||House Bill ($894 billion/10 years)
||Senate Bill ($871 billion/10 years)
|1. Making Insurance More Affordable
||- Expands Medicaid to 150% Federal Poverty Line.
- Offers subsidies to Americans between 150 – 400% FPL on sliding scale; spend 1.5%-12% of income on premiums. Cost-sharing credits are available to individuals and families with incomes up to 400% FPL
|- Expands Medicaid to 133% Federal Poverty Line.
- Offers subsidies to Americans between 133 – 400% FPL on sliding scale; spend 2.8%-9.8% of income on premiums. Cost sharing is only available for individuals and families with incomes between 100-200% FPL.
|Conference report could adopt the House’s Medicaid expansion and use the savings to reduce premium payments and out-of-pocket spending for individuals with incomes between 150% and 200% FPL. The Conferees can also adopt the Senate’s subsidy levels for individuals and families above 250% FPL.
|2. Greater Oversight Of Insurers
||Creates a national exchange but permits states to establish state-based exchanges if they meet national standards and demonstrate the capacity to administer an exchange.
||Creates state-based exchanges.
||A national exchange would allow the federal government to implement the law uniformly and relieve the states from taking-on additional regulatory functions. Conferees should also consider moving up the implementation year to 2013.
|3. More Funding For Prevention
||Includes $34 billion over 5 years in public health investment, including $15.4 billion for a Prevention and Wellness Trust Fund.
||Includes $15 billion over 10 years in public health investment 10 years.
||Conference should retain a Prevention and Wellness Trust with a dedicated funding stream that will increase the use of effective preventive services.
|4. Increase Primary Care Payments To Medicaid Providers
||Increases primary care payment rates to Medicare rates.
||Does not include this provision
|| Conferees should increase payments to Medicaid providers to ensure that the expanded population can access a broad network of providers.
||5.4% surtax on individuals earning more than $500,000, couples earning more than $1 million; Medicare savings.
||Excise tax, increases the payroll tax on individuals who earn more than $200,000 and families earning more than $250,000 a year, taxes on insurers, pharmaceuticals, and medical devices, tax on tanning booths; Medicare savings; Medicare Commission
||The Conference report should add a piece of the House’s surtax or increase other taxes on higher-income Americans and increase the threshold on the excise tax.
|6. Employer Responsibility
||Large employers who don’t offer coverage would pay a fee equal to 8% of their payroll. This raises $135B/10 yrs.
||Large employers who don’t offer coverage would pay a penalty of $750 per full-time employee if any worker receives a subsidy in the exchange. This raises $28 billion/10 yrs.
||To prevent employers from dropping coverage, the conferees — rather than adopting the Senate’s policy — should increase the financial obligation of employers and apply it across full and part-time workers.
|7. Filling The Doughnut Hole
||Completely closes the Medicare Part D ‘doughnut hole’ by 2019.
||Does not fully close the Medicare Part D ‘doughnut hole.’
||The conferees should completely close the doughnut hole using extra dollars from pharmaceutical industry.
|8. Protecting Older Americans From Higher Premiums
||Allows rating variation between 2:1.
||Allows rating variation between 3:1.
||The House’s rating would make coverage more affordable for older Americans.
|9. LGBT Equality
||Expands pre-tax employer-provided health insurance benefits to heterosexual and same-sex domestic partners
||Does not include this provision
|| Employees with partner health benefits now pay on average $1,069 per year more in taxes than would a married employee with the same coverage. The conference report should make coverage more affordable and equitable by adopting tax equality.
|10. Retain COBRA Continuation Until Exchanges Are Established
||Individuals eligible for COBRA continuation coverage my retain COBRA coverage until the Exchange is established.
||No such provision exists.
||The House language would ensure greater continuity in care and give Americans the choice of staying on COBRA until they have more affordable choices.
|11. Tighter Regulations Of High-Risk Pools
||Premiums for high risk-pools will be set at no higher than 125% of the prevailing rate for comparable coverage, rates could vary no more than 2:1 due to age. Annual deductibles will be limited to $1,500 for an individual and maximum cost sharing will be limited to $5,000 for individuals.
||Premiums could vary no more than 4:1 due to age. Maximum cost sharing will be limited to $5,950 for individuals.
||The House language would provide Americans who can’t find coverage in the individual market with more affordable interim coverage.