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Comparison of Major Health Care Reform Proposals

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Comparison of Major Health Care Reform Proposals ;D8JH on Health Reform H>9:"7N"H>9:8DBE6G>HDCD;B6?DG=:6AI=86G:G:;DGBEGDEDH6AH This side-by-side compares the leading comprehensive reform proposals across a number of key characteristics and plan components. Included in this side-by- side are proposals for moving toward universal coverage that have been put forward by the President and Members of Congress. In an effort to capture the most important proposals, we have included those that have been formally introduced as legislation as well as those that have been offered as principles or in White Paper form. This side-by-side will be regularly updated to reflect changes in the proposals and to incorporate major new proposals as they are announced. The House Tri-Committee summary incorporates the major amendments to the legislation adopted by the three committees of jurisdiction during their mark-ups of the bill. These amendments are identified using an abbreviation for the House panel that approved it — “E&C” for the Committee on Energy and Commerce; “E&L” for the Committee on Education and Labor; and “W&M” for the Committee on Ways and Means. Senate Finance Committee Senate HELP Committee House Tri-Committee America’s Healthy Future Act Affordable Health Choices Act America’s Affordable Health President Obama of 2009 (S. 1679) Choices Act of 2009 (H.R. 3200) Principles for Health Reform Date plan announced September 16, 2009 June 9, 2009 June 19, 2009 February 26, 2009 (passed by Committee October 13, (passed by Committee July 15, 2009) 2009) Overall approach Require most U.S. citizens and legal Require individuals to have health Require all individuals to have President Obama outlined eight to expanding access residents to have health insurance. insurance. Create state-based health insurance. Create a Health principles for health care reform to coverage Create state-based health insurance American Health Benefit Gateways Insurance Exchange through which in his FY 2010 Budget overview. exchanges through which individuals through which individuals and small individuals and smaller employers The President has indicated that can purchase coverage, with premium businesses can purchase health can purchase health coverage, with comprehensive health reform should: and cost-sharing credits available coverage, with subsidies available to premium and cost-sharing credits • Reduce long-term growth of to individuals/families with income individuals/families with incomes up available to individuals/families health care costs for businesses between 100-400% of the federal to 400% of the federal poverty level with incomes up to 400% of the and government. poverty level (the poverty level is (or $73,240 for a family of three in federal poverty level (or $73,240 for • Protect families from bankruptcy or $18,310 for a family of three in 2009) 2009). Require employers to provide a family of three in 2009). Require debt because of health care costs. and create separate exchanges through coverage to their employees or employers to provide coverage to • Guarantee choice of doctors and which small businesses can purchase pay an annual fee, with exceptions employees or pay into a Health health plans. coverage. Assess a fee on certain for small employers, and provide Insurance Exchange Trust Fund, employers that do not offer coverage certain small employers a credit with exceptions for certain small • Invest in prevention and wellness. for each employee who receives a tax to offset the costs of providing employers, and provide certain • Improve patient safety and quality credit for health insurance through coverage. Impose new regulations small employers a credit to offset care. an exchange, with exceptions for on the individual and small group the costs of providing coverage. • Assure affordable, quality health small employers. Impose new insurance markets. Expand Impose new regulations on plans coverage for all Americans. regulations on health plans in the Medicaid to all individuals with participating in the Exchange and in • Maintain coverage when you exchange and in the individual incomes up to 150% of the federal the small group insurance market. change or lose your job. and small group markets. Expand poverty level. Expand Medicaid to 133% of the • End barriers to coverage for Medicaid to all individuals with incomes poverty level. people with pre-existing medical up to 133% of the federal poverty level. conditions. SIDE-BY-SIDE COMPARISON OF MAJOR HEALTH CARE REFORM PROPOSALS — Last Modified: October 15, 2009 1 Senate Finance Committee Senate HELP Committee House Tri-Committee America’s Healthy Future Act Affordable Health Choices Act America’s Affordable Health President Obama of 2009 (S. 1679) Choices Act of 2009 (H.R. 3200) Principles for Health Reform Individual mandate • Require U.S. citizens and legal • Require individuals to have • Require all individuals to have • The plan must put the country residents to have qualifying health qualifying health coverage. “acceptable health coverage”. on a clear path to cover all coverage. Enforced