March 19, 2010
- COST: $940 billion over 10 years, with deficit reduction pegged at $138 billion.
- COVERAGE: Major expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today. That would add coverage for 32 million Americans.
- INSURANCE MANDATE: Starting in 2014, everyone is required to be insured or else pay a fine, with an exemption for low-income people.
- MARKET REFORMS: Major consumer safeguards take effect in 2014, including prohibiting insurers from denying coverage to people with medical problems and prohibiting higher premiums for women. Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies and from denying coverage to children because of preexisting medical problems. Parents would be able to keep children on their policies up to age 26.
- MEDICAID: The program for the poor would expand to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. A special deal to give Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity is eliminated. Massachusetts, which already provides Medicaid to a broader group of low-income people than other states, would receive an additional $2 billion over the next 10 years to help cover patients. The federal reimbursement for the Bay State would increase to 75 percent in 2014, from 50 percent. After 2020, Massachusetts will be reimbursed for Medicaid costs in line with other states, with the federal government subsidizing 90 percent of cost.
- TAXES: New bill dramatically scales back a Senate-passed tax on high-cost insurance plans. Dubbed the Cadillac tax, it would be delayed until 2018, with thresholds at $10,200 for individuals and $27,500 for families. The tax would affect 8,600 people in Massachusetts, out of 6.2 million insured. To make up for the lost revenue, the bill applies an increased Medicare payroll tax to investment income, as well as wages for individuals making more than $200,000 or couples above $250,000. The tax on investment income would be 3.8 percent.
- PRESCRIPTION DRUGS: The “doughnut hole’’ coverage gap in the Medicare drug benefit for seniors would be gradually closed, with elimination in 2020. This would ease costs for 80,700 seniors in Massachusetts, which had its own program to help seniors cover the gap but canceled it last year because of budget cuts.
- EMPLOYER: As in the Senate bill, businesses are not required to offer coverage. Instead, employers are hit with a fee if the government subsidizes their workers’ coverage. Companies with 50 or fewer workers are exempt from the requirement.
- SUBSIDIES: The proposal provides more generous tax credits for purchasing insurance than the Senate bill. The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income.
- GOP HEALTH CARE IDEAS: Following the bipartisan health care summit, President Obama said he was open to incorporating Republican ideas in his legislation. But two of the principal ones — hiring investigators to pose as patients and search for fraud at hospitals and increasing spending for medical malpractice overhaul initiatives — did not make it into the bill released yesterday. Only one did, an increase in payments to primary care physicians under Medicaid, proposed by Senator Charles Grassley, Republican of Iowa.
SOURCES: Associated Press, office of Senator John F. Kerry
