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Calendar No.
_____
111
TH
 
C
ONGRESS
R
EPORT
 
1
st 
Session
SENATE 111-________________________________________________________________________
AMERICA‘S HEALTHY FUTURE ACT OF 2009
 _______________O
CTOBER
19,
 
2009.--Ordered to be printed_______________Mr. Baucus, from the Committee on Finance,submitted the following
R E P O R T
together withADDITIONAL AND MINORITY VIEWS[To accompany ???][Including cost estimate of the Congressional Budget Office]The Committee on Finance, having considered an original bill, S. ___, to provideaffordable, quality health care for all Americans and reduce the growth in health carespending, and for other purposes, reports favorably thereon and recommends that the bill dopass.
CONTENTSPageI.
Background and Need for Legislation…………………………………………………
 II.
Explanation of the Bill…………………………………………………………………
 
 
 
2
TITLEI
 — 
HEALTH CARE COVERAGE
 
Subtitle A
 – 
Insurance Market ReformsSec. 1001. Insurance Market Reforms in the Individual and Small GroupMarkets.
Sec. 2200. Ensuring Essential and Affordable Health Benefits Coverage for All Americans.
 
Sec. 2201. General Requirements and Definitions.
 
Sec. 2202. Prohibition on Preexisting Condition Exclusions.
 
Sec. 2203. Guaranteed Issue and Renewal for Insured Plans.
 
Sec. 2204. Premium Rating Rules.
 
Sec. 2205. Use of Uniform Outline of Coverage Documents.
 
Sec. 2211. Rating Areas; Pooling of Risks; Phase In of Rating Rules in Small Group Markets.
 
Sec. 2212. Risk Adjustment.
 
Sec. 2213. Establishment of Transitional Reinsurance Program for Individual Markets in Each State.
 
Sec. 2214. Establishment of Risk Corridors for Plans in Individual and Small Group Markets.
 
Sec. 2215. Temporary High Risk Pools for Individuals with PreexistingConditions.
 
Sec. 2216. Reinsurance for Retirees Covered by Employer-Based Plans.
 
Sec. 2221. Grandfathered Health Benefit Plans.
 
Sec. 2225. Continued State Enforcement of Insurance Regulations.
 
Sec. 2226. Waiver of Health Insurance Reform Requirements.
 
Sec. 2227. Provisions Relating to Offering of Plans in More Than One State.
 
Sec. 2228. State Flexibility to Establish Basic Health Plans for Low-Income Individuals not Eligible for Medicaid.
 
Sec. 2230. Other Definitions and Rules.
 Subtitle B
 – 
Exchanges and Consumer AssistanceSec. 1101. Establishment of Qualified Health Benefits Plans Exchanges.
Sec. 2231. Rights and Responsibilities Regarding Choice of CoverageThrough Exchange.
 
Sec. 2232. Qualified Individuals and Small Employers: Access Limited toCitizens and Lawful Residents.
 
Sec. 2235. Establishment of Exchanges by States.
 
Sec. 2236. Functions Performed by Secretary, States, and Exchanges.
 
Sec. 2237. Duties of the Secretary to Facilitate Exchanges.
 
Sec. 2238. Procedures for Determining Eligibility for Exchange Participation, Premium Credits, and Cost-Sharing Subsidies.
 
Sec. 2239. Streamlining of Procedures for Enrollment through an Exchange and State Medicaid and CHIP Programs.
 Sec. 1102. Encouraging Meaningful Use of Electronic Health Records
 .
 Subtitle C
 – 
Making Coverage AffordablePART I
 – 
Essential Benefits CoverageSec. 1201. Provisions to Ensure Coverage to Essential Benefits.
Sec. 2241. Requirements for Qualified Health Benefits Plan.
 
 
 
3
Sec. 2242. Essential Benefits Package Defined.
 
Sec. 2243. Levels of Coverage.
 
Sec. 2244. Application of Certain Rules to Plans in Group Markets.
 
Sec. 2245. Special Rules Relating to Coverage of Abortion Services.
 Sec. 1202. Application of State and Federal Laws Regarding Abortion.Sec. 1203. Application of Emergency Services Laws.PART II
 – 
Low Income and Small Business Credits and SubsidiesSec. 1205. Premium Tax Credits and Cost-sharing SubsidiesSec. 1206. Cost-sharing subsidies and advance payments of premium creditsand cost-sharing subsidies
Sec. 2246. Premium Credits for Low-Income Individuals.
 
Sec. 2247. Cost-sharing Subsidies for Low-Income Individuals Enrolling inQualified Health Benefit Plans.
 
Sec. 2248. Advance Determination and Payment of Premium Credits and Cost-sharing Subsides.
 Sec. 1207. Disclosures to Carry Out Eligibility Requirements for CertainProgramsSec. 1208. Premium Credits and Subsidy Refunds and Payments Disregardedfor Federal and Federally-Assisted ProgramsSec. 1209. Fail-safe Mechanism to Prevent Inscrease in Federal Budget Deficit.Sec. 1221. Small Business Tax Credit
 
Subtitle D
 – 
Shared ResponsibilityPART I
 – 
Individual ResponsibilitySec. 1301. Penalty on Individuals Without Essential Health Benefits CoverageSec. 1302. Reporting of Health Insurance CoveragePART II
 – 
Employer ResponsibilitySec. 1306. Employer-Provided Health Insurance CoverageSubtitle E
 – 
Federal Program for Health Care CooperativesSec. 1401. Establishment of Federal Program for Health Care Cooperatives.
Sec. 2251. Federal Program To Assist Establishment and Operation of  Nonprofit, Member-Run Health Insurance Issuers.
 Subtitle F
 – 
Transparency and AccountabilitySec. 1501. Provisions Ensuring Transparency and Accountability.
Sec. 2229. Requirements Relating to Transparency and Accountability.
 Sec. 1502 Reporting on Utilization of Premium Dollars and Standard HospitalCharges.Sec. 1503. Development and Utilization of Uniform Outline of CoverageDocuments.Sec. 1504. Development of Standard Definitions, Personal Scenarios, andAnnual Personalized Statements.
Subtitle G
 – 
Role of Public Programs
 
PART I
 – 
Medicaid Coverage for the Lowest Income Populations
 Sec. 1601. Eligibility Standards and MethodologiesSec. 1602. Income Eligibility for Nonelderly Determined Using Modified GrossIncome
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