Differences among health bills, Obama law

Here are the differences among the Senate’s health bill released Thursday, a version approved by the House in May and the Affordable Care Act, signed into law by President Barack Obama in 2010.

INDIVIDUAL MANDATE

The ACA: Requires most Americans to have health coverage or pay a fine.

The Senate version: The individual mandate would be eliminated. Nothing would replace it to incentivize healthy people to buy insurance.

The House version: Insurers would be allowed to impose a 30 percent premium surcharge on consumers who purchase a new plan after letting their previous coverage lapse, giving healthy people incentive to remain insured.

MEDICAID

The ACA: States are allowed to expand Medicaid, known as Medi-Cal in California, to cover people making up to 138 percent of the poverty line, and the federal government would cover an outsize portion of their costs.

Senate version: Would be funded by giving states a per capita amount or block grant, beginning in 2021. For states that expand Medicaid, the federal government would pay a smaller portion of the cost starting in 2021.

House version: Would be funded by giving states a per capita amount or block grant based on how much each state is spending, not adjusting for rising costs. States would not be able to expand Medicaid after 2017.

EMPLOYER MANDATE

The ACA: Requires companies with 50 or more employees to provide health coverage to their workers and dependents to age 26, or pay a fee. House and Senate versions: The mandate would be eliminated.

PRE-EXISTING CONDITIONS

The ACA: Insurance companies are prohibited from denying coverage or increasing premiums.

Senate version: Insurance companies would be prohibited from denying coverage or increasing premiums, though states would have the option not to cover costs associated with some conditions.

House version: States could allow insurers to increase premiums if there is a break in coverage. The state would then have to set up some other program, such as a high-risk pool, to cover its sickest residents.

YOUNG ADULTS

Senate/House/ACA version: Can stay on their parents’ plan until they are 26 years old.

TAX CREDITS

The ACA: Tax credits to individuals are primarily based on income, age and geography, which benefits lower- and moderate-income people who buy coverage through ACA marketplaces.

Senate version: Tax credits would be primarily based on age, income and geography. House version: Tax credits would be based primarily on age.

COST-SHARING SUBSIDIES

The ACA: Subsidies provided to insurers to help some customers cover deductibles and co-payments.

House and Senate versions: Subsidies would end in 2020, although President Trump could cut them off earlier.

OLDER CUSTOMERS

The ACA: Insurers can charge up to three times as much as they charge younger customers.

Senate/House versions: Insurers would be able to charge up to five times as much as they charge younger customers.