Some Info on HR 3962 - Affordable Health Care for America Act

Key information taken from the Education and Labor committee website with some PDF links transferred into comment forms below:

Affordable Health Care for America Act

By Kruger, Mike on October 29, 2009 10:30 AM


For the first time in U.S. history, all Americans would have access to
quality, affordable health care under updated health insurance reform
legislation unveiled by House Democrats.

The
Affordable Health Care for America Act [H.R. 3962], which blends and
updates the three versions of previous bills passed by the House
committees of jurisdiction in July, embodies President Obama’s key
goals for health reform. It will slow the growth in out-of-control
costs, introduce competition into the health care marketplace to keep
coverage affordable and insurers honest, protect people’s choices of
doctors and health plans, and assure all Americans access to quality,
stable, affordable health care.


The key components of the Affordable health Care for America Act include:

Increasing choice and competition. The bill will protect and improve consumers’ choices.

  • If people like their current plans, they will be able to keep them.
  • For
    individuals who aren’t currently covered by their employer, , and some
    small businesses, the proposal will establish a new Health Insurance
    Exchange where consumers can comparison shop from a menu of affordable,
    quality health care options that will include private plans, health
    co-ops, and a new public health insurance option. The public health
    insurance option will play on a level playing field with private
    insurers, spurring additional competition.
  • This Exchange will
    create competition based on quality and price that leads to better
    coverage and care. Patients and doctors will have control over
    decisions about their health care, instead of insurance companies.

Giving Americans peace of mind. The legislation will ensure that
Americans have portable, secure health care coverage – so that they
won’t lose care if their employer drops their plan or they lose their
job.

  • Every American who receives coverage through the
    Exchange will have a plan that includes standardized, comprehensive and
    quality health care benefits.
  • It will end increases in premiums
    or denials of care based on pre-existing conditions, race, or gender,
    and strictly limit age rating.
  • The proposal will also
    eliminate co-pays for preventive care, and cap out-of-pocket expensesto
    protects every American from bankruptcy.

Improving quality of care for every American. The legislation
will ensure that Americans of all ages, from young children to retirees
have access to greater quality of care by focusing on prevention,
wellness, and strengthening programs that work.<

  • Guarantees that every child in America will have health care coverage that includes dental, hearing and vision benefits.
  • Provides better preventive and wellness care. Every health care plan
    offered through the exchange and by employers after a grace period will
    cover preventive care at no cost to the patient.
  • Increases
    the health care workforce to ensure that more doctors and nurses are
    available to provide quality care as more Americans get coverage.
  • Strengthens
    Medicare and Medicaid and closes the Medicare Part D ‘donut hole’ so
    that seniors and low-income Americans receive better quality of care
    and see lower prescription drug costs and out-of-pocket expenses.

Ensuring shared responsibility. The bill will ensure that
individuals, employers, and the federal government share responsibility
for a quality and affordable health care system.

  • Employers can
    continue offering coverage to workers, and those who choose not offer
    coveragecontribute a fee of eight percent of payroll.
  • All
    individuals will generally be required to get coverage, either through
    their employer or the exchange, or pay a penalty of 2.5 percent of
    income, subject to a hardship exemption.
  • The federal
    government will provide affordability credits, available on a sliding
    scale for low- and middle-income individuals and families to make
    premiums affordable and reduce cost-sharing.

Protecting consumers and reducing waste, fraud, and abuse. The
legislation will put the interests of consumers first, protect them
from problems in getting and keeping health care coverage, and reduce
waste, fraud, and abuse.

  • Provides transparency in plans in the
    Health Exchange so that consumers have the clear, complete information,
    in plain English, needed to select the plan that best meets their needs.
  • Establishes
    consumer advocacy offices as part of the Exchange in order to protect
    consumers, answer questions, and assist with any problems related to
    their plans.
  • Simplifies paperwork and other administrative
    burdens. Patients, doctors, nurses, insurance companies, providers, and
    employers will all encounter a streamlined, less confusing, more
    consumer friendly system.
  • Increases funding of efforts to reduce waste, fraud and abuse; creates enhanced oversight of Medicare and Medicaid programs.

