Health Insurance Exchange. States would establish an exchange in 2010 to provide easier, more efficient comparison of health insurance plan benefits and premium costs. Information about coverage and cost-sharing would be available in a standard format. So-called “mini-medical” plans with limited benefits and low annual caps would not be offered in the exchange.Click here to access the posted document.
Ombudsman. In 2010, states would be required to establish an ombudsman office to act as a consumer advocate for those with private coverage in the individual and small group markets. Policyholders whose health insurers have rejected claims and who have exhausted internal appeals would be able to access the ombudsman office for assistance.
Transparency. Beginning in 2010, to ensure transparency and accountability, health plans would be required to report the proportion of premium dollars that are spent on items other than medical care. Also, beginning in 2010, hospitals would be required to list standard charges for all services and Medicare DRGs.
Individual Responsibility. Beginning in 2013, all US citizens and legal residents would be required to purchase health insurance or have health coverage from an employer, through a public program (i.e., Medicare, Medicaid, or CHIP), or through some other source that meets the minimum creditable coverage standard. Exemptions from the requirement would be allowed for religious objections consistent with those allowed under Medicare and for undocumented immigrants. Individuals who choose to keep the plan they have today would be deemed to have satisfied the requirement.
Employer Responsibility. Employers would not be required to offer health insurance coverage. However, employers with more than 50 full-time employees (30 hours and above) that do not offer health coverage must pay a fee for each employee who receives the tax credit for health insurance through an exchange. The assessment is based on the amount of the tax credit received by the employee(s), but would be capped at an amount equal to $400 multiplied by the total number of employees at the firm (regardless of how many receive a credit in the exchange). Employees participating in a welfare-to-work program, children in foster care and workers with a disability are exempted from this calculation.
Interstate Sale of Insurance. Starting in 2015, states may form “health care choice compacts” to allow for the purchase of non-group health insurance across state lines. Such compacts may exist between two or more states. Once compacts have been formed, insurers would be allowed to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.
State Health Insurance Exchanges. State-based “exchanges” will be established to facilitate enrollment for individuals and separately for small group (through a SHOP exchange modeled after S. 979, the “Small Business Health Options Program Act”). The exchange will provide a standardized enrollment application, a standard format for describing insurance options and marketing, call center support and customer service. The exchanges must be self-sustaining after the first year.
Wednesday, September 09, 2009
"Framework for Comprehensive Health Care Reform"
is posted at the website of Senator Baucus. Some excerpts: