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{{Use American English|date = March 2019}}
{{Short description|Proposed U.S. law}}
{{Use mdy dates|date = March 2019}}
{{for multi|the U.S. health care legislation signed into law in 2010|Patient Protection and Affordable Care Act|the bill proposed in 2017|American Health Care Act}}
{{Health care reform in the United States}}
The '''Affordable Health Care for America Act''' (or '''HR 3962''')<ref>{{USBill|111|H.R.|3962}}</ref> was a [[Bill (proposed law)|bill]] that was crafted by the [[United States House of Representatives]] of the [[111th United States Congress]] on October 29, 2009. The bill was sponsored by Representative [[Charles Rangel]].
At the encouragement of the [[Obama administration]], the [[111th Congress]] devoted much of its time to enacting [[Health care reform in the United States|reform of the United States' health care system]]. Known as the "House bill", HR 3962 was the House of Representatives' chief legislative proposal during the health reform debate.
On December 24, 2009, the Senate passed an alternative health care bill, the [[Patient Protection and Affordable Care Act]] (H.R. 3590).<ref>{{cite news|url=https://www.nytimes.com/2009/12/25/health/policy/25health.html?_r=1&hp|title=Senate Passes Health Care Overhaul Bill |last=Pear|first=Robert |date=December 24, 2009|work=The New York Times|access-date=December 24, 2009| archive-url= https://web.archive.org/web/20131115013125/http://www.nytimes.com/2009/12/25/health/policy/25health.html?_r=1&hp| archive-date=November 15, 2013| url-status= live}}</ref> In 2010, the House abandoned its reform bill in favor of amending the Senate bill (via the [[Reconciliation (United States Congress)|reconciliation]] process) in the form of the [[Health Care and Education Reconciliation Act of 2010]].
==Key provisions==
The central changes that would have been made by the legislation, had it been enacted, included the following:
* prohibiting health insurers from refusing coverage based on patients' [[Pre-existing condition|medical histories]]<ref name="CRS">[http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR03962:@@@D&summ2=m& Congressional Research Service (CRS) Summary] {{Webarchive|url=https://web.archive.org/web/20131017155553/http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR03962:@@@D&summ2=m& |date=October 17, 2013 }} of H.R. 3962 as introduced, the Library of Congress, October 29, 2009</ref><ref name="AP1">{{cite news|url=http://www.physorg.com/news176878805.html|title=Landmark health bill passes House on close vote|last=Espo|first=David|date=November 8, 2009|publisher=PhysOrg.com|access-date=November 24, 2009|agency=Associated Press| archive-url= https://web.archive.org/web/20110606101058/http://www.physorg.com/news176878805.html| archive-date=June 6, 2011| url-status= live}}</ref>
* prohibiting health insurers from charging different rates based on patients' medical histories or gender<ref name="CRS" /><ref name="AP1" />
* repeal of insurance companies' [[McCarran–Ferguson Act|exemption]] from [[anti-trust]] laws<ref name="AP1" /><ref name="Sec. 262">{{USBill|111|H.R.|3962}} Affordable Health Care for America Act, [[s:H.R. 3962/Division A/Title II/Subtitle F#Sec. 262.|Division A, Title II, Subtitle F, Section 262]], [[111th Congress]].</ref>
* establishing minimum standards for [[Qualified Health Benefit Plan|qualified health benefit plans]]<ref name="CRS"/>
* establishing a National Healthcare Workforce Commission to be composed of 15 individuals who will assess healthcare needs and make recommendations to congressional leaders <ref name="McNeal 2010">{{cite journal|last=McNeal|first=Gloria|title=The Healthcare Reform Bill and Its Impact on the Nursing Profession|journal=The ABNF Journal|year=2010|volume=21|issue=2|pmid=20533752|url=http://connection.ebscohost.com/c/articles/20533752|access-date=17 September 2013|pages=38}}</ref>
