Signed by President Barack Obama II

Vote Smart's Synopsis:

Vote to concur with Senate amendments and pass a bill that issues various amendments to HR 3590, including, but not limited to, the following highlights.

Highlights:

• Amends the penalty for individuals who fail to maintain "minimum essential health care coverage" as follows (Sec. 1002):
• Amends the income exemption from under 100 percent of the federal poverty line to below the income filing threshold;
• Reduces the applicable dollar amount that is used to determine the penalty (multiplied by the number of people for whom the individual is liable or 300 percent of such amount for the taxable year) from $495 to $325 for 2015, and from $750 to $695 for 2016 and each subsequent year thereafter; and 
• Increases the alternative penalty, assessed if it's greater than the penalty calculated by the applicable dollar amount, from 0.5 to 1 percent of income for 2014, 1 to 2 percent of income for 2015, and 2 to 2.5 for 2016 and each subsequent year thereafter.

• Amends the penalty for large employers (average of at least 50 full time employees, with exceptions for seasonal workers) that fail to offer minimum essential health care coverage to their employees as follows (Sec. 1003):
• Reduces the first 30 employees from the payment calculation; and
• Increases the applicable payment amount from $750 to $2,000.

• Repeals the $600 penalty for large employers that impose a waiting period for new employees to enroll in the company's health benefits plan (Sec. 1003).

• Appropriates $1 billion to the Health Insurance Reform Implementation Fund for the Secretary of Health and Human Services to cover administrative costs associated with implementing the Act (Sec. 1005).

• Repeals the $500 reduction in the coverage gap under Medicare Part D that separates the limit on initial coverage and the coverage for catastrophic care ("donut hole") in 2010, establishes a $250 rebate for individuals affected by the gap beginning in 2010, and phases out the gap by 2020 (Sec. 1101).

• Repeals amendments to Medicare Part C (Medicare Advantage Plan) rates of payments, and amends benchmarks beginning in 2012 based on Medicare costs, to be phased-in over 3, 5, or 7 years depending on the amount reduced, as follows (Sec. 1102):
• 95 percent of Medicare spending for areas ranked by the Secretary in the highest quartile;
• 100 percent of Medicare spending for areas ranked by the Secretary in the second highest quartile;
• 107.5 percent of Medicare spending for areas ranked by the Secretary in the third highest quartile; and
• 115 percent of Medicare spending for areas ranked by the Secretary in the highest quartile.

• Repeals the provision that exempts the state of Nebraska from the federal compensation guidelines for the expansion of Medicaid eligibility and guaranteed that the state will be compensated for 100 percent of the costs beginning in 2014 and each subsequent year thereafter (Sec. 1201).

• Specifies that states will be compensated for the expansion of Medicaid eligibility as follows (Sec. 1201):
• 100 percent for 2014, 2015, and 2016;
• 95 percent for 2017;
• 94 percent for 2018;
• 93 percent for 2019; and
• 90 percent for 2020 and each year thereafter.

• Requires Medicaid payment rates to physicians for primary care services be no less than 100 percent of the rates in 2013 and 2014 (Sec. 1202).

• Amends the effective date for the excise tax on "high cost employer-sponsored health care plans" from 2013 to 2018, and increases the cost threshold for imposing the tax as follows (Sec. 1401):
• For single coverage, the threshold is increased from $8,500 to $10,200, or from $9,850 to $11,850 for retirees and employees of high-risk professions; and
• For family coverage, the threshold is increased from $23,000 to $27,500, or from $26,000 to $30,950 for retirees and employees of high-risk professions.

• Repeals the non-deductible fee to be collected annually after 2010 totaling $2 billion on medical device manufacturers and importers making more than $5 million during a calendar year, and establishes a 2.3 percent excise tax on the first sale of medical devices beginning in 2013, with the following exemptions (Sec. 1405):
• Eyeglasses;
• Contact lenses;
• Hearing aids; and
• Any other medical device available to individuals for retail sale, as determined by the Secretary.

