| Plan |
Stark Americare Health Care Act H.R. 193 | |
| Date |
January 2009 | |
| Overall Approach |
Yes | |
| Universal Coverage |
Yes | |
| Guaranteed Coverage |
Yes | |
| Portability |
Yes | |
| Voluntary Employer-Based System |
Yes | |
| New Programs |
Requires a mechanism to enroll eligible individuals, including automatic enrollment at birth | |
| Expansion of Existing Public Programs/Federal Law |
Expands Medicare to create a new public health benefit, "AmeriCare"
Provides adults Medicare Part A and B benefits, preventive services, substance abuse treatment, mental health parity; and prescription drug coverage
Provides children comprehensive benefits and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) coverage | |
| Insurance Pool |
Requires every individual to be enrolled in either a national public health insurance plan or private health coverage | |
| State Responsibility |
Requires states to continue to pay their share of the cost of providing AmeriCare benefits for individuals who would otherwise qualify for Medicaid and S-CHIP
Authorizes states to implement standards that are more stringent than the federal standards for Americare supplemental coverage | |
| Individual Mandate |
Individuals required to demonstrate equivalent coverage through their employer or pay the AmeriCare premium annually | |
| Employer Mandate |
Employers may either pay 80 percent of the AmeriCare premium or provide equivalent benefits through a group health plan | |
| Private Insurance Mandates |
Establishes standards for private insurers providing AmeriCare supplemental health insurance policies which prohibit discrimination based on health status, limits use of pre-existing condition exclusions | |
| Individual Subsidies |
Out of pocket costs are capped
Sliding scale subsidies are for cost-sharing for individuals between 200 percent and 300 percent FPL | |
| Individual Vouchers |
No | |
| Employer Subsidies |
Not addressed | |
| Individual Plan/Provider Choice |
Yes | |
| National Health Board |
Not addressed | |
| Tax Changes |
Requires processes for collecting premiums using mechanisms similar to payroll tax withholding | |
| Premium/Co-Pay/Deductible |
$350 deductible and 20% coinsurance
Total spending capped at out-of-pocket maximum of $2,500 individual/$4,000 family
Out-of-pocket max sliding scale of 5%-7.5% of income for beneficiaries with incomes between 200% and 500% of federal poverty level
No cost sharing for children, pregnant women and low-income individuals (below 200 percent FPL) | |
| Health Quality Improvement |
Not addressed | |
| Information Technology / Electronic Medical Records |
Requires the creation of an electronic system for verification of an individual's entitlement to benefits
Establishes a website health service providersand AmeriCare supplemental plans may make inquiries, and receive responses, with respect to the eligibility and benefits of an individual under plans | |
| Individual Responsibility for Health and Lifestyle |
Not addressed | |
| Preventive care |
Preventive services provided without copay and not subject to deductible
Provides a 5 percent fee bonus for treatment of women who present for prenatal care during the first trimester | |
| Transparency |
Requires the disclosure of information to enable individuals to evaluate the value of AmeriCare supplemental policies | |
| Drug Reimportation |
Not addressed | |
| Medicare Rx Drug Price Negotiation |
Yes | |
| Medical Personnel Education |
Not addressed | |
| Mental Health Parity |
Yes | |
| Other Provisions |
Does not affect contracts or collective bargaining agreements in effect as of the date of enactment
Coverage of non-residents is available to the extent the Secretary determines that such benefits would be available to US nationals in other countries | |
| Cost |
$154.5 billion in the first year | |
| Cost Containment |
Not specifically addressed | |
| Financing |
Payment for benefits | |
| Source |
Press Release, "Stark Reintroduces Health Reform Bills," Rep. Pete Stark, Jan. 6, 2009
H.R. 193 - Bill Text, Library of Congress - Thomas Website, Jan. 6, 2009
"Introduction of the AmeriCare Health Insurance Act of 2009, Extension of Remarks," Rep. Pete Stark, Jan. 6, 2009
"AmeriCare Health Care Act of 2006, Section-by-Section," Rep. Pete Stark, Accessed Jan. 15, 2009
Press Release, "Stark Introduces AmeriCare," Rep. Pete Stark, March 29, 2007 | |