* requiring most employers to provide coverage for their workers or pay a surtax on the workers wage up to 8%
* restrictions on [[abortion]] coverage in any insurance plans for which federal funds are used<ref name="AP1" /><ref name="NYT1">{{cite news|first1=Carl |last1=Hulse |first2=Rolbert |last2=Pear|url=https://www.nytimes.com/2009/11/08/health/policy/08health.html|title=Sweeping Health Care Plan Passes House|date=November 7, 2009|work=The New York Times|access-date=November 24, 2009| archive-url= https://web.archive.org/web/20110331033230/http://www.nytimes.com/2009/11/08/health/policy/08health.html| archive-date=March 31, 2011| url-status= live}}</ref>
* an expansion of [[Medicaid]] to include more [[low-income]] Americans by increasing Medicaid eligibility limits to 133% of the [[Federal Poverty Level]] and by covering adults without dependents as long as either or any segment doesn't fall under the narrow exceptions outlined by various clauses throughout the proposal,<ref name="Sec. 1701">{{USBill|111|H.R.|3962}} Affordable Health Care for America Act, Division B, Title VII, Subtitle A (entire), [[111th Congress]].</ref><ref>{{cite news|url=http://www.tampabay.com/news/politics/national/health-care-reform-where-the-house-senate-agree-and-disagree/1051127|title=Health care reform: Where the House, Senate agree and disagree|last=Leary|first=Alex|date=November 12, 2009|work=St. Petersburg Times|access-date=November 24, 2009|archive-url=https://web.archive.org/web/20091205005130/http://www.tampabay.com/news/politics/national/health-care-reform-where-the-house-senate-agree-and-disagree/1051127|archive-date=December 5, 2009|url-status=dead}}</ref>
* a [[subsidy]] to low- and middle-income Americans to help buy insurance<ref name="NYT1" />
* a central [[health insurance exchange]] where the public can compare policies and rates<ref name="NYT1" />
* allowing insurers to continue to dictate limits on evaluation and care provided consumers by their physicians ("managed" or "rationed" care)
* avoidance of capitating or regulating premiums which are routinely and in accordance with this law, charged by an insurance company for coverage, which might make the coverage non-affordable with regard to a consumer's income<ref name="NYT1"/>
* requiring most Americans to carry or obtain qualifying health insurance coverage or face a [[fine (penalty)|fine]] for non-compliance<ref name="CRS" /><ref name="Sec. 501">{{USBill|111|H.R.|3962}} Affordable Health Care for America Act, [[s:H.R. 3962/Division A/Title V/Subtitle A/Part 1/Subpart A#Sec. 501.|Division A, Title V, Subtitle A, Part 1, Subpart A, Section 501]], [[111th Congress]].</ref>
* a 5.4% [[surtax]] on individuals whose adjusted gross income exceeds $500,000 ($1 million for married couples filing joint returns)<ref name="CRS" />
* a 2.5% [[excise tax]] on [[medical device]]s<ref name="CRS" />
* reductions in projected spending on [[Medicare (United States)|Medicare]] of $400 billion over a ten-year period<ref name="AP1" />
* inclusion of language originally proposed in the [[Tax Equity for Domestic Partner and Health Plan Beneficiaries Act]]<ref>{{cite web|url=http://www.hrcbackstory.org/2009/11/house-passes-health-reform-bill-with-key-lgbt-provisions/|title=House Passes Health Reform Bill with Key LGBT Provisions|last=Cole|first=Michael|date=November 7, 2009|publisher=[[Human Rights Campaign]]|access-date=November 9, 2009| archive-url= https://web.archive.org/web/20091112075016/http://www.hrcbackstory.org/2009/11/house-passes-health-reform-bill-with-key-lgbt-provisions/| archive-date= 12 November 2009 | url-status= live}}</ref><ref name="Sec. 571">{{USBill|111|H.R.|3962}} Affordable Health Care for America Act, Division A, Title V, Subtitle B, Part 3, Section 571, [[111th Congress]].</ref>
