| Plan |
*UPDATED* House Democrats Tri-Committee Health Reform Plan | |
| Date |
| |
| Overall Approach |
Universal access through state and National health care exchanges, including a public option | |
| Universal Coverage |
Yes | |
| Guaranteed Coverage |
Yes | |
| Portability |
Not Addressed | |
| Voluntary Employer-Based System |
Yes | |
| New Programs |
Creates a new national health Exchange that permits States the option of developing a State or regional exchange in lieu of the national Exchange
Creates a new public health insurance option within the Exchange
Creates an independent public/private advisory committee to recommend benefit packages
Establishes a Health Choices Administration to oversee health insurance regulation
Establishes a Center for Comparative Effectiveness Research
Creates a new public health insurance option within the Exchange
Creates an independent public/private advisory committee recommends benefit packages | |
| Expansion of Existing Public Programs/Federal Law |
Expands Medicaid for the most vulnerable, low-income populations and improves payment rates to enhance access to primary care under Medicaid
Expands authority to prevent waste, fraud and abuse
Expands the National Health Service Corps
Expands scholarships and loans for individuals in needed professions and shortage areas
Expands Community Health Centers | |
| Insurance Pool |
Health Choices Commissioner creates and operates a risk pooling mechanism, and ensures consumer protections | |
| State Responsibility |
Permits States the option of developing a State or regional exchange in lieu of the national Exchange
Requires states to increase Medicaid physician reimbursement rates for primary care practitioners | |
| Individual Mandate |
Individuals are responsible for having health insurance with an exception in cases of hardship | |
| Employer Mandate |
Employers choose between providing coverage for their workers or contributing funds on behalf of their uncovered workers | |
| Private Insurance Mandates |
Prohibits insurers from excluding preexisting conditions or engaging in other discriminatory practices
Prohibits rating based on gender, health status, or occupation and strictly limits premium variation based on age
Administrative simplification and standardization to reduce administrative costs across all plans and providers
Requires qualified plans to meet the benefit standards recommended by the Benefits Advisory Committee | |
| Individual Subsidies |
Includes sliding scale affordability credits in the Exchange to support individuals and families with incomes between Medicaid eligibility levels and 400% of the federal poverty level | |
| Individual Vouchers |
No | |
| Employer Subsidies |
Protects small businesses by exempting small low-wage firms and providing a new small business tax credit for firms providing health coverage | |
| Individual Plan/Provider Choice |
When individuals “enter” the Exchange, whether on their own or as employees of a business that is purchasing in the Exchange, they are free to choose among available public and private options
Allows the maintenance of current individual health plans as “grandfathered plans” | |
| National Health Board |
Establishes a Health Benefits Advisory Committee to recommend benefit packages based on standards set in statute | |
| Tax Changes |
Provides a new small business tax credit for firms providing health coverage
Imposes tax penalties on individuals without coverage and employers not offering coverage to their employees
Establishes affordability tax credits for individuals up to 400% of federal poverty level
Imposes a sliding scale tax on individuals earning in excess of $280,000 and married couples with incomes above$350,000
Makes tax adjustments to foreign tax credit beneifts and the U.S. income of foreign multinational companies | |
| Premium/Co-Pay/Deductible |
Caps total out-of-pocket spending in all new policies to prevent bankruptcies from medical expenses
Prohibits cost-sharing for preventive services | |
| Health Quality Improvement |
Uses federal health programs (Medicare, Medicaid and the new public health insurance option) to reward high quality, efficient care, and reduce disparities
Adopts innovative payment approaches and promotes better coordinated care in Medicare and the new public option through programs such as accountable care organizations
Addresses the high rate of cost growth to generate savings for reform and fiscal sustainability, including a program in Medicare to reduce preventable hospital readmissions
Adopts innovative payment approaches and promotes better coordinated care in Medicare and the new public option through programs such as accountable care organizations
Attacks the high rate of cost growth to generate savings for reform and fiscal sustainability, including a program in Medicare to reduce preventable hospital readmissions | |
| Information Technology / Electronic Medical Records |
Not addressed | |
| Individual Responsibility for Health and Lifestyle |
Not addressed | |
| Preventive care |
Waives cost-sharing for preventive services in benefit packages
Creates community-based programs to deliver prevention and wellness services
Expands Community Health Centers
Targets community-based programs and new data collection efforts to better identify and address racial, ethnic and other health disparities
Strengthens state, local, tribal and territorial public health departments and programs | |
| Transparency |
Requires qualified insurance plans to comply with federal standards relating to transparency
Requires reports on financial relationships between medical manufacturers and distributors and physicians and health care entities
Requires public reporting of acquired healthcare-associated infections | |
| Drug Reimportation |
Not addressed | |
| Medicare Rx Drug Price Negotiation |
Not addressed | |
| Medical Personnel Education |
Expands the National Health Service Corps
Provides funding for training of primary care doctors and individuals going into health professions, including primary care, nursing and public health
Supports workforce diversity efforts
Expands scholarships and loans for individuals in needed professions and shortage areas | |
| Mental Health Parity |
Provides Medicare coverage of mental health counselors
Temporarily increases the payment rate for psychiatric services | |
| Other Provisions |
Prohibits illegal aliens from eligibility for affordability credits
Limits Medicare physician referrals to physician-owned hospitals
Limits the ability of Medicare Advantage plans providing coverage to employer-based plans to offer coverage outside their coverage area
Requires drug manufacturers to offer rebates for drugs used by full dual eligibles
Extends Medicare Part B coverage to disabled TRICARE beneficiaries
Establishes a Medical Home pilot program
Provides an increased reimbursement rate for certified nurse midwives
Prohibits states from adopting more restrictive SCHIP eligibility standards than are currently in place
Allows state Medicaid programs to cover family planning services without a waiver | |
| Cost |
$1.042 trillion over 10 years | |
| Cost Containment |
Reduces Medicare disproportionate share hospital payments based on the reduced number of uninsured
Authorizes the HHS Secretary to adjust Medicare physician fee schedules
Provides regional Medicare payment incentives for cost-efficiency
Transitions Medicare Advantage payments to a fee-for-service structure
Authorizes $100 million to combat and increases penalties for waste, fraud and abuse
Reduced Medicaid payments to Pharmacists
Increases the minimum manufacturer rebate for drugs purchased by State Medicaid programs | |
| Financing |
Increased taxes | |
| Source |
Cost Estimate for HR 3200, Congressional Budget Office, July 17, 2009
“America’s Affordable Health Choices Act Section-by-Section Analysis,” House Committee on Ways and Means, July 16, 2009 | |
