Download (CARE) Proposal

Comparison of Relevant Provisions of the
Affordable Care Act (ACA) and the
Patient Choice, Affordability, Responsibility, and Empowerment (CARE) Proposal
Policy/Topic
ACA
CARE
Individual mandate to obtain
health coverage or pay a tax
penalty
Employer mandate to offer
affordable health insurance to
employees or pay a penalty
Prohibit insurers from denying
coverage or increasing
premiums based on preexisting conditions
Yes
No
Yes (not yet implemented)
No
Yes; insurers cannot deny
coverage or vary premium costs
based on pre-existing health
conditions or medical history
Prohibit insurers from imposing
lifetime caps on benefits
Prohibit insurers from imposing
annual caps on benefits
Limit insurers’ ability to charge
older enrollees more than
younger enrollees
Yes
In certain cases; insurers cannot
deny coverage or vary premium
costs based on pre-existing
conditions if individual has
maintained continuous
coverage for at least 18 months;
uninsured would have one open
enrollment period to obtain
coverage without medical
underwriting or increased
premiums for health history
Yes
Require coverage for
dependents up to age 26
Exclude costs of employersponsored insurance from
taxation
Yes
Allow small businesses to join
together to aggregate their
No
Yes
Yes; insurers cannot charge
oldest enrollees more than
three times premiums charged
to youngest adult enrollees
Yes, for employer and employee
up to certain level, then amount
in excess of threshold is taxable
for employer and employee
Unknown; not addressed in
available materials
Yes; initially, insurers cannot
charge oldest enrollees more
than five times premiums
charged to youngest adult
enrollees, then states may
decide to impose their own
higher or lower limits on
premium variation
Yes, unless state opts out of this
federal provision
Yes for employers;
Yes for employees up to
$12,000 per year for individual
or $30,000 per year for family
with annual increases at rate of
CPI + 1%
Yes
employees to increase health
insurance purchasing power
Federal subsidies for
individuals to purchase
commercial health coverage
Calculation of federal subsidy
to purchase health insurance
Ability to use federal subsidy to
pay for health services (as
opposed to health insurance)
Use state high risk pools to
mitigate premiums costs in
individual market
Allow sale of insurance across
state lines
Require plans to cover an
essential benefit set
Health care provider
transparency
Health plan transparency
Hospital charity care
transparency
Yes, for those who earn up to
400% of the federal poverty
limit and purchase their
coverage through a health
insurance exchange
Sliding scale based on
individual/family income and
amount of premiums for
second-lowest silver plan sold in
state
No, unless eligible for costsharing subsidies for plans
purchased through a health
insurance exchange
No; high risk pools eliminated
Yes, for those who earn up to
300% of the federal poverty
limit; no requirement to
purchase through exchange
No; although requires at least
two multi-state health plans to
be offered in each state’s health
insurance exchange
Yes; states had three options for
designating an essential benefit
set
Yes; hospital charges
Yes, if state enters into
interstate compact(s)
Yes; no apparent difference
from CARE proposals
Yes; nonprofit hospitals must
post financial assistance policy
and report charity care through
IRS Form 990, Schedule H
Sliding scale based on
individual/family income and
age, with annual increases
capped at Consumer Price Index
+ 1%
Yes, regardless of whether
individual purchases health
insurance
Yes; at state’s option with
“targeted federal funding”
Allow each state to establish its
own essential benefit set
Yes; incentive Medicaid
payments to states that require
public reporting of hospital
charges and estimated out-ofpocket costs for common
services; require hospitals
participating in Medicare to
provide consumers with
average payment from
uninsured and average payment
from insured patients for most
common inpatient and
outpatient services
Yes; no apparent difference
from ACA
Yes; all hospitals participating in
Medicare required to post
charity care policy and amount
of charity care provided
Precluding sale high deductible
plans to certain populations
Allow use of HSA funds to pay
COBRA premiums
Allow use of FSA funds to pay
for over-the-counter
medications
Federal government’s role in
Medicaid financing
Yes; veterans, service members,
those covered through Indian
Health Services
No
No
No
Yes
Federal government pays 50100% of state expenses on care
for Medicaid beneficiaries,
depending on state
demographics and eligibility
status of beneficiary and
Federal government pays
capped allotment to state based
on number of residents who
earn less than 100% of federal
poverty level, regardless of
services beneficiaries receive or
amount of state expenses” as
well as “a defined budget for
long-term care services and
support for low-income elderly
or disabled individuals” who
enroll in Medicaid instead of
purchasing commercial
coverage with federal tax
credits
No
Expand Medicaid eligibility to
adults without dependent
children
Automatic enrollment for
Medicaid beneficiaries
Yes (if state elects to expand its
Medicaid program)
Allow Medicaid-eligible
individuals to purchase
federally subsidized
commercial insurance
Medical malpractice reform
No
No, but allows for automatic reenrollment
No; authorizes demonstration
projects
Yes
Yes, states could automatically
enroll Medicaid-eligible
residents into Medicaid or
commercial plans so long as
premiums did not exceed
amount of federal tax credits
Yes; individuals could chose to
enroll in Medicaid or receive
federal tax credit to buy
commercial insurance
Yes; caps on non-economic
damages and attorney’s fees;
authorizes states to create
“health courts” or voluntary
expedited-decision-making
processes using panel of
medical experts