The Patient Protection and Affordable Care Act (H.R. 3590).
Health Care and Education Reconciliation Act (H.R. 4872)

Health Insurance Provisions

● Prohibits a health plan from rescinding coverage of an enrollee except in the case of fraud or intentional misrepresentation of material fact.

● Requires health plans to provide coverage for: (1) specified preventive items or services; (2) recommended immunizations; and (3) recommended preventive care and screenings for women and children.

● Requires a health plan that provides dependent coverage of children to make such coverage available for an unmarried adult child (whether or not employed) until the child turns 26 years of age.

● Requires the establishment of a temporary high risk health insurance pool program to provide health insurance coverage to eligible adults with preexisting conditions. On January 1, 2014 provides for a transition to a Health Benefit Exchange. Exclusions for children with preexisting conditions will be eliminated in 2010.

● Eliminates the practice of gender rating in premiums for employers with fewer than 100 employees. This practice has resulted in higher premiums for women.

● Prohibits a health plan from establishing individual eligibility rules based on health status-related factors, including medical condition, claims experience, receipt of health care, medical history, genetic information, and evidence of insurability.

● Sets forth special rules for abortion coverage, including: (1) permitting states to elect to prohibit abortion coverage in qualified health plans offered through an Exchange in the state; (2) prohibiting federal funds from being used for abortion services; and (3) requiring separate accounts for payments for such services. Prohibits any qualified health plan offered through an Exchange from discriminating against any individual health care provider or health care facility because of its unwillingness to provide, pay for, provide coverage of, or refer for abortions.

● Applies mental health parity provisions to qualified health plans.

● Allows individual taxpayers whose household income equals or exceeds 100%, but does not exceed 400%, of the federal poverty line a refundable tax credit for a percentage of the cost of premiums for coverage under a qualified health plan.

● Requires reductions in the maximum limits for out-of-pocket expenses for individuals enrolled in qualified health plans whose incomes are between 100% and 400% of the poverty line.

●. Requires individuals to maintain minimal essential health care coverage beginning in 2014. Imposes a penalty for failure to maintain coverage beginning in 2014, except for certain low-income individuals who cannot afford coverage, members of Indian tribes, and individuals who suffer hardship. Exempts from the coverage requirement individuals who object to health care coverage on religious grounds.

● Extends Medicaid coverage, beginning in calendar 2014, to individuals under age 65 who are not entitled to or enrolled in Medicare and have incomes at or below 133% of the federal poverty line ($10,830 for an individual and $22,050 for a family of four) . Grants a state the option to expand Medicaid eligibility to such individuals as early as April 1, 2010 and to extend coverage to individuals above 133% of poverty level beginning in 2014.

●. Authorizes states to offer home and community-based attendant services and supports to Medicaid beneficiaries with disabilities who would otherwise require care in a hospital, nursing facility, intermediate care facility for the mentally retarded, or an institution for mental diseases and creates an optional eligibility category to provide full Medicaid benefits to individuals receiving home and community-based services under a state plan amendment.

● Makes appropriations of $250 million for FY2010-FY2014 for abstinence education programs.

● Makes appropriations for $375 million for comprehensive sex education programs that are based on scientific, evidence-based, sex education on family planning and STIs.

● Medicare Prescription Drug “Donut Hole” will be reduced out over the next several years beginning in 2010 with a $250 payment for beneficiaries. By 2020 beneficiaries will be responsible for 25% of their drug costs in the gap.

● Increases funding to community health centers by $11 billion dollars, estimated to double the capacity of current community health centers; establish new programs to support school-based health centers and nurse managed health centers.

Education Provisions Included in the Health Care and Education Reconciliation Act

● Provides funding to increase federal Pell Grants from $5,550 in FY 2010 to $5,975 in 2017.

● Replaces the private, for-profit, bank-based federal student loan program with a federal Direct Loan Program; allows contracts for loan servicing to eligible non-for-profit services.

● Provides $500 million a year for four years (2011-2014) for the Community College and Career Training Grant Program that was authorized under the American Recovery and Reinvestment Act.
● Provides $150 million a year for five years (2010-2014) for the College Access Challenge Grant Program, increasing the program from the current $66 million per year. This program provides funding to each state on a formula basis.

● Extends the Historically Black Colleges and Universities and the Minority Serving Institutions Program for 10 years by providing $255 million a year for 2010 through 2019.

● After July 1, 2014, reduces cap on federal student loan payments for new borrowers from the current 15% to 10% of their discretionary income; discharges unpaid balance after 20 years.