The legislation instructs state exchanges to require insurance carriers seeking certification as qualified health plans to submit a justification for any premium increase prior to implementation of the increase. The exchange is then required to take the information into consideration when determining whether to allow the sale of the plan through the exchange. The legislation requires state insurance commissioners to provide data on premium trends and make recommendations to the HHS secretary about whether certain insurance carriers should be excluded from the exchange based on a pattern of excessive premium increases. In addition, the legislation requires the secretary in conjunction with the states to monitor premium increases inside and outside the exchange beginning in 2014. In considering whether to open the exchanges to large employers (more than 100 workers) in 2017, states must consider trends in premium growth outside and inside the exchanges.

Source: The Common Wealth Fund

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

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

Penalty for use of Health Savings Account Funds for withdrawal goes from 10 to 20%

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

Requires all employers to include on W-2s the aggregate cost of employer-sponsored health benefits for informational purposes only. If employee receives health insurance coverage under multiple plans, the employer must disclose the aggregate value of all such health coverage, but exclude all contributions to HSAs and Archer MSAs and salary reduction contributions to FSAs.

Source: Kaiser Family Foundation

$500,000 deduction limitation on taxable year remuneration to officers, employees, directors, and service providers of covered health insurance providers.

Source: Kaiser Family Foundation

Excise Tax on High-Cost Insurance Plans—Tax Years Beginning 2018 or Later. Insurers will face a 40 percent excise tax on health coverage with premiums in excess of $10,200 for an individual or $27,500 for family coverage. These thresholds are increased to $11,850 for individuals or $30,950 for families in the case of retirees over age 55, electrical or telecommunications repairmen, law enforcement or fire protection workers, out-of-hospital emergency medical providers, and those engaged in the construction, mining, agriculture, forestry, and fishing industries. Thresholds are subject to adjustment for an unexpected increase in medical costs prior to the effective date, and will be indexed for inflation by the consumer price index plus 1 percent, with additional adjustment based on age and gender profiles of covered employees. The tax is levied at the insurer level, with employers aggregating and reporting information for insurers indicating the amount subject to the excise tax. This will yield an estimated $12.2 billion in 2018 and $32 billion total over 2018–2019.

Source: The Common Wealth Fund

Establish a Medicaid global payments demonstration to fund large, safety-net hospitals in five states to alter payment from fee-for-service to a capitated, global payment structure. Demonstration projects to occur in 2010–2012.

Source: The Common Wealth Fund