Breaking Down the Health Reform Bill: Part I

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altThe following summary of the health care reform bill, passed by the Congress and signed by the President, was published by the Democratic Policy Committee, chaired by Sen. Byron L Dorgan (D- North Dakota). Additional commentary in red by EPM executive editor Mark Plaster, MD.

The following summary of the health care reform bill, passed by the Congress and signed by the President, was published by the Democratic Policy Committee, chaired by Sen. Byron L Dorgan (D- North Dakota).  


Comments in red by Mark Plaster, MD
Links to the full text of the acts and more summaries are at the end of the article.

Section‐by‐Section Analysis with Changes Made by Title X and Reconciliation included within Titles I – IX. Some parts of Title X (the Managers’ Amendment) and the Health Care and Education Reconciliation Act (Reconciliation Act) made changes to provisions in Titles I – IX of the Patient Protection and Affordable Care Act.  This section-by-section analysis includes a description of those provisions within the description of the section that was amended.  Provisions of Title X and the Health Care and Education Reconciliation Act that did not make changes to Titles X – IX are described separately at the end of the document.
Subtitle A—Immediate Improvements in Health Care Coverage for All Americans
Sec. 1001. Amendments to the Public Health Service Act.
Sec. 2711.  No lifetime or annual limits.  As amended by Section 10101, prohibits plans
from establishing lifetime limits, and annual limits beginning in 2014, on the dollar value of
benefits.  Prior to 2014, plans may only establish restricted annual limits as defined by the
Secretary of Health and Human Services (HHS), ensuring access to needed services with
minimal impact on premiums.

Comment:  Insurance is based on putting away money today for needs that arise tomorrow.  While the goals of the provision are laudable, it is exactly the same position that insurance companies found themselves when malpractice awards began to skyrocket.  Premiums had to skyrocket even faster to stay ahead of the uncertainty of the future.  It seems likely that health insurance premiums will do likewise if there is little predictability of future costs.


Sec. 2712.  Prohibition on rescissions.  Prohibits all plans from rescinding coverage except
in instances of fraud or misrepresentation.  

Comment:  This was right and long overdue.
Sec. 2713.  Coverage of preventive health services.  Requires all plans to cover preventive
services and immunizations recommended by the U.S. Preventive Services Task Force and
the CDC, certain child preventive services recommended by the Health Resources and
Services Administration (HRSA), and women’s preventive care and screening recommended
by HRSA, without any cost-sharing.

Comment:  This is a ‘good idea’ that is likely to have many unintended consequences.  While preventive care, in general, is good, what services are covered is likely to become a political football.  Further, preventive care will lead to more care and more costs.  Maybe that’s good.  But the conclusions of the Dartmouth Atlas Group was that we were ‘over-doctored’ already.  Will more preventive care lead to better health outcomes or just more tests and procedures?  It’s all in how it’s executed.
Sec. 2714.  Extension of dependent coverage.  Requires all plans offering dependent
coverage to allow individuals until age 26 to remain on their parents’ health insurance.  
Section 2301 of the Reconciliation Act eliminates the requirement that adult children be

Comment:  This makes no sense to me.  Why 26?  Will the taxpayers continue to take dependent deductions for such ‘children’?  This strikes me as a purely political gesture not related to health.
Sec. 2715.  Development and utilization of uniform explanation of coverage documents
and standardized definitions.  Requires the Secretary to develop standards for use by health
insurers in compiling and providing an accurate summary of benefits and explanation of
coverage for applicants, policyholders or certificate holders, and enrollees.  The standards
must be in a uniform format, using language that is easily understood by the average
enrollee, and must include uniform definitions of standard insurance and medical terms.  The explanation must also describe any cost-sharing, exceptions, reductions, and limitations on
coverage, and examples to illustrate common benefits scenarios.   


Comment:  This is a great idea, long overdue.  It will help insureds to compare policies ‘apples-to-apples’ and could help drive out unscrupulous insurers.
Sec. 2715A.  Provision of additional information.  As added by Section 10101, requires all
plans to disclose the information required in section 1311(e), such as claims payment policies
and rating practices.  Plans that are not offered through the Exchange must submit this
information to the Secretary of HHS and the State insurance commissioner and make such
information available to the public.

Comment:  Transparency is always good.  ‘Available to the public’ must, however, mean easily available.
Sec. 2716.  Prohibition of discrimination in favor of highly compensated individuals.  
Employers that provide health coverage will be prohibited from limiting eligibility for
coverage to highly compensated individuals.

Comment:  An employer can’t discriminate on which employees get insurance, but they can make higher paid employees pay more for the same insurance.  It’s the same old song, second verse.  Soon, when you go to buy a car and ask the price, the salesman’s first question will be “How much do you make?”

Sec. 2717.  Ensuring quality of care.  Requires the Secretary to develop guidelines for use
by health insurers to report information on initiatives and programs that improve health
outcomes through the use of care coordination and chronic disease management, prevent
hospital readmissions and improve patient safety, and promote wellness and health.  As
added by Section 10101, protects Second Amendment gun rights by precluding the collection
and disclosure of information related to gun ownership or use for purposes of determining
premium rates.

Comment:  This is the real meat of government control of health care.  HHS will control insurers, through guidelines, and how they are managing certain disease states.  Clinicians have a justifiable fear that HHS will use this authority to set standards of care than may not be in the best interests of individual patients.


To view the f
ull text of the following acts, click on the title

Full Text of the Patient Protection and Affordable Care Act (P.L. 111-148)

Full Text of the Health Care and Education Reconciliation Act (P.L. 111-152)

Note: To save a copy of this legislation on your computer, please right-click on the link and select the "save" option.




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