| Plan |
Senate Finance Committee America's Healthy Future Act | |
| Date |
September 2009 | |
| Overall Approach |
Universal coverage through public & private insurers, made available through state exchanges | |
| Universal Coverage |
Yes | |
| Guaranteed Coverage |
Yes | |
| Portability |
Not Addressed | |
| Voluntary Employer-Based System |
Yes | |
| New Programs |
State-based Exchanges
Allows State Basic Health Care Plans
Authorizes Health Care Choice Compacts
Creates Consumer Operated and Oriented Plan Program option
Establishes a Community First Choice Option
Creates a School-Based Health Centers Grant program
Creates a Patient-Centered Outcomes Research Institute | |
| Expansion of Existing Public Programs/Federal Law |
Expands Medicaid coverage
Increases CHIP funding
Establishes a Federal Coordinated Health Care Office at CMS
Creates Medicare Commission to address costs | |
| Insurance Pool |
Yes - High-Risk Pool | |
| State Responsibility |
Must establish an exchange
Must implement reinsurance program for high-risk individuals
Must adopt and enforce federal insurance regulations/standards
Required to establish an ombudsman office to act as a consumer advocate | |
| Individual Mandate |
Yes - Coverage enforced through penalty | |
| Employer Mandate |
Employers with more than 50 employees that do not offer coverage would be required to pay a fee for each employee who receives a tax credit for health insurance
Required to disclose the value of the benefit provided by the employer on W-2's | |
| Private Insurance Mandates |
Guaranteed issue and renewal
Required to pay annual fee based on market share
Must provide at least minimum benefits set by federal and state laws
No lifetime or annual limits on coverage
Required to cover emergency room services regardless of prior authorization
Required to report health insurance coverage to both individuals and the IRS | |
| Individual Subsidies |
Sliding scale cost-sharing subsidy for individuals and families with income up to 200% of the federal poverty level | |
| Individual Vouchers |
Not Specifically Addressed | |
| Employer Subsidies |
Provides credits to small businesses for coverage of employees | |
| Individual Plan/Provider Choice |
Yes | |
| National Health Board |
Establishes a Patient-Centered Outcomes Research Institute to assist patients, clinicians, purchasers, and policy makers in making informed health decisions by advancing the quality and relevance of clinical evidence through research and evidence synthesis | |
| Tax Changes |
$750 tax penalty for individuals not purchasing health insurance
Imposes an excise tax on insurers if the aggregate value of employer-sponsored health coverage for an employee exceeds a threshold amount
Provides a tax credit for a qualified small employer for contributions to purchase health insurance for its employees
Provides a refundable tax credit for low-income individuals and families who purchase health insurance through the state exchanges
Creates a temporary credit subject to an overall cap to encourage investments in new therapies
Makes changes to tax law relative to HSA's and itemized medical deductions
Prohibits tax deduction for insurers for executive compensation in excess of $500,000 | |
| Premium/Co-Pay/Deductible |
Limits out-of-pocket expenses for low-income individuals
Limits deductibles for plans offered by small employers to $2,000 for individuals/$4,000 for families
Limits premiums for individuals in high-risk pools
Premiums for individual plans could vary only based on tobacco use, age, family composition, and among geographical regions
Plans could charge no cost-sharing (e.g., deductibles, copayments) for preventive care services
Eliminates cost-sharing (co-payment and deductible) for services covered by Medicare and recommended by the U.S. Preventive Services Task Force
Prohibits cost-sharing (including premiums, deductibles, copayments, co-insurance, etc.) for low-income American Indians and Alaska Natives
Eliminates cost-sharing for Medicaid coverage of tobacco cessation services for pregnant women
Limits cost-sharing for some benefits allowed under Medicare Advantage | |
| Health Quality Improvement |
Establishes the Medicaid Quality Measurement Program
Prohibits Federal payments to states for Medicaid services related to health care acquired conditions
Establishes Value-Based Purchasing (VBP) programs (pay-for-performance) for hospitals, physicians, home health agencies and skilled nursing facilities
Provides Physician Quality Reporting Initiative incentive payments to practitioners completing a Maintenance of Certification practice assessment
Requires comparison of physician resource utilization
Establish quality reporting programs
Reduces payments to hospitals with high hospital acquired condition (HAC) rates
Calls for the creation of a national quality improvement strategy
Calls for the development by HHS of quality measures
Provides for gainsharing programs
Establishes an Innovation Center within CMS
Provides for payment bundling
Provides for incentives for coordinated care
Creates pilot programs focused on community care transitions and home-based chronic care | |
| Information Technology / Electronic Medical Records |
Establishes a timeline for accelerating the development, adoption and implementation of a set of operating rules for each HIPAA transaction electronic standards
Requires a study to examine ways to encourage increased meaningful use of electronic health records
Requires the development of quality measures that pertain to the “meaningful use of health information technology
Makes free clinics eligible for Medicare and Medicaid health information technology incentives