• Prohibits all existing health insurance plans ("grandfathered health plans") from imposing lifetime limits or rescinding coverage for reasons other than intentional misrepresentation of material fact, and requires such plans to provide coverage for non-dependent children up to 26 years of age who are ineligible to enroll in employer-sponsored coverage (Sec. 2301).

• Amends tax credits for the cost of health insurance premiums to be based on household income according to the following sliding scale (Sec. 1001):
• For household incomes up to 133 percent of the federal poverty line, the premium percentage is 2.0 percent;
• For household incomes between 133 percent and 150 percent of the federal poverty line, the initial premium percentage is 3 percent and the final premium percentage is 4 percent;
• For household incomes between 150 percent and 200 percent of the federal poverty line, the initial premium percentage is 4 percent and the final premium percentage is 6.3 percent;
• For household incomes between 200 percent and 250 percent of the federal poverty line, the initial premium percentage is 6.3 percent and the final premium percentage is 8.05 percent;
• For household incomes between 250 percent and 300 percent of the federal poverty line, the initial premium percentage is 8.05 percent and the final premium percentage is 9.5 percent; and
• For household incomes between 300 percent and 400 percent of the federal poverty line, the premium percentage is 9.5 percent.

• Appropriates $13.5 billion for the Federal Pell Grant program (Sec. 2101).

• Repeals the authority to issue loans through the Federal Family Education Loan program beginning July 1, 2010, and requires all loans be issued directly through a financial institution located or operating in the U.S. and designated by the Secretary of Education (Secs. 2201 & 2206).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that issues various amendments to HR 3590, including, but not limited to, the following highlights.

Highlights:

• Amends the penalty for individuals who fail to maintain "minimum essential health care coverage" as follows (Sec. 1002):
• Amends the income exemption from under 100 percent of the federal poverty line to below the income filing threshold;
• Reduces the applicable dollar amount that is used to determine the penalty (multiplied by the number of people for whom the individual is liable or 300 percent of such amount for the taxable year) from $495 to $325 for 2015, and from $750 to $695 for 2016 and each subsequent year thereafter; and 
• Increases the alternative penalty, assessed if it's greater than the penalty calculated by the applicable dollar amount, from 0.5 to 1 percent of income for 2014, 1 to 2 percent of income for 2015, and 2 to 2.5 for 2016 and each subsequent year thereafter.

• Amends the penalty for large employers (average of at least 50 full time employees, with exceptions for seasonal workers) that fail to offer minimum essential health care coverage to their employees as follows (Sec. 1003):
• Reduces the first 30 employees from the payment calculation; and
• Increases the applicable payment amount from $750 to $2,000.

• Repeals the $600 penalty for large employers that impose a waiting period for new employees to enroll in the company's health benefits plan (Sec. 1003).

• Appropriates $1 billion to the Health Insurance Reform Implementation Fund for the Secretary of Health and Human Services to cover administrative costs associated with implementing the Act (Sec. 1005).

• Repeals the $500 reduction in the coverage gap under Medicare Part D that separates the limit on initial coverage and the coverage for catastrophic care ("donut hole") in 2010, establishes a $250 rebate for individuals affected by the gap beginning in 2010, and phases out the gap by 2020 (Sec. 1101).

• Repeals amendments to Medicare Part C (Medicare Advantage Plan) rates of payments, and amends benchmarks beginning in 2012 based on Medicare costs, to be phased-in over 3, 5, or 7 years depending on the amount reduced, as follows (Sec. 1102):
• 95 percent of Medicare spending for areas ranked by the Secretary in the highest quartile;
• 100 percent of Medicare spending for areas ranked by the Secretary in the second highest quartile;
• 107.5 percent of Medicare spending for areas ranked by the Secretary in the third highest quartile; and
• 115 percent of Medicare spending for areas ranked by the Secretary in the highest quartile.

• Repeals the provision that exempts the state of Nebraska from the federal compensation guidelines for the expansion of Medicaid eligibility and guaranteed that the state will be compensated for 100 percent of the costs beginning in 2014 and each subsequent year thereafter (Sec. 1201).

