Index of Documents website - Michigan · LOGIC MODEL - Recommendation # 6: Promote Meaningful Consumer Participation and Education by Creating a Long-Term Care Commission and Informing

Index of Documents

Michigan Long-Term Care Supports and Services Advisory Commission Meeting of September 28, 2009

Capitol View Building, Lansing, MI

• Agenda, Monday, September 28, 2009 • Logic Model - Recommendation # 6 – Jane Church • “Insuring the uninsured in Michigan, A look at the House and Senate Plans”

- Eric Schneidewind, AARP • Healthcare Reform Policy Briefing

- Joann Genovich-Richards, AARP • AARP Letter to Honorable Max Baucus • Provisions of Health Care Overhaul Bills Compared • Page 26 CQ Today

- Amanda Therrian, Legislative Aide in DC office of Congressman Mark Schauer, and resident expert on the health insurance reform bills

MICHIGAN LONG TERM CARE SUPPORTS & SERVICES ADVISORY COMMISSION

MONDAY, SEPTEMBER 28, 2009 FROM 10:00 – 4:00 AGENDA

I. 10:00 A.M. – Organizing Ourselves A. Introductions/Roll Call B. Review & Approval of July Draft Minutes C. Review & Approval of September Agenda II. 10:15 P.M. – What’s Happening A. Task Force Recommendation Logic Model Review: Public Education & Consumer Participation in the System -- Jane Church B. OLTCSS Update & Transition – Peggy Brey C. Commission Discussion

12:00 LUNCH BREAK

III. 1:00 P.M. – What Else is Happening

A. Public Comment B. Michigan Healthcare Reform Legislative Proposals – Eric Schneidewind, AARP Michigan President C. Federal Healthcare Reform Legislative Proposals – [TBA] D. Commission Q&A, Discussion

[BREAK @ 2:30] IV. 3:00 P.M. – What Needs to Happen A. Michigan State Budget Crisis & Revenues Modernization

Advocacy – A Better Michigan Future Campaign B. Commission Action on Next Steps in State Budget and

Healthcare Reform Advisement & Advocacy C. November Commission Needs D. Other Commissioner Announcements & Adjournment

LOGIC MODEL - Recommendation # 6: Promote Meaningful Consumer Participation and Education by Creating a Long-Term Care Commission and Informing the Public about the Available Array of Long-Term Care Options.

Page 1 jc-9/21/09 Review and Revised Dates

PAT date: September 14, 2009 Commission Workgroup date: September 14, 2009

Commission Presentation: September 28, 2009

Objective

Activity Output (tangible products)

Outcome (expected changes)

Indicator/measure

Champion/ Time Frame

Obtain input on subject matter for campaign via focus groups.

Focus group questions. Schedule for conducting focus group. Focus group findings.

Campaign subject matter/messages identified.

Outline campaign. Campaign template.

Public awareness and education campaign to promote informed decision-making and personal planning

Work with partners to develop messages and materials

Materials and messages in the form of : -LTC planning/ information kits -Radio spots/PSAs -Newspaper/ newsletter articles -Decision tree to guide personal decision-making.





Objective



Indicator/measure


Facilitate conduct of campaign

Implementation plan/timeline.

Increased public awareness of LTC service options and the need for pre-planning.

Number of community presentations made. Number of planning/ information kits distributed. Number of PSAs/radio spots aired. Number of newspaper/ newsletter articles published.

Inventory and review existing informational materials. Work with partners to revise existing and/or develop new materials.

Feedback to partners

Increased public awareness.

Increase community stakeholders awareness of 1) the full array of supports and services, and 2) PCP

Work with partners to ensure wide distribution of materials/messages.

Distribution plan Increased public awareness





Objective



Indicator/measure


Review content of milongtermcare.org website. Determine need for additional and/or edited content.

Recommendations re: changes needed to website content.

Website updated on regular basis.

Develop a launch a comprehensive state LTC website

Develop marketing strategy to increase awareness of existing website.

Marketing strategy Increased awareness of website. Website visitors return.

