Analytical Breakdown of HR 3200

Analytical Breakdown of HR 3200: “America’s Affordable Health Choice Act of 2009” Pages 1-167

Page 1: “To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.” (What does the prepositional phrase “for other purposes” mean?)

Page 17:Dictates to private insurers how and what rates may be charged as determined by the Commissioner

Page 19:No pre-existing conditions exclusions may be imposed ( A Positive)

Page 20: HIE: Health Insurance Exchange Program—network of all insurance plans including the Public Option; Participation for all insurances plans is mandated;

Page 22:Commissioner and Sec. of HHS will have the authority to determine the financial solvency and AUDIT of private insurers and all employers that self-insure.

Page 25:Commissioner and Sec. of HHS will determine QBHP (qualified benefits health plan) that comprises a plans essential benefits plan

Page 26-29:lists the general benefits a plan in the private sector market must provide;Specifies all plans will be co-pay not co-insurance;

Page 29:Limitations will be placed on the amount of benefits permitted in a fiscal year (FY). $5000 per individual/$10,000 per family;

Page 30:A national Health Benefits Advisory Committee will make recommendations for benefits and treatments in the essential, enhanced and premium plans; No appeals process is specified.

Page 37:Commissioner shall establish uniform marketing standards that all insured QBHP (benefits plans) offering entities shall meet. Commissioner will establish the grievance and claims mechanisms

Page 38:(apparently the program is going to be run through States as there is reference to the State Judicial Review process concerning grievances and claims; there is no Judical Review permitted under HR 3200 at the Federal level)

Page 39-40:Commissioner will oversee transparency of QBHPs through mandated audits

Page 40-41: Commissioner will standardize benefits and reimbursement of payments

Page 41:A QHBP offering entity is required to comply with
standards for electronic financial and administrative
transactions under section 1173A of the Social Security
6 Act, added by section 163(a).

Page 41-43:Governance will be by the Health Choices Administration headed by the Health Choices Commissioner;(new government agency in the Executive Branch)Commissioner will be appointed by the President and confirmed by the Senate (a political appointment);

DUTIES.—The Commissioner is responsible forcarrying out the following functions under this division:
(1) QUALIFIED PLAN STANDARDS.—The establishment of qualified health benefits plan standards under this title, including the enforcement of such standards in coordination with State insurance regulators and the Secretaries of Labor and the Treasury.

(2) HEALTH INSURANCE EXCHANGE.—The establishment and operation of a Health Insurance Exchange under subtitle A of title II.

Commissioner will have the authority to audit QBHPs and recoup payment from QBHPs for the audit.

Plans that fail to meet the standards established by the Commissioner will be subjected to fines and suspension of of enrollment of individuals;

Commissioner is responsible for development of standards for the definitions of terms used in health insurance coverage, including insurance-related terms.

Commissioner is responsible for determining regulations and standards of efficient and effective administration in the HIE.

Page 42:Commissioner will determine all health benefits for all persons and all insurance plans.

Page 46:Commissioner will appoint QBHP Ombudsman

Page 50:Sec. 152 prohibits any discrimination in healthcare coverage;

Page 51: Whistleblower Protection

Page 57:Standardized Electronic Administrative Transactions

Page 58:“authoritative, permitting no additions or constraints for electronic transactions, including companion guides; be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications; enable the real-time (or near realtime) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;”

‘‘ enable, where feasible, near real-time adjudication of claims; provide for timely acknowledgment, response, and status reporting applicable to any electronic transaction deemed appropriate by the Secretary;

“The goals for Financial and Administrative Transactions call for eanbling the real-time (or near real time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;… and enable, where feasible, near real-time adjudication of claims.”

Every individual will be required to have a National ID Health card.

Page 59:“enable electronic funds transfers, in order to allow automated reconciliation with the related health care payment and remittance advice;

(The Congressional Budget Office: CBO has stated this power will be the greatest concentration of an individual’s financial records in the hands of the US Government’s computer systems.)

Page 65:Reinsurance Program for Retirees who do not fall under Social Security

Page 72:All private healthcare plans must conform to government rules and to participate in the Healthcare Insurance Exchange

Page 84:All private healthcare plans benefits must conform to the Healthcare Insurance Exchange benefits

Page 91:Mandated requirement of linguistic infrastructure for services

Page 102:Mandates automatic enrollment of individuals who are eligible for Medicaid. Individuals will have no choice in the matter.

Page 124:No healthcare insurance company can sue the government for price-fixing; No ‘judicial review’ is permitted against the government monopoly of nationalized healthcare.


Page 127:The government will determine how much physicians will be paid for treatments;

Page 145:Employers must automatically enroll employees into the government public plan.

Page 146:Employers must pay healthcare bills for part-time employees and their families.

Page 149:An employer with a payroll of $400,000 + and does not offer the public option plan must pay an 8% payroll tax on each employee

Page 150:Employers with a $250,000-$400,000 payroll who do not offer the public option must pay 2-6% payroll tax on each employee

Page 167:Individuals who do not have acceptable healthcare as determined by the Sec. of HHS will be taxed 2.5% on their income.