1. Side-by-Side Comparison of Health Reform Bills
Senate Patient Protection and Affordable Care Act (H.R. 3590) and the House Health Care and Education
Affordability Reconciliation Bill of 2010 (H.R. 4782)
Senate Bill House Reconciliation Bill
Patient Protection and Affordable Care Act - H.R. 3590 Health Care and Education Affordability Act of 2010 - H.R. 4782
Key Provision (Signed by President 3/23/10) (Passed by House 3/21/10; currently debated in Senate)
Individual Mandate  Health coverage required for U.S. citizens and legal  Health coverage required for U.S. citizens and legal
(January 1, 2014) residents. residents.
 Tax penalty of $750/year per adult up to $2,250  Decreases tax penalty for not obtaining coverage to
maximum per family or 2% of income for not obtaining $695/year per adult up to $2,085 maximum per family
coverage, phased in from 2014 to 2016. or 2.5% of income, phased in from 2014 to 2016.
Employer Mandate  Penalty assessed for employers (ERs) with 50 or more  Penalty for employers (ERs) who do not offer coverage
(January 1, 2014) full-time employees (EEs) who do not provide health and at least one employee (EE) receives tax credit
coverage. through Exchange: increases penalty from $750 to
 ERs with 50 or more employees who do not offer $2,000 times the total number of full-time EEs (first 30
coverage with 60% actuarial value or whose premium EEs exempt from penalty calculation).
is unaffordable (> than 9.8% income) must pay a  Penalty for ERs that offer health coverage and EEs
penalty government for each full-time EE (30 hours) opts out due to the lack of affordability or inadequate
receiving tax credit (subsidy) through the Exchange. coverage: lesser of $3,000 times the total number of
 Penalty for ERs who do not offer coverage and at least full-time EEs who receive the tax credit or $2,000 times
one EE receives tax credit through Exchange: $750 the total number of full-time EEs.
times the total number of full-time EEs.  Penalties eliminated for ERs who impose waiting
 Penalty for ERs that offer health coverage and periods of up to 90 days for health coverage.
employees opts out due to the lack of affordability or
inadequate coverage: lesser of $3,000 times the total
number of full-time EEs who receive the tax credit or
$750 times the total number of full-time EEs.
 Penalties apply for ERs who impose a 30-90 day
waiting period for health coverage.
Employer Free  ERs that offer health coverage must provide free  No changes to Senate bill
Choice Voucher choice vouchers in the amount equal to the ER
(January 1, 2014) premium contribution to EEs whose premium
contribution would be between 8% and 9.8% of income
and whose household income is less than 400% of the
federal poverty level (FPL) and who enroll in Exchange.
 Voucher amount is tax deductible to ER.
March 24, 2010 1

2. Senate Bill House Reconciliation Bill
Patient Protection and Affordable Care Act - H.R. 3590 Health Care and Education Affordability Act of 2010 - H.R. 4782
Key Provision (Signed by President 3/23/10) (Passed by House 3/21/10; currently debated in Senate)
Employer Auto-  ERs with 200 or more EEs are required to automatically  No changes to Senate bill
Enrollment enroll new EEs in ER-provided health plans; EEs may
(January 1, 2014) opt out.
Small Business Tax  ERs that provide health coverage and have 25 or EEs  No changes to Senate bill
Credits and average wages of less than $50,000 will receive a
(2010) tax credit.
 Phase 1: 2010-2013, until Exchanges are established,
tax credits of up to 35% of health premium if ER
contributes at least 50% of the total premium costs will
be provided. Full credit available for ERs with 10 or
fewer EEs and average annual wages less than
$25,000.
 Phase 2: From 2014 onwards, eligible ERs that get
coverage through Exchange may receive tax credit up
to 50% of health premium if ER contributes at least
50% of the total premium costs. Full credit available for
ERs with 10 or fewer EEs and average annual wages
less than $25,000. Credit available for 2 years.
Retiree Reinsurance  Federal government will finance a $5 billion temporary  No changes to Senate bill
Program reinsurance program for ERs to offset costs of
(90 days after providing health coverage to retirees > age 55 who are
enactment) not eligible for Medicare.
 ERs or insurers will be reimbursed for 80% of retiree
claims between $15,000 and $90,000.
 Program ends January 1, 2014 or when funds are
depleted.
ERISA  Maintains ERISA framework.  Maintains ERISA framework but imposes some benefit
mandates on ERISA plans.
March 24, 2010 2

