Summary
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Issues, Solutions, Administrative Structure and Cost
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ISSUE 1:  REGIONAL OPTIONS.— (1) INTERSTATECOMPACTS.—"Two or more States that establish a State Exchange may enter into interstate compacts providing for the regulations of health insurance coverage offered within such States…..The State Exchange shall ensure that each health insurance issuer that provides health insurance coverage through the Exchange disseminate to eligible individuals and employers within the State information concerning health insurance coverage options, including the plans offered and premiums and benefits for such plans........."

ISSUE 2:  STATE GRANTS TO CREATE HEALTH COURT SOLUTIONS
(HR 2520 - Page 172)  “....... The Secretary may award grants to States for the development, implementation, and evaluation of alternatives to current tort litigation that comply with this section, for the resolution of disputes concerning injuries allegedly caused by health care providers or health care organizations.......
……A State may use amounts received under a grant under this section to develop and implement an expert panel and early offer review system …….
……A State may use amounts received under a grant under this section to develop and implement an administrative health care tribunal system under which the parties involved shall have the right to request a hearing to review any dispute concerning injuries allegedly caused by health care providers or health care organizations before an administrative health care tribunal established by the State involved….”

ISSUE 3: Repeal of Employer Tax Exclusion " for providing health insurance to their employees; Limitation or capped on the participating individuals’ insurance premium, savings and out-of-pocket expenses beyond which will be subject to taxation..."

"……. NO EXCLUSION FOR INDIVIDUALS ELIGIBLE FOR QUALIFIED HEALTH INSURANCE CREDIT…….) shall not apply with respect to any employer provided coverage under an accident or health plan for any individual for any month unless such individual …... MODIFICATION OF DEDUCTION FOR MEDICAL EXPENSES…”

....... PREMIUMS FOR QUALIFIED HEALTH INSURANCE.—The term ‘medical care’ does not include any amount paid as a premium for coverage of an eligible individual (as defined in section 25 E(e)) under qualified health insurance (as defined in section 25E(f)) for any month.’’.

(g) RETIRED PUBLIC SAFETY OFFICERS……: ‘‘Such term shall not include any premium for coverage by an accident or health insurance plan for any month unless such individual ……. EFFECTIVE DATE.—The amendments made by this section shall apply to taxable years beginning after December 31, 2010…..”

(i) NO INTENT TO ENCOURAGE STATE TAXATION OF HEALTH BENEFITS.—No intent to encourage any State to treat health benefits as taxable income for the purpose of increasing State income taxes may be inferred from the provisions of, and amendments made by, this section.

TITLE III—FAIR TAX TREATMENT FOR ALL AMERICANS TO AFFORD HEALTH CARE (2) LIMITATION ON AGGREGATE AMOUNT.—“ …… the aggregate monthly limitations for the taxpayer and the tax payer’s spouse and dependents for any month shall not exceed 1⁄12th of the applicable aggregate amount….The applicable adult amount is $2,290.‘‘(ii) APPLICABLE CHILD AMOUNT.— The applicable child amount is $1,710.‘‘(iii) APPLICABLE AGGREGATE AMOUNT.—The applicable aggregate amount is $5,710…”

SEC. 311. IMPROVEMENTS TO HEALTH SAVINGS ACCOUNTS. .. MONTHLY LIMITATION.— “ ….In the case of an eligible individual who has coverage under a high deductible health plan, the monthly limitation for any month of such coverage is 1⁄12 of the sum of 50 or the greater of— (I) the sum of the annual deductible and the other annual out-of pocket expenses (other than for premiums) required to be paid under the plan by the eligible individual for covered benefits, or self-only coverage under a high deductible health plan as of the first day of such month, $3,000, or family coverage under a high deductible health plan as of the first day of such month, $5,950, and in the case of an eligible individual who has coverage under a qualified long-term care insurance contract, the annual premium for such coverage, or $1,000."

