on
                                            Health Reform


This side-by-side compares the leading comprehensive reform...
Senate Finance Committee                 Senate HELP Committee             House Tri-Committee                    Presiden...
Senate Finance Committee               Senate HELP Committee                   House Tri-Committee                      Pr...
Senate Finance Committee              Senate HELP Committee           House Tri-Committee                     President Ob...
Senate Finance Committee               Senate HELP Committee                 House Tri-Committee                     Presi...
Senate Finance Committee              Senate HELP Committee                  House Tri-Committee                    Presid...
Senate Finance Committee                Senate HELP Committee                   House Tri-Committee                    Pre...
Senate Finance Committee               Senate HELP Committee                  House Tri-Committee                     Pres...
Senate Finance Committee               Senate HELP Committee                   House Tri-Committee                       P...
Senate Finance Committee             Senate HELP Committee                 House Tri-Committee                  President ...
Senate Finance Committee        Senate HELP Committee           House Tri-Committee                    President Obama
   ...
Senate Finance Committee                Senate HELP Committee                 House Tri-Committee                   Presid...
Senate Finance Committee               Senate HELP Committee                   House Tri-Committee                      Pr...
Senate Finance Committee                Senate HELP Committee           House Tri-Committee             President Obama
  ...
Sens. Tom Coburn and Richard Burr
                        Reps. Paul Ryan and Devin Nunes                      Rep. John C...
Sens. Tom Coburn and Richard Burr
                         Reps. Paul Ryan and Devin Nunes                    Rep. John Co...
Sens. Tom Coburn and Richard Burr
                      Reps. Paul Ryan and Devin Nunes                    Rep. John Conye...
Sens. Tom Coburn and Richard Burr
                      Reps. Paul Ryan and Devin Nunes                        Rep. John C...
Sens. Tom Coburn and Richard Burr
                          Reps. Paul Ryan and Devin Nunes                     Rep. John ...
Side by Side Comparison of Major Health Reform Proposals
Side by Side Comparison of Major Health Reform Proposals
Side by Side Comparison of Major Health Reform Proposals
Side by Side Comparison of Major Health Reform Proposals
Side by Side Comparison of Major Health Reform Proposals
Side by Side Comparison of Major Health Reform Proposals
Side by Side Comparison of Major Health Reform Proposals
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Side by Side Comparison of Major Health Reform Proposals

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Side by Side Comparison of Major Health Reform Proposals

  1. 1. on Health Reform This side-by-side compares the leading comprehensive reform proposals across a number of key characteristics and plan components. Included in this side-by- side are proposals for moving toward universal coverage that have been put forward by the President and Members of Congress. In an effort to capture the most important proposals, we have included those that have been formally introduced as legislation as well as those that have been offered as principles or in White Paper form. This side-by-side will be regularly updated to reflect changes in the proposals and to incorporate major new proposals as they are announced. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Date plan announced April – May 2009 June 9, 2009 June 19, 2009 February 26, 2009 Overall approach to The Senate Finance Committee Require all individuals to have Require all individuals to have President Obama outlined eight expanding access to released a series of papers laying health insurance. Create state- health insurance. Create a Health principles for health care reform coverage out options for health reform. While based American Health Benefit Insurance Exchange through which in his FY 2010 Budget overview. not a formal proposal, these papers Gateways through which individuals individuals and employers can The President has indicated that offer a framework for achieving and small businesses can purchase purchase health coverage, with comprehensive health reform health reform goals and present the health coverage, with subsidies premium and cost-sharing credits should: range of options the Committee will available to individuals/families available to individuals/families • Reduce long-term growth of consider as it works to draft health with incomes up to 500% of the with incomes up to 400% of the health care costs for businesses reform legislation. federal poverty level. Impose new federal poverty level. Require and government. Require all individuals to have regulations on the individual and employers to provide coverage to • Protect families from bankruptcy health insurance. Create a Health small group insurance markets. employees or pay into a Health or debt because of health care Insurance Exchange through which Expand Medicaid to all individuals Insurance Exchange Trust Fund, costs. individuals and small businesses with incomes up to 150% of the with exceptions for certain small • Guarantee choice of doctors and can purchase health coverage, with poverty level. employers, and provide certain health plans. subsidies available to individuals/ small employers a credit to offset the costs of providing coverage. • Invest in prevention and wellness. families with incomes between 100 Impose new regulations on plans • Improve patient safety and quality and 400% of the federal poverty participating in the Exchange and in care. level. Impose new regulations on the non-group and small group the small group insurance market. • Assure affordable, quality health insurance markets. Expand Expand Medicaid to 133% of the coverage for all Americans. Medicaid and CHIP and offer a poverty level. • Maintain coverage when you temporary Medicare buy-in for the change or lose your job. pre-Medicare population. • End barriers to coverage for people with pre-existing medical conditions. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  2. 2. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Individual mandate • Require all individuals to have • Require all individuals to have • Require all individuals to have • The plan must put the country insurance that meets minimum qualifying health coverage. “acceptable health coverage”. on a clear path to cover all coverage standards. Enforced Enforced through a tax penalty, Enforced through a 2% tax Americans. through an excise tax equal to a the amount of which is to be on adjusted gross income percentage of the premium for determined by the Secretary of up to the cost of the average the lowest cost option available the Treasury. Exemptions to the national premium for the basic through the Health Insurance individual mandate will be granted plan in the Health Insurance Exchange in the area where the to residents of states that do not Exchange. Exceptions granted for individual resides. Exemptions will establish an American Health dependents, religious objections, be granted for financial hardship; Benefit Gateway, members of and financial hardship. if the lowest cost plan option Indian tribes, those for whom exceeds 10% of an individual’s affordable coverage is not income; and if the individual has available, and those who can income below 100% of the poverty demonstrate financial hardship. level. Employer requirements • Proposed Option A: Require Policy under development. • Require employers to offer Not specified. employers with more than coverage to their employees and $500,000 in total payroll per contribute at least 72.5% of the year to offer coverage to their premium cost for single coverage employees and contribute at and 65% of the premium cost for least 50% of the premium or pay family coverage of the lowest cost an assessment. The employer plan that meets the essential assessment could be structured benefits package requirements or in several ways: 1) a set fee per pay 8% of payroll into the Health enrollee per month based on total Insurance Exchange Trust Fund. annual payroll; 2) a tiered penalty • Exempt certain small businesses calculated as a percentage of (to be determined) from payroll; or 3) a larger penalty only the employer “pay or play” on firms with annual payroll of requirement. more than $1,500,000. • Proposed Option B: No employer “pay or play” requirement. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  3. 3. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Expansion of public Medicaid • Expand Medicaid to all individuals • Expand Medicaid to all individuals • As a foundation for health programs • Expand Medicaid to all individuals with incomes up to 150% FPL. with incomes up to 133% FPL. reform, the President signed with incomes up to 115% FPL, Individuals eligible for Medicaid Newly eligible, non-traditional the Children’s Health Insurance with a possible increase in will be covered through state (childless adults) Medicaid Program Reauthorization eligibility for parents, pregnant Medicaid programs and will not beneficiaries may enroll in Act (CHIPRA), which provides women, and children to a be eligible for credits to purchase coverage through the Exchange coverage to 11 million children. higher level. Coverage could be coverage through American if they were enrolled in qualified provided through the current Health Benefit Gateways. health coverage during the program structure or by enrolling • Grant individuals eligible for six months before becoming children, pregnant women, the Children’s Health Insurance Medicaid eligible. After five years, parents, and childless adults in Program (CHIP) the option of states may request that some the Health Insurance Exchange. enrolling in CHIP or enrolling in or all categories of Medicaid Another alternative is to enroll a qualified health plan through a beneficiaries obtain coverage all populations except childless Gateway. through the Exchange provided adults in Medicaid. Under this • Create a public plan to be offered the state can demonstrate the approach, childless adults would through state Gateways. The ability to provide wrap-around not be eligible for Medicaid but details of the public plan are coverage and the plans in the would be given tax credits to under development. Exchange are deemed capable of purchase coverage through the supporting this population. Exchange or to buy-in to Medicaid. • Provide optional Medicaid Children’s Health Insurance coverage to low-income HIV- Program infected individuals; provide • After September 30, 2013, expand optional Medicaid coverage for CHIP eligibility to 275% FPL. Once family planning services to certain the Health Insurance Exchange is low-income women. fully operational, CHIP enrollees • Require CHIP enrollees to obtain would obtain coverage through coverage through the Health the Exchange and states would Insurance Exchange. be required to continue to provide services not covered by plans in the Exchange, including Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) services. Medicare • Until the Health Insurance Exchange is underway, allow individuals aged 55-64 without coverage to buy-in to Medicare at full-cost. • Phase-out or reduce the two- year waiting period for Medicare eligibility for people with disabilities. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  4. 4. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Expansion of public Public Health Insurance Option • Create a new public health programs (continued) • Proposed Option A: Create a insurance option to be offered new public plan to be offered through the Health Insurance through the Exchange that will Exchange that must meet the be subject to the same rating same requirements as private and risk adjustment rules as the plans regarding benefit levels, private plans. The public plan provider networks, consumer could be administered by the protections, and cost-sharing. federal government, by multiple Require that costs of the public third-party administrators, or by plan be financed through revenues the states. from premiums. Set provider • Proposed Option B: Do not create payment rates in the public plan a public plan option. at Medicare rates and allow bonus payments of 5% for providers that participate in both Medicare and the public plan and for pediatricians and other providers that don’t typically participate in Medicare. Permit the public plan to develop innovative payment mechanisms, including medical home and other care management payments, value-based purchasing, bundling of services, performance based payments, or partial capitation. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  5. 5. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Premium subsidies to • Provide refundable tax credits • Provide premium credits • Provide affordability premium • The plan must protect families’ individuals to individuals and families with on a sliding scale basis to credits to individuals and families from bankruptcy or debt because incomes between 100 and 400% individuals and families with with incomes up to 400% FPL of health care costs. FPL to purchase insurance incomes up to 500% to purchase to purchase insurance through • The American Recovery and through the Health Insurance coverage through the Gateway. the Health Insurance Exchange. Reinvestment Act makes coverage Exchange. The level of the The premium credits will be The premium credits will be more affordable for Americans premium tax credit could be set determined by the Secretary, but based on the average cost of the who lose their jobs and their as a percentage of income or as a will be such that individuals with three lowest cost basic health access to employer-based health percentage of the premium, with incomes less than 500% FPL pay plans in the area and will be set coverage by offering a subsidy of additional limits on cost-sharing. no more than 10% of income and on a sliding scale such that the 65 percent of the premium costs individuals with incomes less than premium contribution is no more for COBRA coverage. 150% FPL pay 1% of income, with than 1% of income for individuals additional limits on cost sharing. with income at or below 133% FPL • Individuals are not eligible for and no more than 10% of income premium credits through the for individuals with income at Gateway if they have access to 400% FPL. employer-based coverage that • Provide affordability cost-sharing meets minimum qualifying criteria credits to individuals and families and affordability standards, or are with incomes up to 400% FPL. The eligible for Medicare, Medicaid, cost-sharing credits are offered TRICARE, or FEHBP. on a sliding scale basis such that the cost-sharing limit for those with income at or below 133% FPL is $250 per individual and $500 per family and for those with income at 400% FPL is $5,000 per individual and $10,000 per family. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  6. 6. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Premium subsidies to • Provide certain small employers • Provide qualifying small • Provide small employers with Not specified. employers that purchase insurance for their employers with a health options fewer than 25 employees and employees with a tax credit. The program credit. To qualify for the average wages of less than full credit of 50% of the average credit, employers must have fewer $40,000 with a health coverage total premium cost paid by the than 50 full-time employees, pay tax credit. The full credit of 50% of employer would be available an average wage of less than premium costs paid by employers to employers with 10 or fewer $50,000, and must pay at least is available to employers with 10 employees and whose employees 60% of employee health expenses. or fewer employees and average have average annual wages of less The credit is equal to $1,000 annual wages of $20,000 or less. than $20,000. The tax credit would for each employee with single The credit phases-out as firm size be phased out as firm size and coverage and $2,000 for each and average wage increases. earnings increase. The tax credit employee with family coverage, would not be payable in advance adjusted for firm size (phasing or refundable. out as firm size increases) and number of months of coverage provided. Bonus payments are given for each additional 10% of employee health expenses above 60% paid by the employer. • Create a temporary reinsurance program for employers providing health insurance coverage to retirees ages 55 to 64. Program will reimburse employers for 80% of retiree claims between $15,000 and $90,000. Program will end when the state Gateway is established. Tax changes related to • Considers several health Not specified. Not specified. Not specified. health insurance insurance-related tax changes affecting the tax preference for employer-sponsored insurance, health savings accounts, flexible spending accounts, and deductions for medical expenses. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  7. 7. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Creation of insurance • Create one national or multiple • Create state-based American • Create a National Health • The plan should provide portability pooling mechanisms regional Health Insurance Health Benefit Gateways through Insurance Exchange through of coverage and should offer Exchanges through which which individuals and small which individuals and employers Americans a choice of health individuals and small employers employers can purchase qualified (phasing-in eligibility for employers plans. can purchase qualified insurance. coverage. States may form starting with smallest employers) • Require all state-licensed insurers regional Gateways or allow more can purchase qualified insurance. in the non-group and small group than one Gateway to operate in • Restrict access to coverage markets to participate in the a state as long as each Gateway through the Exchange to Health Insurance Exchange(s). serves a distinct geographic area. individuals who are not enrolled • Require guarantee issue and • Require the Gateway to certify in qualified or grandfathered renewability and allow rating participating health plans, provide coverage, Medicare, Medicaid variation based only on age, consumers with information (with some exceptions), TRICARE, tobacco use, family composition, allowing them to choose among or VA coverage. and geography (not health status) plans, contract with navigators to • Create four benefit categories in the Exchange(s). conduct outreach and enrollment (basic, enhanced, premium, and • Require the Exchange(s) to assistance, and create a single premium plus) of plans to be develop a standardized format point of entry for enrolling in offered through the Exchange. for presenting insurance coverage through the Gateway or Require participating plans to options, create a web portal to through Medicaid, CHIP or other offer one basic plan for each help consumers find insurance, federal programs. service area and permit them to maintain a call center for • Require states to adjust payments offer additional plans. customer service, and establish to health plans based on the • Require guarantee issue and procedures for enrolling actuarial risk of plan enrollees renewability; allow rating variation individuals and businesses and using methods established by the based only on age (limited to 2 to for determining eligibility for tax Secretary. 1 ratio), premium rating area, and credits. • Require plans participating family enrollment; and limit the in the Gateway to provide medical loss ratio to 85%. incentives to providers to better • Require plans participating coordinate care, reduce hospital in the Exchange to be state readmissions and implement licensed, report data as required, wellness and health promotion implement affordability credits, activities; prohibit plans from meet network adequacy contracting with hospitals with standards, provide wrap-around greater than 50 beds unless those coverage for Medicaid eligible hospitals adopt patient safety and individuals, provide culturally and discharge planning programs. linguistically appropriate services, and contract with essential community providers. • Require risk adjustment of participating Exchange plans. • Provide information to consumers to enable them to choose among plans in the Exchange, including establishing a telephone hotline and maintaining a website. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  8. 8. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Benefit design • Create four benefit categories • Create three benefit tiers based on • Create an essential benefits Not specified. (lowest, low, medium, and high). the percentage of allowed benefit package that provides a Require all plans to provide a costs covered by the plan, ranging comprehensive set of services comprehensive set of services and from 76% of benefit costs for the as recommended by the Health prohibit inclusion of lifetime limits lowest tier to 93% of benefit costs Benefits Advisory Council. The on coverage or annual limits on for the highest tier. Require plans essential benefits package covers benefits. to provide at least the essential 70% of the actuarial value of the • All policies (except certain benefits specified by the Medical covered benefits; limits annual grandfathered employer- Advisory Council and prohibit cost-sharing to $5,000/individual sponsored plans) must comply inclusion of lifetime or annual and $10,000/family; and does not with one of the four benefit limits on benefits. impose annual or lifetime limits categories, including those offered • Establish a Medical Advisory on coverage. through the Exchange and those Council to make recommendations • All qualified health benefits plans, offered outside of the Exchange. on essential health care benefits, including those offered through criteria for minimum qualifying the Exchange and those offered coverage, and affordability outside of the Exchange (except standards. certain grandfathered individual and employer-sponsored plans) must provide at least the essential benefits package. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  9. 9. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Changes to private • Require guarantee issue and • Require guarantee issue and • Prohibit coverage purchased • The plan must end barriers to insurance renewability and allow rating renewability of health insurance through the individual market coverage for people with pre- variation based only on age, policies in the individual and small from qualifying as acceptable existing medical conditions. tobacco use, family composition, group markets; prohibit pre- coverage for purposes of the and geography (not health status) existing condition exclusions; and individual mandate unless it in the non-group, micro-group allow rating variation based only is grandfathered coverage. (2-10 employees), and small group on family structure, geography, Individuals can purchase a markets. Require risk adjustment the actuarial value of the health qualifying health benefit plan in all markets. plan benefit, and age (with only 2 through the Health Insurance • Require all state-licensed insurers to 1 variation). Exchange. in the non-group and small group • Require health insurers to: • Require guarantee issue and markets to participate in the report cost information; to meet renewability and allow rating Health Insurance Exchange. medical loss ratios established variation based only on age • Require all insurers to issue by the Secretary or provide (limited to a 2 to 1 ratio), premium policies in each of the four new rebates to enrollees; to provide rating area, and family enrollment benefit categories. incentives to providers to better in the small group market and • Allow states the option of merging coordinate care, reduce hospital the Exchange. Prohibit imposition the non-group and small group readmissions and reduce medical of any pre-existing condition markets. errors. exclusions. • Require insurers to provide • Limit health plans’ medical loss coverage for preventive care ratio to 85% enforced through a services without cost sharing. rebate back to consumers. • Provide dependent coverage for • Require all insurers to offer children up to age 26. coverage that meets the essential benefits package requirements. • Standardize health care claims forms, operating rules for using and processing health care transactions, and quality reporting requirements and increase electronic exchange of administrative and clinical data. State role • Allow states the option of merging • Establish American Health • Require states to enter into a Not specified. the non-group and small group Benefit Gateways meeting Memorandum of Understanding insurance markets. federal standards and adopt with the Health Insurance • Require state insurance individual and small group market Exchange to coordinate commissioners to provide regulation changes. enrollment of individuals in oversight of health plans with • Create temporary “RightChoices” Exchange-participating health regard to consumer protections, programs to provide uninsured plans and under the state’s rate reviews, solvency, reserve individuals with immediate access Medicaid program. fund requirements, and premium to preventive care and treatment • May require states to determine taxes and to define rating areas. for identified chronic conditions. eligibility for affordability credits States will receive federal grants through the Health Insurance to finance these programs. Exchange. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  10. 10. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Cost containment • Encourage adoption and use of • Establish a Health Care Program • Simplify health insurance • The plan should reduce high health information technology Integrity Coordinating Council administration by standardizing administrative costs, unnecessary by expanding eligibility for and two new federal department health care claims forms, tests and services, waste, and the Medicare HIT incentives positions to oversee policy, operating rules for using other inefficiencies that consume in the American Recovery and program development, and and processing health care money with no added benefit. Reinvestment Act to include oversight of health care fraud, transactions, and quality • The plan must invest in public additional providers. waste, and abuse in public and reporting requirements and health measures proven to reduce • Eliminate fraud, waste, and abuse private coverage. increasing electronic exchange of cost drivers in our system— in public programs through more • Develop a national prevention and administrative and clinical data. such as obesity, sedentary intensive screening of providers, health promotion strategy that • Modify provider