Talking Points on Patient Protection and Affordable Care Act (H.R.3590)

The Patient Protection and Affordable Care Act is a positive step forward on the path to reform.

• The bill will insure 31 million Americans, or 94% of the under-65 population.
• The bill also includes necessary insurance reforms, including prohibiting coverage denials due to pre-existing condition or health status and ending lifetime caps on benefits.
• Middle class families will get assistance, so premiums are no more than 10% of income and out-of-pocket expenses are capped.
• Health plans will cover recommended preventive services and other essential benefits, as defined by the Secretary.
• Families eligible for the Exchange will have a choice of private plans or a national public plan, called the Community Health Insurance Option, unless a State enacts a law to opt out of it.

The bill needs additional improvements before it can be passed.

• Improved affordability for lower-income families: The bill must do better for families with modest incomes, whose premiums under this bill are higher than in the Senate HELP or House-passed bills. Recommendation: Lower the percentage of income lower-income families must pay toward premiums.
• Higher value of benefits: Benefit packages in the Exchange could leave families vulnerable to high out-of-pocket costs. Recommendation: Raise the value of the benefit packages so that deductibles and out-of-pocket-costs are affordable.
• Fair financing: The tax on high-cost plans will reduce benefits and shift costs to middle class workers, particularly those in dangerous occupations, who are older, or who live in costlier states. Recommendation: Replace the excise tax on the middle class with a small tax on the wealthiest Americans.
• True shared responsibility: In the bill, large employers are not required to offer coverage, but they are fined if they do not. Gaps in the plan create incentives for employers to offer high-deductible health plans with fewer benefits and eliminate the positions of full-time workers and replace them with part-time workers. Recommendation: Require employers to offer good coverage or pay some amount for both full-time and part-time workers.
• Immigrants: Adult legal immigrants will still be prohibited from Medicaid eligibility during their first 5 years in the country. Undocumented immigrants will be barred from the purchase of unsubsidized coverage in the Exchange. Recommendation: Lift the 5-year bar on legal immigrants and allow undocumented immigrants to purchase unsubsidized coverage.

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