Comparison of Features in Major Health Care Reform Proposals
7/19/03 2:10 PM

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1) Family of 4 or more get $3000 tax “credit” if income is under $25K/year, gradually phased out for families with incomes up to $60K

2) Tax credits of up to 50% for small business and employees to buy health insurance

3) Expanded aid to support state initiatives and individuals not covered by mandatory employment insurance

4) $176B to the states to expand Medicaid and S-CHIP

5) Plan would cover all children and parents with household incomes up to 300% of the federal poverty level, or $55,200 for a family of four,

6) Children to age 25 in families up to $54K income, initially $67B annually to expand S-CHIP

7) Everyone under age 65 with incomes below 185% of poverty in new “Family and Children Health Insurance Plan” (replaces acute care Medicaid)

8) “Expand” assistance to the states (no more specifics at this time)

9) Graham would incrementally add to S-CHIP, then low income families, and then to “near elderly”

10) Doubles employer tax credit for employee health insurance from 30% to 60% of costs; mandates employers carry employee health insurance

11) Tax credits to small employers (50 or fewer employees)

12) Employers would have “contribute” to laid-off employee COBRA coverage for 2 months, after that tax credits would cover up to 70% of the COBRA costs

13) Revokes tax credits for larger employers NOT offering health insurance

14) Divide Medicare into three parts: traditional, “Enhanced Medicare” (PPO) and “Medicare Advantage” (HMO) – starting in 2006

15) Seniors get two options: traditional Medicare or "Medicare Advantage" (“private” PPOs and HMOs) offering catastrophic coverage and preventive care

16)Seniors in PPO/HMOs pay a single $400 annual deductible for all care, compared w/$840 for hospitals and $100 for doctors for seniors in traditional Medicare

17) House suggests they will build “incentives” to encourage seniors to leave traditional Medicare and go to “private” HMOs and PPOs – “incentives” not yet identified

18) Gephardt estimates 97% of the people would be covered by his plan

19) Kerry estimates coverage to 95% of all adults, and “virtually every” child

20) Insurers offer FEHBP “model” plans, individuals pay max of 7.5% of AGI, tax credits to pay for the rest

21) Dean says 31M of the 41M uninsured will “opt” in

22) Kucinich estimates 100% coverage of all American residents

23) “Traditional Medicare” beneficiaries would get limited Rx; “Enhanced Medicare” get (and pay for) more; “Medicare Advantage” may or may not get Rx depending upon plan

24) On June 9, the White House announced that it would accept an Rx plan that equalized drug benefits for all Medicare recipients, see note #31 below

25) Plan would “remove barriers” to generic drugs and disallow efforts by PhRMAs to bar generic drugs from the marketplace

26) Open disclosure of PBM practices and discounts

27) Promote generics, allow re-importation from Canada

28) Under the bill, for a $25 monthly premium, seniors would have a $10 co-pay for generic drugs and $40 for brand names.

29) Lieberman proposes “cooperative efforts” between government and PhRMA research, with the government sharing in royalties

30) Plan would purchase prescription drugs “in bulk” for distribution through single-payer mechanism

31) Seniors would get Rx benefit but must pay a $35 monthly fee and a $275 annual deductible (Senate version) or $250 deductible (House version)

32) Seniors pay half of annual Rx costs up to $4,500 and all Rx costs between $4,501 and $5,800, after $5,800, seniors pay 10% of Rx costs, Medicare pays the remainder

33) Rx Insurance pays 80% of their drug costs from $251-to $2,000; no coverage for $2,001-$5,100; when out-of-pocket spending hits $3,700, 90% of all drug costs covered

34) Association Health Plans and expanded MSAs; roll-over “flex-spending” accounts

35) Plans would allow the “near-elderly” to buy into Medicare between the ages of 56-64

36) The president supports HR 5, which would cap judgments, shorten statutes of limitations, and limit attorney’s fees

37) Non-binding mediation, pre-review by a board of physicians, no punitive damages, except in egregious cases

38) “Encourage” FEHBP “model” plans

39) Takes catastrophic care (over $50K a year) from private system; government which would pay 75% of excess, employers must reduce employee share of costs

40) “Quality bonuses” to help prevent medical errors; financial incentives for e-Rx and for “modern” information systems to reduce errors and improve efficiency

41) Expand “patients’ rights” and hold HMOs accountable

42) Lieberman proposes spending $150B/10 years to more efficiently treat chronic illnesses, saving from the $750B currently spent yearly on these cases

43) Using a "systems approach" to reduce medical errors, encourage innovation, include coverage for new procedures; and reduce "bureaucracy and paperwork."

44) Estimated annual savings of $100B to offset cost of program

45) Nationwide federal government-run “single-payer” system, eliminates private health insurance

46) Tom Scully, CM2 administrator, says PPOs will reduce overall Medicare expenditures by $22B over 10 years

47) To be partially financed by the repeal of ALL the 2001 tax cuts

48) To help pay for his proposal, Kerry would “freeze” tax cuts for the highest brackets and “roll-back” any cuts passed this year

49) To be partially financed by repeal of some unspecified scheduled future tax cuts

50) Neither Edwards or Graham have provided an estimate of the costs of their proposals

51) Lieberman says his proposal will save a net of $600B through reduced costs for the treatment of chronic diseases

52) You read it right — $20 TRILLION — partially offset by the $1 trillion currently being spent by state and federal payers. I have left Kucinich in for comparison purposes

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