Following months of intense negotiations and extensive input from stakeholders, House Speaker Nancy Pelosi (D, Calif.) and the three chairmen of the House committees overseeing health care presented their blended House health insurance reform bill on October 29.

The new legislation, the Affordable Health Care for America Act (H.R. 3962), would extend coverage to 96 percent of Americans.

Some of the most significant provisions of the bill include a public insurance option, limited employer mandate and access to the health insurance exchange for small businesses, and a surtax on individuals with an income above $500,000 (and couples above $1 million).

There were also many provisions (pdf) — some related to health coverage, others to long-term care services — that could have significant impact on direct-care workers. The major changes, since the individual House committees released their proposals this summer, include:

• Expansion of mandatory Medicaid coverage from 133 percent of the federal poverty level (FPL) to 150 percent ($27,465 for a family of three). (While affordability premium credits for individuals between 150 and 400 percent FPL have been scaled back, out-of-pocket spending has been capped to protect individuals’ level of cost sharing at each income tier.) With median annual wages of $17,000, many direct-care workers would gain affordable comprehensive coverage through Medicaid.
• Inclusion of the CLASS Act — a new, voluntary, public long-term care insurance program to purchase community living assistance services and support for individuals with functional limitations.
• Advancing the establishment of core training competencies for personal care attendants through three-year demonstrations in four states.

Preliminary CBO estimates of the blended bill project a cost of $894 billion and said the bill would reduce the deficit by about $104 billion over the next 10 years.

The next step is floor consideration, where the entire House will debate and vote on the bill. A vote has been scheduled for 6 p.m. on Saturday, November 7.

Meanwhile, the merging of the two Senate bills continues. Delays in CBO analyses have led to increasing speculation that work on health reform could continue into the beginning of next year.

PHI’s side-by-side chart (pdf) has been updated to reflect the new House bill, and to help readers compare the House and Senate provisions.