERNAL REVENUE CODE OF 1986
Subtitle A—Shared Responsibility
PART 1—INDIVIDUAL RESPONSIBILITY
Sec. 401. Tax on individuals without acceptable health care coverage.
PART 2—EMPLOYER RESPONSIBILITY
Sec. 411. Election to satisfy health coverage participation requirements.
Sec. 412. Responsibilities of nonelecting employers.
Subtitle B—Credit for Small Business Employee Health Coverage Expenses
Sec. 421. Credit for small business employee health coverage expenses.
Subtitle C—Disclosures to Carry Out Health Insurance Exchange Subsidies
Sec. 431. Disclosures to carry out health insurance exchange subsidies.
Subtitle D—Other Revenue Provisions
PART 1—GENERAL PROVISIONS
Sec. 441. Surcharge on high income individuals.
Sec. 442. Delay in application of worldwide allocation of interest.
PART 2—PREVENTION OF TAX AVOIDANCE
Sec. 451. Limitation on treaty benefits for certain deductible payments.
Sec. 452. Codification of economic substance doctrine.
Sec. 453. Penalties for underpayments.
2 provided, in this division:
3 (1) ACCEPTABLE COVERAGE.—The term ‘‘ac4
ceptable coverage’’ has the meaning given such term
5 in section 202(d)(2).
6 (2) BASIC PLAN.—The term ‘‘basic plan’’ has
7 the meaning given such term in section 203(c).
8 (3) COMMISSIONER.—The term ‘‘Commis9
sioner’’ means the Health Choices Commissioner es10
tablished under section 141.
11 (4) COST-SHARING.—The term ‘‘cost-sharing’’
12 includes deductibles, coinsurance, copayments, and
1 similar charges but does not include premiums or
2 any network payment differential for covered serv3
ices or spending for non-covered services.
4 (5) DEPENDENT.—The term ‘‘dependent’’ has
5 the meaning given such term by the Commissioner
6 and includes a spouse.
7 (6) EMPLOYMENT-BASED HEALTH PLAN.—The
8 term ‘‘employment-based health plan’’—
9 (A) means a group health plan (as defined
10 in section 733(a)(1) of the Employee Retire11
ment Income Security Act of 1974); and
12 (B) includes such a plan that is the fol13
14 (i) FEDERAL, STATE, AND TRIBAL
15 GOVERNMENTAL PLANS.—A governmental
16 plan (as defined in section 3(32) of the
17 Employee Retirement Income Security Act
18 of 1974), including a health benefits plan
19 offered under chapter 89 of title 5, United
20 States Code.
21 (ii) CHURCH PLANS.—A church plan
22 (as defined in section 3(33) of the Em23
ployee Retirement Income Security Act of
1 (7) ENHANCED PLAN.—The term ‘‘enhanced
2 plan’’ has the meaning given such term in section
4 (8) ESSENTIAL BENEFITS PACKAGE.—The term
5 ‘‘essential benefits package’’ is defined in section
7 (9) FAMILY.—The term ‘‘family’’ means an in8
dividual and includes the individual’s dependents.
9 (10) FEDERAL POVERTY LEVEL; FPL.—The
10 terms ‘‘Federal poverty level’’ and ‘‘FPL’’ have the
11 meaning given the term ‘‘poverty line’’ in section
12 673(2) of the Community Services Block Grant Act
13 (42 U.S.C. 9902(2)), including any revision required
14 by such section.
15 (11) HEALTH BENEFITS PLAN.—The terms
16 ‘‘health benefits plan’’ means health insurance cov17
erage and an employment-based health plan and in18
cludes the public health insurance option.
19 (12) HEALTH INSURANCE COVERAGE; HEALTH
20 INSURANCE ISSUER.—The terms ‘‘health insurance
21 coverage’’ and ‘‘health insurance issuer’’ have the
22 meanings given such terms in section 2791 of the
23 Public Health Service Act.
24 (13) HEALTH INSURANCE EXCHANGE.—The
25 term ‘‘Health Insurance Exchange’’ means the
1 Health Insurance Exchange established under sec2
3 (14) MEDICAID.—The term ‘‘Medicaid’’ means
4 a State plan under title XIX of the Social Security
5 Act (whether or not the plan is operating under a
6 waiver under section 1115 of such Act).
