{ "id": "R40942", "type": "CRS Report", "typeId": "REPORTS", "number": "R40942", "active": false, "source": "EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source": "EveryCRSReport.com", "id": 372425, "date": "2010-09-21", "retrieved": "2016-04-07T01:28:11.226679", "title": "Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (PPACA)", "summary": "The Patient Protection and Affordable Care Act (P.L. 111-148, PPACA) was signed into law on March 23, 2010. On March 30, 2010, PPACA was amended by P.L. 111-152, the Health Care and Education Reconciliation Act of 2010. This report summarizes the key provisions in PPACA (hereafter referring to PPACA as amended by P.L. 111-152) that affect private health insurance. PPACA imposes new requirements on individuals, employers, and health plans; restructures the private health insurance market; sets minimum standards for health coverage; and provides financial assistance to certain individuals and, in some cases, small employers. \nIn general, PPACA requires individuals, beginning in 2014, to maintain health insurance, with some exceptions. Individuals will be required to maintain minimum essential coverage, which includes eligible employer coverage, individual coverage, grandfathered plans, and federal programs such as Medicare and Medicaid, among others. Employers are not explicitly required to provide health benefits, although certain employers with more than 50 employees may be required to pay a penalty if either (1) they do not provide insurance, under certain circumstances, or (2) the insurance they provide does not meet specified requirements. Several insurance market reforms will be implemented, including some prior to full implementation in 2014, such as prohibition against lifetime benefit limits and coverage for preexisting health conditions for children. \nIn addition to establishing new federal private health insurance standards, PPACA will enable and support states\u2019 creation by 2014 of \u201cAmerican Health Benefit Exchanges.\u201d An exchange cannot be an insurer, but will provide eligible individuals and small businesses with access to insurers\u2019 plans in a comparable way. The exchange will consist of a selection of private plans as well as \u201cmulti-state qualified health plans,\u201d administered by the Office of Personnel Management. Individuals will only be eligible to enroll in an exchange plan if they are not enrolled in Medicare, Medicaid, or acceptable employer coverage as a full-time employee. Based on income, certain individuals may qualify for a tax credit toward their premium costs and a subsidy for their cost-sharing; the credits and subsidies will be available only through an exchange. States will have the flexibility to establish basic health plans for low-income individuals not eligible for Medicaid.\nIndividual and small group coverage will be allowed to be offered through nonprofit, member-run health insurance companies. Such nonprofit insurers will be eligible for grants and loans distributed through the new Consumer Operated and Oriented Plan (CO-OP) program.", "type": "CRS Report", "typeId": "REPORTS", "active": false, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R40942", "sha1": "e44961364783af3b7c1804f0d986966605064e2f", "filename": "files/20100921_R40942_e44961364783af3b7c1804f0d986966605064e2f.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R40942", "sha1": "41e26d7ea9ace305b81b123c2e6f94dc488f0352", "filename": "files/20100921_R40942_41e26d7ea9ace305b81b123c2e6f94dc488f0352.pdf", "images": null } ], "topics": [] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc822151/", "id": "R40942_2010May04", "date": "2010-05-04", "retrieved": "2016-03-19T13:57:26", "title": "Private Health Insurance Provisions in the Patient Protection and Affordable Care Act (PPACA)", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20100504_R40942_b392e53f0efc133bc1e920336ab3b5ca1becc2a6.pdf" }, { "format": "HTML", "filename": "files/20100504_R40942_b392e53f0efc133bc1e920336ab3b5ca1becc2a6.html" } ], "topics": [] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc819027/", "id": "R40942_2010Apr15", "date": "2010-04-15", "retrieved": "2016-03-19T13:57:26", "title": "Private Health Insurance Provisions in PPACA (P.L. 111-148)", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20100415_R40942_95f0724248acecb9e9a6aa8e7448e888ef2d78d1.pdf" }, { "format": "HTML", "filename": "files/20100415_R40942_95f0724248acecb9e9a6aa8e7448e888ef2d78d1.html" } ], "topics": [] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc817400/", "id": "R40942_2010Jan29", "date": "2010-01-29", "retrieved": "2016-03-19T13:57:26", "title": "Private Health Insurance Provisions in Senate-Passed H.R. 3590, The Patient Protection and Affordable Care Act", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20100129_R40942_3f335f36e6918855dedaed0fca7ac310e22c87d3.pdf" }, { "format": "HTML", "filename": "files/20100129_R40942_3f335f36e6918855dedaed0fca7ac310e22c87d3.html" } ], "topics": [] } ], "topics": [ "Domestic Social Policy", "Health Policy" ] }