Status Quo

President’s proposal

House Republican proposal

Covering the uninsured

46 million uninsured and rising every year.

-Reduces the number of uninsured by 31+ million

-Creates state based Exchanges, a marketplace of several private insurance options, for people to purchase insurance. Subsidies will be offered for low income and middle class families.

Reduces the number of uninsured by 3 million by:

-Allowing individuals to purchase insurance in state high-risk pools (15 states do not currently have high-risk pools) at costs that can be 1.5 times the standard rate.

-Allows people to use Health Savings Accounts to pay for premiums for high deductible health insurance.

Pre-existing conditions

In 45 states, insurance companies can deny people coverage or charge them higher rates because they have pre-existing conditions.

-Temporary high-risk pool for people denied coverage due to pre-existing conditions

-Complete ban against denying coverage or charging higher rates due to pre-existing conditions begins in 2014

-People with pre-existing conditions could access to high risk pools and reinsurance programs

-Insurers would continue to be able to deny coverage based on pre-existing conditions

- Insurers could not rescind policies unless a person commits fraud or conceals facts.

Annual and lifetime limits

Insurance companies can set annual and lifetime limits on the benefits they will pay out, bankrupting people who face serious illnesses.

Bars insurance companies from imposing annual or lifetime limits on benefits.

Bars insurance companies from imposing annual or lifetime limits on benefits.

Federal subsidies

None available to a broad portion of Americans.

-Families earning between 133% – 400% of the Federal Poverty Level ($24,352-$73,240 for a family of three) will get subsidies to purchase health insurance. On a sliding scale they will pay 2% - 9.5% of their income for premiums.  This proposal significantly lowers premiums and out-of-pocket costs for low and moderate-income families, compared to the Senate bill.

No subsidies

Small businesses

Small businesses pay higher rates for health insurance than larger companies.

-$40 Billion in tax credits beginning in 2010 to help small businesses pay the cost of premiums for their employees

-Businesses with less than 50 workers are exempt from any employer responsibility policies.

-Gives some small businesses the ability to pool together to purchase coverage which may allow companies with healthier employees to obtain lower rates. 

Regulating Insurance Companies

Some insurance companies currently skim off 40% of premiums for administration, marketing and profit.  And insurers have a lot of leeway to charge higher rates based on health, gender, age and other factors

-Immediately requires that insurers devote at least 80% of their premiums to medical benefits, and provide rebates to consumers if an insurer spends less than this level.

-Creates a new federal authority to review premium increases.

-Greater deregulation allows insurance companies to sell policies across state-lines

Preventative Care

Co-pays, co-insurance and deductibles apply.  

-No out-of-pocket costs for preventative care, such as cancer screenings and wellness check ups, for people with insurance.

-Gives employers some latitude to charge employees higher or lower premiums based on health status or behavior.

-Gives employers more latitude to charge employees higher or lower premiums based on health status and behavior.

Limits on out of pocket costs

Currently insurance companies are not required to cap out-of-pocket costs for individuals and families, which leads to many bankruptcies.

Annual limit of $5,800 on out-of-pocket costs for an individual and $11,600 for a family, lower limits for lower income families.

None

Dependent coverage

State laws vary, but most do not require insurers to provide dependent coverage up to any age.

Immediately extend dependent coverage in all insurance plans up to age 26

Encourages dependent coverage on insurance plans through age 25.

Seniors

Currently, Medicare annual drug coverage stops at $2,700, then resumes when drug bills reach $4,350. This referred to as the “donut hole”.

- No losses in existing coverage.

- Reduces prescription drug costs by eliminating the Medicare “donut hole”

- Preventative care, such as cancer screenings, are free

- Eliminates overpayments that private insurers receive through Medicare Advantage

- Restructures payments to health care providers to encourage greater quality

-Extends the life of the Medicare Trust Fund by 5 yrs

-Leaves in place the Medicare prescription drug coverage “donut hole”

Medicaid

-In most states, only very poor adults who have children qualify for Medicaid.

-Each state decides the income eligibility level - the median income cutoff for parents is 41% of the Federal Poverty Level, or $7,500 for a family of 3.

-45 states provide no Medicaid coverage to childless adults

-Access to Medicaid for individuals and families earning up to 133% of the Federal Poverty Level ($24,352 for a family of three or $14,404 for an individual)

- Federal support to states for Medicaid expansion: federal support to cover 100% cost of expansion for 2014-2017, 95% of cost for 2018-2019 and 90% for 2020 and subsequent years.

-Eliminates special treatment for the State of Nebraska

-No expansion

CHIP

Nearly 8 million children are covered through the CHIP program.

Preserves CHIP through September 30, 2019 with full funding extended through fiscal year 2016.

Federal deficit

Rising health costs are driving up the deficit

Reduces the federal deficit by $100 billion over ten years and about $1 trillion over the second decade.

Reduces the federal deficit by 68 billion over the next ten years.

Other note worthy elements

-Incorporates several bi-partisan ideas to address fraud and waste within Medicaid and Medicare.

-Invests $11 billion dollars into Community Health Centers.

-Prevents delays in access to generic drugs

-Medical liability reform  designed to reduce defensive medicine

-Incentives for state initiatives to lower premiums and reduce the number of uninsured.