House bill contains measure to control medical premium costs. The House bill as introduced requires qualified health insurance plans to meet a specified medical loss ratio, which is the part of revenue from premiums that actually pays for medical services. If insurers fail to meet this requirement, they are required to provide rebates to their enrollees.
Bills include provisions to help those who lose their insurance purchase new policies
Congressional bills prohibit the use of pre-existing conditions to deny coverage. According to a Ways and Means Committee staff description of the House bill, Section 111 "[p]rohibits the application of pre-existing condition exclusions," and Section 112 "[r]equires guaranteed issue (no one can be denied health insurance)." The Senate HELP bill similarly prohibits "discrimination based on health status," stating that a "group health plan and a health insurance issuer offering group or individual health insurance coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan or coverage based on [a number of] health status-related factors in relation to the individual or a dependent of the individual."
House and Senate bills provide subsidies to buy individual insurance. The House bill provides "individual affordability credits" through a Health Insurance Exchange to individuals who meet certain criteria, including being "enrolled under an Exchange-participating health benefits plan," not being "enrolled under such plan as an employee (or dependent of an employee) through an employer qualified health benefits plan," and having a "family income below 400 percent of the Federal poverty level for a family of the size involved." And according to a HELP Committee release, the Senate bill provides credits to "low-income" and "moderate-income" individuals "who enroll in plans through the Gateways" -- one term used to describe the exchanges. "Credits are provided on sliding scale, so that those with the lowest incomes receive the most help. Gateways, which will provide information on health insurance options, will administer these credits. The premium credits would be on a sliding scale up to 400% of the poverty line ($88,080 for a family of 4), with those at lower end receiving more."
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