Friday, November 20, 2009

As with most legislation, the “devil is in the details”, this is also true for H. R. 3962: the ‘‘Affordable Health Care for America Act’’ recently passed by the U. S. House of Representatives on November 7, 2009, by a vote of 220-215.

Title I—Immediate Reforms: the ‘‘Affordable Health Care for America Act’’ addresses the creation of temporary “high risk pools” to allow certain uninsurable individuals to purchase health insurance coverage through a state based pooled risk program. The Act provides the Secretary of Health and Human Services the power to form such pools in cooperation with states using existing or newly created pools beginning on January 1, 2010.

To be eligible to participate in such pools, individuals, including dependents, must not be eligible for an employment based plan, any of the various public health care plans (Medicare, Medicaid, … etc.), must have been without employment based coverage for at least 6 months, must have applied for and been denied coverage by a private health insurance carrier, must have applied for private coverage but been rated at a premium higher than the high risk pool rate, and/or “who has an eligible medical condition as defined by the Secretary”.

The Act provides the Secretary with the ability to assess health insurance carriers and employment based plans (i.e., employers) with penalties if the Secretary determines that the carrier and/or employment based plan “discouraged” the individual from remaining enrolled in the prior plan. Would a 25%, 50%, 75% or 100% increase in premiums constitute discouragement? If the premium increase is applied to ALL enrolled individuals, is that considered discouragement?