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Health Care Reform: Legislative Proposals

Final Bills

• Reconciliation

Legislative Language

• Health Care and Education Affordability Reconciliation Act of 2010. The reconciliation bill makes changes to the Patient Protection and Affordable Care Act, including the subsidy structure and the Medicaid matching rate.
  

Congressional Budget Office Cost Estimates

• HR 4872: Reconciliation Act of 2010 (March 18, 2010)
  

• Senate

Legislative Language

• Patient Protection and Affordable Care Act (As passed December 24, 2009).The bill expands Medicaid eligibility levels to 133% of the FPL for individuals and families. It would also provide affordability credits on a sliding scale up to 400% of the FPL for the purchase of coverage on a new health insurance exchange. Children enrolled in CHIP would remain in the program.
• Roll Call Vote
  
• Manager's Amendment (December 19, 2009).

CCF Fact Sheets

• Key Medicaid, CHIP, and Low-Income Provisions in the Final Senate Bill (December 24, 2009)
• Key Medicaid, CHIP, and Low-Income Provisions in the Merged Senate Bill (December 3, 2009)
  

Congressional Budget Office Cost Estimates

• HR 3590: The Patient Protection and Affordable Care Act (March 11, 2010)
  
• HR 3590: The Patient Protection and Affordable Care Act, Incorporating the Manager's Amendment (December 19, 2009)
• HR 3590: The Patient Protection and Affordable Care Act (November 18, 2009)

House

Legislative Language

• Affordable Health Care for America Act (HR 3962) (As passed November 7, 2009). The bill expands Medicaid eligibility levels to 150% of the FPL for individuals and families. It would also provide affordability credits on a sliding scale up to 400% of the FPL for the purchase of coverage on a new health insurance exchange. CHIP-eligible children would move to the Exchange in 2014.
• Roll Call Vote
• Manager's Amendment to HR 3962 Offered by Mr. Dingell of Michigan (November 4, 2009)

CCF Fact Sheets

• Key Medicaid, CHIP, and Low-Income Provisions in HR 3962 (November 4, 2009)

Congressional Budget Office Cost Estimates

• Revised Cost Estimate of HR 3962: Affordable Health Care for America Act (November 20, 2009)
  

Republican Substitute Amendment

• Amendment in the Nature of a Substitute to HR 3962 Offered by Mr. Boehner of Ohio (November 4, 2009). The bill would institute regulatory reforms in the small and non-group insurance market, provide federal funding for state high-risk pools, make changes to health savings accounts, and provide incentive payments to states for reducing the number of uninsured.
• Congressional Budget Office, Preliminary Analysis of a Substitute Amendment to HR 3962

Senate Finance Committee Proposals

• America's Healthy Future Act of 2009 (October 19, 2009). Legislative language reflecting the amended Chairman's Mark.


• Chairman's Mark as Amended - America's Healthy Future Act of 2009 (October 2, 2009). A number of amendments accepted in the Mark affect children and families, including an amendment by Senator Rockefeller that requires states to continue CHIP through 2019 and maintain existing Medicaid coverage for children.
  Congressional Budget Office: Preliminary Analysis of the Chairman's Mark for the America's Healthy Future Act, as Amended (October 7, 2009)
  


• Chairman's Mark - America's Healthy Future Act of 2009. Medicaid would be expanded to 133% FPL and families and individuals earning up to 400% FPL would be eligible for sliding scale tax credits to help offset the cost of premiums. Children in CHIP would move to exchange coverage, with a CHIP wrap, beginning in 2013.
Modifications to the Chairman's Mark (September 22, 2009)
FMAP Estimates used by the Senate Finance Committee during markup
Congressional Budget Office: Preliminary Analysis of Specifications for the Chairman's Mark of the America's Healthy Future Act (September 16, 2009)


• Framework for Comprehensive Health Reform. Medicaid would be expanded to 133% FPL and families and individuals earning up to 400% FPL would be eligible for sliding scale tax credits to help offset the cost of premiums. Children in CHIP would move to exchange coverage, with a CHIP wrap, beginning in 2013.
  


• Financing Comprehensive Health Care Reform. Three areas of potential funding sources are: savings from reductions in current health spending, current health tax subsidies, and changing non‐health tax provisions.
  
  
• Expanding Health Care Coverage. Options for providing health coverage include reforming the individual and small group markets, expanding public health insurance programs, and making coverage more affordable through tax credits.
  CCF Summary: Preliminary Review of Key Provisions Affecting Children, Families and Low-Income People
  


• Transforming the Health Care Delivery System. This proposal outlines ways to revise payment systems and policies within Medicare by promoting higher-quality care and reducing fraud and abuse.
  