payments under lifestyles, and smoking—as the development of the “One PI sets specific goals for improving Medicare to: well as guarantee access to database” to capture and share health. Create a prevention and – Reform the sustainable growth proven preventive treatments. data across federal and state public health investment fund rate for physicians and include The American Recovery and programs, increased penalties to expand and sustain funding incentive payments to physicians Reinvestment Act provides for submitting false claims and for prevention and public health practicing in efficient areas; $1 billion for prevention and violating EMTALA, and increase programs. – Reduce payments to hospitals wellness. funding for anti-fraud activities. • Provide grants for improving with excess readmissions and • Restructure payments to Medicare health system efficiency, including apply the readmissions policy to Advantage plans to promote grants to establish community post acute care providers and efficiency and quality. health teams to support a medical physicians; and • Require drug or device home model; to implement – Reform payment for post acute manufacturers to disclose medication management services; care services to include a payments and incentives given to design and implement regional bundled payment for post acute to providers and any investment emergency care and trauma care services. interest held by a physician. systems. • Restructure payments to Medicare • Improve transparency of Advantage plans to link to information about skilled nursing fee-for-services payments and facilities. incorporate incentives for quality; • Allow providers organized as require Medicare Advantage plans accountable care organizations to have medical loss ratios of at that voluntarily meet quality least 85%. thresholds to share in the cost- • Increase the Medicaid drug savings they achieve for the rebate percentage and extend Medicare program. the prescription drug rebate to • Improve prevention by covering Medicaid managed care plans. only proven preventive services in Medicare and Medicaid and providing incentives to Medicare and Medicaid beneficiaries to complete behavior modification programs. Side-by-Side CompariSon of major HealtH Care reform propoSalS 0
  11. 11. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Cost containment • Reduce waste, fraud, and abuse in (continued) public programs by – Refusing Medicaid payments for health care-acquired conditions; – Allowing provider screening, enhanced oversight periods, and enrollment moratoria in areas identified as being at elevated risk of fraud in all public programs; – Requiring Medicare and Medicaid program providers and suppliers to establish compliance programs; and – Requiring evaluations and reports under Medicare and Medicaid integrity programs. • Improve transparency of information about skilled nursing facilities. • Improve prevention by covering only proven preventive services in Medicare and Medicaid and eliminate any cost-sharing for preventive services. • Develop a national strategy to improve the nation’s health through evidenced-based clinical and community-based prevention and wellness activities. Create task forces on Clinical Preventive Services and Community Preventive Services to develop, update, and disseminate evidenced-based recommendations on the use of clinical and community prevention services. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  12. 12. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Improving quality/health • Strengthen primary care and • Develop a national strategy to • Support comparative effectiveness • The plan must ensure the system performance chronic care management by improve the delivery of health research by establishing a Center implementation of patient safety providing bonus payments to care services, patient health for Comparative Effectiveness measures and provide incentives certain primary care providers outcomes, and population health Research within the Agency for changes in the delivery and providing reimbursement that includes publishing an annual for Healthcare Research and system to reduce unnecessary for certain care management national health care quality report Quality to conduct, support, variability in patient care. It must activities for patients with hospital card. and synthesize research on support the widespread use of stays related to a major chronic • Develop, through a multi- outcomes, effectiveness, and health information technology condition. stakeholder process, quality appropriateness of health care and the development of data • Establish a framework to set measures that allow assessments services and procedures. An on the effectiveness of medical national priorities for comparative of health outcomes; continuity independent CER Commission interventions to improve the clinical effectiveness research. and coordination of care; safety, will oversee the activities of the quality of care delivered. • Create a Chronic Care effectiveness and timeliness Center. • To lay the foundation for improving Management Innovation Center of care; health disparities; • Strengthen primary care and the health care delivery system within CMS to disseminate and appropriate use of health care coordination by increasing and quality of care, the American innovations that foster patient- care resources. Require public Medicaid payments for primary Recovery and Reinvestment centered care coordination reporting on quality measures care providers, providing Medicare Act invests $19 billion in health innovations for high-cost, through a user-friendly website. bonus payments to primary care information technology, including chronically ill Medicare • Create a Patient Safety Research practitioners serving in health $17 billion in incentives to beneficiaries. Center charged with identifying, professional shortage area, providers to encourage their use • Bundle payments for acute, evaluating, and disseminating conducting a Medicare pilot of electronic medical records, inpatient hospital services and information on best practices for program to test payment incentive and provides $1.1 billion for post-acute care services occurring improving health care quality. models for accountable care comparative effectiveness within 30 days of discharge from a • Develop interoperable standards organizations, and conducting research. hospital. for using HIT to enroll individuals pilot programs in Medicare and • Establish a hospital value-based in public programs and provide Medicaid to assess the feasibility purchasing program to pay grants to states and other of reimbursing qualified patient- hospitals based on performance governmental entities to adopt centered medical homes. on quality measures. and implement enrollment • Improve coordination of care • Develop a strategy for the technology. for dual eligibles by creating a development, selection, and new office within the Centers for implementation of quality Medicare and Medicaid Services measures that involves input from and allow certain Medicare multiple stakeholders. Improve Advantage plans to serve as fully public reporting of quality and integrated dual eligible special performance information that needs plans. includes making information • Develop national priorities for available on the web. performance improvement and • Require enhanced collection quality measures for the delivery and reporting of data on race, of health care services. ethnicity, and primary language. Also require collection of access and treatment data for people with disabilities. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  13. 13. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Improving quality/health • Reduce racial and ethnic system performance disparities by conducting a study (continued) on the feasibility of developing Medicare payment systems for language services and provide Medicare demonstration grants to reimburse culturally and linguistically appropriate services. • Develop standards for the collection of data on race, ethnicity, and primary language. Other investments • Promote prevention and wellness • Establish a national, voluntary • Require a report on the • As an initial investment in by providing grants to states to insurance program for purchasing continued role for Medicare and strengthening the health care implement innovative approaches community living assistance Medicaid Disproportionate Share workforce, the American Recovery to promoting integration of health services and supports (CLASS Hospital payments including the and Reinvestment Act provides care services to improve health program). The program will appropriate targeting of Medicare $500 million to train the next and wellness outcomes and provide individuals with functional and Medicaid DSH payments to generation of doctors and nurses. providing tax credits to small limitations a cash benefit to hospitals and the distribution of businesses that implement proven purchase non-medical services and Medicaid DSH among the states. wellness programs. supports necessary to maintain • Reform Graduate Medical • Change the Medicaid FMAP community residence. The program Education to increase training formula to include data on a is financed through voluntary of primary care providers by state’s poverty level and increase payroll deductions: all working redistributing residency positions Medicaid FMAP rates during adults will be automatically enrolled and promote training in outpatient economic downturns to assist in the program, unless they settings. states in financing increased choose to opt-out. • Support training of health Medicaid enrollment. • Establish a National Health professionals, including • Reform Graduate Medical Care Workforce Commission to advanced education nurses, Education to increase training make recommendations and who will practice in underserved of primary care providers and disseminate information on health areas; establish a public health promote training in outpatient workforce priorities, goals, and workforce corps; and promote settings, and ensure the policies including education and training of a diverse workforce availability of residency programs training, workforce supply and and provide cultural competence in rural and underserved areas. demand, and retention practices. training for health care • Improve the availability of long- • Reform Graduate Medical professionals. term care services by increasing Education to increase the supply, • Provide grants to each state access to home and community education, and training of doctors, health department to address based services through changes in nurses, and other health care core public health infrastructure Medicaid program requirements workers, especially in pediatric, needs. and through grants to states. geriatric, and primary care. • Provide full federal funding • Improve access to care by for Medicaid expansions and providing additional funding enhanced federal funding for to increase the number of Medicaid improvements. community health centers and school-based health centers. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  14. 14. Senate Finance Committee Senate HELP Committee House Tri-Committee President Obama Policy Options Affordable Health Choices Act Health Reform Proposal Principles for Health Reform Financing Not specified. Considering a range Not specified. Not specified. President Obama dedicated $630 of options for achieving savings and billion over ten years toward a for generating new revenues. Health Reform Reserve Fund in his budget outline released in February 2009 to partially offset the cost of health reform. Sources of information Go to following link: http://finance. http://help.senate.gov/ http://edworkforce.house.gov/ http://www.whitehouse.gov/omb/ senate.gov/sitepages/baucus.htm budget/ then select these items http://www.HealthReform.gov 5-11-09 Baucus, Grassley Policy Options for Expanding Health Care Coverage: Proposals to Provide Affordable Coverage to All Americans 4-28-09 Baucus, Grassley Policy Options for Transforming the Health Care Delivery System: Proposals to Improve Patient Care and Reduce Health Care Costs Side-by-Side CompariSon of major HealtH Care reform propoSalS
  15. 15. Sens. Tom Coburn and Richard Burr Reps. Paul Ryan and Devin Nunes Rep. John Conyers Rep. John Dingell Patients’ Choice Act of 2009 U.S. National Health Care Act National Health Insurance Act (S. 1099 and H.R. 2520) (H.R. 676) (H.R. 15) Date plan announced May 20, 2009 January 26, 2009 January 6, 2009 (Has introduced similar legislation in each Congressional session since 1957) Overall approach to Create state-based health insurance exchanges Create a public health insurance program for Create a national health insurance program for expanding access to through which private plans offer coverage all U.S. residents. Replace employer coverage individuals meeting eligibility requirements. coverage meeting certain benefit and other standards. and eliminate the Medicare, Medicaid and CHIP Require states to administer the program Allow employers to continue providing coverage programs. Individuals are not required to pay and provide for equivalent care for “needy” to their employees, but replace the current tax premiums or cost-sharing. Require conversion individuals who do not meet eligibility preference for employer-sponsored insurance to a non-profit health care system. Provide requirements. A National Health Insurance with a tax credit for individuals and families for global budgets for hospitals