* inclusion of language originally proposed in the Indian Health Care Improvement Act Amendments of 2009<ref name="Div. D">{{USBill|111|H.R.|3962}} Affordable Health Care for America Act, Division D (entire), [[111th Congress]].</ref><ref name="HR2708">{{USBill|111|H.R.|2708}} Indian Health Care Improvement Act Amendments of 2009, [[111th Congress]]</ref>
* imposing a $2,500 limit on contributions to [[flexible spending account]]s (FSAs), which allow for payment of health costs with pre-tax funds, to pay for a portion of health care reform costs<ref name="CRS" /><ref>[http://www.freep.com/article/20091224/NEWS07/91224017/1001/NEWS/A-comparison-of-House-Senate-health-care-bills "A Comparison of House Senate Health Care Bills"], ''[[Detroit Free Press]]'', December 24, 2009</ref>
===Comparison with Senate version===
The main House reform bill was the '''Affordable Health Care for America Act''', which passed on November 7, 2009. The [[Patient Protection and Affordable Care Act]] is the Senate version, passed December 24.<ref name="compare">[https://www.washingtonpost.com/wp-srv/special/nation/health/compare-health-plans-2009/ Health-Care Reform: How the Bills Stack Up], ''The Washington Post'', September 16, 2009 (updated December 24, 2009), Retrieved February 5, 2010</ref> The following table compares the two versions.
{| class="wikitable"
|-
!
! House
! Senate
! Notes
|-
| New 10-year costs (billions)<ref name="compare" />
| $1,052
| $848
|
|-
| Projected 10-year change in deficit (billions)<ref name="compare" />
| -$109
| -$132
| New costs minus new savings and revenue
|-
| Number uninsured by 2019 (millions)<ref name="compare" />
| 17
| 23
| 54 without bill
|-
| [[Public option]]<ref name="compare" />
| Yes
| No
|
|-
| [[Health insurance marketplace|Insurance exchanges]]<ref name="compare" />
| Yes
| Yes
| H: National exchange;<br /> S: State-based exchanges
|-
| Individual mandate<ref name="compare" />
| Yes
| Yes
| Penalty tax or fine if coverage not carried<br />(See Insurance subsidies below)
|-
| Employer mandate<ref name="compare" />
| Yes
| Yes
| Small businesses exempted
|-
| [[Abortion]] coverage<ref name="compare" />
| No
| Yes
| H: No in public option or subsidized plans;<br />may be covered by separate riders<br />S: Yes, but must be paid for separately without subsidies
|-
| New and increased taxes<ref name="compare" />
| Yes
| Yes
| H: Families with income > $1 million<br />S: High-cost insurance plans;<br />Wealthiest Americans Medicare taxes;<br />[[Tanning tax|Indoor tanning tax]]
|-
| Insurance reforms<ref name="compare" />
| Yes
| Yes
| H: Remove anti-trust exemption<br />Both: Define qualified health benefit plan
|-
| Expand [[Medicaid]]<ref name="compare" />
| Yes
| Yes
| Max 2009 income, family of 4:<br />H: $33,000<br />S: $29,000.
|-
| Insurance subsidies<ref name="compare" />
| Yes
| Yes
| Prorated to $88,000 for family of 4 (2009)<br />H: Premium subsidies; S: Tax credits
|-
| [[Tax Equity for Domestic Partner and Health Plan Beneficiaries Act|Tax equity for domestic partners]]<ref>{{cite web|url=http://www.hrcbackstory.org/2010/03/house-posts-health-care-bill-leaves-out-lgbt-specific-provisions/|title=House Posts Health Care Bill, Leaves Out LGBT-Specific Provisions|last=Moulton|first=Brian|date=18 March 2010|publisher=Human Rights Campaign|access-date=22 March 2010| archive-url= https://web.archive.org/web/20100323080953/http://www.hrcbackstory.org/2010/03/house-posts-health-care-bill-leaves-out-lgbt-specific-provisions/| archive-date= 23 March 2010 | url-status= live}}</ref>
| Yes
| No
|
|}
* 2015 year rates are based on the second-tier level of a [[Patient Protection and Affordable Care Act|silver plan]] that was determined by the D.O.R.A.