Reducing the deficit and ensuring the solvency of Medicare and Medicaid.
The legislation will be entirely paid for – it will not add a dime to
the deficit. It will also put Medicare and Medicaid on the path to a
more fiscally sound future, so seniors and low-income Americans can
continue to receive the quality health care benefits for years to come.

  • Pays
    for the entire cost of the legislation though a combination of savings
    achieved by making Medicare and Medicaid more efficient – without
    cutting seniors’ benefits in any way – and  revenue generated from
    placing a surcharge the top 0.3 percent of all households in the
    U.S.(married couples with adjusted gross income of over $1,000,000) and
    other tax measures.
  • The Congressional Budget estimates the bill will reduce the deficit by at least $100 billion over ten years.
  • Estimates
    also show the bill will slow the rate of growth of the Medicare program
    from 6.6 percent annually to 5.3 percent annually.
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Taken from this PDF and I tied to fix the formatting after the copy'n'paste:

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IMPLEMENTATION TIMELINE


2010


INSURANCE MARKET REFORMS


ENDS HEALTH INSURANCE RESCISSIONS: Prohibits abusive practices whereby health insurance companies
rescind existing health insurance policies when a person gets sick as a way of avoiding covering the costs of
enrollees’ health care needs.


NEW LIMITS ON PRE-EXISTING CONDITION EXCLUSIONS: Prior to the bill’s complete prohibition on preexisting
condition exclusions beginning in 2013, reduces the window that plans can look back for pre-existing
conditions from 6 months to 30 days and shortens the period that plans may exclude coverage of certain
benefits. It also prohibits insurers from limiting or denying coverage based on acts stemming from domestic
violence.


BAN ON LIFETIME LIMITS: Prohibits insurance companies from placing lifetime caps on coverage.

IMMEDIATE SUNSHINE AGAINST INSURER PRICE GOUGING (RATE REVIEW): Discourages excessive price
increases by insurance companies through review and disclosure of insurance rate increases.

ENACTS ADMINISTRATIVE SIMPLIFICATION: Begins adopting and implementing administrative simplification
requirements to reduce paperwork, standardize transactions, and greatly diminish the administrative burdens
and associated costs in today’s health care system.

ENSURING VALUE (MEDICAL LOSS RATIO): Specifies that health plans spend a minimum of 85 percent of
premium dollars on medical care, while making sure that such a change doesn’t further destabilize the current
individual health insurance market.

INCREASE DEPENDENT AGE FOR POLICIES THROUGH AGE 26: Allows those through age 26 not otherwise
covered to remain on their parents’ policies at their parents’ discretion.

COBRA EXTENSION: Allows individuals to keep their COBRA coverage until the Exchange is up and running.
[NOTE: This is separate from the Recovery Act provisions that provide premium assistance for selected groups.]
ENSURING RECONSTRUCTIVE SURGERY FOR CHILDREN: Requires plans to pay for reconstructive surgery for
children with deformities.

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LIMITATION ON POST-RETIREMENT REDUCTIONS OF RETIREE HEALTH BENEFITS: Prohibits employers from
reducing retirees’ health benefits after those retirees have retired, unless the reduction is also made to
benefits for active participants.

GRANTS TO STATES FOR IMMEDIATE HEALTH REFORM INITITATIVES: Builds on an existing grant program to
enhance incentives for states to move forward with a variety of health reform initiatives prior to 2013.
IIMPROVED BENEFIITS

CREATES REINSURANCE FOR EARLY RETIREES: Creates a new temporary reinsurance program to help offset
the cost of coverage for companies that provide early retiree health benefits for those ages 55-64.

IMMEDIATE HELP FOR THE UNINSURED (INTERIM HIGH-RISK POOL): Creates a $5 billion fund, modeled after
the President’s plan, to finance an immediate, temporary insurance program for those who are uninsurable
because of pre-existing conditions.

NEW LONG-TERM CARE PROGRAM (CLASS ACT): Creates a new, voluntary, public long-term care insurance
program to help purchase services and supports for people who have functional limitations. Benefits are a
daily or weekly cash benefit to help people with functional limitations purchase the services and supports
needed to maintain personal and financial independence. CLASS would supplement, not supplant, traditional
payers of long-term care (e.g. Medicaid and/or private long term care insurance).

ESTABLISHES THE HEALTH BENEFITS ADVISORY COMMITTEE: Establishes within 60 days of enactment the
Health Benefits Advisory Committee—led by the Surgeon General and made up of health care experts, health
care providers and patients—provides recommendations on the essential benefits package to the Secretary of
HHS for approval.

PUBLIIC HEALTH IIMPROVEMENTS

INCREASES FUNDING FOR COMMUNITY HEALTH CENTERS: Provides increased funding for community health
centers that will allow them to double the number of patients served over the next five years.

IMPLEMENTS NEW PREVENTIVE HEALTH SERVICES PROGRAM IN COMMUNITIES: Provides immediate
funding for preventive services at the community and local level to address public health problems such as
obesity, tobacco use, and diabetes.

EXPANDS PRIMARY CARE, NURSING AND PUBLIC HEALTH WORKFORCE: Increases access to primary care by
sustaining the current efforts to increase the size of the National Health Service Corps. Primary care and nurse
training programs are also immediately expanded to increase the size of the primary care and nursing
workforce. Ensures that public health challenges are adequately addressed.

EMPLOYER WELLNESS PROGRAMS: Establishes a grant program for employers to promote healthy behaviors
among their employees.

MEDIICARE AND MEDIICAIID IIMPROVEMENTS

BEGINS TO FILL IN THE MEDICARE PART D DRUG DONUT HOLE: Provides for a 50% discount on brand-name
drugs in the Part D donut hole, and immediately shrinks the size of the donut hole by $500 in 2010. The donut
hole continues to be narrowed over the coming years until it is fully eliminated by 2019.

3

IMPROVES PREVENTIVE HEALTH COVERAGE IN MEDICARE & MEDICAID: Eliminates cost sharing for
preventive services to encourage wider use of preventive care for Medicare beneficiaries. Requires State
Medicaid programs to cover preventive services recommended to the Secretary of HHS based on evidence,
such as tobacco cessation counseling for pregnant women.

ALLOWS STATES TO COVER LOW-INCOME INDIVIDUALS WITH HIV: Gives States the option of extending
Medicaid coverage to HIV-positive individuals and provides enhanced federal matching payments for the costs
of care.

INCREASES REIMBURSEMENT FOR PRIMARY CARE IN MEDICAID: Brings reimbursement for primary care
services in Medicaid up to Medicare levels with 100% federal funding (phased in over several years).

PROVIDES FOR 12-MONTH CONTINUOUS ELIGIBILITY IN CHIP: Provides continuity of care for children by
requiring that states provide 12-month continuous eligibility for children in the CHIP program

CREATES MEDICARE ACCOUNTABLE CARE ORGANIZATIONS AND MEDICAL HOME PILOT PROGRAMS:
Requires the Secretary to set specific benchmarks for expansion of these programs and to test them in a
variety of settings and geographic regions. If the initial pilots prove successful, the Secretary is directed to
continue expanding them on a large-scale basis.

2011

ELIMINATES BARRIERS TO ENROLLMENT IN MEDICARE LOW-INCOME SUBSIDY FOR PART D DRUG
PROGRAM: Eases burdens on enrollment so more low-income beneficiaries can get the financial help they
need to make health care affordable.

NEW PROTECTIONS IN MEDICARE ADVANTAGE: Limits cost-sharing for services in Medicare Advantage plans
to no more than cost-sharing in traditional Medicare, and provides for bonus payments to high-quality plans.

ESSENTIAL BENEFITS: In preparation for reform, the Health Benefits Advisory Committee reports their
recommended essential benefits package to the Secretary of HHS for adoption.
Additional federal funds to states with high unemployment. Assists States in maintaining access to
Medicaid services during the recession by extending the current Recovery Act increase in federal Medicaid
payments to states with high unemployment rates.

2012

IMPROVES LOW-INCOME PROTECTIONS IN MEDICARE: Increases the assets test limits in the Part D drug
program and Medicare Savings Programs to ensure that more low-income beneficiaries get the financial help
they need to make their health care affordable.

EXTENDS MONTHS OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT PATIENTS:
Lifts the current 36-month limitation on Medicare coverage of immunosuppressive drugs for kidney transplant
patients who would otherwise lose this coverage on or after January 1, 2012.

4

2013

HEALTH INSURANCE REFORMS: Implements comprehensive health insurance reforms that prohibit insurance
companies from engaging in discriminatory practices that enable them to refuse to sell or renew policies due
to an individual’s health status. In addition, insurance companies can no longer exclude coverage for
treatments based on pre-existing health conditions. The legislation also limits their ability to charge higher
rates due to health status, gender, or other factors, and permits premiums to vary only by age (no more than
2:1), geography and family size.

HEALTH INSURANCE EXCHANGE: Opens the Health Insurance Exchange to individuals without other coverage
and to small employers with 25 or fewer employees. This new venue will enable people to comparison shop
for standardized health packages. It facilitates enrollment and administers affordability credits so that people
of all incomes can obtain affordable coverage.

PUBLIC HEALTH INSURANCE OPTION: Creates a new public health insurance plan option that is available only
within the Health Insurance Exchange. It competes on a level playing field against private health plans and will
inject competition into the many parts of our country without a competitive health insurance market.
Because it doesn’t operate at the behest of investors, it will be able to offer stiff competition to private
insurers—forcing them to compete on cost and quality for the first time.

AFFORDABILITY CREDITS: Makes Health Insurance Affordability Credits available through the Exchange to
ensure people can obtain affordable coverage. Credits are available for people with incomes above Medicaid
eligibility and below 400% of poverty who are not eligible for or offered other acceptable coverage. They
apply to both premiums and cost sharing to ensure that no families face bankruptcy due to medical expenses.

INDIVIDUAL RESPONSIBILITY: Requires individuals to obtain acceptable health insurance coverage or pay a
penalty of 2.5% of their income that is capped at the cost of the average cost of qualified coverage.

EMPLOYER RESPONSIBILITY: Employers are required to offer coverage to their workers and their workers’
families with minimum contributions and meet standards for that coverage or pay a penalty of 8% of their
payroll to help offset the cost of their workers obtaining coverage through the Exchange. Employers have a
grace period and are not required to meet the benefit standards until 2018.

PROTECTS SMALL BUSINESS: Small businesses with annual payrolls below $500,000 are exempt from
requirements to offer or contribute to coverage, including the 8% payroll contribution for failure to provide
health benefits to their workers. The 8% requirement is phased in for small businesses with an annual payroll
between $500,000 and $750,000.

SMALL BUSINESS TAX CREDITS: Provides certain lower-wage small businesses that choose to provide health
coverage with a new tax credit worth up to 50% of the amount paid by a small employer for employee health
coverage. The credits are available on a rolling basis for the first two years that an employer offers qualified
coverage.

EXPANDS MEDICAID ELIGIBILITY: Expands Medicaid to 150% of poverty to ensure that people obtain

affordable health care in the most efficient and appropriate manner. The expansion is fully federally funded in
2013 and 2014; thereafter states pay 9% and the federal government pays 91%.

PROTECTS THE HEALTH OF NEWBORN BABIES: Provides temporary Medicaid coverage for up to 60 days for
babies who are born without proof of other health coverage.

5

2014

INITIATES AN AFFORDABILITY TEST FOR EMPLOYER-SPONSORED COVERAGE: Opens the Health Insurance
Exchange to individuals who have an offer of employer-sponsored coverage, but for whom that coverage
would be unaffordable because the premium would absorb more than 12% of their family income. People
who meet this test will be able to enter the Exchange and are eligible for affordability credits based on their
incomes.

HEALTH INSURANCE EXCHANGE EXPANDS: Opens the Health Insurance Exchange to small businesses with 50
or fewer employees.

ENSURING VALUE IN MEDICARE ADVANTAGE (MEDICAL LOSS RATIO): Requires Medicare Advantage plans to
spend a minimum of 85 percent of premium dollars on medical care.

2015

EXPANDS HEALTH INSURANCE EXCHANGE: Opens the Health Insurance Exchange to small businesses with
100 or fewer employees and provides the Health Choices Commissioner the authority, from 2015 forward, to
continue expanding the Exchange to larger employers as the system is ready to handle increased capacity.

2018

EMPLOYERS OUTSIDE THE EXCHANGE ARE REQUIRED TO MEET ESSENTIAL BENEFITS PACKAGE: The grace
period ends for employer-sponsored plans to meet the health insurance standards. All employer-sponsored
coverage and health insurance offered within the Exchange is required to meet benefit and contribution
standards.

PREPARED BY THE COMMITTEES ON WAYS & MEANS, ENERGY & COMMERCE, AND EDUCATION & LABOR
OCTOBER 29, 2009

available here, but I am not reformatting 1990 pages of PDF into comment form. :)

Taken from PDF:

SHORT 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

 

II..

COVERAGE AND CHOIICE::

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 achieves these reforms through:


 Immediate reforms. Includes immediate reforms to improve today’s health care system as we implement
full-scale health reform. These improvements include the creation of a new national program to provide
affordable coverage for those who can’t get health insurance today because of pre-existing conditions
(including the use of domestic violence as a pre-existing condition); implementation of insurance reforms to
enforce an 85% medical loss ratio, coverage of young adults on their parents’ policies through age 26, limits
on pre-existing condition exclusions, protections for treatments for children with deformities;
implementation of new programs to protect retiree health benefits; enactment of administrative
simplification; and creation of a new federal grant incentives for wellness programs and early advancement
of reform by states.


 Health Insurance Exchange. The new Health Insurance Exchange (starting in 2013) creates a transparent and
functional marketplace for individuals and small employers to comparison shop among private and public
insurers, including new health insurance co-ops. It works with state insurance departments to set and
enforce insurance reforms and consumer protections, facilitates enrollment, and administers affordability
credits to help low- and middle-income individuals and families purchase insurance. Within three years, the
Exchange will be open to employers with 100 employees as another choice for covering their employees.
Over time, more employers will obtain that option. States may opt to operate the Exchange in lieu of the
national Exchange provided they follow the federal rules.


 A Public Health Insurance Option. One of the many choices of health insurance within the Health Insurance
Exchange is a public health insurance option. It will be a new choice in many areas of our country
dominated by just one or two private insurers today. The public option will operate on a level playing field.
It will be subject to the same market reforms and consumer protections as other private plans in the
Exchange and it will be self-sustaining – financed only by its premiums. The Secretary of Health and Human
Services will administer the public option and negotiate rates for providers that participate in the public
option. The public health insurance option is provided startup administrative funding, but it is required to
amortize these costs into future premiums. Providers are presumed to be participants in the public option
unless they opt-out of participating.


 Guaranteed coverage and insurance market reforms. Insurance companies will no longer be able to engage
in discriminatory practices that enable them to refuse to sell or renew policies today due to an individual’s
health status. In addition, they can no longer exclude coverage of treatments for pre-existing health
conditions. The bill also protects consumers by prohibiting lifetime and annual limits on benefits. It also
limits the ability of insurance companies to charge higher rates due to health status, gender, or other
factors. Under the proposal, premiums can vary based only on age (no more than 2:1), geography and
family size.


 Essential benefits. A new independent Advisory Committee with practicing providers and other health care
experts, chaired by the Surgeon General, will recommend a benefit package based on standards set in the
law. This new essential benefit package will serve as the basic benefit package for coverage in the Exchange
and over time will become the minimum quality standard for employer plans. The basic package will 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. Within the Exchange,
there will be four plan levels – all of which cover the essential benefit package, but have varied levels of
cost-sharing. The “Premium Plus” plans will offer additional benefits such as adult dental or vision and
private hospital rooms.