and negotiate Board determines allotments for the classes of to provide incentives for insurance coverage. annual reimbursement rates with physicians covered services. Financed by a value-added tax Integrate low-income families into private and other non-institutional providers. Finance imposed on certain transactions. insurance by providing additional financial program by redirecting current federal and state support and maintain Medicaid coverage for health care spending, impose an employer/ low-income people with disabilities. employee payroll tax, and leverage additional taxes. Individual mandate • No requirement for individuals to have • All individuals residing in the US are covered • Individuals meeting certain requirements are coverage. under the United States National Health Care entitled to benefits under the National Health Act (USNHC). Insurance Program. Employer requirements Not specified. No provision. No provision. Expansion of public • Restructure the Medicaid program to • Create a new public plan, the USNHC program, • Create a new public plan, covering medical, programs provide care only to low-income people with that provides coverage for a comprehensive set dental, podiatric, home-nursing, hospital, and disabilities. Integrate low-income families into of benefits, including long-term care services, auxiliary services. A National Health Insurance private insurance by providing them with a tax to all US residents. Board, in consultation with a National Advisory credit plus other financial support. • Eliminate the Medicare, Medicaid, and CHIP Medical Council determines the scope of • Allow private facilities to compete with programs as beneficiaries of these programs benefits consistent with the statute. Veteran’s Administration facilities to provide are eligible for the USNHC program. • Continue Medicare, but enrollees may be care to veterans. • VA health programs will remain independent transferred into the new program in the future. • Allow eligible American Indians to access for 10 years after which they will either remain Medicare beneficiaries are covered under the medical care outside of Indian Health Service independent or be integrated into the USNHC new program for services that are not covered facilities. program. The Indian Health Service will remain by Medicare. independent for 5 years after which it will be • Require states to provide equivalent services to integrated into the USNHC program. those not eligible under the new plan. Current federal Medicaid funds and other federal funds provided to states under the Social Security Act are available for this purpose. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  16. 16. Sens. Tom Coburn and Richard Burr Reps. Paul Ryan and Devin Nunes Rep. John Conyers Rep. John Dingell Patients’ Choice Act of 2009 U.S. National Health Care Act National Health Insurance Act (S. 1099 and H.R. 2520) (H.R. 676) (H.R. 15) Premium subsidies to • Provide a tax credit of $2,300 for individuals • Individuals are not required to pay premiums • Individuals are not required to pay premiums to individuals and $5,700 for families to be used to purchase to obtain coverage nor are they charged obtain coverage. insurance. copayments or coinsurance for covered • Provide additional financial support to low- benefits. income families to enable them to afford private insurance. Premium subsidies to Not specified. No provision. No provision. employers Tax changes related to • Reform the tax code to eliminate the exclusion No provision. No provision. health insurance of the value of health insurance plans offered by employers from workers’ taxable income. • Allow individuals and families purchasing high-deductible health plans that are less than the value of the tax credit to deposit the excess amount into a health savings account. • Change health savings account (HSA) requirements by allowing health insurance premiums to be paid tax-free from an HSA, increasing the allowable contribution amounts for people with chronic conditions, and permitting high-deductible health plans to cover preventive services, maintenance costs of chronic diseases, and concierge-style primary care services. Creation of insurance • Partner with states to create State Health No provision other than pooling achieved through No provision other than pooling achieved through pooling mechanisms Insurance Exchanges through which individuals USNHC. new public program. can purchase qualified private insurance. • Require plans participating in the Exchanges to provide coverage on a guarantee issue basis and to provide coverage similar to that provided to Members of Congress. • Require risk-adjustment among insurance plans participating in the Exchange. A non- profit, independent board will develop the risk- adjustment methodology. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  17. 17. Sens. Tom Coburn and Richard Burr Reps. Paul Ryan and Devin Nunes Rep. John Conyers Rep. John Dingell Patients’ Choice Act of 2009 U.S. National Health Care Act National Health Insurance Act (S. 1099 and H.R. 2520) (H.R. 676) (H.R. 15) Benefit design • Provide coverage that meets the same • Provide coverage for all medically necessary • Provide the following classes of personal statutory requirements used for the health services, including primary care and health services: benefits for Members of Congress. prevention; inpatient care; outpatient care; – Medical services including primary and emergency care; prescription drugs; durable specialty care; medical equipment; long-term care; palliative – Dental services; care; mental health services; dental services; – Podiatric services; chiropractic services; basic vision correction; – Home-nursing services; hearing services; and podiatric care. – Hospital services, for a maximum of 60 days in a benefit year; – Auxiliary services including diagnostic laboratory services, X-ray and related therapy, physiotherapy, optometry services, prescription drugs, and eyeglasses. Changes to private Not specified. • Prohibit insurers from duplicating USNHC No provision. insurance benefits but they may offer coverage for benefits not covered by the USNHC program. State role • Create state Health Insurance Exchanges that No provision. • Assume responsibility for administration of the meet federal standards. program. States must submit a state plan of • Form voluntary compacts (at state option) with operations that designates a state agency for other state Exchanges to diversify pooling, administering the program benefits; creates, ease administrative burdens, and increase the among other things, an advisory committee; availability of innovative insurance products. establishes local health service areas to further decentralize program administration; and provides a plan for ensuring that benefits will be provided efficiently and to all areas of the state. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  18. 18. Sens. Tom Coburn and Richard Burr Reps. Paul Ryan and Devin Nunes Rep. John Conyers Rep. John Dingell Patients’ Choice Act of 2009 U.S. National Health Care Act National Health Insurance Act (S. 1099 and H.R. 2520) (H.R. 676) (H.R. 15) Cost containment • Encourage adoption and use of health • Establish annual budgets for health care • Require the National Health Insurance information technology by providing incentives professional staffing, capital expenditures, Board to establish allotments for each of five to hospitals and individual providers. Create reimbursement for providers, and health classes of services to be provided under the personal health records maintained by an professional education. program (medical services, dental services, independent health record bank and available • Pay institutional providers, including hospitals, home-nursing services, hospital services, to the individual through a card, much like an nursing homes, community or migrant health and auxiliary services). Allotments are made ATM card. centers, home care agencies, and other to the states based on population, medical • Emphasize prevention by developing a institutional and prepaid group practices, professionals and facilities, and cost of national strategic prevention plan, creating a monthly lump sum to cover operating services. a web-based prevention tool capable of expenses. • Require a study of cost control mechanisms, producing personalized prevention plans, and • Pay physicians and other non-institutional including an analysis of the impact on medical implementing national science-based media providers based on a simplified fee scheduled malpractice claims and liability insurance on campaigns on health promotion and disease or as a salaried employee in an institution health care costs. prevention. receiving a global budget or in a group practice • Reward seniors who adopt healthier behaviors or HMO receiving capitation payments. with lower Medicare premiums. • Establish a uniform electronic billing system • Allow providers to form accountable care and create an electronic patient record system. organizations and receive bonuses in Medicare • Allow only public or not-for-profit institutions if they improve quality and satisfaction while to participate in USNHC. Private physicians, also lowering costs. clinics, and other participating providers may • Adopt competitive bidding for private plans in not be investor owned. Medicare. • Require USNHC program to negotiate annually • Require higher income Medicare beneficiaries prices for drugs, medical supplies, and to pay more for Medicare Part B and Part D assistive equipment. premiums. • Establish a prescription drug formulary that • Adopt medical malpractice reforms that create encourages best practices in prescribing and independent expert panels or state “health promotes use of generics and other lower cost courts” or both to review cases and render alternatives. decisions. Parties will still have access to state courts if not satisfied with decisions. Side-by-Side CompariSon of major HealtH Care reform propoSalS
  19. 19. Sens. Tom Coburn and Richard Burr Reps. Paul Ryan and Devin Nunes Rep. John Conyers Rep. John Dingell Patients’ Choice Act of 2009 U.S. National Health Care Act National Health Insurance Act (S. 1099 and H.R. 2520) (H.R. 676) (H.R. 15) Improving quality/health • Create a new Health Care Services • Require participating providers to meet state • Require state and local administration to: system performance Commission to establish uniform measures quality and licensing guidelines. – Promote coordination among providers, for reporting price and quality information. The • Create a National Board of Universal Quality between providers and public health centers HSC, managed by five commissioners from the and Access to address issues, such as access and educational and research institutions. private sector appointed by the President, will to care, quality improvement, administrative – Emphasize prevention of disease, disability, issue a report containing guidelines regulating efficiency, budget adequacy, reimbursement and premature death. the publication and dissemination of health levels, capital needs, long term care, and – Insure the provision of efficient, high quality care information and will be authorized to staffing levels. services. enforce these standards. • Establish a universal standard of care relating to appropriate staffing levels; appropriate medical technology; scope of work in the workplace; best practices; salary levels for medical professional and support staff. Other investments • Make changes to Medicaid long-term care • Establish regional budgets to cover the full • Provide grants for training and education of services to provide states with a defined array of long-term care services covered by the professional and technical personnel needed to allotment for Medicaid long-term care services USNHC program. provide or administer benefits. Makes available in exchange for having the Medicare program • Establish a USNHC Employment Transition $5 million in 2010 and 2011; and up to one half assume responsibility for the premiums, Fund to assist people who lose their jobs as of one percent of benefit payments annually cost-sharing, and deductibles for low-income a result of the transition to the new national thereafter. Medicare beneficiaries and ensure choice system. between institutionalized and home-based • Create a mechanism to facilitate the conversion long-term care services. of for-profit providers of care to not-for-profit status and provide compensation for the financial losses associated with the conversion. Financing Not specified, but claims proposal is revenue and The USNHC program will be funded through Program will be financed through a National budget neutral. the USNHC Trust Fund. Funding for the Trust Health Care Trust Fund. The trust fund will Fund will come from redirecting existing federal be funded with a value-added tax of 5 percent payments for health care; increasing the imposed on certain transactions. income tax for the top 5% of earners, instituting a modest and progressive payroll tax, and imposing a tax on stock and bond transactions. Sources of information http://coburn.senate.gov/public/index. http://conyers.house.gov/index. http://www.house.gov/dingell/issue_healthcare. cfm?FuseAction=HealthCareReform. cfm?FuseAction=Issues.HomeIssue_ shtml HomeContentRecord_id=5e3b30a4-802a-23ad- id=063b74a4-19b9-b4b1-126b-f67f60e05f8c 4b44-14f0219114c6 Side-by-Side CompariSon of major HealtH Care reform propoSalS
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