Here is the 1000+ page bill, and here is a summary. Here is the House combined committee overview page with lots of links and discussion.

Reading through the first 200 or so pages related to health insurance coverage, following are some highlights as I understood them:

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Affordable coverage and consumer protections:

• Sets medical loss ratios for insurance companies and plans, provides rebates to policyholders if not met.

• Prohibits rescission except in provable cases of fraud, provides for independent appeals process.

• Prohibits exclusions for pre-existing conditions or limitations of benefits based on health-related factors.

• Standardized electronic claims filing

• Standardized electronic eligibility determination at point of service

• Requires timely payment of claims.

• Disclosure of plan terms and conditions, financial disclosures, enrollment data, claims denials, rating practices, and cost-sharing in "plain language."

• Guarantees issue and renewability

Guaranteed essential benefits:

• Hospitalization, outpatient, and emergency room services

• Professional services of physicians and other health professionals

• Related equipment and supplies

• Rehabilitative services

• Mental health and substance use disorder services

• Preventive services

• Maternity care

• Infant and children care, oral, health, vision, and hearing for under 21

• Sets annual limits for out of pocket cost sharing

• No annual or lifetime limits

• No cost sharing for preventive services

• Premiums may vary by age

• Premiums may vary by premium rating area (geographic?)

• Provider networks must meet standards of adequacy

• Must provide 70% of full actuarial value of benefits

• Additional provisions for "enhanced" and "premium" plans

Health Insurance Exchange:

• Individuals eligible to obtain coverage unless enrolled in another plan or have other acceptable coverage or are eligible for Medicare, Medicaid, or VA.

• Employers eligible to enroll employees if certain requirements are met.

• Provides affordability credits for individuals up to 400% of poverty, with tiered cost-sharing for those with employer provided plans with premiums exceeding 11% of income.

• Automatic Medicaid enrollment if exchange determines individuals are eligible.

• Plans must provide essential benefits package, participating insurance companies may also offer enhanced and premium plans if they are already provided in their service area.

• Available only to individuals and smallest employers (10 employees or fewer) the first year. Phased in for larger employers over three years or more.

• States may opt out of federal program and operate their own exchange.

• Participating insurance plans must meet certain requirements, such as providing information for risk pooling and providing for implementation of affordability credits.

• Consumers pay premiums directly to insurance companies, exchange commission will provide consumer assistance with choosing plans.

• Participating insurance companies regulated by federal and state government.

Public Option:

• Available only through the exchange.

• Meets requirements of exchange basic, enhanced and premium plans.

• Government may outsource administration, but not risk.

• Geographically adjusted premiums that fully finance health benefits and administrative costs.

• Provider payment rates same as Medicare plus 5% for the first three years.

• Payment rates for prescription drugs will be negotiated.

• Provider network is the same as Medicare unless provider opts out of public option.

Shared Responsibility:

• Individuals required to obtain acceptable coverage or pay penalty equal to 2.5% of income into the exchange.

• Employers must provide insurance and pay a substantial part of the premium or pay penalty of 8% of payroll into the exchange.

• Employers must automatically enroll employees unless employee opts out, in which case employers must pay 8% of employees wages into the exchange.

• Employers with payroll under $250,000 are exempt from the 8% rule, graduated percentage up to $400,000 in payroll.

• Employers prohibited from "steering" employees away from employer plan into individual exchange plan.

• A small business tax credit is available for businesses who provide employee insurance.

• Additional tax surcharge on high income individuals (1% if over $350,000, 1.5% if over $500,000, 5.4% if over $1,000,000). The 1% and 1.5% surcharges double after two years if federal health care savings targets are not met.

There are 800 more pages dealing with changes to Medicare and Medicaid that I have not studied.

On the whole, these are pretty good changes. My main objection is the focus on employer provided insurance. Health insurance must be divorced from employment.

It is not clear if individual plans available through the exchange are portable from state to state. It is also not clear whether lower income individuals who are self-employed or underemployed will be able to afford the basic essentials plan, which is pretty good insurance and presumably won't be cheap, even with affordability credits. And if they work for someone who doesn't provide insurance or they opt out of their employer's plan, it does not appear that they directly benefit from the 8% employer penalty in terms of premium reduction.

On the plus side, employers who are providing insurance and paying more than 8% will likely opt out and pay the 8% instead. This means more people end up in the exchange pool with individual policies, which is where everyone should be whether it's the public option or some other plan.

I don't understand why new taxes on high-income individuals (or the employer penalties) are needed to pay for this. If most individual and group insurance is provided through the exchange and the exchange is managed as a single risk pool, the premiums should pay for the coverage including the affordability credits.

At any rate, after looking at some of the details it's not a bad start. It addresses exclusion and rescission, provides other consumer protections and efficiencies, and includes a public option. It does not appear to address portability, and it does not remove employment from the equation. Allowing states to opt out of the exchange dilutes the purpose of the exchange and could lead to a whole new set of problems. It's ridiculously complicated, and it's certainly not single payer or anything close to it. But maybe it's better than nothing, assuming it can be done.