Issues

Federal Healthcare ~ What is in the Bill?

April 24th, 2012

Patient Protection and Affordable Care Act:  HR3590: Basic Structural Components

(Sec. 1501):  The individual responsibility requirement provided for in this section is commercial and economic in nature and substantially affects interstate commerce…

Note: It is this principle that has been challenged by more than 25 states and pending in the U.S. Supreme Court.

(Sec. 1321): State Flexibility Relating to Exchanges

If a state is not an electing state OR the HHS Secretary determines on or before January 1, 2013 that an electing state will not have any required Exchange operational by Jan. 1, 2014, OR  has not taken actions the Secretary determines necessary to implement…the Secretary shall establish and operate such Exchange within the State…

(Sec. 1311): State Exchanges

Each State shall, not later than Jan. 1, 2014 establish and American Health Benefit Exchange that facilitates the purchase of qualified health plans.

(Sec. 1301): Qualified Health Plans

Qualified health plan means a health plan that is federally certified, provides essential health benefits, and is offered by an insurance issuer that complies with regulations developed by the HHS Secretary.

(Sec. 1302): Essential Health Benefits

The HHS Secretary shall define the essential health benefits, which must include at least 10 of the specified categories (e.g. hospitalization). The degree of coverage within each category will be defined by the HHS Secretary.

(Sec. 5000A): Individual Penalty

IRS statutes are amended to require the imposition of a penalty on a taxpayer’s return for each month that he/she/any dependent does not maintain minimum essential coverage.  The penalty will be phased in for 2014 and 2015. It will be $750 per person beginning in the tax year 2016. Dependents younger than 18 will be assessed ½ the penalty.  The penalty will be capped at 300% of the value of one individual.

(Sec. 4980H): Penalty for Large Employers

If a large employer (> 100 employees) fails to offer the opportunity for full time employees and their dependents to enroll in minimum essential coverage AND at least one employee secures coverage with taxpayer funded assistance from the Exchange, then the employer will be assessed on his/her taxes an amount equal to the payment assistance received by the employee times the number of individuals employed by the employer as full-time.

If a large employer DOES offer the opportunity for full time employees to enroll and one employee secures a policy from the Exchange with taxpayer funded assistance, then the employer is assessed a tax penalty of just that amount of assistance time 400%.

(Sec. 9022): Cafeteria Plans for Small Businesses

If a cafeteria plan is established and maintained by a small business employer, the requirements are met if the employer makes a contribution to provide “qualified benefits” on behalf of each employee in an amount equal to a uniform percentage (at least 2%) of the employee’s compensation OR an amount not less than either 6% of the employee’s compensation for the plan year or twice the amount of the salary reduction contributions of each qualified employee.

(Sec. 2713): Preventive Care with No Co-Pay

U.S. Preventive Services Task Force becomes the gatekeeper to cost sharing of “evidence-based items or services”.  A rating of  ‘A’ or  ‘B’ is required.

With respect to women … guidelines published by the Health Resources and Services Administration (a division of the U.S. Dept. of Health and Human Services) will determine what employers must provide for group health policies. Regulations issued based on this section of the law requires even faith-based employers to cover abortafacients, sterilizations, contraceptives, and other controversial services. Ohio has joined as a co-plaintiff in a federal lawsuit which challenges these regulations based on the free exercise clause of the First Amendment.