Health Comp 1119
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Overview
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- Words: 744
- Pages: 3
Provision
Senate Democratic Leadership Patient Protection & Affordable Care Act Substitute to HR 3590
Pages
House - HR 3962 Affordable Health Care for America Act
2070
1990
General approach
Requires most citizens and legal residents to Requires individuals to be covered, sets up health get coverage; State-based insurance exchanges; exchanges; employers cover or pay fee to a employers cover or pay fee if any employee trust fund, with some small firms left out gets government subsidy for insurance
Estimated 10 year net cost
$848 billion
$864 billion
Coverage level under age 65
94 percent covered -- 23 million still uninsured
96 percent -- 17 million still uninsured
Illegal immigrants covered
No - only citizens and legal immigrants could take part in exchanges
No -- limits availability of premium/cost sharing credits to citizens and legal immigrants undocumented aliens could use own funds to buy coverage though exchanges
Abortion coverage
Plans can choose to cover; in each state, at least one plan would cover & one would not; subsidies could not be used to pay for abortion; accounts to cover would have to be separate; public plan could cover under same rules
Plans could cover abortions but no one getting subsidies could enroll in those plans; public plan would not cover elective abortion
Individuals
Must be covered or have employer coverage; penalties start at $95 in 2014, rise to $750 in 2 years; max of $2,250 per family
Must have insurance or pay tax penalty; hardship exceptions to 2.5 percent penalty that starts at $9,350 individual income; couples $18,700
Employers
Not required to cover workers; firms with more than 50 workers would pay $750 penalty for each worker if any employee gets subsidy
Cover at least 65 pct of premium or 8 pct of payroll; firms with payroll under $500,000 exempt
Subsidies
For Individuals and families up to 400
Individuals and families up to 400 percent of
pct poverty; up to $88,299 for family of 4 Tied to 2nd lowest cost plan in area Small employers also get tax credits
poverty; $88,000 for family of 4 Tied to average cost of 3 lowest basic plans Start in 2013
Tax/penalty
$750 a year for adults without qualifying covg.; excise tax on high value plans worth more than $8,000 individual; $21,000 for family 5 pct excise tax on elective plastic surgery; bumps Medicare payroll tax .5 pct on salaries of more than $200,000/ $250 couples
Tax of 2.5 percent of modified adjusted gross income on individuals without qualifying coverage; income surcharge on people making more than $500,000, couples $1 million
Benefits
All plans cover basic benefits -- primary care, Experts recommend a basic package that would hospitalization and primary care. There would be cover about 70 percent of costs; out of pocket 4 levels of coverage covering 65-90 pct. of costs limit of $5,000/$10,000 individual/family; no annual or lifetime limits; 4 levels of benefits include mental health, durable medical equipment
Insurance rules
No denial of coverage based on existing conditions; premiums could not be higher due to health or gender; limits on higher premiums by age, family size, location and tobacco use. No lifetime coverage limits.
No denials or refusals to renew based on health; premiums could vary only due to location, family structure, and, with limits, age. Sale of policies across state lines allowed if states involved agree
Antitrust
Not addressed in bill; may be added during debate
Removes exemption from federal anti-trust laws on market allocation, price fixing, bid rigging. Adds Federal Trade Commission jurisdiction.