* 2015 Federal Poverty Level is now 133% to 401%
* Everyone must obtain health insurance that meets the Minimal Essential Coverage (MEC) that is defined by the department of Human Services (DHS)
* Affordable is based on percentage of 9.5% annual income of an individual
* There is no out of pocket cost of Preventive care even on grandfather plan
==History==
The bill was introduced on October 29, 2009 and passed on November 7, during the 1st Session of the 111th Congress. Its primary sponsor was the [[Dean of the United States House of Representatives|Dean of the House]], [[John Dingell]] of [[Michigan]].
The bill is a revised version of an earlier measure, the proposed [[America's Affordable Health Choices Act of 2009]] (HR 3200 <ref>({{USBill|111|H.R.|3200}})</ref><ref name="blended_bill">[http://energycommerce.house.gov/Press_111/health_care/hr3962_TOPLINE.pdf Topline Changes From Introduced Bill to Blended Bill] {{webarchive |url=https://web.archive.org/web/20091103235228/http://energycommerce.house.gov/Press_111/health_care/hr3962_TOPLINE.pdf |date=November 3, 2009 }}, (PDF), ''House Committee on Energy and Commerce'', October 29, 2009.</ref>). The revisions included refinements designed to meet the goals outlined in the [[Barack Obama speech to joint session of Congress, September 2009|President's address to a joint session of Congress in September, 2009]] concerning health care reform.
=== House actions ===
[[Image:HR3962 US House Voting Map.png|thumb|400px|House voting map for H.R. 3590 where green indicates a 'Yes' and red a 'No'.]]
The Affordable Health Care for America Act, H.R. 3962, was introduced in the House of Representatives on October 29, 2009, and referred to several Committees for consideration.
On November 6, 2009, the House Committee on Energy and Commerce was discharged. The [[House Committee on Rules]] introduced House Resolution 903 ({{USBill|111|H.Res.|903}}) along with a Committee Report, [http://thomas.loc.gov/cgi-bin/cpquery/R?cp111:FLD010:@1(hr330) No. 111-330] {{Webarchive|url=https://web.archive.org/web/20140920044043/http://thomas.loc.gov/cgi-bin/cpquery/R?cp111:FLD010:@1(hr330) |date=September 20, 2014 }}. The Committee Report detailed the amendments considered as adopted if and when the bill passed the full House in Parts A & B; it provided the [[Stupak–Pitts Amendment]] for consideration in Part C as well as the Boehner Amendment, a substitute for the bill, in Part D. The House Resolution outlined the process to be followed for Parts A through D in relation to H.R. 3962 and set the rules for debating the proposed bill.