ISSUE 4:  REDUCTION IN PREMIUM SUBSIDY BASED ON INCOME Social Security, Medicare Part B and D  "….. In the case of an individual whose modified adjusted gross income exceeds the threshold of section 1839 for the calendar year, the monthly amount of the premium subsidy applicable to the premium under this section for a month after December 2010 shall be reduced (and the monthly beneficiary premium shall be increased) by the monthly adjustment amount specified in subparagraph the amount of the income-related reduction in premium subsidy for an individual for a month shall be paid through withholding from benefit payments in the manner provided under section 1840. ..."

ISSUE 5: ESTABLISHMENT, CERTIFICATION, AND MEMBERSHIP OF INDEPENDENT HEALTH RECORD TRUSTS. ESTABLISHMENT

" ...Not later than one year after the date of the enactment of this Act, the Federal Trade Commission, in consultation with the National Committee on Vital and Health Statistics, shall prescribe standards for the establishment, certification, operation, and interoperability of IHRTs to carry out the purposes described in section 842 in accordance with the provisions of this subtitle.

“SEC. 702. HEALTH RECORD BANKING. (a) ESTABLISHMENT.—Not later than 1 year after the date of enactment of this Act, the Secretary of Health and Human Services shall promulgate regulations to provide for the certification and auditing of the banking of electronic medical records….”

“(3) RULES FOR SECONDARY USES OF RECORDS FOR RESEARCH AND OTHER PURPOSES.—
(A) IN GENERAL.—With respect to the electronic health record of an IHRT participant (or specified parts of such electronic health record) maintained by an IHRT, the IHRT MAY SELL SUCH RECORDS (or specified parts of such record) only if— …..”

ISSUE 6: Rewards and Penalties
"SEC. 504. Rewarding Prevention on States. (g) WELLNESS BONUSES.— (1) IN GENERAL.—The Secretary shall award wellness bonus payments to at least 5, but not more than 10, States that demonstrate the greatest progress in reducing disease rates and risk factors and increasing healthy behaviors.

SEC. 504. Rewarding Prevention on Individual Premiums. (1) With respect to the monthly premium amount for months after December 2010, the Secretary may adjust (under procedures established by the Secretary) the amount of such premium for an individual is based on whether or not the individual participates in certain healthy behaviors, such as weight management, exercise, nutrition counseling, refraining from tobacco use, designating a health home, and other behaviors determined appropriate by the Secretary.

(2) In making the adjustments under paragraph (1) for a month, the Secretary shall ensure that the total amount of premiums to be paid under this part for the month is equal to the total amount of premiums that would have been paid under this part for the month if no such adjustments had been made, as estimated by the Secretary.’’.

Section. 311. Improvements to Health Savings Account. Increase in monthly contribution limit  coverage under a high deductible health plan, the monthly limitation for any month of such coverage for self-only coverage under a high deductible health plan as of the first day of such month, $3,000, or family coverage under a high deductible health plan as of the first day of such month, $5,950, and in the case of an eligible individual who has coverage under a qualified long-term care insurance contract the annual premium for such coverage, or $1,000.”

ISSUE 7: Inefficiency in Bureaucracy

"TITLE VIII—HEALTH CARE SERVICES COMMISSION There is hereby established a Health Care Services Commission (in this title, referred to as the ‘‘Commission’’) to be composed of 5 commissioners (in this title referred to as the ‘‘Commissioners’’) to be appointed by the President by and with the advice and consent of the Senate. Not more than 3 of such Commissioners shall be members of the same political party, and in making appointments members of different political parties shall be appointed alternately as nearly as may be practicable. No Commissioner shall engage in any other business, vocation, or employment than that of serving as Commissioner. Each Commissioner shall hold office for a term of 5 years and until a successor is appointed and has qualified, except that—

Subtitle B—Forum for Quality and Effectiveness in Health Care SEC. 811. ESTABLISHMENT OF OFFICE. There is established within the Commission an office to be known as the Office of the Forum for Quality and Effectiveness in Health Care. The office shall be headed by a director (referred to in this title as the ‘‘Director’’) who shall be appointed by the Commissioners. (a) IN GENERAL.—The Office of the Forum for Quality and Effectiveness in Health Care shall be composed of 15 individuals nominated by private sector health care organizations and appointed by the Commission and shall include representation from at least the following: