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Core Components of U.S. Health Care System Reform

A comprehensive set of insurance, payment, and system reforms are being considered in the House and Senate as potential options to help guarantee more affordable health insurance coverage, improved health outcomes, and to slow the growth of health spending. The following is a chart reflecting the core issues and how they currently are being addressed in the Committees:

Core Issues	Senate Help	Senate Finance	House Bill
Public Plan Option	Yes (through exchange) Requires negotiated rates paid to providers	Somewhat (through private, non-profit cooperatives) Negotiated rates	Yes (through exchange) Requires negotiated rates paid to providers.
Insurance Market Regulations¹	Yes	Yes	Yes
Insurance Exchange	Yes (Gateway)	Yes (Co-op)	Yes
Individual Mandate	Yes	Yes	Yes
Employer Mandate (Pay or Play)	Yes Minimum coverage, employer contribution & plan actuarial value (76%) $750/$375 penalty.	Somewhat (Free-Rider fee, capped) No minimum coverage. Indirect contribution & actuarial value (65%) standards	Yes Minimum coverage, employer contribution & plan actuarial value (70%) 8% payroll penalty, including for opt-outs.
Medicaid/CHIP Expansion	Yes	Yes	Yes
Small Business Tax Credits	No	Yes	Yes
Low Income Subsidies	Yes	Yes	Yes
Revenue Raisers/Excise Tax	No (no jurisdiction over tax policy)	Yes – high cost plan tax. $8,000/$21,000. $9,850/$26,000 retirees & high risk occupations. Indexed by CPI +1. High cost states schedule. Tax on employer retireed drug subsidies, in 2011. W-2 reporting on value of health benefits, in 2010. $2,500 FSA cap, in 2011. HAS penalty increased to 20%, in 2011. Restricts use of HSAs, FSAs, HRAs for over-the-counter drugs, in 2010. Annual fees on insurers, medical devices, pharmaceuticals, in 2010. Comparative effectiveness premium tax.	Yes- yielded from high income taxpayers. Surtax on high earners, $500,000 single, $1 million joint. Tax on employer retiree drug subsidies, in 2013. $2500 FSA cap, in 2013. HAS penalty increased to 20%. Restricts use of HSAs, FSAs,HRAs for over-the-counter drugs. 2.5% excise tax on medical devices. Fees on plan sponsores used to fund comparative effectiveness. Tax parity for domestic partners/other non-dependents.
ERISA Protection	Yes, retains ERISA preemption framework	Somewhat- retains ERISA preemption framework. Broad state waivers, but limited to HHS authority.	No- state remedies in exchange. Limits on changes to retiree health plans.
Minimum Benefit Standard	Yes	Yes	Yes
Comparative Effectiveness Research Funding	Yes	Yes	Yes

¹Examples include guaranteed issue, guaranteed renewal, no pre-existing condition exclusions, preventive services cost-sharing, annual or lifetime dollar limits ,timely claims payment, etc.)