Where to choose a plan
State based exchanges for individuals and small businesses to buy coverage; all statelicensed insurers would have to take part to sell individual and small group plans
National Health Insurance Exchange for individuals and small employers (larger firms would join later); plans in the exchange required to be state licensed, states could also be permitted to run exchanges under same rules
Public programs
Expand Medicaid to all up to 133 percent of
Expand Medicaid to 150 percent of poverty;
Public option
poverty level ($29,327 family of 4); feds pay all costs first 3 years, then about 90 pct
($33,100 family of 4); federal government pays full cost 2013-14, then 91/9 percent split with states
Federal insurance plan set up to compete with private plans; government would negotiate with providers on payment; states could opt out
Creates a new public health insurance option to be offered through exchanges; HHS would run, negotiate rates with providers separate from Medicare
Senate Democratic Leadership Patient Protection & Affordable Care Act Substitute to HR 3590
Pages
House - HR 3962 Affordable Health Care for America Act
2070
1990
General approach
Requires most citizens and legal residents to Requires individuals to be covered, sets up health get coverage; State-based insurance exchanges; exchanges; employers cover or pay fee to a employers cover or pay fee if any employee trust fund, with some small firms left out gets government subsidy for insurance
Estimated 10 year net cost
$848 billion
$864 billion
Coverage level under age 65
94 percent covered -- 23 million still uninsured
96 percent -- 17 million still uninsured
Illegal immigrants covered
No - only citizens and legal immigrants could take part in exchanges
No -- limits availability of premium/cost sharing credits to citizens and legal immigrants undocumented aliens could use own funds to buy coverage though exchanges
Abortion coverage
Plans can choose to cover; in each state, at least one plan would cover & one would not; subsidies could not be used to pay for abortion; accounts to cover would have to be separate; public plan could cover under same rules
Plans could cover abortions but no one getting subsidies could enroll in those plans; public plan would not cover elective abortion
Individuals
Must be covered or have employer coverage; penalties start at $95 in 2014, rise to $750 in 2 years; max of $2,250 per family
Must have insurance or pay tax penalty; hardship exceptions to 2.5 percent penalty that starts at $9,350 individual income; couples $18,700
Employers
Not required to cover workers; firms with more than 50 workers would pay $750 penalty for each worker if any employee gets subsidy
Cover at least 65 pct of premium or 8 pct of payroll; firms with payroll under $500,000 exempt
Subsidies
For Individuals and families up to 400
Individuals and families up to 400 percent of
pct poverty; up to $88,299 for family of 4 Tied to 2nd lowest cost plan in area Small employers also get tax credits
poverty; $88,000 for family of 4 Tied to average cost of 3 lowest basic plans Start in 2013
Tax/penalty
$750 a year for adults without qualifying covg.; excise tax on high value plans worth more than $8,000 individual; $21,000 for family 5 pct excise tax on elective plastic surgery; bumps Medicare payroll tax .5 pct on salaries of more than $200,000/ $250 couples
Tax of 2.5 percent of modified adjusted gross income on individuals without qualifying coverage; income surcharge on people making more than $500,000, couples $1 million
Benefits
All plans cover basic benefits -- primary care, Experts recommend a basic package that would hospitalization and primary care. There would be cover about 70 percent of costs; out of pocket 4 levels of coverage covering 65-90 pct. of costs limit of $5,000/$10,000 individual/family; no annual or lifetime limits; 4 levels of benefits include mental health, durable medical equipment
Insurance rules
No denial of coverage based on existing conditions; premiums could not be higher due to health or gender; limits on higher premiums by age, family size, location and tobacco use. No lifetime coverage limits.
No denials or refusals to renew based on health; premiums could vary only due to location, family structure, and, with limits, age. Sale of policies across state lines allowed if states involved agree
Antitrust
Not addressed in bill; may be added during debate
Removes exemption from federal anti-trust laws on market allocation, price fixing, bid rigging. Adds Federal Trade Commission jurisdiction.
Where to choose a plan
State based exchanges for individuals and small businesses to buy coverage; all statelicensed insurers would have to take part to sell individual and small group plans
National Health Insurance Exchange for individuals and small employers (larger firms would join later); plans in the exchange required to be state licensed, states could also be permitted to run exchanges under same rules
Public programs
Expand Medicaid to all up to 133 percent of
Expand Medicaid to 150 percent of poverty;
Public option
poverty level ($29,327 family of 4); feds pay all costs first 3 years, then about 90 pct
($33,100 family of 4); federal government pays full cost 2013-14, then 91/9 percent split with states
Federal insurance plan set up to compete with private plans; government would negotiate with providers on payment; states could opt out
Creates a new public health insurance option to be offered through exchanges; HHS would run, negotiate rates with providers separate from Medicare
