A Breakdown of Health Care Reform Part 3

First and foremost, I'd like to send out a congratulations to one of our contributors, my Secretary of State, "AM Donkey" on finding out him and his wife are going to have a baby girl. Secondly, thanks to the people at The Henry J. Kaiser Family Foundation for providing a side by side analysis of every Health Care reform legislation. And finally, thank you to Opencongress.org for using this website as a means of getting information about the Health Care reform legislation out there. If your new to Political Liability, and like what you read, feel free to view more of our post and tell us what you think. Ok, now down to business.

Part 3

A-Expansion of public programs: President Obama signed the reauthorization for CHIP which provides 11 million children with coverage. However, we will focus not only on the expansion of CHIP, but the other government run programs like Medicaid and Medicare and how each proposal plans to reach more Americans and to what effect this will have on those covered.

-Senate Finance Committee: Their proposal breaks the government run programs down like so, starting with Medicaid: They would expand medicaid to individuals within 115% the Federal Poverty Level, with the possibility of increasing it for eligible parents, pregnant women and children. Medicaid coverage could use its current structure or enroll children, pregnant women, parents and childless adults into the Health Insurance Exchange. Another option is to enroll everyone except childless adults into Medicaid. Childless adults would then be given a tax credit to purchase coverage through the Health Insurance Exchange or to buy into Medicaid.

CHIP: After Sept. 20, 2013, CHIP would be expand eligibility to within 275% of the Federal Poverty Level. Once the Health Insurance Exchange become operational, all those in CHIP would be covered under the exchange, while the states would be required to provide services such as Early and Periodic Screening, Diagnosis, and Treatment services and others not provided by plans within the exchange.

Medicare: Until the Health Insurance Exchange is operational, individuals between 55 and 64 years old who are without coverage would be allowed to buy into Medicare at full cost. Their plan would phase out or reduce the two year waiting period for individuals with disabilities who are Medicare eligible.

Public Health Insurance Option: Their plan has two options for public health insurance. Option A) would create a new public plan that would be offered through the Health Insurance Exchange that would be subject to the same ratings as private plans. This public plan could be ran either by the Federal government, multiple third parties or the states. Option B) is to not create a public plan.

-Senate HELP Committee: Their plan would expand Medicaid to children, pregnant women, parents, and adults without dependents whose incomes are within 150% of the Federal Poverty Level. These individuals would be covered through state Medicaid, and would not be eligible for credits to purchase health care within the American Health Benefit Gateways.

CHIP: Their plan would give those eligible the option to stay in CHIP or enroll in health care through the Gateways.

House Tri-Committee: Their plan would expand Medicaid to children, pregnant women, parents, and adults without dependents with incomes within 133% of the Federal Poverty Line. Those who are newly eligible for Medicaid have the option to enroll through the Health Insurance Exchange if they had qualified health care for six months before becoming eligible for Medicaid. The proposal would also provide coverage for all newborns lacking acceptable coverage as well as provide health care for low-income HIV infected individuals and family planning services for certain low-income women.

The Committee on Energy and Commerce amended their proposed increase of Medicaid payment for primary care of 100% the Medicaid rates to requiring states to submit a plan amendment detailing the payment rates under each states Medicaid program. The committee also amended the proposed expansion and provider payments that were going to be fully funded through Federal funds to be fully Federally funded until 2014, and then 90% Federally funded starting 2015.

That same committee amended the proposed requirement of enrollees to obtain health care through the Health Insurance Exchange if the Health Choices Commissioner determines the exchange has that capacity and the procedures are in place to integrate in a timely fashion without a lapse in coverage to state that those covered under CHIP could not join the exchange until the Secretary determines that they can be integrated into an exchange plan comparable to the average CHIP plan in 2011 and be done so in a timely fashion without lapse in coverage.

-Senators Tom Coburn and Richard Burr and Representatives Paul Ryan and Devin Nunes: Their plan would restructure Medicaid to provide care for low-income individuals with disabilities, foster children, low-income women with cervical or breast cancer, and certain TB-infected individuals. Their proposal would provide low income families with tax credits and financial support for private health care. It would replace long term care that falls under Medicaid with block grants for states to provide long term care for eligible elderly and disabled individuals. Their plan would also allow private facilities to compete with VAs to provide care for veterans, as well as allow eligible American Indians access to medical care options outside the Indian Health Service facilities.

-Representative John Conyers: His plan would create the US National Health Care program that would provide a comprehensive amount of benefits including long term care to all US residents. His proposal would eliminate Medicaid, Medicare and CHIP. It would allow VAs to run independently for 10 years before they get integrated into the program, while Indian Health Services ran independently for 5 years before being integrated.