3. Senate Bill House Reconciliation Bill
Patient Protection and Affordable Care Act - H.R. 3590 Health Care and Education Affordability Act of 2010 - H.R. 4782
Key Provision (Signed by President 3/23/10) (Passed by House 3/21/10; currently debated in Senate)
Tax Provisions for  High-cost “Cadillac” plan excise tax: 40% tax on the  High-cost “Cadillac” plan excise tax: Maintains 40% tax
Health Benefits aggregate costs of insured and self-insured group on aggregate costs of insured and self-insured group
health coverage that exceeds $8,500 for individuals health coverage, but increases the threshold to $10,200
and $23,000 for families (effective 2013). for individuals and $27,500 for families (delays effective
 Taxation of retiree drug subsidy: eliminates tax date to 2018).
deduction for ERs receiving retiree drug subsidy  Taxation of retiree drug subsidy: retains Senate
(effective 2011). provisions, but delays effective date until 2013.
 W-2 Reporting: ERs required to report value of health  Maintains W-2 reporting provision.
benefits provided on EE W-2 form (effective 2011 for
2012 issuance).
Other Taxes  Increases Medicare hospital insurance tax by 0.9% for  Maintains Medicare hospital insurance tax increase and
those with wages above $200,000 (single) and adds a new 3.8% tax on net investment income above
$250,000 for those filing jointly (effective January 1, the thresholds.
2013).  Modifies tax amounts and effective dates for health
 New taxes on pharmaceutical manufacturers, medical care sector taxes.
device manufacturers, and health insurers allocated by  Maintains 10% tax on indoor tanning services (effective
market share (effective 2008-2009). January 1, 2010).
 New 10% tax on indoor tanning services (effective  New 2.9% excise tax on sale of medical devices
2010). (effective January 1, 2013).
Account-Based  Limits annual FSA contributions to $2,500.  No changes to Senate bill
Health Insurance  OTC drugs not prescribed by physician cannot be
(FSA, HSA, HRA) reimbursed through HRA or health FSA.
(January 1, 2011)  Increases tax penalty for use of HSA funds for non-
qualified medical expenses from 10% to 20%.
Benefit Design  Creates an essential health benefits package that  No changes to Senate bill
(January 1, 2014) provides a comprehensive set of services and covers at
least 60% of the actuarial value of the covered benefits,
limits annual cost sharing to the current HSA limits
(currently $5,950 for individual and $11,900 for family).
 All qualified health plans must offer at least the
essential health benefits package (except
grandfathered individuals and ER sponsored plans).
 Prohibits abortion coverage from being required as part
of essential benefits package.
March 24, 2010 3

4. Senate Bill House Reconciliation Bill
Patient Protection and Affordable Care Act - H.R. 3590 Health Care and Education Affordability Act of 2010 - H.R. 4782
Key Provision (Signed by President 3/23/10) (Passed by House 3/21/10; currently debated in Senate)
Wellness/Prevention  Allows ERs to offer up to 30% premium discount for  No changes to Senate bill
participating in wellness programs; may be increased to
50% by HHS. Small businesses that establish wellness
programs will receive grants for 5 years (effective fiscal
year 2011).
 All new group health plans must provide preventative
care recommended by U.S. Preventative Services Task
Force, with no cost-sharing (effective 6 months after
enactment).
Public Health  Does not include a public option.  No changes to Senate bill
Insurance Option  Includes multi-state private health plan options (both
non-profit and for profit) administered through the
Office of Personnel Management (OPM).
 Creates non-profit, member run, health care
cooperatives to be offered in the health insurance
exchange.
Health Insurance  Establishes state-based health care exchanges for  No changes to Senate bill
Exchanges individuals and small ERs with up to 100 EEs to
purchase coverage starting in 2014; expands eligibility
to larger ERs in 2017.
 Five standard benefit tiers will be offered: bronze,
silver, gold, platinum and catastrophic.
Insurance Market  Group health plans must cover children up to age 26  All group health plans must comply with Senate bill’s
Reforms (effective 6 months after enactment). market reforms (removes grandfathered status).
 Bars rescissions (effective 6 months after enactment).
 Bars discrimination for pre-existing conditions for
children starting 6 months after enactment, and for
adults in 2014
 Bars group health plans from imposing lifetime caps on
coverage (effective 6 months after enactment).
 Bars group health plans from imposing annual caps on
coverage (effective January 1, 2014).
 Group health plans would generally be grandfathered
from above market reform requirements.
March 24, 2010 4

5. Senate Bill House Reconciliation Bill
Patient Protection and Affordable Care Act - H.R. 3590 Health Care and Education Affordability Act of 2010 - H.R. 4782
Key Provision (Signed by President 3/23/10) (Passed by House 3/21/10; currently debated in Senate)
Cost of Health Care  Overall costs (CBO estimate): $875 billion over 10  Overall costs (CBO estimate): $940 billion over 10
Reform years. years.
Sources: Aon Health & Benefits Public Policy Team, The Kaiser Family Foundation, American Benefits Council
March 24, 2010 5