Division A - Affordable Health Care Choices - Research

Division A - sounds good on its face, but if you look at it line by line - you find out that it is vague in some places as to its intent and far too specific in denying enrollment into healthcare plans after this bill is passed and give WAY to much POWER to "the Commissioner".

Check out my comments in red and leave me a message telling me what you think...

DIVISION A—AFFORDABLE HEALTH CARE CHOICES SEC. 100. PURPOSE; TABLE OF CONTENTS OF DIVISION;
GENERAL DEFINITIONS.
(a) PURPOSE.—
(1) IN GENERAL.—The purpose of this division is to provide affordable, quality health care for all Americans and reduce the growth in health care spending. (Spending by who??? cost would be a better word)
(2) BUILDING ON CURRENT SYSTEM.—This division achieves this purpose by building on what works in today’s health care system, while repairing the aspects that are broken.(Too vague...broken?  what is broken - what does broken mean in this sense)  
(3) INSURANCE REFORMS.—This division— (A) enacts strong insurance market reforms (Yeah, we like market reform!); (B) creates a new Health Insurance Exchange, with a public health insurance option alongside private plans (This is a BIG sticking point as many believe it will take over the private industry by forcing private insurance companies out of business); (C) includes sliding scale affordability credits; and (D) initiates shared responsibility among workers, employers, and the government; so that all Americans have coverage of essential health benefits (This is an issue even to me...it sounds like I will be paying for others health care - don't I already do that with Medicare and Medicaid???).
(4) HEALTH DELIVERY REFORM.—This division institutes health delivery system reforms both to increase quality and to reduce growth in health spending so that health care becomes more affordable for businesses, families, and government (yeah!!!).

Here's the meat of it???
TITLE I—PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS (Yeah!)
Subtitle A—General Standards SEC. 101. REQUIREMENTS REFORMING HEALTH INSURANCE MARKETPLACE. (Yeah!)
(a) PURPOSE.—The purpose of this title is to establish standards to ensure that new health insurance coverage and employment-based health plans that are offered meet standards guaranteeing access to affordable coverage, essential benefits, and other consumer protections. (Yeah!)
(b) REQUIREMENTS FOR QUALIFIED HEALTH BENEFITS PLANS.—On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:
(1) Subtitle B (relating to affordable coverage).
(2) Subtitle C (relating to essential benefits).
(3) Subtitle D (relating to consumer protection) (ok guess have to check those later).
(c) TERMINOLOGY.—In this division: 
(1) ENROLLMENT IN EMPLOYMENT-BASED HEALTH PLANS.—An individual shall be treated as being ‘‘enrolled’’ in an employment-based health plan if the individual is a participant or beneficiary (as such terms are defined in section 3(7) and 3(8), respectively, of the Employee Retirement Income Security Act of 1974) in such plan. (Good)
(2) INDIVIDUAL AND GROUP HEALTH INSURANCE COVERAGE.—The terms ‘‘individual health insurance coverage’’ and ‘‘group health insurance coverage’’ mean health insurance coverage offered in the individual market or large or small group market, respectively, as defined in section 2791 of the Public Health Service Act.(also Good)

SEC. 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE.
(a) GRANDFATHERED HEALTH INSURANCE COVERAGE DEFINED.—Subject to the succeeding provisions of this section, for purposes of establishing acceptable coverage under this division, the term ‘‘grandfathered health insurance coverage’’ means individual health insurance coverage that is offered and in force and effect before the first day of Y1 if the following conditions are met:
(1) LIMITATION ON NEW ENROLLMENT.—
(A) IN GENERAL.—Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day of Y1. (This sounds like you can't get into private health insurance after this bill passes - not good)
(B) DEPENDENT COVERAGE PERMITTED.—Subparagraph (A) shall not affect the subsequent enrollment of a dependent of an individual who is covered as of such first day.

(2) LIMITATION ON CHANGES IN TERMS OR CONDITIONS.—Subject to paragraph (3) and except as required by law, the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of Y1. (This is not good either as it sounds like you can't change your private insurance after this bill passes)

(3) RESTRICTIONS ON PREMIUM INCREASES.—The issuer cannot vary the percentage increase in the premium for a risk group of enrollees in specific grandfathered health insurance coverage without changing the premium for all enrollees in the same risk group at the same rate, as specified by the Commissioner.(This is good in that is sounds like it provides some controls on insurance rates...but who is this Commissioner and isn't this too much power for him?)
(b) GRACE PERIOD FOR CURRENT EMPLOYMENT BASED HEALTH PLANS.—
(1) GRACE PERIOD.—
(A) IN GENERAL.—The Commissioner shall establish a grace period whereby, for plan years beginning after the end of the 5-year period beginning with Y1, an employment-based health plan in operation as of the day before the first day of Y1 must meet the same requirements as apply to a qualified health benefits plan under section 101, including the essential benefit package requirement under section 121. (This is VERY scary...sounds like you can only have your plan for 5yrs and then you have to go to the public option...and again who is this Commissioner...too much power)
(B) EXCEPTION FOR LIMITED BENEFITS PLANS.—Subparagraph (A) shall not apply to an employment-based health plan in which the coverage consists only of one or more of the following:  (i) Any coverage described in section 3001(a)(1)(B)(ii)(IV) of division B of the American Recovery and Reinvestment Act of 2009 (Public Law 111–5). (ii) Excepted benefits (as defined in section 733(c) of the Employee Retirement Income Security Act of 1974), including coverage under a specified disease or illness policy described in paragraph (3)(A) of such section. (iii) Such other limited benefits as the Commissioner may specify.  In no case shall an employment-based health plan in which the coverage consists only of one or more of the coverage or benefits described in clauses (i) through (iii) be treated as acceptable coverage under this division (If you have all the above docs on file...you could look all this stuff up...who has time? also again who is the Commissioner and too much power!)
(2) TRANSITIONAL TREATMENT AS ACCEPTABLE COVERAGE.—During the grace period specified in paragraph (1)(A), an employment-based health plan that is described in such paragraph shall be treated as acceptable coverage under this division. (c) LIMITATION ON INDIVIDUAL HEALTH INSURANCE COVERAGE.— (1) IN GENERAL.—Individual health insurance coverage that is not grandfathered health insurance coverage under subsection (a) may only be offered on or after the first day of Y1 as an Exchange-participating health benefits plan.(Again sounds like you can't get individual coverage after this passes)
(2) SEPARATE, EXCEPTED COVERAGE PERMITTED.—Excepted benefits (as defined in section 2791(c) of the Public Health Service Act) are not included within the definition of health insurance coverage. Nothing in paragraph (1) shall prevent the offering, other than through the Health Insurance Exchange, of excepted benefits so long as it is offered and priced separately from health insurance coverage.(Guess I need to look up section 2791(c) of the Public Health Service Act...why can't they just put it in here?)