-Representative John Dingell: His proposal would create a new public plan that would cover medical, dental, pediatric, home nursing, hospital and auxiliary services. His plan would also continue Medicare, but those enrolled may be transferred to the new program at a future time as well as allow those covered by Medicare access to services otherwise not covered. States would be required to provide equivalent services to ineligible individuals that would be funded by current Federal Medicaid funds and other Federal funds under the Social Security Act.

-Representative Tom Price: His plan would require states to cover a minimum of 90% of families within 200% of the Federal Poverty Level who are eligible before expanding CHIP to between 200% and 300% the Federal Poverty Level. States would also be required to provide premium assistance for Medicaid and CHIP enrollees that also have access to employer sponsored health care. States would also be required to offer vouchers to individuals eligible for Medicaid and CHIP for alternative private insurance.

-Senator Bernie Sanders: His plan would create a state based American Health Security Program that would provide comprehensive coverage to all US residents. Programs such as Medicaid, Medicare and CHIP would be eliminated. VAs and the Indian Health Service programs would run independently of his plan.

-Representative Stark: His proposal would create a new default plan for all Americans, modeled after Medicare. Under his AmeriCare plan, enrollees would pay a deductible of $350 per individual, $500 per family and 20% of coinsurance until the $2,500 per individual, $4,000 per family out of pocket expense was met. Those covered under AmeriCare are prohibited from coverage under state Medicaid or CHIP.

-Senators Ron Wyden and Bob Bennett: Their proposal would create comprehensive programs that provide supplemental coverage for low income individuals as well as a modified Medicaid for long term services. It would eliminate Medicaid and CHIP as comprehensive coverage programs.

-Former Majority Leaders: Senators Howard Barker, Tom Daschle and Bob Dole: Their plan would expand Medicaid to all individuals within 100% the Federal Poverty Level. At the start, all eligible individuals will obtain or keep state Medicaid. After five years, the Health and Human Services Secretary would be authorized to permit those eligible individuals to enroll in the Health Insurance Exchange granted it does not result in cost sharing or coverage loss. States would be allowed to create a plan option as an alternative in the exchange and is subject to certain regulations. If, after five years, Health and Human Services determines that goals are not met, a proposal for a state or Federal plan would be considered by Congress under an expedited procedures.

B-Premium subsidies for individuals: President Obama wants a plan that would protect families from bankruptcy or debt due to health care cost. We will be focusing on how each proposal plans to prevent debt and bankruptcy as it pertains to health care cost, as well as affordable plans for individuals who lose their jobs and employer based health care.

-Senate Finance: Their plan would provide refundable tax credits to individuals and families within 100% to 400% the Federal Poverty Level for purchase of insurance through Health Insurance Exchange. This tax credit would be based on either a set percentage of income or a percentage of the premium with cost sharing limits.

-Senate HELP: Their proposal would provide a sliding scale of premium credit for individuals and families within 400% of the Federal Poverty Level to purchase insurance through the Gateway. This credit would be based on the average cost of the three lowest, qualifying health plans in the area but will not exceed 12.5% of the income of individuals within 400% the Federal Poverty Level, or 1% of the income of individuals within 100% the Federal Poverty Level with limits on cost sharing. Limits would be placed on availability of premium credits for individuals not eligible for employer sponsored health care, but meet eligibility for Medicare, Medicaid, TRICARE or Federal Employee Health Benefits. Their plan would also allow those individuals who have employer sponsored health care a premium credit if the cost is 12.5% or more of their individual income.

-House Tri-Committee: Their plan would provide premium credits to those eligible individuals and families within 400% the Federal Poverty Level to purchase insurance through the Health Insurance Exchange. This credit would be based on the average cost of the three lowest basic plans in the area and are set on a sliding scale based on the following income tiers that have been amended by the Committee on Energy and Commerce: 133% to 150% of the Federal Poverty Level would receive credit of 1.5% to 3% of income, same as original; 150% to 200% Federal Poverty Level would receive 3% to 5.5%, up from 5% originally; 200% to 250% Federal Poverty Level would receive 5.5% to 8%, up from 5% to 7% originally; 250% to 300% Federal Poverty Level would receive 8% to 10%, up from 7% to 9% originally; 300% to 350% Federal Poverty Level would receive 10% to 11%, up from 9% to 10% originally; and 350% to 400% Federal Poverty Level would receive 11% to 12%, up from 10% to 11% originally.

