I was wondering what the bare minimum requirements are going to be, with regard to the health insurance reform bill, in order to avoid the tax penalty.
I went to the online
reconciliation bill:
H. R. 4872; To provide for reconciliation pursuant to section 202 of the concurrent resolution on the budget for fiscal year 2010. (thomas.gov link. If it doesn't work, go to thomas.gov and search h.r. 4872.)
I looked through for the tax repercussions and the basic requirements for coverage in order to comply with the soon to be legislated mandate. The short question was,
what do I need to purchase and how much will it cost me for the bare minimum compliance?This is how it went.
Search through H.R. 4872 for "tax."
Subpart A--Tax on Individuals Without Acceptable Health Care Coverage
SEC. 59B. TAX ON INDIVIDUALS WITHOUT ACCEPTABLE HEALTH CARE COVERAGE.
(a) Tax Imposed- In the case of any individual who does not meet the requirements of subsection (d) at any time during the taxable year, there is hereby imposed a tax equal to 2.5 percent of the excess of--
(1) the taxpayer's modified adjusted gross income for the taxable year, over
(2) the amount of gross income specified in section 6012(a)(1) with respect to the taxpayer.
<snip a list of exceptions. I predict church membership increases.>
Search for "acceptable health care coverage."
{Subsection} (d) Acceptable Coverage Requirement-
(1) IN GENERAL- The requirements of this subsection are met with respect to any individual for any period if such individual (and each qualifying child of such individual) is covered by acceptable coverage at all times during such period.
(2) ACCEPTABLE COVERAGE- For purposes of this section, the term `acceptable coverage' means any of the following:
(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE- Coverage under a qualified health benefits plan (as defined in section 100(c) of the America's Affordable Health Choices Act of 2009).
(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER GRANDFATHERED EMPLOYMENT-BASED HEALTH PLAN
(C) MEDICARE
(D) MEDICAID
(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE
(F) VA
(G) OTHER COVERAGE
<details of B through G above, left blank to keep you from going blind>
Search for "section 100."
section 100(c)
(c) General Definitions- Except as otherwise provided, in this division:
(1) ACCEPTABLE COVERAGE- The term `acceptable coverage' has the meaning given such term in section 202(d)(2).
(2) BASIC PLAN- The term `basic plan' has the meaning given such term in section 203(c).
<more snip>
Search for "section 202."
section 202(d)(2)
{Section 202} (d) Individuals-
<snippage>
(2) ACCEPTABLE COVERAGE- For purposes of this division, the term `acceptable coverage' means any of the following:
(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE- Coverage under a qualified health benefits plan.
(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN
(C) MEDICARE-.
(D) MEDICAID
(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE
(F) VA
(G) OTHER COVERAGE
<details of B through G above, left blank to keep you from going blind>
Section 202 says "acceptable coverage" equals a "qualified health benefits plan."
AAAAAAAAAAAAAAAAGGGGGGGGGGGGGGGGGGGGGGGHHHHHHHHHHHHHHHHHHHH!!!!!!!!!!!!!!!!!!!!!!!!!! (spaghetti code, FFS!!!!)
Qualified health benefits plan is defined where???? Search for "qualified health benefits plan."
Subtitle D <snippage>
Part 2--Prevention of Tax Avoidance <snippage>
(c) General Definitions- Except as otherwise provided, in this division: <snip 1-19>
(20) QUALIFIED HEALTH BENEFITS PLAN- The term `qualified health benefits plan' means a health benefits plan that meets the requirements for such a plan under title I and includes the public health insurance option and cooperatives under subtitle D of title II.
"Qualified Health Benefits Plan" is defined in Title What? Goto where? Return to what? Loop? Endless? WTF?! If, then, else, loop, if then, rather, this, go to section that, return from section other, find title I and II, under then over or through...
Search for "Title I."
TITLE I--PROTECTIONS AND STANDARDS FOR QUALIFIED HEALTH BENEFITS PLANS
Subtitle A--General Standards
Sec. 101. Requirements reforming health insurance marketplace.
<lots of snippage>
Okay, Title I, Section 101.
Look, look, I found it! Or...
SEC. 101. REQUIREMENTS REFORMING HEALTH INSURANCE MARKETPLACE.
(a) Purpose- The purpose of this title is to establish standards to ensure that new health insurance coverage and employment-based health plans that are offered meet standards guaranteeing access to affordable coverage, essential benefits, and other consumer protections.
(b) Requirements for Qualified Health Benefits Plans- On or after the first day of Y1, a health benefits plan shall not be a qualified health benefits plan under this division unless the plan meets the applicable requirements of the following subtitles for the type of plan and plan year involved:
(1) Subtitle B (relating to affordable coverage).
