Who is eligible to participate in the exchange

[ProSense]

SEC. 302. EXCHANGE-ELIGIBLE INDIVIDUALS AND EMPLOYERS.

(a) ACCESS TO COVERAGE.—In accordance with this section, all individuals are eligible to obtain coverage through enrollment in an Exchange-participating health benefits plan offered through the Health Insurance Exchange unless such individuals are enrolled in another qualified health benefits plan or other acceptable coverage.

(b) DEFINITIONS.—In this division:

(1) EXCHANGE-ELIGIBLE INDIVIDUAL.—The term ‘‘Exchange-eligible individual’’ means an individual who is eligible under this section to be enrolled through the Health Insurance Exchange in an Exchange-participating health benefits plan and, with respect to family coverage, includes dependents of such individual.

(2) EXCHANGE-ELIGIBLE EMPLOYER.—The term ‘‘Exchange-eligible employer’’ means an employer that is eligible under this section to enroll through the Health Insurance Exchange employees of the employer (and their dependents) in Exchange eligible health benefits plans.

(3) EMPLOYMENT-RELATED DEFINITIONS.— The terms ‘‘employer’’, ‘‘employee’’, ‘‘full-time employee’’, and ‘‘part-time employee’’ have the meanings given such terms by the Commissioner for purposes of this division.

(c) TRANSITION.—Individuals and employers shall only be eligible to enroll or participate in the Health Insurance Exchange in accordance with the following transition schedule:

(1) FIRST YEAR.—In Y1 (as defined in section 100(c))— (A) individuals described in subsection(d)(1), including individuals described in sub section (d)(3); and (B) smallest employers described in subsection (e)(1).

(2) SECOND YEAR.—In Y2— (A) individuals and employers described in paragraph (1); and (B) smaller employers described in subsection (e)(2).

(3) THIRD AND SUBSEQUENT YEARS.—In Y3— (A) individuals and employers described in paragraph (2); (B) small employers described in subsection (e)(3); and (C) larger employers as permitted by the Commissioner under subsection (e)(4).

(d) INDIVIDUALS.—

(1) INDIVIDUAL DESCRIBED.— Subject to the succeeding provisions of this subsection, an individual described in this paragraph is an individual who— (A) is not enrolled in coverage described in subparagraph (C) or (D) of paragraph (2); and (B) is not enrolled in coverage as a fulltime employee (or as a dependent of such an employee) under a group health plan if the coverage and an employer contribution under the plan meet the requirements of section 412. For purposes of subparagraph (B), in the case of an individual who is self-employed, who has at least 1 employee, and who meets the requirements of section 412, such individual shall be deemed a full-time employee described in such subparagraph.

(2) ACCEPTABLE COVERAGE.—For purposes of this division, the term ‘‘acceptable coverage’’ means any of the following:

(A) QUALIFIED HEALTH BENEFITS PLAN COVERAGE.—Coverage under a qualified health benefits plan.

(B) GRANDFATHERED HEALTH INSURANCE COVERAGE; COVERAGE UNDER CURRENT GROUP HEALTH PLAN.—Coverage under a grand fathered health insurance coverage (as defined in subsection (a) of section 202) or under a current group health plan (described in sub section (b) of such section).

(C) MEDICARE.—Coverage under part A of title XVIII of the Social Security Act.

(D) MEDICAID.—Coverage for medical assistance under title XIX of the Social Security Act, excluding such coverage that is only available because of the application of subsection (u), (z), or (aa) of section 1902 of such Act.

(E) MEMBERS OF THE ARMED FORCES AND DEPENDENTS (INCLUDING TRICARE).— Coverage under chapter 55 of title 10, United States Code, including similar coverage furnished under section 1781 of title 38 of such Code.

(F) VA.—Coverage under the veteran’s health care program under chapter 17 of title 38, United States Code.

(G) OTHER COVERAGE.—Such other health benefits coverage, such as a State health benefits risk pool, as the Commissioner, in coordination with the Secretary of the Treasury, recognizes for purposes of this paragraph. The Commissioner shall make determinations under this paragraph in coordination with the Secretary of the Treasury.

(3) CONTINUING ELIGIBILITY PERMITTED.—(A) IN GENERAL.—Except as provided in subparagraph (B), once an individual qualifies as an Exchange-eligible individual under this subsection (including as an employee or dependent of an employee of an Exchange-eligible employer) and enrolls under an Exchange-participating health benefits plan through the Health Insurance Exchange, the individual shall continue to be treated as an Exchange-eligible individual until the individual is no longer enrolled with an Exchange-participating health benefits plan.

(B) EXCEPTIONS.—(i) IN GENERAL.—Subparagraph (A) shall not apply to an individual once the individual becomes eligible for coverage— (I) under part A of the Medicare program; (II) under the Medicaid program as a Medicaid-eligible individual, except as permitted under clause (ii); or (III) in such other circumstances as the Commissioner may provide.

(ii) TRANSITION PERIOD.—In the case described in clause (i)(II), the Commissioner shall permit the individual to continue treatment under subparagraph (A) until such limited time as the Commissioner determines it is administratively feasible, consistent with minimizing disruption in the individual’s access to health care.

(emphasis added)

[derby378]

1. Section 302(d)(1) is the clause that kills the public option in the House

If your employer offers coverage, no public option for you.

[Cha]

2. My employer does not offer it and

I have no health coverage. I've been fortunate so far in that I haven't needed it..knock on wood.

[ProSense]

3. No it doesn't. From what I read in

SEC. 412, it doesn't appear that the right an employee currently has to opt-out changes.

(2) OPT-OUT.—In no case may an employer automatically enroll an employee in a plan under paragraph (1) if such employee makes an affirmative election to opt out of such plan or to elect coverage under an employment-based health benefits plan offered by such employer. An employer shall provide an employee with a 30-day period to make such an affirmative election before the employer may automatically enroll the employee in such a plan.

[derby378]

6. So it's a 30-day probationary window. What if you've been there for 10-20 years?

Do you, as a long-term employee, get an opt-out window that qualifies you for a public option, or are you just stuck?

[ProSense]

7. People opt out during open enrollment all the time. n/t

[kestrel91316]

4. Employers will stop providing coverage, would be my guess.

Anything to improve the bottom line. They won't feel any obligation to provide it anymore, since people can just turn to the PO.

Fine with me.

[stevenleser]

5. Yup. Same here.

Which would accomplish two things. Single payer for everyone and more competitive American businesses.

[kestrel91316]

8. Exactly. I see it as speeding the demise altogether of medical "insurance"

companies in the US. They are profiting from denial of care. A pox on them.

[ProSense]

9. It's really interesting that some people ignore the facts and the obvious.

There is also the case that once a person becomes eligible for the exchange, the person remains eligible on a continuing basis.

[Clio the Leo]

10. There is a reason why Hatch and others.....

.... keep describing the bill as "bad" because it is a "quick path to socialized medicine."

"SOLD!" I said. :)

[vaberella]

11. I love parts of this bill. This is the one Pelosi is pushing right? n/t

[ProSense]

12. Yes, it is. n/t