Monthly web trends reports

Legislate a Commission to provide meaningful consumer oversight and accountability

No activity required. Objective accomplished via EO establishing Advisory Commission.

Authorize continuing education for professionals on SPE, PCP, develop multi-disciplinary curricula for CEUs/CMEs

Objective being addressed by PCP PAT. Monitor activity and provide feedback via Tari Muniz

Feedback to PCP PAT.

Tari Muniz

Assure all state employees involved in any aspect of LTC have mandatory training on PCP

“

“

Tari Muniz





Objective



Indicator/measure


Provide orientation to legislators et al on PCP, the array of services.

“

“

Tari Muniz

Collect definitions of consumer being used by various state-level workgroups.

Working definition of “consumer”

Agreement on working definition of consumer and ability to move forward on development of value/inclusion statement.

Date working definition adopted.

Develop a consumer value/inclusion statement

Draft statement. Date draft statement accepted and released for presentation to LTCSS AC.

Present to LTCSS AC for concurrence/ support/adoption.

Recommendation/ rationale for adoption.

New Objective: Increase consumer participation and diversity in public policy development and Commission workgroup processes.

Present statement to DCH Director for concurrence/support/ adoption.

Correspondence from LTCSS AC Chair to MDCH Director.

Consumer voice included in public policy development process.

Response from DCH director that consumer value statement is adopted. Correspondence from DCH director to staff transmitting consumer value statement





Objective



Indicator/measure


Conduct inventory within DCH to determine level and diversity of consumer involvement.

Baseline measure of consumer involvement.

Increase in number of primary and secondary consumers participating in DCH workgroups .

Increase from baseline.

Identify potential sources of funds to support consumers’ participation.

Written DCH directive that grant application budgets include funding for consumer support.

It becomes standard practice to include request for consumer support funds in all grant requests developed by DCH.

Grant budgets include line item to provide stipends for consumer travel and accommodations.





Objective



Indicator/measure


Ensure consumers are supported – grow informed consumers Work with DCH to develop and conduct interviews with currently involved consumers to determine impact of their involvement on their lives and the lives of others.

Tools/strategies to increase consumer participation. Interview questions. Interview results Baseline from which to measure “meaningful” participation.

Informed consumers actively participate at all levels. Consumers are provided with opportunities to participate in meaningful ways.

Unduplicated number of consumers actively involved. Number of consumer generated recommendations that result in new or revised policy and practice.





Increase awareness of SPE agencies

Partner with LTCCs to extend their existing marketing efforts Activity on this particular objective discontinued effective 6/1/2009 due to elimination of SPEs by Executive Order 2009-22. Advocate within House and Senate approps processes on behalf of SPEs

Branding: Logo Website, Brochures E-blasts Testimony before appropriations committees.

People will know where to call for assistance in LTC planning. Legislative support for continuation/expansion of SPE initiative.

Increase in number of I&A calls within SPE areas. Complete – number of calls increased by ___% from year 1 to year 3 of demonstration Increase in I&A calls from outside of SPE areas. Complete – number of calls increased by ___% from year 1 to year 3 of demo. Continuation funding in FY 2010 budget. Expansion funding in FY 2011 budget. Discontinued due to elimination of SPEs.

Insuring the uninsured in MichiganA look at the House and Senate plans

Rick MurdockMichigan Association of Health Plans

Eric SchneidewindAARP

1

PMPF and MAHP analysis• The Problem

– More than 1.2 million uninsured residents in Michigan

– 15,000 new Medicaid patients every month

• The goal

– Provide coverage to as many of the uninsured as possible withoutdriving up costs to others

– Leverage federal support• Medicaid today paying 70 percent of costs

– Level playing field to encourage competition among insurers

– Enhance basic consumer protections

• Potential beneficiaries

– The uninsured

– Companies and individuals who are paying $900/family in hidden taxes for uncompensated care caused by state and federal policies