(2) Subtitle C (relating to essential benefits).
(3) Subtitle D (relating to consumer protection).
What? Where? Search for "Subtitle C (relating to essential benefits)". Woo hoo! I'm there...um...
Subtitle C--Standards Guaranteeing Access to Essential Benefits
SEC. 121. COVERAGE OF ESSENTIAL BENEFITS PACKAGE.
(a) In General- A qualified health benefits plan shall provide coverage that at least meets the benefit standards adopted under section 124 for the essential benefits package described in section 122 for the plan year involved.
<scroll doooooown and snip to Sec. 122>
SEC. 122. ESSENTIAL BENEFITS PACKAGE DEFINED. {look! look! there it is!}
(a) In General- In this division, the term `essential benefits package' means health benefits coverage, consistent with standards adopted under section 124 to ensure the provision of quality health care and financial security, that--
(1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;
(2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);
(3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;
(4) complies with section 115(a) (relating to network adequacy); and
(5) is equivalent, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage.
(b) Minimum Services to Be Covered- Subject to subsection (d), the items and services described in this subsection are the following:
(1) Hospitalization.
(2) Outpatient hospital and outpatient clinic services, including emergency department services.
(3) Professional services of physicians and other health professionals.
(4) Such services, equipment, and supplies incident to the services of a physician's or a health professional's delivery of care in institutional settings, physician offices, patients' homes or place of residence, or other settings, as appropriate.
(5) Prescription drugs.
(6) Rehabilitative and habilitative services.
(7) Mental health and substance use disorder services, including behavioral health treatments.
(8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
(9) Maternity care.
(10) Well baby and well child care; treatment of a congenital or developmental deformity, disease, or injury; and oral health, vision, and hearing services, equipment, and supplies at least for children under 21 years of age.
<scroll doooown and snip to Sec. 124>
SEC. 124. PROCESS FOR ADOPTION OF RECOMMENDATIONS; ADOPTION OF BENEFIT STANDARDS.
(a) Process for Adoption of Recommendations-
(1) REVIEW OF RECOMMENDED STANDARDS- Not later than 45 days after the date of receipt of benefit standards recommended under section 123 (including such standards as modified under paragraph (2)(B)), the Secretary shall review such standards and shall determine whether to propose adoption of such standards as a package.
(2) DETERMINATION TO ADOPT STANDARDS- If the Secretary determines--
(A) to propose adoption of benefit standards so recommended as a package, the Secretary shall, by regulation under section 553 of title 5, United States Code, propose adoption such {sic} standards; or
(B) not to propose adoption of such standards as a package {there's a damned typo in the bill?!}, the Secretary shall notify the Health Benefits Advisory Committee in writing of such determination and the reasons for not proposing the adoption of such recommendation and provide the Committee with a further opportunity to modify its previous recommendations and submit new recommendations to the Secretary on a timely basis.
(3) CONTINGENCY- If, because of the application of paragraph (2)(B), the Secretary would otherwise be unable to propose initial adoption of such recommended standards by the deadline specified in subsection (b)(1), the Secretary shall, by regulation under section 553 of title 5, United States Code, propose adoption of initial benefit standards by such deadline.
(4) PUBLICATION- The Secretary shall provide for publication in the Federal Register of all determinations made by the Secretary under this subsection.
(b) Adoption of Standards-
(1) INITIAL STANDARDS- Not later than 18 months after the date of the enactment of this Act, the Secretary shall, through the rulemaking process consistent with subsection (a), adopt an initial set of benefit standards.
(2) PERIODIC UPDATING STANDARDS- Under subsection (a), the Secretary shall provide for the periodic updating of the benefit standards previously adopted under this section.
(3) REQUIREMENT- The Secretary may not adopt any benefit standards for an essential benefits package or for level of cost-sharing that are inconsistent with the requirements for such a package or level under sections 122 (including subsection (d)) and 123(b)(5).
Oh, nevermind. It hasn't been adopted yet. May not be adopted. Could be adopted. Won't know for sure until
"Not later than 18 months after the date of the enactment of this Act, the Secretary shall, through the rulemaking process consistent with subsection (a), adopt an initial set of benefit standards." Go to, Title I, Section 124(a).
Alllllllrighty then. Moving on to "basic plan."
section 100(c)
(c) General Definitions- Except as otherwise provided, in this division:
(2) BASIC PLAN- The term `basic plan' has the meaning given such term in section 203(c).
Yeah, right after I stick an ice pick into my right eye and hang my favorite earring off it for decoration.
Ya know, I just don't understand why there aren't more people engaged in the legislative process.
:crazy: :argh: :grr: :nuke: :banghead: :sarcasm: