NCPPR-HealthPlanSummaries.xlsx
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Name of Health Care Reform PlanTax Credit/DeductionEmployer-Based Tax ExclusionPre-Existing ConditionsDefinition of InsuranceHSAsMedicaidMedicareMedical Liability/Legal Reforms SubsidiesMandatesOther distinguishing characteristics
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National Center for Public Policy ResearchRefundable tax credit of $900 for those under age 18, $1,200 ages 18-34, $2,100 ages 35-49, $3,000 over age 49 for the purchase of insurance.Employers can stay with current system, or switch to a system of "large HSAs." See description under HSAs for deposit amounts and tax reductions.Allow individuals to put money into large HSAs for the purchase of insurance and health care. Amount that people can deposit is three times amount of the tax credit. So, $2,700 can be deposited for those under age 18, $3,600 ages 18-34, $6,300 ages 35-49, $9,000 over age 49. The amount individuals can deduct from their taxes is the same amount as the tax credit. For a person who deposits less than the full amount into a large HSA, he receives a percentage of the tax deduction based on how much he put in. So, if a person age 35 puts in $1,800, or 50% of the total he can deposit, he receives 50% of the tax deduction, or $900.Reform Medicaid into a block grant program. Use Medicaid to help fund the refundable tax credit. For people who leave Medicaid to make use of the tax credit, Medicaid will be reduced by the amount of the tax credit.
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Governor Scott Walker, "Patient Freedom Plan"Refundable tax credit of $900 for those under age 18, $1,200 ages 18-34, $2,100 ages 35-49, $3,000 over age 49 for the purchase of insurance.No change.People who remain continuously insured will not be required to pay higher premiums should they develop a costly health condition. No exact time period given.No definition given.Gives individuals a one-time tax credit of $1,000 for having or opening an HSA. Limits on annual controbutions to HSAs expanded to $6,250 for individual, $12,000 for family. Breaks Medicaid up into three smaller programs: Medical Assistance for Need Families (MANF); accute care for the disabled and low-income seniors; long-term services for the disabled and low-income seniors. Both MANF and the long-term services program would give capped allotments to the states. The accute care program would retain the current matching sytem.NoneIncentivize states to pass meaningful lawsuit reform. Incentivize them how or with what, plan does not say.Funding to states for people with pre-exsiting conditions who don't have insurance.None.Allows across-state purchase of insurance. Deregulates the Long-Term Care insurance market to make such insurance more affordable.
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Senator Marco Rubio's PlanRefundable tax credit. Amount of tax credit not given.Tax exclusion will change gradually so that at the end of ten years it will be equal to the level of the tax credit.State high-risk pools that are federally supported.No definition given.Says HSAs should be "encouraged and expanded" but gives no specifics.Change Medicaid into a per-capita block grant system and give states greater freedom in running their Medicaid programs.Premium support for private plans.None.See high-risk pools.None.Allows across-state purchase of insurance.
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2017 Project, "A Winning Alternative To ObamaCare."Refundable tax credit of $1,200 for those under age 35; $2,100 for those between 35 and 50; $3,000 for those over 50; $900 per child for the purchase of insurance.Caps exclusion at $8,000 for an individual and $20,000 for a family plan.Those who remain continuously insured for at least one year will not be required to pay higher premiums should they develop a costly health condition.Insurance must be bought from a licensed and solvent insurer and must have reasonably high or nonexistent annual and lifetime caps on coverage.When tax credit exceeds amount of health insurance premiums the excess would go into an HSA. Also, gives individuals a one-time tax credit of $1,000 for having or opening an HSA.Medicaid recipients who are part of the ObamaCare Medicaid expansion would receive refundable tax credits automatically. Others on Medicaid would have option of staying on Medicaid or taking the tax credit.The study calls Medicare reform a "tangential issue" as it pertains to ObamaCare. Opposes using the Medicare cuts in ObamaCare for other purposes.State should consider capping non-economic damages at $250,000. States could replace 12-man juries with smaller medical malpractice tribunals composed of medical experts.None.None.
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James Capretta, Ethics and Public Policy Center, "Health-Care Reform to Lower Cost and Improve Access and Quality."Refundable tax credit of $1,200 for those under age 35; $2,100 for those between 35 and 50; $3,000 for those over 50; $900 per child for the purchase of insurance.Caps the employer deduction at the cost of the plan at the 75th percentile of employer-based plans. Above that is taxed at marginal rate.People who remain continuously insured will not be required to pay higher premiums should they develop a costly health condition. No exact time period given.Tax credits can be used for state-approved insurance, with one federal rule: there must be an out-of-pocket maximum for necessary care.When the age-adjusted tax credit for an individual without employer coverage exceeds their premium, the excess would go into an HSA.Medicaid recipients take the base part of the entitlement as a federal tax credit. States would receive per capita funding, not matching federal funds, and allow enrollees to use their credits, and funding provided by the State, to buy same coverage as workers on individual market.Advocates a separate bill to restore the cuts ($700 Billion) made to Medicare Advantage, and to hospital payment systems. Long-term, wants to reform Medicare using a premium support model.NoneNone.None.
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Heritage Foundation, "A Fresh Start for Health Care Reform."A new tax option to which all individuals have access. Over time, replaces the employer-based tax exclusion.Caps the employer-based deduction and indexes it down over time, as take up increases for the new tax option.Extend HIPAA regulations that govern group markets to individual market.No definitionThis plan would allow for individauls including Medicare beneficiaries to set up HSAs.Let Medicaid enrollees use Medicaid money to purchase private plans. States can supplement.Premiums support to buy private plans. Increases premiums for Part B and D. Combines part A and B so that there is one deductible.Endorses legal reform but does not specify.None.NoneInstitutes a Part A premium in any year that the Medicare HI Trust Fund is running a deficit. It also proposes reassigning the "wrap around" coverage for low-income seniors by adding it to their premium support, and advocates removing statutory restrictions on Medicare private contracting.
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Avik Roy, Manhattan Institute, "Transcending ObamaCare."See HSAs.Keeps the ObamaCare Cadillac Tax or puts a cap on the employer-based tax exclusion.Maintains ObamaCare's guaranteed issue regulations.Vague, although health insurance would have to have some "essential benefits." Goal is to liberalize the definition as much as possible.Converts ObamaCare exchange subsidies into contributions to HSAs.Let Medicaid take care of long-term care. Give state full autonomy to offer long-term care benefits to the Medicaid population in the way states see fit. Move Medicaid acute care into private insurance. Increase the Medicare eligibility age by four months every year in perpetuity. This changes Medicare into a program that primarily takes care of people in their last years. Makes Medicare trust fund solvent.Cap damages for people on a federal program such as Medicaid, Medicare, etc. $250,000 for economic damages; $500,000 for punitive.Keeps most of ObamaCare subsidies for those up 317% of the federal poverty level. Reduces the "subsidy cliff"--the rise in premiums once an individual crosses the income level at which subsidies stop--from $495 under ObamaCare to $112.Maintains Obamacare's guaranteed issue.Roy's reform works either as repeal-and-replace, or as a transition away from Obamacare into a better system.
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Bobby Jindal, America Next, "The Freedom and Empowerment Plan: The Prescription for Conservative Consumer-Focused Health Reform."Standard tax deduction for health insurance.Replaced with standard tax deduction.Individual must maintain continuous coverage, but does not say for how long.No definitionLink HSA to the size of deductible; Allow more flexibility in what can be purchased with HASBlock grant to the statesPremium support for private plansCaps on non-economic damages and attorney contingency fees.$100 billion over ten years to the states to fund subsidies for people under 150% FPL to purchase insurance."Guaranteed renewability" would be mandated for those with pre-existing conditions who have maintained continuous coverage.The federal subsidy for those at 150% of FPL is tied to keeping premiums at a percentage of the state's median income, setting up high-risk pools, and granting each state $10 billion in DSH funds.
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Thomas Miller, American Enterprise Institute, "When Obamacare Fails: The Playbook for Market-Based Reform."A "fixed percentage tax credit." If the percentage is, say, 30%, and a person buys insurance that costs $2,000, he gets a tax credit of $600. Possibly put a cap on this credit.Moved from open ended "defined benefit" tax exclusion to a "defined contribution." The tax break for the defined contribution must not exceed the amount available under the fixed percentage tax credit. Make this change gradually, over a period of years.Extend HIPAA regulations that govern group markets to individual market. Federal funding for high-risk pools.No definition.No change.Block grant to states and let states experiment.Premium support to purchase private plans. None.None.None.Guarantee that no individual or family will have to spend more than 15% of annual income on insurance premiums and out-of-pocket costs for health care.
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John Goodman, Goodman Institute, "A Republican Alternative To ObamaCare."Refundable tax credit of $2,500 for every adult and $1,500 for every child for the purchase of insurance.Allow employers to use pre-tax dollars to purchase employees individual plans that will be owned by the employees. This would enhance portability, allowing individuals to take their plans with them from job to job or should they leave the labor market.Allow people to buy pre-existing condition insurance so that if an individual has a pre-existing condition and switches insurers and, thus, pays higher premiums, the pre-existing condition insurance will help pay for those higher premiums.Standard I.R.S. definition. No mandates.Lift restrictions on HSAs so that they can "wrap around" an insurance plan. That is, HSAs can be used not only to pay for a deductible but other out-of-pocket costs as well.Block grant to states. Let people buy into Medicaid with the tax credit. Base price of Medicaid will be equal to the tax credit. People earning over 100% of the federal poverty could be charged more to buy in. People can leave Medicaid at any time and re-enter the private insurance market.Seniors will pay premiums that are equal to 15% of Medicare's costs. They will get access to a Standard Comprehensive Plan with a $2,500 deductible. Seniors will be able to deposit $2,500 in a Roth-type HSA. Seniors may also enroll in private plans with their Medicare premiums going to the private plans. In addition, Medicare will send the private insurer any additional funds needed to cover the senior's additional health risks.Patients would have the option of forgoing the courts and instead signing a contract that if they experience an adverse outcome, the provider will right them an instant check. The compensation amounts for various adverse events will be set by state commissions.None.None.Send unclaimed tax credits to safety-net institutions in the communities where the uninsured live.
