NAHU's analysis of the Wyden bill
The Healthy Americans Act would require all Americans to purchase “Healthy Americans Private Insurance (HAPI) through”state “health help agencies,” which would be a type of purchasing pool. State health help agencies would be required to offer two or more HAPI plan options based on specified standards.
All citizens over age 19 not in Medicare, an employer retiree health plan, or in a plan offered by the departments of Defense or Veterans Affairs or the Indian Health Service, would be required to enroll in private coverage or face federal financial penalties. The penalty would be equal to the amount of the average health insurance premium for each uninsured month plus 15 percent, with enforcement determined by each state.
Employers would be required to contribute an amount equal to a percentage of the average premium of their workforce times the number of their workers. The percentage of the average premium each employer would have to pay would vary based on the group size and would range from 2-25 percent. The current employer deduction for employee health care costs would be limited.
Individuals with incomes below the federal poverty level (FPL) would receive a full subsidy. Subsidies would be given on a sliding scale basis for those between 100-400 percent of the FPL. The legislation eliminates the current federal income tax exclusion on employer-paid health insurance premiums and replaces it with a standard health insurance deduction for those above 100 percent of FPL.
All private health insurance products would have to be guarantee issue and guarantee renewable and subject to either pure community rating or modified community rating based only on geography, smoking status and/or family size. The rating mechanism would be determined by each state. Discounts would be allowed for wellness program and disease management participation. All plans would have to abide by all HIPAA provisions and federal mandates, and could also not discriminate based on genetic information.
The legislation also addresses many other issues like standardizing long-term care insurance, quality of care issues, wellness incentives, Medicare changes and more.
The Healthy Americans Act is estimated to cost $813 billion over 10 years. However, the Lewin Group estimates it would lead to federal savings of $1.5 trillion over the same period by slowing the annual rate of growth in national health spending.
The Healthy Americans Act does not guarantee a role for licensed and professional health insurance producers.
Jessica Fulginiti Waltman
610-971-2404 Phone/Fax
703-496-0796 Cell
jwaltman@nahu.org