The following day, House Resolution 903 was voted on and passed.<ref>{{USHRollCall|2009|882}} – H.Res.903: On Agreeing to the Resolution</ref> This, in effect, added the amendments outlined in Rules Committee Report No. 111-330, Parts A & B, to H.R. 3962. Part C, the Stupak–Pitts Amendment, was brought up, considered and passed.<ref>{{USBill|111|h.amdt.|509}}, the Stupak of Michigan Amendment</ref><ref>{{USHRollCall|2009|884}} – H.Amdt.509: On Agreeing to the Stupak of Michigan Amendment</ref> Part D, the Boehner Substitute Amendment, was then brought up, considered but failed passage.<ref>{{USBill|111|h.amdt.|510}}, the Boehner of Ohio Substitute Amendment</ref><ref>{{USHRollCall|2009|885}} – H.Amdt.510: On Agreeing to the Boehner of Ohio Substitute Amendment</ref>
The newly amended bill eventually passed the House of Representatives at 11:19 PM EST on Saturday, November 7, 2009, by a vote of 220–215. The bill passed with support of the majority of Democrats, together with [[Joseph Cao|one Republican]] who voted only after the necessary 218 votes had already been cast. Thirty-nine Democrats voted against the bill. All members of the House voted, and none voted "present".<ref>{{USHRollCall|2009|887}} – H.R.3590: On Passage Affordable Health Care for America Act</ref>
Both before and after passage in the House, significant controversy surrounded the [[Stupak–Pitts Amendment]] added to the bill to prohibit coverage of abortions – with limited exceptions – in the [[public option]] or in any of the [[health insurance exchange|exchange]]'s private plans sold to customers receiving federal subsidies. In mid-November, it was reported that 40 House Democrats said they will not support a final bill containing the Amendment's provisions.<ref>{{cite news|url=https://www.washingtonpost.com/wp-dyn/content/article/2009/11/14/AR2009111401597.html?hpid=topnews|title=Health-care reform and abortion coverage: Questions and answers|last=MacGillis|first=Alec|date=November 14, 2009|newspaper=Washington Post|access-date=November 24, 2009}}</ref> Stupak has said that 15–20 Democrats will oppose adoption of the Senate bill because of objections to its abortion provisions as well as its tax on high-value health insurance plans.<ref name="stupakmayblockNYT">{{cite news|first=Jodi|last=Kantor|url=https://www.nytimes.com/2010/01/07/us/politics/07stupak.html?pagewanted=1&hp|title=Abortion Foe Defies Party on Health Care Bill|work=New York Times|date=January 6, 2010|access-date=January 7, 2010}}</ref><ref>Weisman, Jonathan (February 24, 2010), [https://blogs.wsj.com/washwire/2010/02/24/stupak-15-20-dems-cant-back-obama-health-plan/ "Stupak: 15–20 Dems Can’t Back Obama Health Plan"], ''Washington Wire'', [[The Wall Street Journal]], Retrieved February 24, 2010</ref> In March 2010, Stupak voted for the Senate language health care bill excluding the Stupak Amendment language.
=== Senate actions ===
The Affordable Health Care for America Act, H.R. 3962, as [[Engrossed bill|engrossed]] or passed by the House of Representatives, was received in the Senate, read into the record and placed on the [[Legislative calendar|Senate Legislative Calendar]] under [[Standing Rules of the United States Senate, Rule VIII|General Orders]] (Calendar No. 210, Nov. 16, 2009).
=== H.R. 3962 as eventually enacted ===
A different bill, under the same bill number H.R. 3962, was eventually passed by Congress and, on June 25, 2010, was signed by the President. This is the "Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010."<ref>Public Law no. 111-192, summarized at [http://www.govtrack.us/congress/bill.xpd?bill=h111-3962]. For the full text of what was actually enacted under the heading "H.R. 3962," see [http://www.gpo.gov/fdsys/pkg/PLAW-111publ192/pdf/PLAW-111publ192.pdf].</ref>
==See also==
*[[Patient Protection and Affordable Care Act]]
*[[Qualified Health Benefit Plan]]
==References==
{{Reflist|colwidth=30em}}
== External links ==
* Chris L. Peterson, [https://web.archive.org/web/20110716022628/http://opencrs.com/document/R40981/2009-12-16/?24216 ''A Comparative Analysis of Private Health Insurance Provisions of H.R. 3962 and S.Amdt. 2786 to H.R. 3590''], [[Congressional Research Service]], R40981, December 16, 2009
* {{cite web |url=http://www.gpo.gov/fdsys/pkg/PLAW-111publ192/content-detail.html |title=P.L. 111-192 – Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 |author=111th Congress |publisher=U.S. Government Printing Office |pages=29}}
* {{cite web |url=http://www.gpo.gov/fdsys/pkg/BILLS-111hr3962ih |title=H.R. 3962 (IH) – To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes. |author=111th Congress |publisher=U.S. Government Printing Office |pages=1990}} Plain Text, PDF or XML formats of H.R. 3962, passed in the House of Representatives & as received in the Senate via [[Federal Digital System|FDsys]]
* [http://thomas.loc.gov/cgi-bin/bdquery/z?d111:HR03962:@@@L&summ2=m&summary Summary of H.R. 3962]{{Dead link|date=August 2021 |bot=InternetArchiveBot |fix-attempted=yes }} as introduced (October 29, 2009) by the [[Congressional Research Service]] (CRS) via THOMAS.