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Michael Cannon, Cato Institute, "Yes, Mr. President: A Free Market Can Fix Health Care."None (see HSAs).Eliminate it.None.No definition.Establish large HSAs. $8,000 for individual, $16,000 for family. Can be used to purchase insurance or saved and used to purchase health care directly.Block grant to states and let states experiment.Voucher to purchase private plans.None.None.None.States should get rid of clinical licensing.
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Senators Hatch, Burr and Coburn, "The Patient Choice, Affordability, Responsibility, and Empowerment Act, 2014."Refundable tax credit for purchase of health insurance for everyone up to age 64, adjusted for age. Only eligible for tax credit if make 300% FPL or less.Caps the tax exclusion for employee's health coverage at 65 percent of an average plan's costs.Allows any individual with 18-months of continuous coverage to purchase insurance any time regardless of pre-existing condition.No definition.Allow purchase of over-the-counter drugs with HSAs.Block grant and give states the flexibility to reform their own Medicaid programs.None.Give states more flexibility to deal with medical malpractice. For example, allow them to establish special medical courtsTargeted federal funding for high-risk pools.None.
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Senators Hatch and Burr and Rep. Upton, "The Patient Choice, Affordability, Responsibility, and Empowerment Act, 2015."Refundable tax credit for purchase of health insurance for everyone up to age 64, adjusted for age. Only eligible for tax credit if make 300% FPL or less.Caps tax exclusion at $12,000 for individual and $30,000 for familyAllows any individual with 18-months of continuous coverage to purchase insurance any time regardless of pre-existing condition.No definition.Allow purchase of over-the-counter drugs with HSAs.Block grant and give states the flexibility to reform their own Medicaid programs.None.Give states more flexibility to deal with medical malpractice. For example, allow them to establish special medical courtsTargeted federal funding for high-risk pools.None.
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Republican Study Committee, H.R. 3121, "The American Health Care Reform Act."A standard deduction for health insurance of $7,500 for individuals and $20,000 for families, indexed annually for inflation (CPI-U), that is deducted in full regardless of the cost of the plan.Eliminates the tax exclusion and replaces it with a tax deduction.Allows any individual with 18-months of continuous coverage to purchase insurance any time regardless of pre-existing condition.Coverage for inpatient, outpatient, emergency, and physician care. Must "meaningfully limit" out-of-pocket expenses as determined by HHS Secretary.Proposes 20 changes to HSAs such as allowing HSA savings to be spent on premiums and increasing the maximum contribution limit to an HSA to match deductible and OOP limit.Health opportunity accounts for Medicaid recipients.None.Imposes a statute of limitations on bringing a case, caps non-economic damages at $250,000, allows courts to restrict contingency fees and limit punitive damages.Expands federal support for state high risk pools to $25 billion over 10 years.None.
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Rep. Tom Price, H.R. 2300, "Empowering Patients First Act." (This is updated to reflect the fact that Rep. Price released a new version of this legislation in May of 2015.)Refundable tax credit of $900 for those under age 18, $1,200 ages 18-34, $2,100 ages 35-49, $3,000 over age 49 for the purchase of insurance.Caps the employer-based tax exclusion for health insurance to $8,000 for an individual and $20,000 for a family.Federal grants for state high-risk pools or reinsurance pools.Insurance that constitutes medical care such as major medical coverage. Will not apply to policies that are only wrap around, vision-only or disease specific. Incentivizes the use of HSAs with a one-time $1000 tax credit. HSAs may be used for concierge medicine or other pre-paid plans.People on Medicaid may choose to opt out and use the tax credit instead to purchase private insurance. However, may not use tax credit and be on Medicaid.People on Medicare may choose to opt out and use the tax credit instead to purchase private insurance. However, may not use tax credit and be on Medicare.The Secretary of HHS and professional physician societies will set up best practice guidelines that will be used in court to settle legal disputes. States will be given grants to set up administrative health care tribunals.Federal grants for state high-risk pools or reinsurance pools. Federal grants to set up administrative health care tribunals.None.Allows insurers who are authorized to sell a policy in one state to sell it in any state. Allows consumers to shop for policies across state lines.
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Senator Ted Cruz, "Health Care Choice Act."None.No change.Extend HIPAA regulations that govern group markets to individual market in any state that lacks a high-risk pool. NoneNo change.None.None.None.None.None.Allows across-state purchase of insurance. An insurer must declare one state as its "primary state" and follow its insurance regulations. It can then sell insurance in other states and, with a few exceptions, does not have to follow the regulations of other states.
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