Below
are some of the key provisions that will take
effect immediately, under the legislative package
the House will consider later this week (the
Senate health bill as amended by the
reconciliation bill.) The reconciliation
bill is based largely on the improvements put
forward by the President's proposal- moving
towards the House bill in certain critical
areas.
1.
SMALL BUSINESS TAX CREDITS—Offers
tax credits to small businesses to make employee
coverage more affordable. Tax credits of up
to 35 percent of premiums will be immediately
available to firms that choose to offer coverage.
Effective beginning for calendar year 2010.
(Beginning in 2014, the small business tax
credits will cover 50 percent of
premiums.)
2.
BEGINS TO CLOSE THE MEDICARE PART D DONUT
HOLE—Provides a $250 rebate to Medicare
beneficiaries who hit the donut hole in 2010.
Effective for calendar year 2010.
(Beginning in 2011, institutes a 50%
discount on brand‐name drugs in the donut hole;
also completely closes the donut hole by
2020.)
3.
FREE PREVENTIVE CARE UNDER
MEDICARE—Eliminates co‐payments for
preventive services and exempts preventive
services from deductibles under the Medicare
program. Effective beginning January 1,
2011.
4.
HELP FOR EARLY RETIREES—Creates a
temporary re‐insurance program (until the
Exchanges are available) to help offset the costs
of expensive premiums for employers and retirees
for health benefits for retirees age 55‐64.
Effective 90 days after
enactment.
5.
ENDS RESCISSIONS—Bans insurance
companies from dropping people from coverage when
they get sick. Effective 6 months after
enactment.
6. NO
DISCRIMINATION AGAINST CHILDREN WITH PRE‐EXISTING
CONDITIONS—Prohibits new health plans in
all markets plus grandfathered group health plans
from denying coverage to children with
pre‐existing conditions. Effective 6 months
after enactment. (Beginning in 2014, this
prohibition would apply to all
persons.)
7.
BANS LIFETIME LIMITS ON
COVERAGE—Prohibits health insurance
companies from placing lifetime caps on coverage.
Effective 6 months after
enactment.
8.
BANS RESTRICTIVE ANNUAL LIMITS ON
COVERAGE—Tightly restricts the use of
annual limits to ensure access to needed care in
all new plans and grandfathered group health
plans. These tight restrictions will be
defined by HHS. Effective 6 months after
enactment. (Beginning in 2014, the use of
any annual limits would be prohibited for all new
plans and grandfathered group health
plans.)
9.
FREE PREVENTIVE CARE UNDER NEW PRIVATE
PLANS—Requires new private plans to cover
preventive services with no co‐payments and with
preventive services being exempt from deductibles.
Effective 6 months after
enactment.
10.
NEW, INDEPENDENT APPEALS
PROCESS—Ensures consumers in new plans
have access to an effective internal and external
appeals process to appeal decisions by their
health insurance plan. Effective 6 months
after enactment.
11.
ENSURING VALUE FOR PREMIUM
PAYMENTS—Requires plans in the individual
and small group market to spend 80 percent of
premium dollars on medical services, and plans in
the large group market to spend 85 percent.
Insurers that do not meet these thresholds
must provide rebates to policyholders.
Effective on January 1,
2011.
12.
IMMEDIATE HELP FOR THE UNINSURED UNTIL
EXCHANGE IS AVAILABLE (INTERIM HIGH‐RISK
POOL)—Provides immediate access to
affordable insurance for Americans who are
uninsured because of a pre‐existing condition ‐
through a temporary subsidized high‐risk pool.
Effective 90 days after
enactment.
13.
EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO
26TH BIRTHDAY THROUGH PARENTS’ INSURANCE
– Requires new health plans and certain
grandfathered plans to allow young people up to
their 26th birthday to remain on their parents’
insurance policy, at the parents’ choice.
Effective 6 months after
enactment.
14.
COMMUNITY HEALTH
CENTERS—Increases funding for Community
Health Centers to allow for nearly a doubling of
the number of patients seen by the centers over
the next 5 years. Effective beginning in
fiscal year 2010.
15.
INCREASING NUMBER OF PRIMARY CARE
DOCTORS—Provides new investment in
training programs to increase the number of
primary care doctors, nurses, and public health
professionals. Effective beginning in fiscal
year 2010.
16.
PROHIBITING DISCRIMINATION BASED ON
SALARY—Prohibits group health plans from
establishing any eligibility rules for health care
coverage that have the effect of discriminating in
favor of higher wage employees. Effective 6
months after enactment.
17.
HEALTH INSURANCE CONSUMER
INFORMATION—Provides aid to states in
establishing offices of health insurance consumer
assistance in order to help individuals with the
filing of complaints and appeals. Effective
beginning in FY 2010.
18.
CREATES NEW, VOLUNTARY, PUBLIC LONG‐TERM
CARE INSURANCE PROGRAM—Creates a
long‐term care insurance program to be financed by
voluntary payroll deductions to provide home and
community-based services to adults who
become functionally disabled. Effective on
January 1, 2011.
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