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Specific Provision |Affordable Care Act (current law ACA) |Better Way (Speaker Paul Ryan) |Patient CARE Act (Senator Hatch, Chairman Senate Finance Committee) |Empowering Patients First Act (HHS Sec. Tom Price, MD - (114th Congress proposal) |Improving Health and Health Care: An Agenda for Reform (American Enterprise Institute) |Government for People Again: Health (Candidate Donald Trump - 2016) |Transcending Obamacare (Foundation for Research on Equal Opportunity) (Avik Roy) |A Fresh Start for Health Care Reform (Heritage) |American Health Care Reform Act (RSC) |House Republican Leadership Draft Proposal (2/10/17 reconciliation)* |Republican Governors Association Medicaid Task Force (2/24/17 draft)** | |Use of health insurance exchanges |√

| | | |√

state option | | | | |√ | | |Essential Health Benefits |√

| | | | | |√

modi-fies; keeps

ACA metal tiers | | |√

states

set EHBs

starting

in 2020 | | |Premium and cost-sharing reductions (CSRs) |√

| | | |√

grand

father

those

in ACA | |√

CSRs

morph to HSAs | | |√

Ends after 2019 but no approps for 2017-19 | | |Refundable tax credits for individual market |√

|√ |√

up to 300% FPL |√

age-based, may opt out of M/M and use |√ | |√

up to 317% FPL | |√

(above the line vs. credit)

$7,500

ind.,

$20.5k

family

|√

Ranges from $2,000 to $4,000 based on age; family cap of $14,000 | | |Individual Mandate |√ | | | | | | | | |√

replaces

with

penalty equal to 30% of premium | | |Open enrollment |√

|√

one

time |√

one

time

for

unin-

sured |√

at least every

two

years | | |√

every two years | | |√ | | |Default health plan equal to tax credit (may include opt out) | | |√ | |√ | |√ | | | | | |

HSA reforms | |

√ |

√ |

√

much

more

flex-ible |

√

use for

M/M

too | |

√ |

√ |

√ |

√

Raises annual HSA limit to deductible, OOP maximum | | |3R’s – reinsurance, risk corridors, and risk adjustment |√ | | | | | | | | | | | |Employer Mandate |√ | | | | | | | | | | | |Cap tax exclusion for employer-sponsored coverage | |√

COLA based on geog. |√

$12k ind., $30k fam |√

$8k ind., $20k fam |√

base on Cad. Tax % |√

may

occur

in tax

reform |√

base on Cad. Tax % |√

base

Cad.

Tax %,

apply

to cost

of plan | |√

Caps beginning 2019; excess amount taxable as gross income | | |Insurance regulations on: | | | | | | | | | | | | | Rating initial policy based on health status |√ |√ |√ |√ |√ |√ |√ | | | | | | Age-Rating |√

3:1 |√

5:1 |√

5:1 | | | |√

6:1 | | |√

5:1 | | | Gender-Rating |√ | | | | | |√ | | | | | | Stay on family coverage to age 26 |√ |√ |√ | | |√ | | | | | | | Lifetime limits prohibited |√ |√ |√ | | | |√ | | | | | | Prohibited from rescinding coverage, except

cases of fraud |√ |√ |√ | | | | | | | | | | Guaranteed renewability with pre-existing conditions |√ |√ |√ | |√ |√ | |√ |√ | | | | Cover certain preventive services with no cost-sharing |√ | | | | | | | | | | | | Review of increases in insurance premiums |√ | | | | | | | | | | | | Medical Loss Ratio of 80% |√ | | | | | | | | | | | | Allow higher premium for non-continuous coverage |√ |√ |√ |√ |√ | | | |√ |√ | | | Continuous coverage protection (portability) |√ |√ |√ |√ |√ | | |√ |√ |√ | | | Grandfathered Plan status | | | | | | | | | |√

plans offering individual market coverage from 1/1/13 through 1/1/17 may continue it or pre-ACA coverage off Exchange | | | Special Enrollment Period restrictions | | | | | | | | | |√ | | |Expansion of Medicaid |√ | | | |√

grand

father

those

under

ACA | | | | |√

ends after 2019 | | |Medicaid reform | |√ |√ | |√ |√ |√

move

non-

LTC to

ind.

mkt | | |√ |√ | | Financing reforms (per capita cap, block grant) | |√ |√ | |√ | |√ |√ | |√

per capita cap with FY16 base year,

CPI adjust;

annual target by coverage population |√

state option of per-capita cap or block grant; cap phased in by population; block grant switch FMAP to MOE by population; LTSS, other services split into Part A, B, C | | Expansion vs. Non-expansion Equity | | | | | | | | | | |√

Expansion states could keep enhanced FFP at/below 100-138%;

Non-expansion states option to expand at/below 100-138% with enhanced FFP | | State flexibility (benefits, premiums, etc.) | |√ |√ | |√ | |√ | | | |√

| | Service Delivery reforms | | | | | | | | | | |√

state option to enroll all populations managed care | | Provider Payments | | | | | | | | | | |√

state option to use value based purchasing | | 100% FMAP for data reporting systems | | | | | | | | | |√

FY18, 19 | | | Medicaid opt-out | | |√ | | | | |√ | | | | |CHIP continuation | |√ | | | | | | | | | | |Taxes | | | | | | | | | | | | | Cadillac Tax |√ | | | | | | | | | | | | Health Issuer Tax |√ | | | | | | | | | | | | Medical Device Tax |√ | | | | | | | | | | | |Sell across state lines | |√ |√ |√ | |√ | |√ |√ | | | |Association health plans for small businesses | |√ |√ |√ | | |√ | |√ | | | |High-risk pools | |√

$25b |√ |√

$3b |√

$10b |√ | | |√

$25b

cap

prem.

200%

state

avg.

|√

State Innovation Grants and Stability Program

2018-26; approps $100b;

expedites relief for 2018-19 based on mkt need | | |Market Stabilization Incentives | | | | | | | | | |√

SIGSP incentives for

ind/small group markets, preventive care, dental,

OOP assistance | | |Medicare reform | | √ | | |√ |√ |√ | | | | | | Premium support | |√ | | |√ | |√ |√ | | | | | Medigap reform | |√ | | |√ | |√ | | | | | | Means test benefits | | | | | | |√ |√ | | | | | Combine Parts A&B | |√ | | |√ | |√ |√ | | | | | Uncompensated care reform | |√ | | | | | | | | | | | Allow MA value based design | |√ | | | | | | | | | | | | | | | | | | | | | | | |Medical malpractice reforms | |√ |√ |√ | | |√ |√ |√ | | | |

Sources:

Better Way (Speaker Paul Ryan)

Patient CARE Act (Senator Hatch)

Empowering Patients First Act (Rep. Tom Price)

Health Care Choice Act (Senator Ted Cruz)

Improving Health and Health Care: An Agenda for Reform (American Enterprise Institute)

Government for People Again: Health (President-elect Donald Trump)

Transcending Obamacare (The Foundation for Research on Equal Opportunity) (Avik Roy)

A Fresh Start for Health Care Reform (Heritage)

American Health Care Reform Act (Republican Study Committee)

*Link not available at this time. Also note: House Leadership draft does not contain non-reconciliation replacement items

**Link not available at this time. RGA task force proposal is limited to Medicaid-related issues

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