CMS Innovation Center to test support care coordination for chronically-ill Medicare beneficiaries at high risk of hospitalization through a health IT-enabled network
Provides bonus payments to Medicare Advantage plans which utilize health information technology programs
Creates a demonstration project promoting the use of Health IT by nursing homes | |
| Individual Responsibility for Health and Lifestyle |
Provides for the use of incentives for participation in healthy lifestyle and wellness programs | |
| Preventive care |
$750 tax penalty for individuals not purchasing health insurance
Imposes an excise tax on insurers if the aggregate value of employer-sponsored health coverage for an employee exceeds a threshold amount
Provides a tax credit for a qualified small employer for contributions to purchase health insurance for its employees
Provides a refundable tax credit for low-income individuals and families who purchase health insurance through the state exchanges
Creates a temporary credit subject to an overall cap to encourage investments in new therapies
Mandatory Coverage of Preventive Services
Authorizes Medicare coverage of a personalized prevention plan
Expands Medicare Coverage of New Preventive Services
Provides Medicaid coverage and/or increased Medicaid funding for preventive services
Creates a new Medicaid state plan option providing a health home for patients with chronic conditions
Provides Medicare reimbursement of preventive services at Federally Qualified | |
| Transparency |
Requires transparency of Health Plan Expenditures
Mandates the development and utilization of uniform outline of coverage documents
Requires transparency of physician payments made by drug and medical device manufacturers
Requires transparency of physician ownership of manufacturers or group purchasing organizations
Requires reporting to the federal and state government of nursing home governing body and organizational structure
Requires additional information be posted on the Medicare Nursing Home Compare website
Requires nursing homes report expenditures for wages and benefits for direct care staff
RE: imaging referrals, requires physicians to inform patients that they may obtain the services from a person other than the referring physician, a physician or employee within the same group practice
Makes hospital charges for each Medicare diagnostic related group (DRG) available to the public | |
| Drug Reimportation |
Not addressed | |
| Medicare Rx Drug Price Negotiation |
Not addressed | |
| Medical Personnel Education |
Encourages increased residency training in the areas of primary care and general surgery
Creates a Workforce Advisory Committee to develop and present a national workforce strategy
Provides grants for workforce training of low-income individuals, to train personal and home health care aides, nurses and to expand primary care medical residency programs
Makes changes to graduate medical education funding to promote residency programs in rural and underserved areas and provide eligibility to teaching health centers | |
| Mental Health Parity |
Not specifically addressed | |
| Other Provisions |
Prohibits tax credit or cost-sharing credits from being used to pay for abortions; ensures that at least one health plan in each state provides abortion coverage
Subjects grandfathered plans to rating rules beginning in 2013
Imposes a fee on the manufacture or importation of prescription drugs ($2.3 billion)
Imposes a fee on the manufacture or importation of certain medical devices ($4 billion)
Increases the Medicaid prescription drug rebate percentage
Establishes a Medicaid Global Payments demonstration project
Increase the Medicare Sustainable Growth Rate in 2010
Eliminates the funding in the Medicare Improvement Fund
Reduces Medicare premium subsidy for high-income beneficiaries
Requires at least 2 categories of prescription drug plans offered by Part D sponsors
Restricts the removal of a covered drug from a Medicare Part D plan formulary
Creates a new bonus payment for care coordination and management activities that are conducted by MA plans
I | |
| Cost |
$829 billion over 10 years | |
| Cost Containment |
Bases the calculation of MA benchmarks on actual plan costs as reflected in plan bids rather than statutorily set rates
Reduces Disproportionate Share Hospital Payments
Makes various adjustments & reductions in Medicare reimbursement rates
Eliminates new Physician-Owned Hospitals
Requires that the Secretary to screen all providers and suppliers before granting Medicare billing privileges
Expands existing program integrity data sources, data sharing and data matching across Federal health care claims and payment data
Requires Medicare and Medicaid providers and suppliers to implement compliance programs
Increases funding for Health Care Fraud and Abuse Control
Establishes a nationwide program for national and State background checks on employees of certain long-term care (LTC) facilities or providers | |
| Financing |
Costs are partly offset by $201 billion in revenues from the excise tax on high-premium insurance plans and $110 billion in net savings from other sources. The net cost of the coverage expansions would be more than offset by the combination of other spending changes that CBO estimates would save $404 billion over the 10 years and other provisions that JCT and CBO estimate would increase federal revenues by $196 billion over the same period | |
| Source |
Chairman’s Mark America’s Healthy Future Act of 2009, Senate Finance Committee, October 2, 2009
“Preliminary Analysis of the Chairman's Mark for the America's Healthy Future Act, as Amended,” Congressional Budget Office, Oct. 7, 2009 | |
