Affordable Health Care for America Act
|Health care reform in the United States|
|Third-party payment models|
The Affordable Health Care for America Act (or HR 3962) was a bill that was crafted by the United States House of Representatives in November 2009. It never became law as originally drafted. At the encouragement of the Obama administration, the 111th Congress devoted much of its time to enacting reform of the United States' health care system. Known as the "House bill", HR 3962 was the House of Representative's 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). In 2010, the House abandoned its reform bill in favor of amending the Senate bill (via the reconciliation process) in the form of the Health Care and Education Reconciliation Act of 2010.
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' medical histories
- prohibiting health insurers from charging different rates based on patients' medical histories or gender
- repeal of insurance companies' exemption from anti-trust laws
- establishing minimum standards for qualified health benefit plans
- establishing a National Healthcare Workforce Commission to be composed of 15 individuals who will assess healthcare needs and make recommendations to congressional leaders 
- 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
- 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,
- a subsidy to low- and middle-income Americans to help buy insurance
- a central health insurance exchange where the public can compare policies and rates
- allowing insurors 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
- requiring most Americans to carry or obtain qualifying health insurance coverage or face a fine for non-compliance
- a 5.4% surtax on individuals whose adjusted gross income exceeds $500,000 ($1 million for married couples filing joint returns)
- a 2.5% excise tax on medical devices
- reductions in projected spending on Medicare of $400 billion over a ten-year period
- inclusion of language originally proposed in the Tax Equity for Domestic Partner and Health Plan Beneficiaries Act
- inclusion of language originally proposed in the Indian Health Care Improvement Act Amendments of 2009
- imposing a $2,500 limit on contributions to flexible spending accounts (FSAs), which allow for payment of health costs with pre-tax funds, to pay for a portion of health care reform costs
Comparison with Senate version
The main House reform bill was the Affordable Health Care for America Act, which passed November 7, 2009. The Patient Protection and Affordable Care Act is the Senate version, passed December 24. The following table compares the two versions.
|New 10-year costs (billions)||$1,052||$848|
|Projected 10-year change in deficit (billions)||-$109||-$132||New costs minus new savings and revenue|
|Number uninsured by 2019 (millions)||17||23||54 without bill|
|Insurance exchanges||Yes||Yes||H: National exchange;
S: State-based exchanges
|Individual mandate||Yes||Yes||Penalty tax or fine if coverage not carried
(See Insurance subsidies below)
|Employer mandate||Yes||Yes||Small businesses exempted|
|Abortion coverage||No||Yes||H: No in public option or subsidized plans;
may be covered by separate riders
S: Yes, but must be paid for separately without subsidies
|New and increased taxes||Yes||Yes||H: Families with income > $1 million
S: High-cost insurance plans;
Wealthiest Americans Medicare taxes;
Indoor tanning tax
|Insurance reforms||Yes||Yes||H: Remove anti-trust exemption
Both: Define qualified health benefit plan
|Expand Medicaid||Yes||Yes||Max 2009 income, family of 4:
|Insurance subsidies||Yes||Yes||Prorated to $88,000 for family of 4 (2009)
H: Premium subsidies; S: Tax credits
|Tax equity for domestic partners||Yes||No|
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 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 ). The revisions included refinements designed to meet the goals outlined in the President's address to a joint session of Congress in September, 2009 concerning health care reform. In 1989 the idea for the "individual mandate" that every household obtain adequate health care was proposed by a conservative think tank known as the Heritage Foundation  and supported in congress by high profile republicans Newt Gingrich, Orin Hatch and Charles Grassley in 1993.
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 (H.Res. 903) along with a Committee Report, No. 111-330. 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. 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. Part D, the Boehner Substitute Amendment, was then brought up, considered but failed passage.
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 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".
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 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. 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. In March 2010, Stupak voted for the Senate language health-care bill excluding the Stupak Amendment language.
The Affordable Health Care for America Act, H.R. 3962, as engrossed or passed by the House of Representatives, was received in the Senate, read into the record and placed on the Senate Legislative Calendar under 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."
The Affordable Care Act is projected to provide more nursing jobs. More patients require more nurses to tend to all of the new patients. The ACA is going to get more nurses involved in the political process by establishing a National Healthcare Workforce Commission to be composed of 15 individuals who will assess health care needs and make recommendations to congressional leaders. Janice Lanier, a Juris Doctor, says that “nurses have been consistently and repeatedly rated as the most trusted professionals for honesty and ethics in polls conducted annually by the Gallup organization.” RoseAnn DeMoro, the executive director of National Nurses United, says that the Affordable Care Act is one of the most perplexing health care arrangements in the business world, and that the proper execution of health care in hospitals has been a huge obstacle for nurses. Anne Wilson, PhD, et al. says that 80% of the health workforce is nurses and emphasized on their important role in health care system in the country. Yet, despite their vital role, nurses are not considered “equal partners in multidisciplinary health care teams, resulting in under-utilization" of this significant workforce.
- H.R. 3962
- Pear, Robert (December 24, 2009). "Senate Passes Health Care Overhaul Bill". The New York Times. Archived from the original on 25 December 2009. Retrieved December 24, 2009.
- Congressional Research Service (CRS) Summary of H.R. 3962 as introduced, the Library of Congress, October 29, 2009
- Espo, David (November 8, 2009). "Landmark health bill passes House on close vote". PhysOrg.com. Associated Press. Archived from the original on 11 November 2009. Retrieved November 24, 2009.