7 (15) MEDICARE.—The term ‘‘Medicare’’ means
8 the health insurance programs under title XVIII of
9 the Social Security Act.
10 (16) PLAN SPONSOR.—The term ‘‘plan spon11
sor’’ has the meaning given such term in section
12 3(16)(B) of the Employee Retirement Income Secu13
rity Act of 1974.
14 (17) PLAN YEAR.—The term ‘‘plan year’’
16 (A) with respect to an employment-based
17 health plan, a plan year as specified under such
18 plan; or
19 (B) with respect to a health benefits plan
20 other than an employment-based health plan, a
21 12-month period as specified by the Commis22
23 (18) PREMIUM PLAN; PREMIUM-PLUS PLAN.—
24 The terms ‘‘premium plan’’ and ‘‘premium-plus
1 plan’’ have the meanings given such terms in section
3 (19) QHBP OFFERING ENTITY.—The terms
4 ‘‘QHBP offering entity’’ means, with respect to a
5 health benefits plan that is—
6 (A) a group health plan (as defined, sub7
ject to subsection (d), in section 733(a)(1) of
8 the Employee Retirement Income Security Act
9 of 1974), the plan sponsor in relation to such
10 group health plan, except that, in the case of a
11 plan maintained jointly by 1 or more employers
12 and 1 or more employee organizations and with
13 respect to which an employer is the primary
14 source of financing, such term means such em15
16 (B) health insurance coverage, the health
17 insurance issuer offering the coverage;
18 (C) the public health insurance option, the
19 Secretary of Health and Human Services;
20 (D) a non-Federal governmental plan (as
21 defined in section 2791(d) of the Public Health
22 Service Act), the State or political subdivision
23 of a State (or agency or instrumentality of such
24 State or subdivision) which establishes or main25
tains such plan; or
1 (E) a Federal governmental plan (as de2
fined in section 2791(d) of the Public Health
3 Service Act), the appropriate Federal official.
4 (20) QUALIFIED HEALTH BENEFITS PLAN.—
5 The term ‘‘qualified health benefits plan’’ means a
6 health benefits plan that meets the requirements for
7 such a plan under title I and includes the public
8 health insurance option.
9 (21) PUBLIC HEALTH INSURANCE OPTION.—
10 The term ‘‘public health insurance option’’ means
11 the public health insurance option as provided under
12 subtitle B of title II.
13 (22) SERVICE AREA; PREMIUM RATING AREA.—
14 The terms ‘‘service area’’ and ‘‘premium rating
15 area’’ mean with respect to health insurance cov16
17 (A) offered other than through the Health
18 Insurance Exchange, such an area as estab19
lished by the QHBP offering entity of such cov20
erage in accordance with applicable State law;
22 (B) offered through the Health Insurance
23 Exchange, such an area as established by such
24 entity in accordance with applicable State law
1 and applicable rules of the Commissioner for
2 Exchange-participating health benefits plans.
3 (23) STATE.—The term ‘‘State’’ means the 50
4 States and the District of Columbia.
5 (24) STATE MEDICAID AGENCY.—The term
6 ‘‘State Medicaid agency’’ means, with respect to a
7 Medicaid plan, the single State agency responsible
8 for administering such plan under title XIX of the
9 Social Security Act.
10 (25) Y1, Y2, ETC..—The terms ‘‘Y1’’ , ‘‘Y2’’,
11 ‘‘Y3’’, ‘‘Y4’’, ‘‘Y5’’, and similar subsequently num12
bered terms, mean 2013 and subsequent years, re13
14 TITLE I—PROTECTIONS AND
15 STANDARDS FOR QUALIFIED
16 HEALTH BENEFITS PLANS
17 Subtitle A—General Standards