Health insurance exchange

“ But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange. Let me be clear — it would only be an option for those who don't have insurance. No one would be forced to choose it, and it would not impact those of you who already have insurance. In fact, based on Congressional Budget Office estimates, we believe that less than 5 percent of Americans would sign up. ”

“ Encouraging the Use of High Value Services.— To the extent allowed by the benefit standards applied to all Exchange-participating health benefits plans, the public health insurance option may modify cost sharing and payment rates to encourage the use of services that promote health and value. (d) Non-uniformity Permitted.— Nothing in this subtitle shall prevent the Secretary from varying payments based on different payment structure models (such as accountable care organizations and medical homes) under the public health insurance option for different geographic areas. ”

“ Enrollment Through Agents or Brokers- The Secretary shall establish procedures under which a State may allow agents or brokers-- (1) to enroll individuals in any qualified health plans in the individual or small group market as soon as the plan is offered through an Exchange in the State; and (2) to assist individuals in applying for premium tax credits and cost-sharing reductions for plans sold through an Exchange. Such procedures may include the establishment of rate schedules for broker commissions paid by health benefits plans offered through an exchange. ”

“ Because of the Affordable Care Act, over 100 million people no longer have to worry that an insurance company will deny coverage or charge higher premiums just because they have a pre-existing condition. ”

“ Many of them may decide that purchasing health insurance is not an economically sound decision—especially since the guaranteed-issue provision will enable them to purchase it at the same cost in later years and even if they have developed a pre-existing condition. But without the contribution of above-risk premiums from the young and healthy, the community-rating provision will not enable insurers to take on high-risk individuals without a massive increase in premiums. ”

“ The Act considered as a whole makes clear that Congress was
concerned that individuals maintain minimum coverage not as an end in itself, but
because of the economic implications on the broader health care market. Virtually
everyone participates in the market for health care delivery, and they finance these
services by either purchasing an insurance policy or by self-insuring. ”

“ By significantly increasing health insurance coverage, the requirement, together with the other provisions of this Act, will minimize this adverse selection and broaden the health insurance risk pool to include healthy individuals, which will lower health insurance premiums. The requirement is essential to creating effective health insurance markets in which improved health insurance products that are guaranteed issue and do not exclude coverage of pre-existing conditions can be sold. ”

“ And finally, the time has come to give Americans the freedom to purchase health insurance across state lines – which will create a truly competitive national marketplace that will bring costs way down and provide far better care. ”

“ To manage the risks associated with medical care—its high cost, its unpredictability, and its inevitability—most people in the United States obtain health insurance. Many (approximately 170 million in 2009) are insured by private insurance companies. Others, including those over 65 and certain poor and disabled persons, rely on government-funded insurance programs, notably Medicare and Medicaid. Combined, private health insurers and State and Federal Governments finance almost 85% of the medical care administered to U.S. residents. ”

“ Within the first year of signing health care reform, thousands of uninsured Americans with preexisting conditions would suddenly be able to purchase health insurance for the very first time in their lives, or the first time in a long time. ”

“ For the first time in their lives -- or oftentimes, in a very long time -- uninsured individuals and small business owners will have the same kind of choice of private health insurance that members of Congress get for themselves. ”

“ Congress found that without the minimum coverage provision, other provisions in the Act, in particular the guaranteed issue and community rating requirements, would increase the incentives for individuals to “wait to purchase health insurance until they needed care.” ”

“ After 60 years of fits and starts, of roadblocks and dead-ends, we're finally making real progress toward comprehensive health care reform. This week, for the first time ever, the relevant committees of Congress in both Houses have begun to review and modify our proposal to guarantee all Americans private health insurance, to give small businesses, farmers, and self-employed people the ability to buy insurance like big business and Government can today. ”

“ Congress has imposed an extensive set of regulations on the health insurance industry, and compliance with those regulations will likely cost the industry a great deal. If the industry does not respond by increasing premiums, it is not likely to survive. And if the industry does increase premiums, then there is a serious risk that its products—insurance plans—will become economically undesirable for many and prohibitively expensive for the rest. ”

“ Mandating every American to buy government-approved health insurance was never the right solution for our country. The way to make health insurance available to everyone is to lower the cost of health insurance, and that is what we are going do. Obamacare premiums nationwide have increased by double and triple digits. ”

