SUMMARY OF KEY PROVISIONS IN FEDERAL HEALTH CARE REFORM by fkm75091

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									               SUMMARY OF KEY PROVISIONS IN FEDERAL HEALTH CARE REFORM PROPOSALS
                                    Current as of September 17, 2009

       The following summary is based on the original proposals outlined by each Committee as presented by the Henry J.
Kaiser Family Foundation but also incorporates revisions made to their original proposals in the past several weeks, including
the Finance Committee’s newly released summary. The following websites provide helpful information regarding the health
care reform debate:
                          www.kff.org (Henry J. Kaiser Family Foundation)
                          http://healthcarerepair.wordpress.com (Mayo Clinic Policy Blog)
                          http://help.senate.gov (Senate Committee on Health, Education, Labor & Pensions)
                          http://www.cbo.gov (Congressional Budget Office)



                                Senate Finance Committee          Senate HELP Committee             House Tri-Committee

Individual Mandate              All individuals are required to   All individuals are required to   All individuals required to have
                                have insurance that meets         have “qualifying health           “acceptable health coverage”
                                “minimum coverage                 coverage.”                        which does not include
                                standards.”                                                         individual insurance policies
                                                                                                    unless grandfathered in.

                                                                                                    Enforced through 2% tax on
                                Enforced through an excise tax.   Enforced through tax penalty.     adjusted gross income with cap.
                                Financial hardship exemptions.    Multiple exemptions.              Exemptions for financial
                                Auto enrollment procedures                                          hardship, dependents and
                                                                                                    religious objections




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                             Senate Finance Committee              Senate HELP Committee                House Tri-Committee

Ensuring Access to           Create Health Insurance               Create state-based American          Create Health Insurance
Coverage/Insurance Pooling   Exchange through which                Health Benefit Gateways through      Exchange through which
                             individuals and small businesses      which individuals and small          individuals and employers can
                             can purchase health coverage.         businesses can purchase health       purchase health coverage but
                                                                   coverage. Plans participating in     restrict access to those not
                             Require all state licensed insurers   the Gateway would receive            covered by qualified or
                             in the non-group and small group      incentives for better coordination   grandfathered coverage,
                             markets to participate.               of care, reduction in hospital       Medicare/Medicaid/Tricare or
                                                                   readmissions and wellness/health     VA.
                                                                   promotion activities.

                             Require guarantee issue and
                             renewability and allow rating                                              Require guarantee issue and
                             variation based only on age,                                               renewability and allow rating
                             tobacco use, family composition                                            variation based only on age,
                             and geography. Not health status.                                          tobacco use, family composition
                                                                                                        and geography. Not health
                             Subsidies available to individuals    Subsidies would be available for     status.
                             or families with incomes up to        individuals and families with
                             400% of federal poverty level         incomes up to 400% of the FPL        Subsidies available for
                             (“FPL”). Workers with employer                                             individuals or families with
                             coverage available do not receive                                          incomes up to 400% of the FPL;
                             credit unless premium is 13% or                                            however, to qualify the cost of
                             more of their income.                                                      the insurance must be exceed
                                                                                                        12% of their income
                                     Senate Finance Committee         Senate HELP Committee           House Tri-Committee

Employer Requirements                No employer requirement to       Employers with more than 25     Require employers to offer
                                     provide health coverage but      workers will have to pay $750   coverage to employees and
(often referred to as the “play or   employers with less than 50      annually for each full-time     contribute at least 72.5% of
pay” requirement)                    employees who don’t offer        employee and $375 annually      the premium cost for single
                                     coverage will have to            for each part-time employee     coverage and 65% of the
                                     reimburse federal government     who is not provided a certain   premium cost for family
                                     up to 100% of tax                minimum level of health         coverage of the lowest cost
                                     credit/subsidy employee          coverage through employer       plan that meets essential
                                     receives up to a cap of $400 x   (either no coverage or          benefit package requirements.
                                     the number of total employees    employer not paying 60% of
                                     the employer employs.            the cost of their monthly       Failure to meet minimum
                                                                      premium)                        contribution requirements
                                                                                                      requires employer to pay 8%
                                                                                                      of payroll into Health
                                                                                                      Insurance Exchange Trust
                                                                                                      Fund. Exemptions for certain
                                                                                                      small businesses.

                                                                                                      Does not apply to employers
                                                                                                      with annual payrolls of less
                                                                                                      than $500,000. Sliding scale
                                                                                                      implementation from $500-
                                                                                                      750,000
                Senate Finance Committee          Senate HELP Committee             House Tri-Committee

Public Option   No public option                  Create a new public plan to be    Create a new public plan to be
                                                  offered through the state based   offered through the Health
                Creates authority for Non-        American Health Benefit           Insurance Exchange which is
                Profit Cooperative Health Plan    Gateways.                         similar to private plan
                Options governed by                                                 coverage.
                consumers. Federal                Only available to “eligible
                government to provide $6          individuals” whose premiums       Provider payment rates would
                billion in seed money for start   are more than 12.5% of the        be negotiated with
                up costs and to meet solvency     individual’s salary               providers/not tied to Medicare.
                requirements.
                                   Senate Finance Committee       Senate HELP Committee         House Tri-Committee

Expansion of Public Programs       Expand eligibility for         Outside jurisdiction of       Expand Medicaid eligibility to
(other than the “public option”)   Medicaid to 133% of federal    Committee but supports        133% of the FPL. Work on
                                   poverty level for children,    expansion of Medicaid         transitioning some Medicaid
                                   pregnant women, parents and    eligibility to 150% of FPL.   beneficiaries to Health
                                   childless adults.                                            Insurance Exchange.

