The legislation authorizes $6 billion in funding for the Consumer Operated and Oriented Plan (CO-OP) program to foster the creation of nonprofit, member-run health insurance companies. Health care cooperatives are nonprofit, consumer-governed organizations that provide insurance and deliver health services. The grants will be available to new co-ops. Priority will be given to plans that operate on a statewide basis, utilize integrated care models, and have significant private support. The secretary shall ensure that there is sufficient funding to establish at least one qualified nonprofit health insurance issuer in each state.

Source: The Common Wealth Fund

The state exchanges will be required to certify qualified health plans, operate a toll-free hotline and Web site, rate qualified health plans, present plan options in a standard format, inform individuals of the eligibility requirements for Medicaid and the Children’s Health Insurance Program, provide an electronic calculator to calculate plan costs, and grant certifications of exemption from the individual requirement to have health insurance. Exchanges will be required to be self-sustaining by 2015 and will be allowed to charge assessments or user fees to participating health insurance issuers or otherwise generate funding to support their operations. The exchanges also will award grants to “navigators” who will educate the public about qualified health plans, distribute information on enrollment and subsidies, facilitate enrollment, and provide referrals on grievances. Navigators may include trade and professional organizations, farming and commercial fishing organizations, community and consumer-focused nonprofit groups, chambers of commerce, unions, or licensed insurance agents or brokers.

Source: The Common Wealth Fund

Creates a temporary reinsurance program for employers providing health insurance coverage to retirees

over age 55 who are not eligible for Medicare. This program would reimburse employers retrospectively

80% of claims between $15,000-90,000, which will be indexed for inflation. It will end on January 1, 2014

and be financed by a $5 billion appropriation.

Source: NAHU

Creates high-risk pool coverage for people who have been uninsured for at least six months and cannot

obtain current individual coverage due to preexisting conditions. This national program can work with

existing state high-risk pools and will end on January 1, 2014, once the Exchanges become operational

and the other preexisting condition and guarantee issue provisions take effect. It will be financed by a

$5 billion appropriation and premiums will be capped. Employers are prohibited from putting individuals

into the high-risk pool with associated fines.

Source: NAHU

Expand and improve coordination of Task Forces on Clinical Preventive Services and Community Preventive Services to develop, update, and disseminate evidence-based recommendations on the use of clinical and community prevention services, with an emphasis on health disparities. Task Forces will review the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community, and updating previous clinical preventive recommendations, to be published in the Guide to Clinical Preventive Services.

Source: Kaiser Family Foundation

Create an Interagency Working Group to coordinate and streamline federal quality activities, as directed by the President. Must issue first report not later than December 31, 2010.

Source: The Common Wealth Fund

Establish a Federal Coordinated Health Care Office within the Centers for Medicare and Medicaid Services (CMS) to more effectively integrate benefits and improve coordination between state and federal governments for individuals eligible for both Medicare and Medicaid. Effective March 1, 2010.

Source: The Common Wealth Fund

Establish a Community Health Centers and National Health Service Corps Fund and expand funding to community health centers by $11 billion over five years beginning in 2010.

Source: The Common Wealth Fund

Direct the U.S. Department of Health and Human Services (HHS) to establish a three-year demonstration project in 10 states to provide comprehensive health care services to the uninsured at reduced fees. Effective not later than six months after enactment.

Source: The Common Wealth Fund

Provide grants for improving health system efficiency, including grants that will implement medication management services. Effective May 1, 2010.

Source: The Common Wealth Fund