• Specifies that states will be compensated for the expansion of Medicaid eligibility as follows (Sec. 1201):
• 100 percent for 2014, 2015, and 2016;
• 95 percent for 2017;
• 94 percent for 2018;
• 93 percent for 2019; and
• 90 percent for 2020 and each year thereafter.

• Requires Medicaid payment rates to physicians for primary care services be no less than 100 percent of the rates in 2013 and 2014 (Sec. 1202).

• Amends the effective date for the excise tax on "high cost employer-sponsored health care plans" from 2013 to 2018, and increases the cost threshold for imposing the tax as follows (Sec. 1401):
• For single coverage, the threshold is increased from $8,500 to $10,200, or from $9,850 to $11,850 for retirees and employees of high-risk professions; and
• For family coverage, the threshold is increased from $23,000 to $27,500, or from $26,000 to $30,950 for retirees and employees of high-risk professions.

• Repeals the non-deductible fee to be collected annually after 2010 totaling $2 billion on medical device manufacturers and importers making more than $5 million during a calendar year, and establishes a 2.3 percent excise tax on the first sale of medical devices beginning in 2013, with the following exemptions (Sec. 1405):
• Eyeglasses;
• Contact lenses;
• Hearing aids; and
• Any other medical device available to individuals for retail sale, as determined by the Secretary.

• Prohibits all existing health insurance plans ("grandfathered health plans") from imposing lifetime limits or rescinding coverage for reasons other than intentional misrepresentation of material fact, and requires such plans to provide coverage for non-dependent children up to 26 years of age who are ineligible to enroll in employer-sponsored coverage (Sec. 2301).

• Amends tax credits for the cost of health insurance premiums to be based on household income according to the following sliding scale (Sec. 1001):
• For household incomes up to 133 percent of the federal poverty line, the premium percentage is 2.0 percent;
• For household incomes between 133 percent and 150 percent of the federal poverty line, the initial premium percentage is 3 percent and the final premium percentage is 4 percent;
• For household incomes between 150 percent and 200 percent of the federal poverty line, the initial premium percentage is 4 percent and the final premium percentage is 6.3 percent;
• For household incomes between 200 percent and 250 percent of the federal poverty line, the initial premium percentage is 6.3 percent and the final premium percentage is 8.05 percent;
• For household incomes between 250 percent and 300 percent of the federal poverty line, the initial premium percentage is 8.05 percent and the final premium percentage is 9.5 percent; and
• For household incomes between 300 percent and 400 percent of the federal poverty line, the premium percentage is 9.5 percent.

• Appropriates $13.5 billion for the Federal Pell Grant program (Sec. 2101).

• Repeals the authority to issue loans through the Federal Family Education Loan program beginning July 1, 2010, and requires all loans be issued directly through a financial institution located or operating in the U.S. and designated by the Secretary of Education (Secs. 2201 & 2206).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that issues various amendments to HR 3590, including, but not limited to, the following highlights.

Highlights:

• Amends the penalty for individuals who fail to maintain "minimum essential health care coverage" as follows (Sec. 1002):
• Amends the income exemption from under 100 percent of the federal poverty line to below the income filing threshold;
• Reduces the applicable dollar amount that is used to determine the penalty (multiplied by the number of people for whom the individual is liable or 300 percent of such amount for the taxable year) from $495 to $325 for 2015, and from $750 to $695 for 2016 and each subsequent year thereafter; and 
• Increases the alternative penalty, assessed if it's greater than the penalty calculated by the applicable dollar amount, from 0.5 to 1 percent of income for 2014, 1 to 2 percent of income for 2015, and 2 to 2.5 for 2016 and each subsequent year thereafter.

• Amends the penalty for large employers (average of at least 50 full time employees, with exceptions for seasonal workers) that fail to offer minimum essential health care coverage to their employees as follows (Sec. 1003):
• Reduces the first 30 employees from the payment calculation; and
• Increases the applicable payment amount from $750 to $2,000.

• Repeals the $600 penalty for large employers that impose a waiting period for new employees to enroll in the company's health benefits plan (Sec. 1003).

• Appropriates $1 billion to the Health Insurance Reform Implementation Fund for the Secretary of Health and Human Services to cover administrative costs associated with implementing the Act (Sec. 1005).