“ Suddenly, just like the federal employees -- there are millions of them so they can drive a harder bargain with insurance companies -- you, as an individual or a small business owner, could be part of this pool, which would give you more negotiating power with the insurance companies for lower rates and a better deal. ”

“ The Patient Protection and Affordable Care Act adopts a series of interlocking reforms designed to expand coverage in the individual health insurance market. First, the Act bars insurers from taking a person’s health into account when deciding whether to sell health insurance or how much to charge. Second, the Act generally requires each person to maintain insurance coverage or make a payment to the Internal Revenue Service. And third, the Act gives tax credits to certain people to make insurance more affordable. ”

“ But the problem that plagues the health care system is not just a problem of the uninsured. Those who do have insurance have never had less security and stability than they do today. More and more Americans worry that if you move, lose your job, or change your job, you'll lose your health insurance too. More and more Americans pay their premiums, only to discover that their insurance company has dropped their coverage when they get sick, or won't pay the full cost of care. ”

“ Each and every day in this country, Americans are grappling with health care premiums that are growing three times the rate of wages and insurance company policies that limit coverage and raise out-of-pocket costs. Thousands are losing their insurance coverage each day.
Without real reform, the burdens on America’s families and businesses will continue to multiply. We’ve had a vigorous debate about health insurance reform, and rightly so. ”

“ What that means is, with a few clicks on HealthCare.gov, you’ll find private insurance companies competing for your business. You can compare plans and choose the one that’s right for your family. In fact, most Americans will find an option that costs less than $75 a month. Even if you already have insurance through the Marketplace, check it out. Shopping around can save you a lot of money -- last year, consumers who shopped saved almost $400. ”

“ And by reforming the health insurance market, my plan assures that Americans will have access to basic health insurance even if they change jobs or develop serious health problem We must bring costs under control, preserve quality, preserve choice and reduce people's nagging daily worry about health insurance. ”

“ Right now, two out of every ten patients account for more than eighty percent of all health care costs. These are patients with serious illnesses like cancer or heart disease who require the most expensive surgeries and treatments. Insurance companies end up spending a lion's share of their expenses on these patients, and not surprisingly, they pass those expenses on to the rest of us in the form of higher premiums. ”

“ These rising costs are driving up the price of health insurance and making it harder for working families to afford coverage. These rising costs also make it harder for small businesses to offer health coverage to their employees. We must address these rising costs so that more Americans can afford basic private health insurance. ”

“ That's why under my plan, individuals will be required to carry basic health insurance — just as most states require you to carry auto insurance. Likewise, businesses will be required to either offer their workers health care, or chip in to help cover the cost of their workers. There will be a hardship waiver for those individuals who still cannot afford coverage, and 95 percent of all small businesses, because of their size and narrow profit margin, would be exempt from these requirements. ”

“ To make matters even more complicated and tougher, when the uninsured low-risk people do get sick or have accidents, they still get health care, but it's too late, too expensive at the emergency room, and very often they can't afford to pay for it themselves. So their costs get passed on from medical providers back through the insurance system, back onto the Americans who are still paying insurance. And the premiums rise again. And again, it becomes harder for working people to afford insurance. ”

“ They are getting billions of dollars a year from the government, from taxpayers, when they’re making a big profit. I'd rather see that money going to people who need it. (Applause.)
We’ll set a new fee on insurance companies that stand to gain as millions of Americans are able to buy insurance. They’re going to have 30 million new customers; there’s nothing wrong with them paying a little bit of the freight. And we’ll make sure that the wealthiest Americans pay their fair share of Medicare, just like everybody else does. ”

“ If you could purchase insurance across State lines, there would be a 50–State market and you could get low-cost, inexpensive catastrophic health insurance. If you think about health insurance right now, it doesn’t work like insurance. ”

“ We cannot realistically afford federally dictated national health insurance providing full coverage for all 215 million Americans. The experience of other countries raises questions about the quality as well as the cost of such plans. But I do envision the day when we may use the private health insurance system to offer more middle-income families high quality health services at prices they can afford and shield them also from their catastrophic illnesses. ”

“ Today, 20 million more American adults know the financial security of health insurance. On top of that, another three million more kids have coverage than when I took office. In fact, never in American history has the uninsured rate been lower than it is right now – and health care prices have been rising slower than they have in 50 years. ”