• Call to Action: Health Reform 2009. Sen. Baucus would establish a national minimum eligibility level in Medicaid at 100% FPL for adults and in CHIP at 250% FPL for children. He also calls for strengthening the employer-based system and establishing a Health Insurance Exchange.
  
CCF Fact Sheet: Call to Action: Health Reform 2009

Senate Health, Education, Labor, and Pensions Committee Proposals

• Affordable Health Choices Act. This amendment includes legislative language for a public insurance option and enhanced employer responsibility.
  
Congressional Budget Office: Preliminary Analysis of the HELP Committee's Health Insurance Coverage Provisions


• Affordable Health Choices Act. The bill would extend Medicaid eligibility to those with incomes up to 150% FPL and establish state-based health insurance exchanges, with subsidies to help purchase coverage for those with income up to 500% FPL.
CCF Summary: Senate HELP Committee Affordable Health Choices Act - Overview and Implications for Children


• A New Vision for American Health Care: Strengthening What Works and Fixing What Doesn't. This "unofficial" summary suggests that a HELP plan would expand Medicaid to 150% FPL and provide subsidies people earning up to 500% FPL to purchase insurance through state-based insurance exchanges.
  

Tri-Committee House Proposals

• America's Affordable Health Choices Act of 2009. The updated draft released by the three committees on July 14, 2009.
  
CCF Fact Sheet: Key Medicaid, CHIP, and Low-Income Provisions in the House Tri-Committee Health Reform Bill
Congressional Budget Office: Cost Estimate of H.R. 3200, America's Affordable Health Choices Act of 2009



• Health Care Reform Discussion Draft. The draft proposal would increase Medicaid for individuals and families up to 133% of the FPL and "affordability credits" on a sliding scale to individuals and families with incomes up to 400% of the FPL for the purchase of coverage on a new Health Insurance Exchange.
  CCF Fact Sheet: Key Medicaid, CHIP, and Low-Income Provisions in the House Tri-Committee Health Reform Bill
  



• Tri-Committee Health Reform Draft Proposal. The outline from the House Committees on Ways and Means, Energy and Commerce, and Education and Labor, seeks to ensure affordability and access by expanding Medicaid and providing subsidies to purchase coverage for individuals and families up to 400% FPL.

President Obama's Proposals

• Letter to Congressional Leadership. Following the health reform summit, the President released this letter outlining four Republican proposals he is exploring.
  


• President Obama's Proposal. President Obama's health reform plan sets the stage for the bipartisan health reform summit the White House and builds on bills passed by the Senate and House.
CCF Fact Sheet: President Obama's Health Care Reform Proposal: Key Medicaid, CHIP, and Low-Income Provisions

• Letter to Senators Kennedy and Baucus. Obama further outlines what he would like to see in health care reform.
  


• 2010 Budget Proposal. In his FY 2010 budget, President Obama establishes a reserve fund of $634 billion to help finance health reform and laid out eight broad principles for reform.


• Plan for a Healthy America. As a candidate, President Obama released a plan to provide additional coverage through a National Health Insurance Exchange and expanded eligibility in Medicaid and CHIP.
  

  Urban Institute Analysis: An Analysis of the Obama Health Care Proposal
  

Other Proposals

• Republican Study Committee - Empowering Patients First Act. This proposal would provide a refundable tax credit for low-income individuals to purchase coverage in the non-group market. Medicaid and CHIP beneficiaries would be given the option of using a voucher to purchase private coverage.
  


• Representative Matsui (D-CA) - Strengthening Medicaid for America's Children Act of 2009. This bill would enhance the states' FMAP for Medicaid children if the state meets certain requirements.


• Senator Wyden (D-OR) and Senator Bennett (R-UT) - The Healthy Americans Act. This plan eliminates coverage under governmental programs and requires families to purchase private coverage through a state-based Health Help Agency.
  
Center on Budget and Policy Priorities Analysis: An Examination of the Wyden-Bennett Health Reform Plan


• Senator Burr (R-NC), Senator Coburn (R-OK), Representative Ryan (R-WI), and Representative Nunes (R-CA) - The Patient's Choice Act. The plan would provide a refundable tax credit to buy a private plan, with Medicaid continuing to cover individuals with disabilities.
  
  
• As health reform is debated at the federal level, many of the solutions being discussed are based on the recent Massachusetts health reform efforts.