Bucks Voices Principles

Feature

House (Bill 3200)

Senate Health, Education, Labor and Pension (HELP) Committee

Senate Finance Committee

Health Promotion and Disease Prevention & Management

• Benefits Covered

• Prevention Program Support

• "Essential" medical care, plus preventive and mental health care, and dental & vision for children; Eliminates co-payments and deductibles for most preventive services in Medicare; Phases out Medicare Part D (prescription drugs) "doughnut hole" where the plan now pays nothing.

• Develops national prevention and public health strategy, goals, measures; Requires health plans to cover evidence-based preventive care services; Gives grants to employers establishing wellness programs.

• Very similar to House bill

• Very similar to House bill

• Unknown

• Likely to be similar to other bills

Access To Care Throughout One's Life

• Individual Coverage Mandate

• Insurance Reforms

• Yes - penalty of 2.5% of family adjusted gross income over $9000, with certain exceptions (e.g., financial hardship)

• Bans limits on pre-existing conditions, termination of coverage due to illness; and guarantees renewable coverage

• Penalty of $750 per year if not enrolled, with certain exceptions (e.g., income <150% of poverty level)

• Very similar to House bill

• Likely; penalty equal to cost of lowest option offered in health exchange

• To be similar to other bills

High-Quality, Evidence-Based Care

• Provider Payment Reforms

• Comparative Effectiveness Research Program

• Includes health care provider payment reforms and higher payments to primary care doctors.

Not specified

Unknown

Financing According To Ability To Pay

• Subsidies for individuals

• Taxability of Employer-Paid Coverage

• Employer Mandate

• New Funding Sources

• Medicaid

• Prorated subsidies for incomes up to 400% of federal poverty limit, for those getting coverage through health exchange. Provides subsidies for low-income people to help pay for Medicare premiums.

• No

• Yes for business with annual payrolls of >=$500,000 : must pay for at least 65% of family coverage cost and 72.5% of single coverage cost; penalty of 8% of payroll (unless "hardship") Subsidies for small employers Must continue to cover laid off employees until they find a new job or can get coverage through the health exchange (see below).

• Added 1% tax on adjusted gross incomes >$280K / single filing, $350K / joint filing, 1.5% if >$500,000, and 5.4% if >$1 million. Bottom threshold may change to $5K and $1M respectively

• Expanded coverage for up to 133% of poverty level and greater federal role in paying for it

• Very similar to House bill

• No

• Yes if have >25 employees. Must pay for at least 60% of costs or pay penalty of $750/year per full-time employee. Subsidies for small employers

• N/A (funding is responsibility of Senate Finance Committee)

• Expanded coverage for up to 150% of poverty level

• Likely

• May impose up to a 35% excise tax on "rich" plans sold by insurance companies

• Possibly will not mandate

• Possible tax on health insurance company profits Not likely to raise income taxes

• Unknown re: Medicaid

Improved Methods to Control Costs

• Medicare

• Health Care Workforce

• Eliminates Medicare Advantage subsidies to private insurers.

• Provides education loan repayment to encourage public health workers and general practitioners

• Not specified

• Very similar to House bill

• Allow individuals aged 55-64 without coverage to buy-in to Medicare at full-cost (until health exchange is available). Phases out two-year wait for eligibility for Medicare if permanently disabled

• Unknown

Transparency and Accountability

• Health Insurance Exchanges

• Transparency provided through exchanges but only for those eligible (see below)

• Very similar to House bill

Minimal Necessary Administrative Costs

• Health Exchanges (sometimes called "Gateways")

• National and optional state-based exchanges. Available only for small businesses, those without employer-based coverage, and where an employee has to pay over 11% of income or wants to pay for all of it

• State-based. Available only for small businesses, those without employer-based coverage, and where an employee has to pay over 12.5% of income (or job-based plans did not meet minimum coverage standards)

• Possibly a national "cooperative" or regional "cooperatives." Only for small businesses, those without employer-based coverage or where employees have to pay over a certain percent of their incomes (or job-based plans did not meet minimum coverage standards)

Consistency of Standards and Policies Across the Country

• Public Plan Option

• Yes, starting in 2013, only for those getting coverage through the exchange. Initial draft would pay providers at 105% of Medicare rates, but July 29 draft requires separately negotiated rates; states can also set up cooperatives.

• Similar to House bill; requires plan to negotiate payment rates with providers and develop innovative payment policies to promote quality, efficiency, and savings

• Considering a national, regional, or state "cooperatives" (not run by the federal government per se)