• Repeals the $500 reduction in the coverage gap under Medicare Part D that separates the limit on initial coverage and the coverage for catastrophic care ("donut hole") in 2010, establishes a $250 rebate for individuals affected by the gap beginning in 2010, and phases out the gap by 2020 (Sec. 1101).

• Repeals amendments to Medicare Part C (Medicare Advantage Plan) rates of payments, and amends benchmarks beginning in 2012 based on Medicare costs, to be phased-in over 3, 5, or 7 years depending on the amount reduced, as follows (Sec. 1102):
• 95 percent of Medicare spending for areas ranked by the Secretary in the highest quartile;
• 100 percent of Medicare spending for areas ranked by the Secretary in the second highest quartile;
• 107.5 percent of Medicare spending for areas ranked by the Secretary in the third highest quartile; and
• 115 percent of Medicare spending for areas ranked by the Secretary in the highest quartile.

• Repeals the provision that exempts the state of Nebraska from the federal compensation guidelines for the expansion of Medicaid eligibility and guaranteed that the state will be compensated for 100 percent of the costs beginning in 2014 and each subsequent year thereafter (Sec. 1201).

• Specifies that states will be compensated for the expansion of Medicaid eligibility as follows (Sec. 1201):
• 100 percent for 2014, 2015, and 2016;
• 95 percent for 2017;
• 94 percent for 2018;
• 93 percent for 2019; and
• 90 percent for 2020 and each year thereafter.

• Requires Medicaid payment rates to physicians for primary care services be no less than 100 percent of the rates in 2013 and 2014 (Sec. 1202).

• Amends the effective date for the excise tax on "high cost employer-sponsored health care plans" from 2013 to 2018, and increases the cost threshold for imposing the tax as follows (Sec. 1401):
• For single coverage, the threshold is increased from $8,500 to $10,200, or from $9,850 to $11,850 for retirees and employees of high-risk professions; and
• For family coverage, the threshold is increased from $23,000 to $27,500, or from $26,000 to $30,950 for retirees and employees of high-risk professions.

• Repeals the non-deductible fee to be collected annually after 2010 totaling $2 billion on medical device manufacturers and importers making more than $5 million during a calendar year, and establishes a 2.3 percent excise tax on the first sale of medical devices beginning in 2013, with the following exemptions (Sec. 1405):
• Eyeglasses;
• Contact lenses;
• Hearing aids; and
• Any other medical device available to individuals for retail sale, as determined by the Secretary.

• Prohibits all existing health insurance plans ("grandfathered health plans") from imposing lifetime limits or rescinding coverage for reasons other than intentional misrepresentation of material fact, and requires such plans to provide coverage for non-dependent children up to 26 years of age who are ineligible to enroll in employer-sponsored coverage (Sec. 2301).

• Amends tax credits for the cost of health insurance premiums to be based on household income according to the following sliding scale (Sec. 1001):
• For household incomes up to 133 percent of the federal poverty line, the premium percentage is 2.0 percent;
• For household incomes between 133 percent and 150 percent of the federal poverty line, the initial premium percentage is 3 percent and the final premium percentage is 4 percent;
• For household incomes between 150 percent and 200 percent of the federal poverty line, the initial premium percentage is 4 percent and the final premium percentage is 6.3 percent;
• For household incomes between 200 percent and 250 percent of the federal poverty line, the initial premium percentage is 6.3 percent and the final premium percentage is 8.05 percent;
• For household incomes between 250 percent and 300 percent of the federal poverty line, the initial premium percentage is 8.05 percent and the final premium percentage is 9.5 percent; and
• For household incomes between 300 percent and 400 percent of the federal poverty line, the premium percentage is 9.5 percent.

• Appropriates $13.5 billion for the Federal Pell Grant program (Sec. 2101).

• Repeals the authority to issue loans through the Federal Family Education Loan program beginning July 1, 2010, and requires all loans be issued directly through a financial institution located or operating in the U.S. and designated by the Secretary of Education (Secs. 2201 & 2206).

Full Bill Text

Full Bill Text