                                   Expand Children’s Health       Give CHIP beneficiaries the   Require CHIP beneficiaries to
                                   Insurance Program to 250% of   option of enrolling in a      obtain coverage through the
                                   FPL.                           qualified health plan.        Health Insurance Exchange
                                 Senate Finance Committee            Senate HELP Committee               House Tri-Committee

Premium Subsidies to Employers   Small employers that purchase       Small employers receive a health    Small employers receive a health
                                 insurance for their employees       options credit equal to $1000 for   coverage tax credit of 50% of
                                 receive a temporary tax credit up   each employee with single           premium costs paid by
                                 to 50% of their premium             coverage and $2000 for each         employers.
                                 contributions. The tax credit is    employee with family coverage
                                 available in the years 2011-2016    (with some adjustments). Bonus
                                                                     payments are given for each
                                                                     additional 10% of employer
                                                                     health expenses above 60% paid
                                                                     by employer


                                                                     Only small employers with fewer     Only small employers with 10 or
What employers qualify?          Available to employers with         than 50 full-time employees who     fewer employees and average
                                 fewer than 25 employees with        pay an average wage of less than    annual wages of $20,000 or less
                                 average wages below $40,000.        $50,000 qualify.                    with phase outs.



Other benefits?                                                      Reinsurance program available
                                                                     for employers providing health
                                                                     insurance coverage to retirees
                                                                     ages 55 to 64 reimbursing
                                                                     employers for 80% of retiree
                                                                     claims between $15,000 and
                                                                     $90,000. Will end when state
                                                                     Gateways are established
                                  Senate Finance Committee              Senate HELP Committee                House Tri-Committee

Changes to Private Insurance

Individual & Small Group Market
                                  Require guarantee issue and           Require guarantee issue and          Require guarantee issue and
                                  renewability, prohibit pre-           renewability, prohibit pre-          renewability, prohibit pre-
                                  existing condition exclusions, and    existing condition exclusions, and   existing condition exclusions, and
                                  allow rating variation based only     allow rating variation based only    allow rating variation based only
                                  on age, tobacco use, family           on age, family composition,          on age, family composition and
                                  composition and geography.            geography and actuarial value of     geography. Not health status.
                                                                        health plan.


All Insurers                                                            Required to cover preventative       Required to offer coverage that
                                  Policies placed in 4 new benefit      care services without cost-sharing   meets “essential benefits
                                  categories: bronze, silver, gold or   & provide dependent coverage         package” which covers 70% of
                                  platinum. (EXCEPTION: for             for children up to age 26            the actuarial value of the covered
                                  grandfathered employer-                                                    benefits; limits annual cost
                                  sponsored health plans)                                                    sharing to $5000/$10,000 and
                                  Insurance companies required to                                            does not impose annual or
                                  offer a silver and gold policy                                             lifetime limits

                                  Out of pocket limits in policies                                           Limit health plans’ medical loss
                                  must be at least equal to HSA                                              ratio to 85% through a rebate
                                  limits ($5950- individual,                                                 back to consumers.
                                  $11,900- family)

                                  Cannot have lifetime or annual
                                  coverage limits
                    Senate Finance Committee          Senate HELP Committee              House Tri-Committee

Other Tax changes   Insurance companies to pay        Have now rejected the idea of      None specified but Democrats are
                    excise tax of 35% on amount of    taxing employer-sponsored          said to be considering taxing
                    insurance premium that exceeds    benefits but are now considering   “generous” employer provided
                    $8,000 for singles, $22,000 for   a tax on individuals making more   benefits as well as raising taxes
                    family                            than $200,000 per year.            on individuals making more than
                                                      Democrats are said to still be     $200,000 per year
                    Requires employers to disclose    considering taxing “generous”
                    value of benefits on W-2s         employer provided benefits.

                    Limit health flexible spending
                    account contributions to $2000
                    per year

                    Eliminate Medicare Part D
                    subsidy for employers

                    Increase tax penalty for use of
                    HSA funds for non-qualified
                    HSA expenses
                   Senate Finance Committee             Senate HELP Committee             House Tri-Committee

Cost Containment   Eliminate fraud, abuse & waste by    Health Care Program Integrity     Reduce fraud, waste and abuse by
                   more intensive screening of          Coordinating Council to oversee   requiring compliance plans for
                   providers, increased penalties for   program and oversight of health   providers, refusing Medicaid
                   false claims, and EMTALA             care fraud, waste and abuse in    payments for health care acquired
                   violations. Require drug or device   public & private coverage         conditions, and better provider
                   manufacturers to disclose                                              screening.
                   payments/incentives to providers
                   and investments held by
                   physicians.
                                                                                          Simplify health insurance
                   Health Information Technology        Provide grants to improve         administration by standardizing
                   promotion                            efficiency, including medical     health care claims forms,
                                                        home models and medication        transactions and reporting
                                                        management services               requirements

                   Change how Medicare pays                                               Restructure Medicare Advantage,
                   providers for services from fee                                        modify Medicare provider
                   based to quality/value based                                           payments and increase Medicaid
                   system                                                                 drug rebate percentage.

                   Improve access to preventative                                         National strategy to improve
                   care services and providing          National prevention and health    health through prevention and
                   incentives for Medicare/Medicaid     promotion programs                wellness activities
                   beneficiaries to seek preventative
                   care

								
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