	Overview of Report

On December 24, 2009, the Senate passed health reform legislation (the Patient Protection and Affordable Care Act, hereafter referred to as H.R. 3590 , or the Senate bill) that would, among other changes, make statutory changes affecting the regulation of and payment for certain types of private health insurance. On March 18, 2010, the House Rules Committee issued an amendment in the nature of a substitute to H.R. 4872 , the Health Care and Education Affordability Reconciliation Act of 2010 (hereafter referred to as the reconciliation bill). This report is a companion report to the one that describes all the private health insurance provisions in H.R. 3590 , CRS Report R40942, Private Health Insurance Provisions in Senate-Passed H.R. 3590, the Patient Protection and Affordable Care Act . Under the reconciliation bill, the prohibition of lifetime limits, prohibition on rescissions, and the requirement to provide coverage for dependent children up to age 26 would also apply to the grandfathered plans starting six months after enactment. There are also some amendments applicable specifically for grandfathered group health plans. For coverage of dependent children prior to 2014, the requirement would be limited to those adult children without an employer offer of coverage. The reconciliation bill would make certain changes to the calculation of the penalties imposed on persons who are not in compliance with the individual mandate, and would modify a rule regarding the exemption from the individual mandate. The reconciliation bill also would include full-time equivalents in the counting of full-time employees, and strike the employer fee based on extended waiting periods. The prohibition relating to preexisting conditions would be amended to apply to grandfathered group health plans. 3590 , some individuals enrolled in private health insurance through an exchange (beginning in 2014) would be eligible for premium credits, based on income. In addition to the Senate bill's requirements and limitations when reconciling taxpayers' advanced premium tax credits to levels ultimately reported on their actual tax returns, the reconciliation bill requires exchanges to provide to the Secretary of Health and Human Services the following: each enrollee's level and length of exchange coverage; the premium for the plan (excluding the premium and cost-sharing subsidies); the advanced payments for premium and cost-sharing subsidies; the name, address, and taxpayer ID number of each individual covered; "any information provided to the Exchange, including any change of circumstances, necessary to determine eligibility for, and the amount of, such credit"; and any "other similar information necessary to carry out this subsection and determine whether a taxpayer has received excess advance payments."
On March 23, 2010, the President signed into law H.R. 3590, the Patient Protection and Affordable Care Act (PPACA) as passed by the Senate on December 24, 2009, and the House on March 21, 2010. The new law will, among other changes, make statutory changes affecting the regulation of and payment for certain types of private health insurance.
On March 21, 2010, the House passed an amendment in the nature of a substitute to H.R. 4872, the Health Care and Education Reconciliation Act of 2010 (hereafter referred to as the reconciliation bill). The reconciliation bill was written as making amendments to PPACA and is now before the Senate for consideration. On March 25, 2010, the bill passed the Senate with amendments and has been sent back to the House.
This report summarizes only the private health insurance provisions in the reconciliation bill and their impact on PPACA. For a description of all the private health insurance provisions in H.R. 3590, see CRS Report R40942, Private Health Insurance Provisions in Senate-Passed H.R. 3590, the Patient Protection and Affordable Care Act.
Among the changes that would be made by the reconciliation bill to PPACA are the following which, except for the first two, would apply beginning in 2014:
extend to grandfathered plans, starting for plan years six months after enactment, the prohibition of lifetime limits, prohibition on rescissions, limitations on excessive waiting periods, and a requirement to provide coverage for non-dependent children up to age 26; for coverage of adult dependent children prior to 2014, the requirement on grandfathered group health plans would be limited to adult children without an employer offer of coverage; make certain changes to the calculation of the penalties imposed on persons who are not in compliance with the individual mandate; modify a rule regarding the exemption from the individual mandate; make changes to how the employer penalties would be calculated; include full-time equivalents in the counting of full-time employees; strike the employer fee based on extended waiting periods; for grandfathered group health plans, prohibit pre-existing condition exclusions and restrict annual limits; increase premium credits and cost-sharing subsidies to certain low- and middle-income individuals enrolled in private coverage through an exchange; and alter how income is counted for purposes of determining eligibility for premium credits and cost-sharing subsidies.