through a tax Enforced through a minimum tax Those without coverage pay Americans. penalty of $750 per adult per year. penalty of $750 per individual a penalty of 2.5% of modified The penalty will be phased-in per year (maximum penalty per adjusted gross income up to according to the following schedule: family of 4 times the individual the cost of the average national $0 in 2013; $200 in 2014; $400 in penalty). Exemptions to the premium for self-only or 2015; $600 in 2016; and $750 in individual mandate will be granted family coverage under a basic 2017. Exemptions will be granted to residents of states that do not plan in the Health Insurance for financial hardship, religious establish an American Health Exchange. Exceptions granted for objections, American Indians, and if Benefit Gateway, members of dependents, religious objections, the lowest cost plan option exceeds Indian tribes, those for whom and financial hardship. 8% of an individual’s income or if affordable coverage is not the individual has income below available, those without coverage 133% of the poverty level. for fewer than 90 days, and those with incomes below 150% FPL. Employer requirements • Assess employers with more than • Require employers to offer health • Require employers to offer Not specified. 50 employees that do not offer coverage to their employees and coverage to their employees and coverage a fee for each employee contribute at least 60% of the contribute at least 72.5% of the who receives a tax credit for premium cost or pay $750 for premium cost for single coverage health insurance through an each uninsured full-time and 65% of the premium cost for exchange. The penalty is the employee and $375 for each family coverage of the lowest cost lesser of a flat dollar amount uninsured part-time employee plan that meets the essential equal to the average national tax who is not offered coverage. For benefits package requirements or credit for each full-time employee employers subject to the pay 8% of payroll into the Health receiving a tax credit or $400 assessment, the first 25 workers Insurance Exchange Trust Fund. times the total number of full- are exempted. [E&L Committee amendment: time employees in the firm. • Exempt employers with 25 or Provide hardship exemptions • Exempt employers with 50 or fewer employees from the for employers that would be fewer employees from the penalty. requirement to provide coverage. negatively affected by job losses • Require employers with 200 or as a result of requirement.] more employees to automatically • Eliminate or reduce the pay enroll employees into health or play assessment for small insurance plans offered by the employers with annual payroll of employer. Employees may opt out less than $400,000: of coverage if they have coverage – Annual payroll less than from another source. $250,000: exempt – Annual payroll between $250,000 and $300,000: 2% of payroll; – Annual payroll between $300,000 and $350,000: 4% of payroll; SIDE-BY-SIDE COMPARISON OF MAJOR HEALTH CARE REFORM PROPOSALS — Last Modified: October 15, 2009 2 Senate Finance Committee Senate HELP Committee House Tri-Committee America’s Healthy Future Act Affordable Health Choices Act America’s Affordable Health President Obama of 2009 (S. 1679) Choices Act of 2009 (H.R. 3200) Principles for Health Reform Employer requirements – Annual payroll between (continued) $350,000 and $400,000: 6% of payroll. [E&C Committee amendment: Extend the reduction in the pay or play assessment for small employers with annual payroll of less than $750,000 and replace the above schedule with the following: – Annual payroll less than $500,000: exempt – Annual payroll between $500,000 and $585,000: 2% of payroll; – Annual payroll between $585,000 and $670,000: 4% of payroll; – Annual payroll between $670,000 and $750,000: 6% of payroll.] • Require employers that offer coverage to automatically enroll into the employer’s lowest cost premium plan any individual who does not elect coverage under the employer plan or does not opt out of such coverage. Expansion of public • Expand Medicaid to all individuals • Expand Medicaid to all individuals • Expand Medicaid to all individuals • As a foundation for health programs (children, pregnant women, (children, pregnant women, (children, pregnant women, reform, the President signed parents, and adults without parents, and adults without parents, and adults without the Children’s Health Insurance dependent children) with dependent children) with incomes dependent children) with incomes Program Reauthorization incomes up to 133% FPL (to be up to 150% FPL. Individuals up to 133% FPL. Newly eligible, Act (CHIPRA), which provides implemented in 2014). Adults with eligible for Medicaid will be non-traditional (childless adults) coverage to 11 million children. incomes between 100-133% FPL covered through state Medicaid Medicaid beneficiaries may will have the option of obtaining programs and will not be eligible enroll in coverage through the coverage through Medicaid or for credits to purchase coverage Exchange if they were enrolled in with federal subsidies through the through American Health Benefit qualified health coverage during exchange.
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