List of Definitions for the H.R. 3200 Health Care Reform Bill

This article will act as a simple glossary of terms and FAQs associated with the health care reform bill. The definitions given in this article are my own and reflect my research mixed with my intuition to create simpler, more easily understandable definitions for the bill's terminology. This will be a frequently updated article, so please leave comments and questions as to other terms that you find confusing. I will do my best to research all vocabulary in question and provide clear, concise definitions that can help you understand the bill.

Note: The numbers in parentheses refer to the section and any subsection of the bill from where the information came. The terms are also listed in alphabetical order for your convenience.

Glossary

Acceptable Coverage
Any plan that is a Qualified Health Benefits Plan, a grandfathered coverage plan, or under Medicare or Medicaid, is deemed acceptable coverage (202(A-G)). Other acceptable coverage forms include VA and Armed Forces health coverage. The bill also contains special instances in which other forms of coverage may be deemed acceptable under the terms outlined in the specific division.

Affordability Credits
Credits for individuals or families that are given on a basis of income level (up to 400% of the Federal poverty level [FPL] ). These affordability credit-eligible parties will then redeem the credits when calculating the cost-sharing of a basic plan in the Health Insurance Exchange. This will determine how much they pay in cost-sharing for a basic QHBP plan. For eligible parties with an income of 350-400% of the FPL, the credit will be worth 70% of the cost-sharing costs in the plan. This percentage ranges up to 97% of costs paid for parties with an income below 150% of the FPL. The percentage that is paid for will come from the Health Insurance Exchange Trust Fund (see below). For more information, please see section 241 of the bill.

Exchange-participating Health Benefits Plan (EPHBP)
Any qualified health benefits plan within the Health Insurance Exchange can be deemed an EPHBP. This includes government sanctioned insurance plans as well as all qualified private plans.

Health Choices Administration/Health Choices Commissioner
An administration established under the H.R. 3200 Health Care Reform Bill under the executive branch of government to be headed by the commissioner. For duties of the administration and commissioner, click here.

Health Insurance Exchange (HIE)
A government-run marketplace that allows individuals and small employers who are not enrolled in any qualified health benefits plan to make side-by-side comparisons when choosing between private and public insurance coverage. For a more detailed definition, click here.

HIE Trust Fund
A fund established under section 207 of the bill to provide compensation for affordability credits. The HIE Trust Fund will be funded by taxes on individuals who choose not to obtain acceptable coverage, employers not offering acceptable coverage, and excise tax on failures to meet health coverage requirements. If these taxes combined are not enough to pay for the affordability credits, then any money from the Treasury that has not been otherwise appropriated, will be used to cover the difference.

QHBP Offering Entity
Any public or private provider of Qualified Health Benefits Plans (100(c)(19)(A-E).

QHBP Ombudsman
An appointee of the Health Choices Commissioner who will provide assistance to individuals choosing a QHBP. Also, the Ombudsman will assist individuals with grievances associated with QHBPs. The Ombudsman will submit annual reports to Congress and the Commissioner that addresses problems with payment and coverage policies.

Qualified Health Benefits Plan (QHBP)
A coverage option that meets the standards of health care as decided by the Health Choices Commissioner and determined under the Essential Benefits Package of section 122. Some of these standards include (but are not limited to) no annual lifetime limit on claims (122(a)(3)); no denial of insurance based on pre-existing conditions (111); minimum services including hospitalization, prescriptions, mental health care, and maternity care (122(b)(1-10)).

Y1, Y2, Y3, etc.
These letter-number combinations refer specific years. "Y1" refers to 2013, the first year the bill will be enacted if passed. "Y2" would then refer to 2014, "Y3" to 2015, and so on.

FAQs

How is the bill laid out/organized?
The bill is divided into three divisions: Division A, titled "Affordable Health Care Choices"; Division B, titled "Medicare and Medicaid Improvements"; and Division C, titled "Public Health and Workforce Development." Each division contains up to nine Titles (listed in Roman numerals), which are further divided into Subtitles (listed with capital letters), and then Parts (listed in numbers).

What is the difference between a section and a title or subtitle?
Sections refer to specific headings within the bill. They act similar to the Dewey Decimal System in a library as they give numerical values that coincide with specific Divisions, Titles, and Subtitles. Sections allow for an easy way to reference specific parts of the bill and are important when citing information found in the bill.