Provision Senate Democratic Leadership House - HR 3962

Patient Protection & Affordable Care Act Affordable Health Care for America Act
Substitute to HR 3590

Pages 2070 1990

General approach Requires most citizens and legal residents to Requires individuals to be covered, sets up health
get coverage; State-based insurance exchanges; exchanges; employers cover or pay fee to a
employers cover or pay fee if any employee trust fund, with some small firms left out
gets government subsidy for insurance

Estimated 10 year net cost $848 billion $864 billion

Coverage level under age 65 94 percent covered -- 23 million still uninsured 96 percent -- 17 million still uninsured

Illegal immigrants covered No - only citizens and legal immigrants could No -- limits availability of premium/cost sharing
take part in exchanges credits to citizens and legal immigrants
undocumented aliens could use own funds to
buy coverage though exchanges

Abortion coverage
Plans can choose to cover; in each state, at
least one plan would cover & one would not;
subsidies could not be used to pay for abortion;
accounts to cover would have to be separate;
public plan could cover under same rules
Plans could cover abortions but no one getting
subsidies could enroll in those plans; public plan
would not cover elective abortion

Individuals Must be covered or have employer coverage; Must have insurance or pay tax penalty;
penalties start at $95 in 2014, rise to $750 hardship exceptions to 2.5 percent penalty
in 2 years; max of $2,250 per family that 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 pct
than 50 workers would pay $750 penalty for of payroll; firms with payroll under $500,000
each worker if any employee gets subsidy exempt

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 4
Tied to 2nd lowest cost plan in area
Small employers also get tax credits
Tax/penalty $750 a year for adults without qualifying covg.;
excise tax on high value plans worth more than
$8,000 individual; $21,000 for family
5 pct excise tax on elective plastic surgery;
bumps Medicare payroll tax .5 pct on salaries
of more than $200,000/ $250 couples
Benefits All plans cover basic benefits -- primary care,
hospitalization and primary care. There would be cover about 70 percent of costs; out of pocket
4 levels of coverage covering 65-90 pct. of costs limit of $5,000/$10,000 individual/family; no
Insurance rules No denial of coverage based on existing
conditions; premiums could not be higher due to
health or gender; limits on higher premiums by
age, family size, location and tobacco use.
No lifetime coverage limits.
Antitrust Not addressed in bill; may be added during
debate
Where to choose a plan State based exchanges for individuals and
small businesses to buy coverage; all state-
licensed insurers would have to take part to
sell individual and small group plans
Public programs Expand Medicaid to all up to 133 percent of
poverty; $88,000 for family of 4
Tied to average cost of 3 lowest basic plans
Start in 2013
Tax of 2.5 percent of modified adjusted gross
income on individuals without qualifying
coverage; income surcharge on people making
more than $500,000, couples $1 million
Experts recommend a basic package that would
annual or lifetime limits; 4 levels of benefits
include mental health, durable medical
equipment
No denials or refusals to renew based on health;
premiums could vary only due to location,
family structure, and, with limits, age.
Sale of policies across state lines allowed if
states involved agree
Removes exemption from federal anti-trust laws
on market allocation, price fixing, bid rigging.
Adds Federal Trade Commission jurisdiction.
National Health Insurance Exchange for
individuals and small employers (larger firms
would join later); plans in the exchange required
to be state licensed, states could also be
permitted to run exchanges under same rules
Expand Medicaid to 150 percent of poverty;
 poverty level ($29,327 family of 4); feds pay all ($33,100 family of 4); federal government pays
costs first 3 years, then about 90 pct full cost 2013-14, then 91/9 percent split with
states

Public option Federal insurance plan set up to compete with Creates a new public health insurance option
private plans; government would negotiate with to be offered through exchanges; HHS would
providers on payment; states could opt out run, negotiate rates with providers separate
from Medicare