On Saturday, November 7, 2009, in a critical step toward the enactment of comprehensive health reform this year, the U.S. House of Representatives passed the Affordable Health Care for America Act. While there were several controversial issues related to funding for abortion and undocumented immigrants, which threatened to delay passage of the bill, H.R. 3962 passed 220-215 on a primarily party-line vote, with 39 Democrats voting against the bill and one Republican voting for it.
The $1.05 trillion bill would expand coverage to an additional 36 million Americans and would create an exchange offering private insurance plans and a public insurance option to facilitate access to insurance coverage. The bill would require individuals to purchase health insurance, and would provide premium subsidies to help them do so. People who do not purchase insurance will be subject to a tax. The bill also makes many reforms to the Medicare and Medicaid programs to make them more efficient and lower health costs. In addition, it implements several insurance market reforms that will be particularly beneficial to people with chronic health conditions.
The bill is fully paid for and would not increase the deficit. It is financed through a series of taxes and cost-saving reforms to Medicare and Medicaid. For example, most employers would be required to offer health insurance to their employees or else pay a tax. The bill also includes a tax on high-earning individuals earning more than $1 million for married taxpayers filing a joint return or $500,000 for single filers.
The lengthy bill includes many reforms that will benefit the bleeding disorders community, including:
- The elimination of lifetime caps in all types of insurance plans in 2010;
- A phase-out of pre-existing conditions exclusions beginning in 2010, with their total elimination in 2013;
- The implementation of modified community rating, which will preclude insurers from rating based on health status;
- Extension of dependent coverage through age 26;
- The elimination of rescissions, a practice whereby insurance companies drop people from their coverage after submitting high claims;
- The creation of a regulatory pathway for the U.S. Food and Drug Administration (FDA) to approve biosimilars; and
- The creation of the federal infrastructure to support comparative effectiveness research, including a patient ombudsman who will serve as the liaison between patients and researchers.
H.R. 3962 will need to be reconciled with the health reform bill that passes the Senate. There will be one final bill voted on by each chamber and then sent to President Obama for his signature or veto. Senate leaders have not released their final health reform bill, but may do so as early as next week. President Obama has requested a final bill on his desk for signature by the end of the year, but it may not be possible for Congress to meet this timeline. Difficulties in combining the House and Senate bills include significant differences in the ways that H.R. 3962 and the health reform bills passed by the Senate Committees would be paid for and the fact that since it requires 60 votes to close debate and allow a vote on a bill, every Democrat will need to support the bill for it to pass.
For more information on the policy and politics of health reform, please visit NHF's healthcare reform page.