 Ending the Antitrust Exemption for Health Insurers. By eliminating the antitrust exemption for health
insurers and medical malpractice insurers, the bill increases competition in the insurance marketplace. It
will remove their shield that has allowed them to price fix, divide up territory, and effectively create
monopolies in particular markets.


 Helping address long-term health care needs. Creates a new, voluntary, public, long-term care insurance
program to help purchase services and supports for people who have functional limitations. Individuals
determined to need assistance because of functional limitations would qualify to receive a daily or weekly
cash benefit to help purchase the services and supports needed to maintain personal and financial
independence. CLASS would supplement, not supplant, traditional payers of long-term care (e.g. Medicaid
and/or private long term care insurance).


IIII..

AFFORDABIILIITY::

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


 Provides sliding scale affordability credits. The affordability credits will be available to low- and moderateincome
individuals and families. The credits are most generous for those who are just above the proposed
new Medicaid eligibility levels; the credits decline with income (so premium and cost-sharing support is
more limited as your income increases) and are completely phased out when income reaches 400 percent of
the federal poverty level ($43,000 for an individual or $88,000 for a family of four). The affordability credits
will make insurance premiums affordable and will reduce cost-sharing to levels that ensure access to care.
The Exchange administers the affordability credits with other federal and state entities, such as local Social
Security offices and state Medicaid agencies.


 Caps annual out-of-pocket spending. Will cap annual out-of-pocket spending at a maximum of $5,000 per
individual and $10,000 per family to prevent bankruptcies from medical expenses.


 Increased competition. The creation of the Health Insurance Exchange and the inclusion of a public health
insurance option and health insurance co-ops will make health insurance more affordable by opening many
market areas in our country to new competition, spurring efficiency and transparency.


 Expands Medicaid. Individuals and families with incomes at or below 150% percent of the federal poverty
level will be eligible for an expanded and improved Medicaid program. Recognizing the budget challenges in
many states, this expansion will initially be fully federally financed then transition to include a 9%
contribution from states starting in 2015. To improve provider participation in this vital safety net –
particularly for low-income children, individuals with disabilities and people with mental illnesses –
reimbursement rates for primary care services will be increased to Medicare rates with new federal funding.


 Improves Medicare. Senior citizens and people with disabilities will benefit from provisions that fill the
donut hole over time in the Part D drug program, eliminate cost-sharing for preventive services, improve the
low-income subsidy programs in Medicare, increase access to primary care providers, and make other
program improvements. The bill will also address future fiscal challenges by improving payment accuracy,
encouraging delivery system reforms and extending solvency of the Medicare Trust Fund. Companion
legislation will permanently reform Medicare’s payment formula for physicians.


IIIIII..

SHARED RESPONSIIBIILIITY::

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. Those who
choose to not obtain coverage will pay a penalty capped at 2.5 percent of modified adjusted gross income
above a specified level.


 Employer responsibility. The proposal builds on the employer-sponsored coverage that exists today.
Employers will have the option of providing health insurance coverage for their workers or contributing
funds on their behalf. 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. The
payroll penalty would then phase in starting at 2% for firms with annual payrolls over $500,000 rising to the
full 8 percent penalty for firms with annual payrolls above $750,000. In addition, a new small business tax
credit will be available for two years for low-wage, small firms who choose to provide health coverage to
their workers. In addition to the targeted assistance, the Exchange and market reforms provide a longsought
opportunity for small businesses to benefit from a more organized, efficient marketplace in which to
purchase coverage.


 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.


IIV..

PREVENTIION,, WELLNESS AND PUBLIIC HEALTH::

Prevention and wellness measures of the bill
include:


 Community Health Centers. Funding for community health centers is significantly increased, allowing for
the creation of new centers and growth in the number of people served.


 Prohibition of cost-sharing for preventive services. Cost sharing requirements in the essential benefits
package, Medicare and Medicaid are specifically prohibited.


 Community-based programs. New programs are established to deliver prevention and wellness services at
the community level and to support grants to small businesses that promote wellness programs.


 Prevention research. A dedicated funding source is created to support research on clinical and community
preventive health services to determine which services are most effective.


 Data Collection. New data collection efforts are required to better identify and address racial, ethnic,
regional and other health disparities.


 Public Health Infrastructure. New investments are made to strengthen state, local, tribal and territorial
public health departments and programs.


V..

WORKFORCE IINVESTMENTS::

The bill expands the health care workforce through:


 National Health Service Corps (NHSC). Increased funding and greater flexibility in meeting service
requirements are provided for the National Health Service Corps.


 Building the nation’s health workforce. Increased funding and other improvements are made to programs
targeted on training primary care doctors. Similar expansions are made to encourage more health
professionals, including nurses, to choose primary care. A new Public Health Service Corps (modeled on the
NHSC) is created to ensure an adequate and qualified public health workforce.


 Workforce diversity. Greater support is provided for workforce diversity programs to help ensure that the
nation’s health workforce reflects the population it serves.


 Scholarship and loan repayment programs. Scholarships and loan repayment programs for individuals in
needed health professions and shortage areas are expanded.


 Training for primary care physicians. Puts in place steps to increase physician training outside the hospital,
where most primary care is delivered, and redistributes unfilled graduate medical education residency slots
for purposes of training more primary care physicians. The proposal also improves accountability for
graduate medical education funding to ensure that physicians are trained with the skills needed to practice
health care in the 21st century.


VII..

CONTROLLIING COSTS::

The bill reduces the deficit and will reduce the growth in health care
spending in a numerous ways. Specifically, it invests in health care through stronger prevention and wellness
measures; increases access to primary care; implements health care delivery system reforms; creates a Health
Insurance Exchange and a new Public Health Insurance Option; improves Medicare payment accuracy and
makes additional reforms to Medicare and Medicaid -- all of which will help slow the growth of health care costs
over time. These savings will accrue to families, employers, and taxpayers.


 Modernization and improvement of Medicare. The bill implements major delivery system reform in
Medicare to reward efficient health care, rolling out innovative concepts such as accountable care
organizations, medical homes, and bundling of acute and post-acute provider payments. New payment
incentives aim to decrease preventable hospital readmissions, expanding this policy over time to recognize
that physicians and post-acute providers also play an important role in avoiding readmissions. The bill
improves the Medicare Part D program by creating new consumer protections for Medicare Advantage
Plans, eliminating the “donut hole” and improving low-income subsidy programs, so that Medicare is
affordable for all seniors and other eligible individuals.


 Innovation and delivery reform through the public health insurance option. The public health insurance
option will be empowered to implement innovative delivery reform initiatives so that it is a nimble
purchaser of health care and gets more value for each health care dollar. It will expand upon the
experiments put forth in Medicare and be provided the flexibility to implement value-based purchasing,
accountable care organizations, medical homes, and bundled payments. These features will ensure the
public option is a leader in efficient delivery of quality care, spurring competition with private plans.


 Improving payment accuracy. The bill eliminates overpayments to Medicare Advantage plans and improves
payment accuracy for numerous other providers, following recommendations by the Medicare Payment
Advisory Commission and the President. These steps will extend Medicare Trust Fund solvency, and put
Medicare on stronger financial footing for the future.


 Preventing waste, fraud and abuse. New tools will be provided to combat waste, fraud and abuse within
the entire health care system. Within Medicare, new authorities allow for pre-enrollment screening of
providers and suppliers, permit designation of certain areas as being at elevated risk of fraud to implement
enhanced oversight, and require compliance programs of providers and suppliers. The new public health
insurance option and Health Insurance Exchange will build upon the safeguards and best practices gleaned
from experience in other areas.


 Administrative simplification. The bill will simplify the paperwork burden that adds tremendous costs and
hassles for patients, providers, and businesses today.


PREPARED BY THE COMMITTEES ON WAYS & MEANS, ENERGY & COMMERCE, AND EDUCATION & LABOR
OCTOBER 29, 2009