TOPICS > Health

Bill Summary: Affordable Health Care for America Act

BY Lea Winerman  October 29, 2009 at 5:19 PM EDT

House Speaker Nancy Pelosi; Getty Images

· New regulations | New insurance industry regulations would prohibit insurers from rejecting customers based on pre-existing conditions. The regulations would also prohibit annual or lifetime caps on benefits.

· Insurance exchange | The bill would set up a new national health insurance exchange, a marketplace where individuals who do not have employer-sponsored insurance would be able to shop for plans. The exchange would also be open to small businesses, and more would be able to join each year. Companies with 25 or fewer employees would be able to join in 2013, companies with 50 or fewer employees could join in 2014, and companies with fewer than 100 employees could join by 2015.

· Public insurance option | The health insurance exchange would include a government-run public plan. Federal officials would negotiate payment rates with doctors and hospitals that accept the plan.

· Employer mandate | Employers with annual payrolls greater than $500,000 would be required to either provide health insurance for their employees, or contribute 8 percent of their payroll to a federal fund to help subsidize employees who purchase coverage through the exchange. Employers with payrolls less than $500,000 would be exempt from the mandate.

· Individual mandate | Individuals will be required to purchase health insurance, or pay a penalty fee. Some people would be eligible to apply for a hardship waiver.

· Medicaid expansion | Medicaid would be expanded to cover everyone whose income is below 150 percent of the poverty line, or about $33,000 per year for a family of four.

· Affordability subsidies | People who earn between 150 percent and 400 percent of the federal poverty level would be eligible for subsidies on a sliding scale to purchase insurance through the exchange. Those subsidies would ensure that people who make 150 percent of the poverty level would not have to pay more than 3 percent of their income in premiums, while those who make 400 percent of the poverty level could pay up to 12 percent of their income in premiums.

· Out-of-pocket expenses caps | New regulations would cap yearly out-of-pocket medical expenses for individuals at $5,000 and families at $10,000. Those who earn less than 400 percent of the poverty level would have lower caps, on a sliding scale.

· Tax surcharge | The bill would help pay for itself by imposing a 5.4 percent tax surcharge on individuals earning more than $500,000 per year and families earning more than $1 million.

· End-of-life counseling | The bill retains a controversial provision that allows Medicare to pay for voluntary end-of-life counseling.