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1THEPRESIDENT’SPROPOSALFebruary22,2010ThePresident’sProposalputsAmericanfamiliesandsmallbusinessownersincontroloftheirownhealthcare.•Itmakesinsurancemoreaffordablebyprovidingthelargestmiddleclasstaxcutforhealthcareinhistory,reducingpremiumcostsfortensofmillionsoffamiliesandsmallbusinessownerswhoarepricedoutofcoveragetoday.Thishelpsover31millionAmericansaffordhealthcarewhodonotgetittoday–andmakescoveragemoreaffordableformanymore.•ItsetsupanewcompetitivehealthinsurancemarketgivingtensofmillionsofAmericanstheexactsameinsurancechoicesthatmembersofCongresswillhave.•Itbringsgreateraccountabilitytohealthcarebylayingoutcommonsenserulesoftheroadtokeeppremiumsdownandpreventinsuranceindustryabusesanddenialofcare.•ItwillenddiscriminationagainstAmericanswithpre-existingconditions.•Itputsourbudgetandeconomyonamorestablepathbyreducingthedeficitby$100billionoverthenexttenyears–andabout$1trillionovertheseconddecade–bycuttinggovernmentoverspendingandreininginwaste,fraudandabuse.ThePresident’sProposalbridgesthegapbetweentheHouseandSenatebillsandincludesnewprovisionstocrackdownonwaste,fraudandabuse.ItincludesatargetedsetofchangestothePatientProtectionandAffordableCareAct,theSenate-passedhealthinsurancereformbill.ThePresident’sProposalreflectspoliciesfromtheHouse-passedbillandthePresident’spriorities.Keychangesinclude:•EliminatingtheNebraskaFMAPprovisionandprovidingsignificantadditionalFederalfinancingtoallStatesfortheexpansionofMedicaid;•ClosingtheMedicareprescriptiondrug“donuthole”coveragegap;•StrengtheningtheSenatebill’sprovisionsthatmakeinsuranceaffordableforindividualsandfamilies;•Strengtheningtheprovisionstofightfraud,waste,andabuseinMedicareandMedicaid;•Increasingthethresholdfortheexcisetaxonthemostexpensivehealthplansfrom$23,000forafamilyplanto$27,500andstartingitin2018forallplans;•ImprovinginsuranceprotectionsforconsumersandcreatinganewHealthInsuranceRateAuthoritytoprovideFederalassistanceandoversighttoStatesinconductingreviewsofunreasonablerateincreasesandotherunfairpracticesofinsuranceplans.2AdetailedsummaryoftheprovisionsincludedinthePresident’sPlanissetforthbelow:PoliciestoImprovetheAffordabilityandAccountabilityIncreaseTaxCreditsforHealthInsurancePremiums.Healthinsurancetodayoftencoststoomuchandcoverstoolittle.Lackofaffordabilityleadspeopletodelaycare,skipcare,rackuplargemedicalbills,orbecomeuninsured.TheHouseandSenatehealthinsurancebillslowerpremiumsthroughincreasedcompetition,oversight,andnewaccountabilitystandardssetbyinsuranceexchanges.Thebillsalsoprovidetaxcreditsandreducedcostsharingforfamilieswithmodestincome.ThePresident’sProposalimprovestheaffordabilityofhealthcarebyincreasingthetaxcreditsforfamilies.RelativetotheSenatebill,thePresident’sProposallowerspremiumsforfamilieswithincomebelow$44,000andabove$66,000.RelativetotheHousebill,theproposalmakespremiumslessexpensiveforfamilieswithincomebetweenroughly$55,000and$88,000.HouseSenatePresident'sProposalFrom:To:$22,000$29,0001.5%2.0%2.0-3.0%$29,000$33,0001.5-3.0%4.0-4.6%3.0-4.0%$33,000$44,0003.0-5.5%4.6-6.3%4.0-6.3%$44,000$55,0005.5-8.0%6.3-8.1%6.3-8.1%$55,000$66,0008.0-10.0%8.1-9.8%8.1-9.5%$66,000$77,00010.0-11.0%9.8%9.5%$77,000$88,00011.0-12.0%9.8%9.5%Rangesfrom133-150%ofpoverty,then150-400%ofpovertyin50%increments,roundedtothenearest$1,000TaxCredits:MaximumPercentofIncomePaidforPremiumsIncomeforaFamilyofFourThePresident’sProposalalsoimprovesthecostsharingassistanceforindividualsandfamiliesrelativetotheSenatebill.Familieswithincomebelow$55,000willgetextraassistance;theadditionalfundingtoinsurerswillcoverbetween73and94%oftheirhealthcarecosts.Itprovidesthesamecost-sharingassistanceastheSenatebillforhigher-incomefamiliesandthesameassistanceastheHousebillforfamilieswithincomefrom$77,000to$88,000.HouseSenatePresident'sProposalFrom:To:$29,000$33,00097%90%94%$33,000$44,00093%80%85%$44,000$55,00085%70%73%$55,000$66,00078%70%70%$66,000$77,00072%70%70%$77,000$88,00070%70%70%Rangesfrom133-150%ofpoverty,then150-400%ofpovertyin50%increments,roundedtothenearest$1,000ReducedCostSharing:PercentofCostsPaidforbyHealthInsurancePlanIncomeforaFamilyofFourClosetheMedicarePrescriptionDrug“DonutHole”.TheMedicaredrugbenefitprovidesvitalhelptoseniorswhotakeprescriptiondrugs,butundercurrentlaw,itleavesmanybeneficiarieswithoutassistancewhentheyneeditmost.Medicarestopspayingforprescriptionsaftertheplanandbeneficiaryhavespent$2,830onprescriptiondrugs,andonlystartspayingagainafterout-of-pocketspendinghits$4,550.This“donuthole”leavesseniorspayingthefull3costofexpensivemedicines,causingmanytoskipdosesornotfillprescriptionsatall–harmingtheirhealthandraisingothertypesofhealthcosts.TheSenatebillprovidesa50%discountforcertaindrugsinthedonuthole.TheHousebillfullyphasesoutthedonutholeover10years.Bothbillsraisethedollaramountbeforethedonutholebeginsby$500in2010.RelativetotheSenatebill,thePresident’sProposalfillsthe“donuthole”entirely.Itbeginsbyreplacingthe$500increaseintheinitialcoveragelimitwitha$250rebatetoMedicarebeneficiarieswhohitthedonutholein2010.Italsoclosesthedonutholecompletelybyphasingdo