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HOUSE OF REPRESENTATIVES
[To accompany H.R. 3200]
The Committee on Energy and Commerce, to whom was referred
Purpose and Summary
Background and Need for Legislation
Committee Oversight Findings and Recommendations
New Budget Authority, Entitlement Authority, and Tax Expenditures
Statement of General Performance Goals and Objectives
Constitutional Authority Statement
Earmarks and Tax and Tariff Benefits
Advisory Committee Statement
Applicability of Law to Legislative Branch
Federal Mandates Statement
Committee Cost Estimate
Congressional Budget Office Estimate
Section-by-Section Analysis of the Legislation
Additional Committee Action Relating to H.R. 3200
Changes in Existing Law Made by the Bill, as Reported
Strike all after the enacting clause (other than sections 321 and
SECTION 1. SHORT TITLE; TABLE OF DIVISIONS, TITLES, AND SUBTITLES.
(a) SHORT TITLE.—This Act may be cited as the “America's Affordable Health
(b) TABLE OF DIVISIONS, TITLES, AND SUBTITLES.—This Act is divided into divi-
DIVISION A-AFFORDABLE HEALTH CARE CHOICES
so that all Americans have coverage of essential health benefits.
(4) HEALTH DELIVERY REFORM.—This division institutes health delivery sys-
tem reforms both to increase quality and to reduce growth in health spending
so that health care becomes more affordable for businesses, families, and gov-
(b) TABLE OF CONTENTS OF DIVISION.—The table of contents of this division is as
Sec. 100. Purpose; table of contents of division; general definitions.
TITLE I-PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS
Subtitle A—General Standards
Sec. 101. Requirements reforming health insurance marketplace.
Sec. 102. Protecting the choice to keep current coverage.
Subtitle B—Standards Guaranteeing Access to Affordable Coverage
Sec. 111. Prohibiting preexisting condition exclusions.
Sec. 112. Guaranteed issue and renewal for insured plans.
Sec. 113. Insurance rating rules.
Sec. 114. Nondiscrimination in benefits; parity in mental health and substance abuse disorder benefits.
Sec. 115. Ensuring adequacy of provider networks.
Sec. 116. Ensuring value and lower premiums.
Subtitle C—Standards Guaranteeing Access to Essential Benefits
Sec. 121. Coverage of essential benefits package.
Sec. 122. Essential benefits package defined.
Sec. 123. Health Benefits Advisory Committee.
Sec. 124. Process for adoption of recommendations; adoption of benefit standards.
Sec. 125. Prohibition of discrimination in health care services based on religious or spiritual content.
Subtitle D—Additional Consumer Protections
Sec. 131. Requiring fair marketing practices by health insurers.
Sec. 132. Requiring fair grievance and appeals mechanisms.
Sec. 133. Requiring information transparency and plan disclosure.
Sec. 134. Application to qualified health benefits plans not offered through the Health Insurance Exchange.
Sec. 135. Timely payment of claims.
Sec. 136. Standardized rules for coordination and subrogation of benefits.
Sec. 137. Application of administrative simplification.
Sec. 138. Information on end-of-life planning.
Sec. 139. Utilization review activities.
Sec. 139A. Internal appeals procedures.
Sec. 139B. External appeals procedures.
Sec. 141. Health Choices Administration; Health Choices Commissioner.
Sec. 142. Duties and authority of Commissioner.
Sec. 143. Consultation and coordination.
Sec. 144. Health Insurance Ombudsman.
Sec. 321. Satisfaction of health coverage participation requirements under the Employee Retirement Income Se-
curity Act of 1974.
Sec. 401. Tax on individuals without acceptable health care coverage.
Sec. 411. Election to satisfy health coverage participation requirements.
Subtitle B-Credit for Small Business Employee Health Coverage Expenses
Subtitle C—Disclosures To Carry Out Health Insurance Exchange Subsidies
Sec. 441. Surcharge on high income individuals.
PART 2—PREVENTION OF TAX AVOIDANCE
(1) ACCEPTABLE COVERAGE. — The term “acceptable coverage” has the meaning
Commissioner established under section 141.
(4) COST-SHARING.–The term “cost-sharing" includes deductibles, coinsurance,
(5) DEPENDENT.—The term “dependent” has the meaning given such term by
(6) EMPLOYMENT-BASED HEALTH PLAN.—The term "employment-based health
ployee Retirement Income Security Act of 1974); and
(i) FEDERAL, STATE, AND TRIBAL GOVERNMENTAL PLANS.—A govern-
(7) ENHANCED PLAN.—The term “enhanced plan” has the meaning given such
defined in section 122(a).
(9) FAMILY.—The term “family” means an individual and includes the individ-
(10) FEDERAL POVERTY LEVEL; FPL.–The terms "Federal poverty level” and
insurance coverage and an employment-based health plan and includes the pub-
(12) HEALTH INSURANCE COVERAGE; HEALTH INSURANCE ISSUER.—The terms
(13) HEALTH INSURANCE EXCHANGE.—The term "Health Insurance Exchange"
(14) MEDICAID.—The term “Medicaid” means a State plan under title XIX of
(15) MEDICARE.—The term "Medicare” means the health insurance programs
specified under such plan; or