– Hospitals and physicians who are covering the uninsured today2

Process

• House and Senate packages introduced last week

• Both chambers moving deliberately

• These are starting points

• Rep. Corriveau and Sen. George have said they want input from all

3

Issues addressed by bills

4

Benefit designSenate House Differences

• Most details left to “Cover Michigan”board

• Mi‐Health plan must include wellness, inpatient and outpatient, preventative care, value‐based pharmaceutical benefit

• Provisions to level playing field among for‐profit, non‐profit and BCBSM

• Most details left to Insurance Commissioner

• Basic and basic enhanced plans must minimize ER use, encourage wellness, appropriate inpatient and outpatient hospital, medical devices, diagnostic services

• Senate leaves details to board

• House leaves details to commissioner

• Package design similar

5

Rating issuesSenate House Differences

• Guarantee issue of Mi‐Health to all eligible

• Rates vary only on age, tobacco use, BMI, behaviors

• No health condition underwriting except when Mi‐Health first issued

• Shortened regulatory review for BCBSM

• All must offer basic benefit and enhanced benefit to all individuals.

• All must guarantee issue for all individual products

• Rates vary with age• More file and use rates, including BCBSM

• Rates OK if meet loss ratios

• Guarantee issue: Senate for Mi‐Health; House for all individual market

• Rating factors: Senate has several; House only age

• Rate regulation: Senate retains most rate oversight; House presumes rates approved based on loss ratios, reimbursed if wrong

6

Provider reimbursementSenate House Differences

• Mi‐Health policies pay providers Medicare rates

• No provision • Senate provides for level playing field for reimbursement; House allows those who can negotiate lower rates to do so.

7

Premium subsidySenate House Differences

• Sliding scale premium based on income up to 300% FPL

• Sources: a.Up to 1.8% surcharge on claims paid

b.BCBSM tax exempt value

c.Possible hospital assessment

• Health Care Affordability Fund goes to:

a.MiChild to 300% FPL

b.Individual coverage, under 300% FPL, no seniors

c.Med Sup for seniors under 300% FPL

• Source: Assessment on non‐profit carriers based on tax exemption

Who gets subsidy: Senate focused on all low income; House focused first on children, then others in individual market

Sources of subsidy: Senate from broad group; House from non‐profits only

Little money in House plan

Senate hospital assessment could bring more federal $s

8

Reinsurance mechanismSenate House Differences

• Michigan Claims fund reimburses carriers for 90% of $ between $25,000 to $250,000/year for each individual policy

• Funded by annual assessment on each carrier writing individual coverage

• MICAPP reimburse carriers 100% of amount above $25,000/year for each individual policy

• Funded by annual assessment on each carrier writing individual coverage

Sources of reinsurance money same

Senate: Limits exposure to 90% of $25,000‐$250,000

Senate: No mention of what happens after $250,000

House: Insurers exposed after first $25,000

Both plans likely to be quite expensive, with burden carried by others in individual market 9

Safety net expansionSenate House Differences

• Mi‐Health premium for eligible's at or below 200% FPL limited to 5% of income

• Funded by Health Access surcharge, BCBSM fee

• Premium for guarantee issue policies subsidized to 300% FPL

• Funded by money left over after MiChild expansion

Senate subsidizes those under 200% FPL; large surcharge makes that possible.

House subsidizes those under 300% FPL; small surcharge makes that difficult to accomplish

10

Consumer ProtectionSenate House Differences

• Pre‐existing provisions limited to 6 months

• No post‐claims underwriting through rescission

• No block closings without offering insured other options

• Adds anti‐steering provisions

• Pre‐existing provisions limited to 6 months

• No post‐claims underwriting through rescission

• No block closings without offering insured other options

• Adds anti‐steering provisions

Both packages basically same

11

Eligibility IssuesSenate House Differences

• Eligible are1.Michigan resident 6 mos.

2.Annual income under 300% FPL

3.Not eligible for Medicaid, Medicare, MiChild

4.No employer access for 6 mos.

