| Plan |
Wyden Healthy Americans Act S. 334 | |
| Date |
| |
| Overall Approach |
Universal coverage through state-administered health care exchanges | |
| Universal Coverage |
Yes | |
| Guaranteed Coverage |
Yes | |
| Portability |
Yes | |
| Voluntary Employer-Based System |
Yes | |
| New Programs |
Establishes a system of state-level Health Help Agencies to provide consumers with information about private health plans, determine premium reductions, and coordinate payments
Requires the creation of a federal fallback plan if a State fails to establish an HHA and no Healthy Americans Private Insurance (HAPI) plan is available
Creation of an advisory committee to report annually on modifications to benefits, items and services
Creates and funds school-based health centers
Creation of Medigap-like models for tax qualified long term care policies
| |
| Expansion of Existing Public Programs/Federal Law |
Requires Medicare to have a chronic disease management program available to all Medicare beneficiaries | |
| Insurance Pool |
Not specifically addressed | |
| State Responsibility |
Every state required establish a Health Help Agency to provide access to Healthy Americans Private Insurance Plans
At least two plans must be available per state
States must establish community rating principles
States may require insurer assessments to cover administrative costs of Health Help Plans | |
| Individual Mandate |
Required enrollment of every individual in either a Healthy Americans Private Insurance plan or other government provided health coverage
Financial penalties assessed for lack of coverage
| |
| Employer Mandate |
Required to convert health care premiums into higher wages for employees to use to pay for private health coverage
Required to make Employer Shared Responsibility Payments | |
| Private Insurance Mandates |
Healthy Americans Insurance Plans must meet federally-established minimum benefit requirements
Cannot raise prices or deny coverage based on health status
Age, gender, industry, health status or claims experience cannot be used to determine premiums
States may require insurer assessments to cover administrative costs of Health Help Plans
Insurers must report performance and outcomes of chronic care management programs and loss ratios | |
| Individual Subsidies |
Fully subsidize the premiums for those who live below the poverty line
Sliding-scale subsidies for individuals between 100 percent and 400 percent of the federal poverty line
Financial incentives for wellness program participation | |
| Individual Vouchers |
No | |
| Employer Subsidies |
An Employer Shared Responsibility Credit may be provided to private employers who provided above average health insurance benefits prior to enactment
Provides for tax incentives for employer-provided wellness programs or worksite health centers | |
| Individual Plan/Provider Choice |
Yes | |
| National Health Board |
Yes | |
| Tax Changes |
Limits employee income and payroll tax exclusion to Employer Shared Responsibility Payments, Historic Retiree Health Contributions, and Transitional Coverage Contributions
Employer-provided wellness programs and on-site first aid coverage for employees is not taxable as income
Creates a new Health Care Standard Deduction
Eliminates various health care tax breaks | |
| Premium/Co-Pay/Deductible |
No co-pays for preventive services or chronic disease management
| |
| Health Quality Improvement |
Requires hospitals to demonstrate improvements in quality control
Requires increased reporting and disclosure of episode of care information by Medicare Advantage Organizations
Insurers must report performance and outcomes of chronic care management programs and loss ratios
Authorizes medical schools/researchers to make available evidence-informed best practices | |
| Information Technology / Electronic Medical Records |
Requires all insurers to offer patients an electronic medical record
School-based health centers required to use electronic medical records
Provides grants for school-based health centers to implement electronic medical records | |
| Individual Responsibility for Health and Lifestyle |
Individuals who participate successfully in approved wellness programs eligible for a discounted premium | |
| Preventive care |
Healthy Americans Private Insurance plans must cover wellness programs, comprehensive disease prevention and early detection and management
Financial incentives for individual participation in wellness programs
Physicians reimbursed for investing time in chronic disease management and prevention
Authorizes reduction of Medicare Part B premiums for healthy behavior | |
| Transparency |
Provide resources to compare plans based on quality, cost and service
Requires insurer disclosure of prevention and disease management success
Hospitals required to send bills in excess of $5,000 to covered individual for review | |
| Drug Reimportation |
Not addressed | |
| Medicare Rx Drug Price Negotiation |
Yes | |
| Medical Personnel Education |
Not addressed | |
| Mental Health Parity |
Yes | |
| Other Provisions |
Prohibits subsidies to adult illegal aliens
Establishes a national information clearing house that the public may access to find out State-specific information regarding advance directives and end-of-life care decisions
Requires facilities receiving Medicare funds to provide patients with a document documenting treatment preferences and coordinating preferences with physician orders
Provisions do not apply to collective
bargaining agreements until the earlier of 7 years after the date of enactment or the date the collective bargaining agreement expires. | |
| Cost |
$1.3 - $1.4 trillion/year initially becoming self-financing over time | |
| Cost Containment |
Cost transparency
Establishing incentives for more economical health coverage purchasing by individuals
Administrative efficiencies
Emphasizing prevention, wellness and disease management
Requiring hospital quality improvement
Requiring all insurers to offer patients an electronic medical record
Increased preventive care to reduce taxpayer-funded emergency care
Provides for state bonus payments for implementation of certain medical malpractice reforms | |
| Financing |
Fully paid for with the $2.2 trillion currently spent on health care
Individual Responsibility Payments
Employer Shared Responsibility Payments
Recapture of Medicare and 90% of Medicaid Federal disproportionate share hospital payments and diverted to the Healthy Americans Public Health Trust Fund
Reduction of employer income and payroll tax exclusions
Eliminates various health care tax credits
Eliminates group coverage, FEHBP, Medicaid (except for its wrap around and long term care functions) and SCHIP | |
| Source |
“HAA: Frequently Asked Questions,” Sen. Ron Wyden, February 2009
“The Healthy Americans Act Section by Section,"" Sen. Ron Wyden, February 2009
“The Healthy Americans Act” Text, Sen. Ron Wyden, February 2009
Sen. Ron Wyden's Official Website, February 2009
Congressional Budget Office Cost Estimate of Similar Legislation -- S.334, 110th Congress, Congressional Budget Office, May 1, 2008 | |
