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ProvisionSenate Democratic Leadership House - HR 3962Patient Protection & Affordable Care ActAffordable Health Care for America ActSubstitute to HR 3590Pages20701990General approach
Requires most citizens and legal residents toRequires individuals to be covered, sets up healthget coverage; State-based insurance exchanges;exchanges; employers cover or pay fee to aemployers cover or pay fee if any employee trust fund, with some small firms left outgets government subsidy for insurance
Estimated 10 year net cost
$848 billion$864 billion
Coverage level under age 65
94 percent covered -- 23 million still uninsured96 percent -- 17 million still uninsured
Illegal immigrants covered
No - only citizens and legal immigrants couldNo -- limits availability of premium/cost sharingtake part in exchangescredits to citizens and legal immigrantsundocumented aliens could use own funds tobuy coverage though exchanges
Abortion coverage
Plans can choose to cover; in each state, at Plans could cover abortions but no one gettingleast one plan would cover & one would not;subsidies could enroll in those plans; public plansubsidies could not be used to pay for abortion;would not cover elective abortionaccounts to cover would have to be separate;public plan could cover under same rules
Individuals
Must be covered or have employer coverage;Must have insurance or pay tax penalty;penalties start at $95 in 2014, rise to $750hardship exceptions to 2.5 percent penaltyin 2 years; max of $2,250 per familythat starts at $9,350 individual income; couples$18,700
Employers
Not required to cover workers; firms with more Cover at least 65 pct of premium or 8 pctthan 50 workers would pay $750 penalty forof payroll; firms with payroll under $500,000each worker if any employee gets subsidyexempt
Subsidies
For Individuals and families up to 400 Individuals and families up to 400 percent of
pct poverty; up to $88,299 for family of 4poverty; $88,000 for family of 4Tied to 2nd lowest cost plan in areaTied to average cost of 3 lowest basic plansSmall employers also get tax creditsStart in 2013
Tax/penalty
$750 a year for adults without qualifying covg.;Tax of 2.5 percent of modified adjusted grossexcise tax on high value plans worth more thanincome on individuals without qualifying$8,000 individual; $21,000 for familycoverage; income surcharge on people making5 pct excise tax on elective plastic surgery; more than $500,000, couples $1 millionbumps Medicare payroll tax .5 pct on salariesof more than $200,000/ $250 couples
Benefits
All plans cover basic benefits -- primary care,Experts recommend a basic package that wouldhospitalization and primary care. There would becover about 70 percent of costs; out of pocket4 levels of coverage covering 65-90 pct. of costslimit of $5,000/$10,000 individual/family; noannual or lifetime limits; 4 levels of benefitsinclude mental health, durable medicalequipment
Insurance rules
No denial of coverage based on existingNo denials or refusals to renew based on health;conditions; premiums could not be higher due to premiums could vary only due to location,health or gender; limits on higher premiums byfamily structure, and, with limits, age.age, family size, location and tobacco use.Sale of policies across state lines allowed if No lifetime coverage limits.states involved agree
Antitrust
Not addressed in bill; may be added during Removes exemption from federal anti-trust lawsdebateon market allocation, price fixing, bid rigging.Adds Federal Trade Commission jurisdiction.
Where to choose a plan
State based exchanges for individuals and National Health Insurance Exchange for small businesses to buy coverage; all state-individuals and small employers (larger firmslicensed insurers would have to take part to would join later); plans in the exchange requiredsell individual and small group plansto be state licensed, states could also bepermitted to run exchanges under same rules
Public programs
Expand Medicaid to all up to 133 percent ofExpand Medicaid to 150 percent of poverty;
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