5.Not accept employer incentive to drop coverage

• All individuals eligible for guarantee issue policies

Senate limits participation to those generally regarded as uninsured

House guarantees issue to all individuals of all products

Concern: Mandating guarantee issue to all products drives up costs for individual market as a whole

12

OversightSenate House Differences

• Mi‐Health in DCH

• 13 member Cover Michigan Board sets benefit policy

• 7 member Michigan Claims Board in OFIR oversees reinsurance

• Both funds established in Treasury

• Oversight by OFIR/Commissioner

• Creates Health Care Affordability Fund in Treasury

• Creates Michigan Catastrophic Protection Plan Fund in Treasury

Senate relies on appointed boards

House relies on Insurance Commissioner

13

Enrollment CapacitySenate House Differences

• Mi‐Health target is uninsured under 300% FPL.

• Cover Michigan board must impost cap on enrollment if Mi‐Health assessments insufficient to meet projected costs of new enrollees

• Target population prioritized

1.Children in households under 300% FPL

2.Non‐Medicare adults

3.Medicare eligible adults (seniors)

Senate aims broadly at low income persons. Limits enrollment if funds insufficient

House sets priorities: Children first, seniors last

Issue: Senate has broad funding, broad reach for its target

House limited funding may prevent it from reaching all in its target population

14

Where do we go from here

• Strong starting points

• Work groups will be important

• Both plans can be improved

• MAHP, PMPF and others will be involved

• Watch www.mahp.org and www.putmichiganpeoplefirst.com for updates

15

Insuring the uninsured in MichiganA look at the House and Senate plans

Rick MurdockMichigan Association of Health Plans

Eric SchneidewindAARP

16

National Policy CouncilHEALTH CARE REFORM UPDATE

Washington, DCSeptember 22, 2009

John Rother, Executive Vice President for Policy & Strategy 1

Michigan Long Term Care Supports and Services Advisory Commission

September 28, 2009

Joann Genovich-Richards, PhD, RN

Based on Presentations by John RotherExecutive Vice President for Policy & Strategy




HC Reform Policy Briefing

President Obama’s ConditionsPresident Obama’s Conditions

• Total cost – no more than $900 b (excluding Doc fix)

• No deficit impact, either first or second 10 years

• Also has indicated his support for:– Tying financing to health expenses, so

financing goes up with HC costs – “Closing” doughnut hole– CLASS Act




Chairman Baucus’ Health Reform Proposal and others

Baucus OverBaucus Over--all Approachall Approach

• “Diet” health reform: a foundation to build upon– Less generous benefits and subsidies– Age-rating at 4 to 1– Slower implementation– Less required in revenues– Doughnut hole only partially closed– No LTC– No improvements for Medicare low-income

• However, much of this will be addressed in Committee markup or on the floor, as Finance bill is merged with HELP




Reform Proposals ComparedReform Proposals Compared

10-year estimated government price tag . . .

$900 b

Excludes Doc fix

$774 b-$49 b from deficit

Includes one-yr Doc fix

$990 b

Plus $230 b for Doc payment fix

HC spending growth outpaces overall econ. growth by 2.1% yr. By 2018, will = $4.4 trillion(20.3% GDP)

ObamaBaucusHouseCurrently

Budget Impact � Net reduction in federal budget deficits of

$49 b over 2010–2019. Estimate includes:

COST: net projected $500 b over 10 years for proposed expansions in coverage

• Gross total of $774 b credits/subsidies provided through “exchanges”

– Increased net outlays for Medicaid and Children’s Health Insurance Program (CHIP)

– Tax credits for small employers

Baucus 10Baucus 10--year Financingyear Financing

Source: Sept 16-09 letter from CBO to Chrm Baucus




Budget Impact (Con’t)

� Net reduction in federal budget deficits of $49 b over 2010–2019. Estimate includes:

COST OFFSET by:• $215 b from excise tax on high-premium insurance• $59 b from other revenue sources• $139 b in other tax provisions over 10-yr period. In

subsequent years, collective effect of tax provisions would probably be continued reductions in deficits.

• $409 b over 10 years from a combination of spending changes in Medicare

Source: Sept 16-09 letter from CBO to Chrm Baucus


From Individuals

•Premiums over $8,000 subject to 35% excise tax(About 10% of insured in this category)-Indexed only to CPI-Excise tax revenues likely to grow 15% a year

•Medicare D premiums are income-related for those above $85,000 a year, per person

-Indexing of income-related thresholds suspended for 5 years-Means more retirees each year subject to both Parts B and D income-related premiums





Independent Medicare Commission (IMAC)

•Can recommend changes to provider reimbursements that go into effect automatically unless blocked by Congress

-Trigger, before 2019: Medicare cost per beneficiary growth above formula (“medical inflation” and CPI)

-After 2020: Medicare growth in excess of per capita GDP + 1%

•Cannot modify eligibility or benefits



Requirements on EMPLOYERS . . .

“Pay or play,” no figure

Pay only for low-income employees’ government assistance

8% “pay or play”

No requirements; some regulation of offerings, if offered

Cost to employer: 14% of union payroll, 10% non-union

Expensive access to insurance for small employers







6%

Minimum coverage standards

3%

Minimum coverage standards

15%+ uncovered

Many more with sub-standard coverage

BaucusHouseCurrently

Help for the UNINSURED . . .





4:1 limit2:1 limitAge-rating 3:1 to 5:1 by State regulation, a few 7:1 (NC, FL, TN)

12% of income max

12% of income max

Affordability is continuously eroding


Under-65 AFFORDABILITY . . .

Affordability cont’d


35%30%Cost-sharing: 13% to 30%+

$5,800$5,000Out-of-pocket capNow, none


Under-65 AFFORDABILITY . . . (Cont’d)




Baucus Benefit ChoicesBaucus Benefit Choices

80%“Gold

$5,800CatastrophicUnder 30

76%NoneMedicare A,B,& D65 Plus

90%“Platinum

70%“Silver

65%“Bronze - Mandatory minimum coverage

Over 30

Actuarial Value*

Cap on Cost-sharing

Type of PlanAge Level

P

* “Actuarial value” measures insurance plan’s generosity. It is expressed as percent of medical expenses estimated to be paid by insurer for a standard population and set of allowed charges

Baucus CostBaucus Cost--Sharing ScheduleSharing Schedule

5.5% -10%$2,90030% w/ Silver200%-300%

--(None needed)MEDICAID: broad benefits, no sharing

Below 133% FPL

No restriction$5,80030% w/ BronzeAbove 400%

10% -12%$5,80020% w/ Silver300%-400%

3% - 5.5%$1,93020% w/ Gold 150% -200%

1.5% - 3%$1,93010% w/ Platinum benefits

133%-150%

Premium -% of Income

Cap on Cost-sharing

% of Income to HC Cost-sharing

Income Level





133% FPL

No categorical restrictions

133% FPL

No categorical restrictions

Medicaid, FPL varies by StateEligibility varies by category

No asset testsNo asset testsStrict asset tests

400% FPL400% FPLPremium subsidiesNow, none


Under-65 low-income ASSISTANCE . . .






Close by 2019.

Substantiallyfilled.

New, 50% Rx brand-name discount in gap means as much as $1,700 a year per person in decreased Rx drug costs

Gap filled by 2023.Requires rebates from companies

A gap in any Part D assistance from $2,700 - $6,154 in Rx drug purchase costs


Doughnut hole . . .


$470 b in Medicare savings

New inspection monitoring capacity

$540 b in Medicare savings

New inspection, monitoring capacity

Waste estimated at 10%-30%= $1.5 - $4.5 trillion

Fraud investigation under-funded


Medicare strengthened . . .





Would extend income-relating to Part D and freeze at $85,000 for 5 years

Income-related higher premium for Part B, (over $85,000) indexed for inflation




Yearly “wellness” visit to cover counseling on healthy living

One-time “Introduction to Medicare” physical







No effort to improve help for low-income 65+

All brought up to Part D standard:150% FPL and $17,000 assets

Part DLIS/MSP(Low-Income Subsidy-Medicare Savings Program)


Medicare low-income benefits . . .


Increases Medicare reim. 10% for primary care docs

Expands funding for primary care physicians, and nurses

Increases Medicaid reim. for primary care

Dwindling supply and increased demand for primary care physicians, nurses, and geriatricians


Medicare workforce . . .





Funding and extension for ADRC’s“Money Follows the Person” Rebalancing Demo

CLASS ACT

New financing option & choices for HCBC services

Limited affordable financing options for LTC


Long-Term Care . . .


Not endorsed a specific proposal

No significant Medicaid HCBS provision yet

No significant Medicaid HCBS provisions

HCBS under waivers and state options


Medicaid HCBS . . .




One year Permanent (unfunded)

Fix of physician reimbursement

Number of employees

Payroll sizeSmall business threshold

Excise taxes on high-valuehealth insurance

High-income surcharge

Revenue source

“Co-op”YesPublic Plan

State/RegionalNationalHI “Exchange”

SENATEHOUSEOTHER ISSUES


What do these proposals What do these proposals

mean to our members?mean to our members?




Timing

• Out of all Committees

• House & Senate Conference Committee

• Thanksgiving to end of year

Lydia Brown, 62 - Lydia was recently diagnosed with multiple sclerosis.

- Lydia switched to part-time work due to her diagnosis; her income dropped significantly to $20k a year (slightly below 200% FPL).

- She is too young to qualify for Medicare, still makes too much to qualify for Medicaid, yet can no longer afford her coverage along with high medical co-pays.

- Lydia can purchase coverage through the Exchange. She cannot be denied coverage, and her premiums may not vary based on her medical diagnosis

-With 4:1 age rating, Lydia is faces about $6,081 per year in premiums. With 2:1 age rating, about $4,913 per year

- Because her income is low, she qualifies for premium assistance, she would pay no more than $1,0001 ($1,100)2 yr, or 5%1 (5.5%)2 of her income.

- Lydia would also receive cost-sharing assistance: her max in cost-sharing out-of-pocket for her medical expenses would be $1,933 (2009).

1 Provisions under Finance bill (America’s Healthy Future Act of 2009) as of 09/16/09

2 Provisions under House Energy & Commerce bill with “Blue Dog” amendments as of 09/16/09

BEFORE AFTER




Ingrid Baker, 58

- Ingrid is just diagnosed with breast cancer. After meeting with her doctors, she realizes that she will have to undergo extensive tests and treatment, including chemotherapy.

- Her salary is $40,000 (just below 400% FPL) She will keep working so that she keeps her health insurance.

- Ingrid has NO annual benefit limit

- With 4:1 age-rating, Ingrid pays $5,308 a year in premiums; with 2:1, $4,504 in premiums.- With Exchange coverage, she gets assistance only if premiums exceed $4,800. Then, she pays no more than 12% of income. So, premium help with 4:1 age-rating; none with 2:1 (premiums just below $4,800 yr.)

- With her $40k income, her cost sharing out-of-pocket will cap at $5,8001 ($5,000)2

- With 4:1 rating, and even with premium help, Ingrid’s premium and cost-sharing eat up 26.5%1

(24.5%)2 of income. (With 2:1 rating, almost 26%1(24%)2


2 Provisions under House Energy & Commerce biil with “Blue Dog” amendments as of 09/16/09

BEFORE AFTER

Rob & Diane Reed, both 52 - Rob and Diane run a small cake catering business. Rob works the business full-time, while Diane has a part-time job to supplement their income for a combined annual income of $70,000 (above 400% FPL). Diane has coverage through her employer, but Bob is uninsured.

- Diane has diabetes, needs insulin shots daily. Rob is in fair health.

- If Rob & Diane choose Exchange coverage, no help paying premiums ($70k income well above 400% FLP)

- With 4:1 age-rating, Rob & Diane are looking at $4,618 x 2, or $9,236 a year, in premiums; 2:1, $8,278.

- Since Rob and Diane earn more than 400% FLP, they are also not eligible for cost-sharing assistance. Yet, most they have to pay in cost-sharing out-of-pocket is $11,6001

($10,000)2 for family coverage.

- With 4:1 rating, they would spend $21k or 30%1 (27.5%)2 of their income on premiums and cost-sharing. With 2:1 rating, Rob and Diane would spend almost $20k or 28%1 (26%)2.