- H.R. 3962 Affordable Health Care for America Act, Division A, Title II, Subtitle F, Section 262, 111th Congress.
- McNeal, Gloria (2010). "The Healthcare Reform Bill and Its Impact on the Nursing Profession". The ABNF Journal: Official Journal of the Association of Black Nursing Faculty in Higher Education, Inc 21 (2): 38. PMID 20533752. Retrieved 17 September 2013.
- Hulse, Carl; Pear, Rolbert (November 7, 2009). "Sweeping Health Care Plan Passes House". The New York Times. Archived from the original on 26 November 2009. Retrieved November 24, 2009.
- H.R. 3962 Affordable Health Care for America Act, Division B, Title VII, Subtitle A (entire), 111th Congress.
- Leary, Alex (November 12, 2009). "Health care reform: Where the House, Senate agree and disagree". St. Petersburg Times. Archived from the original on 5 December 2009. Retrieved November 24, 2009.
- H.R. 3962 Affordable Health Care for America Act, Division A, Title V, Subtitle A, Part 1, Subpart A, Section 501, 111th Congress.
- Cole, Michael (November 7, 2009). "House Passes Health Reform Bill with Key LGBT Provisions". Human Rights Campaign. Archived from the original on 12 November 2009. Retrieved November 9, 2009.
- H.R. 3962 Affordable Health Care for America Act, Division A, Title V, Subtitle B, Part 3, Section 571, 111th Congress.
- H.R. 3962 Affordable Health Care for America Act, Division D (entire), 111th Congress.
- H.R. 2708 Indian Health Care Improvement Act Amendments of 2009, 111th Congress
- "A Comparison of House Senate Health Care Bills", Detroit Free Press, December 24, 2009
- Health-Care Reform: How the Bills Stack Up, The Washington Post, September 16, 2009 (updated December 24, 2009), Retrieved February 5, 2010
- Moulton, Brian (18 March 2010). "House Posts Health Care Bill, Leaves Out LGBT-Specific Provisions". Human Rights Campaign. Archived from the original on 23 March 2010. Retrieved 22 March 2010.
- (H.R. 3200)
- Topline Changes From Introduced Bill to Blended Bill, (PDF), House Committee on Energy and Commerce, October 29, 2009.
- Roll call vote 882, via Clerk.House.gov - H.Res.903: On Agreeing to the Resolution
- H.Amdt. 509, the Stupak of Michigan Amendment
- Roll call vote 884, via Clerk.House.gov - H.Amdt.509: On Agreeing to the Stupak of Michigan Amendment
- H.Amdt. 510, the Boehner of Ohio Substitute Amendment
- Roll call vote 885, via Clerk.House.gov - H.Amdt.510: On Agreeing to the Boehner of Ohio Substitute Amendment
- Roll call vote 887, via Clerk.House.gov - H.R.3962: On Passage Affordable Health Care for America Act
- MacGillis, Alec (November 14, 2009). "Health-care reform and abortion coverage: Questions and answers". Washington Post. Retrieved November 24, 2009.
- Kantor, Jodi (January 6, 2010). "Abortion Foe Defies Party on Health Care Bill". New York Times. Retrieved January 7, 2010.
- Weisman, Jonathan (February 24, 2010), "Stupak: 15-20 Dems Can’t Back Obama Health Plan", Washington Wire, The Wall Street Journal, Retrieved February 24, 2010
- Public Law no. 111-192, summarized at . For the full text of what was actually enacted under the heading "H.R. 3962," see .
- Lanier, Janice (2012). "Patient Protection and Affordable Care Act What Every Nurse Needs to Know About Health Care Reform". Nursing News 36 (4). Retrieved 23 September 2013.
- "Nursing Challenges". Modern Healthcare 43 (35). 2013. Retrieved 23 September 2013.
- "Rising to the Challenge of Health Care Reform with Entrepreneurial and Intrapreneurial Nursing Initiatives". The Online Journal of Issues in Nursing 17. 2012. Retrieved 25 October 2014.
- Chris L. Peterson, 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
- 111th Congress. "P.L. 111-192 - Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010". U.S. Government Printing Office. p. 29.
- 111th Congress. "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.". U.S. Government Printing Office. p. 1990. Plain Text, PDF or XML formats of H.R. 3962, passed in the House of Representatives & as received in the Senate via FDsys
- Summary of H.R. 3962 as introduced (October 29, 2009) by the Congressional Research Service (CRS) via THOMAS.
- Briefings of the Alliance for Health Reform, Washington, DC, 2008-2009
- Entry for the Act at GovTrack
- Video of Speaker Pelosi and Democrat leaders unveiling the bill : C-SPAN
- How members of Congress voted on the bill : HealthReformVotes.org
- How Does Obamacare Work
- Obamacare pros and cons
- Latest Congressional Budget Office scoring (all previous scoring for now superseded; H.R. 3200 no longer applies)
- Update of Current Analysis - H.R. 3962, Affordable Health Care for America Act, November 25, 2009
- Superseded analysis - H.R. 3962, Affordable Health Care for America Act, November 6, 2009
- Preliminary Analysis of Subsidies to and Payments by Enrollees in Insurance Exchanges, November 3, 2009
- Preliminary 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
- 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 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)