• Eliminate effective 2016.

• Eliminate effective 2016.

• Retain the current structure as under the Affordable Care Act for 2017, 2018 and 2019.

• Appropriate funding for cost-sharing reduction subsidies through 2019.
• Repeal cost-sharing reduction subsidies as of December 31, 2019.

• For 2017 — retain the Affordable Care Act structure.
• For 2018:
  • Tax credits are also available for ACA-compliant individual market insurance purchased off the Marketplace.
  • When buying coverage off the Marketplace, tax credits are not received up front and are not available when the health insurance premium is due.
• For 2019:
  • 2018 changes also apply to 2019.
  • New applicable percentages apply, adjusted for age as well as income. For an individual who is eligible for a tax credit, the applicable percentage determines the maximum premium payment for the second-lowest-cost silver plan. The change in 2019 will generally make the tax credits more generous for younger consumers and less generous for those 50 and older.
• For 2020:
  • Flat tax credits provided to individuals based on age; phases out for incomes over $75,000 for single taxpayers and $150,000 for married filing jointly.

• 2017 and 2018 — retain the Affordable Care Act structure.
• For 2020 on:
  • An individual is eligible if income is no greater than 350 percent of the federal poverty level (excludes those eligible for Medicaid, Medicare or group coverage).
  • Tax credits are adjusted by age (similar to the House American Health Care Act credit in 2019, but with additional phase-out from 300-350 percent of the federal poverty level).
  • A benchmark plan is a 58 percent actuarial value qualified health plan (based on a median plan in the rating area as opposed to the second-lowest-cost silver plan).
• Eliminate limits on recapture of excess advance payments of premium tax credits.
  • Eliminating limits allows the recapture of advance payments of premium tax credits, beginning January 1, 2018.

• Applicants for coverage can be assessed a 30 percent late enrollment charge above their premium if the applicant did not have coverage for longer than 63 days in the previous 12 months. This process would begin for individuals applying for special enrollment in benefit year 2018.

• Applicants for coverage would be subject to a 6 month waiting period beginning on the day of application if the applicant did not have coverage for longer than 63 days in the previous 12 months.  This process would begin in 2019.

• Beginning 2020, permit a state to obtain a waiver to define the essential health benefits package (individual or small group market). This would supersede the 10 essential health benefit categories and the “offered by a typical employer” requirement.

• Does not include any wholesale changes to pre-existing or essential health benefit restrictions. Provides $2 billion in incentives to encourage states to implement Affordable Care Act Section 1332 waivers which could change essential health benefits, actuarial value, and the definition of qualified health plans.

• The age variation permitted in health insurance premium rates is modified. It will be 5:1 beginning in 2018, or an alternative state-set age curve.

Under the Affordable Care Act, variation in cost due to age cannot exceed 3:1 for individual market and small group market plans. This means that the age-related cost for consumers age 64 and older cannot be more than three times the cost for a 21-year-old consumer.

• Beginning January 1, 2019, age bands can be amended to 5:1 or such ratio that the state determines.

• Eliminate effective 2016.

• Eliminate effective 2016.

• The bill does not extend transitional coverage option beyond the end of the 2018 plan year.

• The bill does not address transitional coverage.

• Retain.

• Retain.

• Repeal effective 2020.  No replacement offered.

• Eliminate the disbursement of small business tax credits effective 2020. Also, small employers providing health plans with abortion coverage will not be eligible for the credit after December 31, 2017, until its phase out.

• Delay until 2026.

• Repeal the Cadillac tax from January 1, 2020, to December 31, 2025.

• Did not contain language.

• Establish small business health plans that allow trade and membership associations and others to make fully insured coverage available to their members exempt from most state insurance regulations. Requires that specific filing and certification requirements be submitted to the Secretary of the U.S. Department of Health and Human Services.

• Not addressed.

• Remove the affordability exemption related to employer–sponsored coverage (if an individual has an offer of employer–sponsored insurance that person cannot qualify for the tax credit).

• Beginning in 2020, repeal metal levels and their associated actuarial value requirements.

• Retain except when a state pursues a Section 1332 waiver and could eliminate actuarial value requirements.

• Effective 2018, the maximum contribution limit to HSAs increases to deductible and out-of-pocket maximum limits (currently $6,550 for an individual and $13,100 for a family). This allows spouses to make catch-up payments to the same HSA account, effective 2018.  Beginning 2018, allow an HSA payment for medical expenses incurred during the 60-day period before the account became effective.

• Same as House bill.

• In the event a state chooses to implement a waiver, the state may determine essential health benefits beginning in 2020.  Otherwise, retain essential health benefits requirements.

• Retain essential health benefits requirements unless the state pursues a Section 1332 waiver.

• Not addressed.

• Repeal the federally run medical loss ratio program effective 2019. Require that states set their own medical loss ratio and determine the amount of medical loss ratio rebates, effective January 1, 2019.

• Funded by the same base year calculation as the per capita cap arrangement. Calculated by multiplying the per capita cost by the number of enrollees in the prior year.
• Funding increases year over year by the consumer price index. Unused funds rollover.
• The state must:
  • Submit a report on eligibility, services, cost-sharing and method for delivering care.
  • Cover medical assistance for hospital care, surgical care and treatment, medical care and treatment, obstetrical and prenatal care and treatment, prescription drugs, medicines and prosthetics, other medical supplies and services and health care for children under 18.

• Funded by multiplying the state’s Federal Medical Assistance Percentages by the target per capita amount and the number of enrollees in each category.
• Funding increases year over year by the Consumer Price Index for All Urban Customers. Unused funds rollover.
• Cost-sharing is allowed, and is not to exceed 5 percent of family income.
• The benefit package must include mental health services and substance use disorder services.
• Prescription drugs are subject to the Medicaid Rebate Program.

• Maintains enhanced funding for expansion through 2019. As of January 1, 2020, only maintains enhanced funding for Medicaid expansion beneficiaries enrolled as of December 31, 2019, who do not have a break in eligibility for more than one month after January 1, 2020.

• 90 percent for 2020
• 85 percent for 2021
• 80 percent for 2022
• 75 percent for 2023
• 2024 and beyond: standard Federal Medical Assistance Percentages

• Starting October 2017, states have the option to institute a work requirement for nondisabled, non-elderly and non-pregnant adults. States who implement a work requirement will receive a 5 percent increase in their Federal Medical Assistance Percentages for administrative costs.

• Same as House.

• Repeal most taxes and fees effective 2017.

• Largely the same: Repeal the health insurance tax effective 2017; medical device excise tax and prescription drug fee effective 2018.

• Not addressed, but expires in 2019 – 2020 under current law.

• Not addressed, but expires in 2019 – 2020 under current law.