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The 2009 Congressional Health Reform Bills: Insurance Coverage

The 2009 Congressional Health Reform Bills: Insurance Coverage. Sara R. Collins, Ph.D., Vice President Rachel Nuzum, M.P.H., Senior Policy Director The Commonwealth Fund November 20, 2009. Congressional Health Reform Bills As Of Nov. 2009.

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The 2009 Congressional Health Reform Bills: Insurance Coverage

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  1. The 2009 Congressional Health Reform Bills: Insurance Coverage Sara R. Collins, Ph.D., Vice President Rachel Nuzum, M.P.H., Senior Policy Director The Commonwealth Fund November 20, 2009

  2. Congressional Health Reform Bills As Of Nov. 2009 Source: SR Collins, K Davis, J Nicholson, S Rustgi, R Nuzum, The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs, The Commonwealth Fund, Nov. 2009.

  3. Major Sources of Savings and Revenues Compared with Projected Spending, Net Cumulative Effect on Federal Deficit, 2010–2019 Dollars in billions Source: The Congressional Budget Office Preliminary Analysis of the Patient Protection and Affordable Care Act, Nov. 18, 2009, http://www.cbo.gov/doc.cfm?index=10731. The Congressional Budget Office Analysis of H.R. 3962, The Affordable Health Care for America Act, Incorporating the Manager’s Amendment Offered by Representative Dingell, Nov. 6, 2009, http://www.cbo.gov/doc.cfm?index=10710.

  4. Trend in the Number of Uninsured Nonelderly, 2012–2019Under Current Law and Senate and House Bills Millions Note: The uninsured includes unauthorized immigrants. With unauthorized immigrants excluded from the calculation, nearly 94% and 96% of legal nonelderly residents are projected to have insurance under the Senate and House proposals, respectively. Data: Estimates by The Congressional Budget Office. Source: SR Collins, K Davis, J Nicholson, S Rustgi, R Nuzum, The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs, The Commonwealth Fund, Nov. 2009.

  5. Premium Caps as a Share of Income Under Senate and House Bills Medicaid Medicaid Medicaid Note: Under the Senate bill, people are eligible for Medicaid up to 133% FPL; under the House bill, people are eligible for Medicaid up to 150% FPL. Source: SR Collins, K Davis, J Nicholson, S Rustgi, R Nuzum, The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs, The Commonwealth Fund, Nov. 2009.

  6. Annual Premium Amount Paid Out-of-Pocket by Families and Subsidies Under Senate and House Bills* Annual premium amount paid out-of-pocket by family plus premium subsidy Senate Premium Paid by Family Premium Subsidy House Premium Paid by Family Premium Subsidy $9,435 $9,435 $9,435 $9,435 $9,435 $9,435 $9,435 791 2,952 2,820 6,656 7,009 7,930 8,644 9,435 6,483 6,615 Medicaid 2,778 2,426 1,505 200% FPL 300% FPL 400% FPL 150% FPL *For a family of four in a medium-cost area in 2009 (age 40). Premium estimates are based on: Senate Silver Plan, AV = 0.70; House Basic Plan, AV = 0.70. Source: Premium estimates are from Kaiser Family Foundation Health Reform Subsidy Calculator – Premium Assistance for Coverage in Exchanges/Gateways, http://healthreform.kff.org/Subsidycalculator.aspx.

  7. Percent of Income Spent on Premiums 2009–2019 If the Percent of Total Premiums Paid by Families Remains Constant, Senate Bill and House Bill* Percent of income spent on premiums 200% FPL 400% FPL 150% FPL 300% FPL *For a family of four in a medium-cost area in 2009 (age 40). Premium estimates are based on Senate Silver Plan, AV = 0.70, House Basic Plan, AV = 0.70; 2009 premium estimates are from Kaiser Family Foundation Health Reform Subsidy Calculator – Premium Assistance for Coverage in Exchanges/Gateways, http://healthreform.kff.org/Subsidycalculator.aspx. Source: SR Collins, K Davis, J Nicholson, S Rustgi, R Nuzum, The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs, The Commonwealth Fund, Nov. 2009.

  8. Estimated Out-of-Pocket Exposure Under Senate Bill, by U.S. Spending Distribution and Income Note: Since the Senate bill caps out-of-pocket spending for people at 200–400% of poverty at $2,975 and $3,975, this analysis assumes a Silver plan of .70 AV with the out-of-pocket maximums, which increase the actuarial value of the plan. Source: SR Collins, K Davis, J Nicholson, S Rustgi, R Nuzum, The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs, The Commonwealth Fund, Nov. 2009.

  9. Estimated Out-of-Pocket Exposure Under House Bill, Single Policy, by U.S. Spending Distribution and Income Source: SR Collins, K Davis, J Nicholson, S Rustgi, R Nuzum, The Health Insurance Provisions of the 2009 Congressional Health Reform Bills: Implications for Coverage, Affordability, and Costs, The Commonwealth Fund, Nov. 2009.

  10. Penalties for Noncompliance with the Individual Mandate Under Senate and House Bills Estimated family premium, Senate & House = $9,435 Senate Hardship Exemption Premium > 8% of income Penalty per Person Estimated single premium, Senate & House = $3,500 House Senate (2016) = $750 Senate (2015) = $350 Senate (2014) = $95 Income Note: The penalty under the Senate bill is implemented at $95 in 2014 and increases to $350 in 2015 and $750 in 2016. The House penalty is calculated as 2.5% of the difference between average modified adjusted gross income (MAGI) and the tax filing threshold. Calculations begin at $20,000 because that is the point where MAGI exceeds the tax filing threshold. People are exempt if they have household incomes under 100% FPL or if premiums are greater than 8% (Senate). Projected premiums are under House and Senate proposals. Source: Commonwealth Fund analysis of the proposals; Urban-Brookings Tax Policy Center, “Average Modified Gross Income and Average Modified Adjusted Gross Income Across Cash Income Levels, 2009”, Oct 15, 2009 available at www.taxpolicycenter.org/numbers/displayatab.cfm?Docid=2486&DocTypeID=1.

  11. Small Business Tax Credits Under Senate and House Bills for Family Premiums $9,435 – projected family premium under Senate & House 50% employer contribution 65% employer contribution $6,133* Credit per Employee $4,718* $4,718* $4,718* *To be eligible for tax credits, firms must contribute 50% of premiums per family under the Senate plan, and 65% under the House plan. Firms receive 35% and later 50% of their contribution in tax credits under Senate, and 50% of contribution under House. Note: Projected premium for a family of four in a medium-cost area in 2009 (age 40). Premium estimates are based on: Senate Silver Plan, AV = 0.70; House Basic Plan, AV = 0.70. Senate defines small firms as those with fewer than 25 employees with average wages below $40,000. House defines small firms as those with average wage less than $20,000 or fewer than 10 employees; credits phase out until average wage equals $40,000 or up to 25 employees. Source: Commonwealth Fund analysis of proposals. Premium estimates are from Kaiser Family Foundation Health Reform Subsidy Calculator, http://healthreform.kff.org/Subsidycalculator.aspx.

  12. Acknowledgements Karen Davis, President Rachel Nuzum, Senior Policy Director Jennifer Nicholson, Associate Program Officer, Affordable Health Insurance Sheila Rustgi, Program Associate, Affordable Health Insurance www.commonwealthfund.org

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