Their plan would also provide affordable cost sharing credits to individuals and families within 400% of the Federal Poverty Level. Their plan would also limit the availability premium and cost sharing credits to US citizens and legal residents who are not enrolled into or grandfathered into any coverage with some exceptions. The Committee on Energy and Commerce amended the eligibility requirement for premium and cost sharing credits for individuals with the employer sponsored coverage option from exceeding 11% to exceeding 12% their annual income.

-Senators and Representative: Their plan would provide a credit of $2,290 for individuals, $5,710 for families to be used to purchase health care. Those covered by Medicare, military, and disabled individuals under Medicaid are not eligible for the credit. Any money left over from purchase of health care would be deposited into a medical savings account. Their plan would provide a supplemental debit card for families within 200% the Federal Poverty Level to be used to pay private insurance cost. The amount would vary from $5,000 for families within 100% the Federal Poverty Level to $2,000 for families within 180 to 200% the Federal Poverty Level, with an additional $1,000 for pregnancy and $500 for infants under 1 years old.

-Rep. Conyers: Under his plan, individuals are not required to pay premiums, copays or coinsurance fees.

-Rep. Dingell: Under his plan, individuals are not required to pay premiums.

-Rep. Price: His proposal would provide refundable tax credits of $2,000 for individuals, $5,000 for a family of four within 200% of the Federal Poverty Level to purchase health care in individual markets. This credit would be available to US citizens and permanent legal residents. His plan would allow individuals eligible for other programs to receive tax credit.

-Sen. Sanders: Under his plan, individuals are not required to pay premiums, copays or coinsurance fees.

-Rep. Starks: Under his plan, individuals within 200% of the Federal Poverty Level would not be required to pay premiums, deductibles or coinsurance. Individuals with family incomes within 200% to 300% of the Federal Poverty Level would be provided with premium subsidies and reduced deductibles. The plan would limit out of pocket expenses for deductibles and coinsurance to 5%of their income for those between 200% and 300% the Federal Poverty Level, and 7.5% for those between 300% and 500% Federal Poverty Level. There would be no deductibles or coinsurance for pregnancy related services or for children up to 24 years old.

-Sens. Wyden and Bennett: Their plan would allow individuals and families within 100% of the Federal Poverty Level to not pay premiums and provide subsidies for those between 100% and 400%. There would be a standard tax deduction for individuals and families above 100% the Federal Poverty Level with a phase out at higher income levels.

-Former Majority Leaders: Their plan would provide a sliding scale for families and individuals within 400% of the Federal Poverty Level to purchase insurance through the Health Insurance Exchange. Those families within 100% the Federal Poverty Level would be enrolled in Medicaid and not have to pay premiums. The rest would not exceed the following scale: 100% to 150% the Federal Poverty Level would pay 2% of income; 150% to 250% Federal Poverty Level would pay 5%; 250% to 350% Federal Poverty Level would pay 10%; 350% to 400% would pay 12.5%; those above 400% would not have to pay more than 15% their income.

C-Premium subsidies to Employers: President Obama has not outlined what he would like to see in legislation, so we will focus on how the government plans will help reduce the cost to employers.

-Senate Finance: Their proposal would provide certain small businesses tax credits for purchasing employee insurance. The full tax credit would be equal to 50% of the average total premium cost paid by employers with 10 or less employees, and those employees do not average more than $20,000 in annual wages. The tax credit would be phased out based on business size and employee income.

-House Tri-Committee: Their proposal would provide small businesses with 25 or fewer employees whose averages wages does not exceed $40,000 a health care credit. The full credit would be equal to 50% of the premium cost paid by employers with 10 or fewer employees whose average income does not exceed $20,000. The credit would phase out based on business size and average salary and is not permitted for employees earning more than $80,000.

This proposal would create a temporary reinsurance program for employers who provide coverage for retirees between 55 and 64 years old. This program would reimburse employers 80% of claims between $15,000 and $90,000. $10 billion would be appropriated over 10 years for this program.

-Senators and Representative: Their current proposal does not address this issue.

-Rep. Conyers: His current proposal does not address this issue.

-Rep. Dingell: His current proposal does not address this issue.

-Rep. Price: His proposal would provide small businesses with 50 or less employees a temporary tax credit to adopt auto-enrollment and contribute coverage for employees who purchase private health care on the individual market.

-Sen. Sanders: His current proposal does not address this issue.

-Rep. Starks: His current proposal does not address this issue.

-Sens. Wyden and Bennett: Their current proposal does not address this issue.

-Former Majority Leaders: Their proposal would provide small businesses with 25 or less employees who are low-wage, a tax credit to help offer coverage.

***Coming Soon, Part 4: Tax changes related to health insurance***