2 Provisions under House Energy & Commerce bill with “Blue Dog” amendments as of 09/16/09

BEFORE AFTER




Health Care Reform

Policy Proposals

DISCUSSION

CQToday, Thursday, September 17, 2009 Page 27

Provisions of Health Care Overhaul Bills ComparedThe bill introduced by Senate Finance Chairman Max Baucus, D-Mont., would cost $774 billion over 10 years, and, according to Baucus, be fully offset. All House and Senate versions of the bill would allow the purchase of insurance through exchange markets, bar lifetime limits on health care benefits, and prohibit denial of coverage based on pre-existing conditions. However, there are major differences among the bills.

Senate verSionSHouSe verSionS

Three House committees marked up the same legislation (HR 3200)

Ways and Means approved July 17

education and Labor approved July 17

energy and Commerce approved July 31

Senate Finance proposed Sept. 16

Health, education Labor and Pensions

approved July 15

employer mandatePenalizes employers who don’t offer insurance

No. Starting in 2013, employers with more than 50 workers must repay the government for tax credits for employees.

Yes; exempts employers with 25 or fewer employees.

Yes; exempts employers with pay-roll under $250,000



Fines Would be adminis-tered to those who don’t get insurance

Yes; includes hardship exemption

Yes; includes hard-ship exemption for those unable to find affordable coverage

Yes; includes hardship exemption

Yes; includes hard-ship exemption

Yes; includes hard-ship exemption

individual mandateRequires everyone to have health insurance

Yes, with exceptions Yes Yes Yes Yes

offsets See box, p. 26 Not specified Combination of surtax on wealthy Americans and cost cuts within programs such as Medicare

Not specified Not specified

‘Public option’ A government-run health insurance plan designed to compete with private insurers

No. Proposes nonprofit, consumer-owned co-operatives that wouldoffer alternatives to existing insurance plans.

Yes; the government would negotiate payment rates with health care providers

Yes. Public option provider rates would be 5 percent higher than Medicare rates for the first three years. After that, the administration would set rates.

Yes. Public option provider rates would be 5 percent higher than Medicare rates for the first three years. After that, the administration would set rates.

Yes; the government would negotiate payment rates with health care providers

Subsidies Government funds to assist in the purchase of health insurance

Yes. Would give tax credits to small businesses and low and middle-income families; undocumented immigrants ineligible

Yes Yes Yes Yes; lower subsidies for low-income families than other House versions

other n Expands Medicaid to those at 133 percent be-low poverty level or less

n Medicare would reward providers and hospitals for quality caren Low- to moderate- income Part D recipients would pay half price for brand-name drugs during “donut hole” gap in coveragen Individual or small- employer policies must offer certain coverage and meet requirements of one of four benefit categories

n 12 years of data exclusivity for biologic drugsn Emphasizes prevention and wellnessn Voluntary insurance program for community- based assisted-living services

n Emphasizes prevention and wellness

n Opens insurance exchange to families that spend more than 11 percent of their income on health care, to some retirees, and to more small businesses

n 12 years of data exclusivity for biologic drugs

n Authorizes government to negotiate prices for Medicare Part D prescription drugs

Page 26� CQToday, Thursday,�September�17,�2009

n Starting�in�2013,�charges�a�non-deductible�35�percent�excise�tax�on�insurance�compa-nies�and�administrators�for�plans�costing�more�than�$8,000�a�year�for�individuals�and�$21,000�a�year�for�families.�The�tax�would�apply�to�the�amount�of�the�premium�in�ex-cess�of�the�threshold.�

n Beginning�in�2010,�imposes�annual�flat�fees�on�insurance�companies�($6�billion),�pharma-ceutical�manufacturers�($2.3�billion),�makers�of�medical�devices�($4�billion)�and�clinical�laboratories�($750�million),�allocated�accord-ing�to�market�share.

n Limits�flexible�spending�account�contribu-tions�to�$2,000�per�year,�beginning�2013.

Senate Finance Bill Offsets