*[http://www.allhealth.org/issues.asp?wi=16 Briefings] of the Alliance for Health Reform, Washington, DC, 2008–2009
* [http://www.govtrack.us/congress/bill.xpd?bill=h111-3962 Entry for the Act] at [[GovTrack]]
* [https://web.archive.org/web/20091101115133/http://www.cspan.org/Watch/Media/2009/10/29/HP/R/24837/House%2BSpeaker%2BPelosi%2BUnveils%2BHealth%2BCare%2BBill%2BGOP%2BReacts.aspx Video of Speaker Pelosi and Democrat leaders unveiling the bill : C-SPAN]
* [http://www.healthreformvotes.org How members of Congress voted on the bill : HealthReformVotes.org]
;Latest Congressional Budget Office scoring (''all previous scoring for now superseded; [[H.R. 3200]] no longer applies'')
* [http://cbo.gov/doc.cfm?index=10741 Update of Current Analysis – H.R. 3962, Affordable Health Care for America Act], November 25, 2009
** Superseded [http://cbo.gov/doc.cfm?index=10710 analysis – H.R. 3962, Affordable Health Care for America Act], November 6, 2009
** Preliminary [http://cbo.gov/doc.cfm?index=10691 Analysis of Subsidies to and Payments by Enrollees in Insurance Exchanges], November 3, 2009
** Preliminary [http://cbo.gov/doc.cfm?index=10688 analysis – H.R. 3962, Affordable Health Care for America Act], October 29, 2009
;[[Centers for Medicare and Medicaid Services]] Estimates of the impact of H.R. 3962
*[http://www.cms.hhs.gov/ActuarialStudies/Downloads/HR3962_2009-11-13.pdf ''Estimated Financial Effects of the "America’s Affordable Health Choices Act of 2009" (H.R. 3962), as Passed by the House on November'' 7: 2009 ], November 13, 2009
**Superseded analysis [http://www.cms.hhs.gov/ActuarialStudies/Downloads/HR3200_2009-10-21.pdf ''Estimated Financial Effects of the "America’s Affordable Health Choices Act of 2009" (H.R. 3200), as Reported by the Ways and Means Committee''], October 21, 2009
;Additional House committee generated information accompanying H.R. 3962 (November 6, 2009)
* [http://energycommerce.house.gov/index.php?option=com_content&view=article&id=1687&catid=156&Itemid=55 House Committee on Energy and Commerce]
* [https://web.archive.org/web/20091103214336/http://waysandmeans.house.gov/MoreInfo.asp?section=52 House Committee on Ways & Means]
* [https://web.archive.org/web/20100106013943/http://edlabor.house.gov/blog/2009/10/affordable-health-care.shtml House Committee on Education & Labor]
* [https://web.archive.org/web/20091111093304/http://rules.house.gov/bills_details.aspx?NewsID=4465 House Committee on Rules] (Manager's Amendment, Member Amendments, Rules Reports & similar found here)
** {{USBill|111|H.Res.|903}}, and related Rules Committee Report [http://thomas.loc.gov/cgi-bin/cpquery/R?cp111:FLD010:@1(hr330) 111-330] {{Webarchive|url=https://web.archive.org/web/20140920044043/http://thomas.loc.gov/cgi-bin/cpquery/R?cp111:FLD010:@1(hr330) |date=September 20, 2014 }}
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