Canadian

 Healthcare   British  Healthcare   Massachusetts   Healthy  San  

Swiss  Healthcare   Affordable  Care  Act   Ryan  Plan   Pre-­‐ACA  
  (Medicare)   (NHS)   Health  Reform   Francisco  
89%  of  Uninsured  
Near-­‐universal   Unknown,  similar  to  
Coverage   Universal  (99%)   18.6%  Uninsured   Universal   Universal   Universal  (98%)   (99%  insured  or  HSF-­‐
(90+%)   pre-­‐ACA?  
covered)  
Tax  penalty  for  not   Flat  refundable  tax   Tax  penalty  for  not  
Individual  Mandate   Yes   purchasing   credit  for  purchasing   No   N/A   N/A   purchasing   No  
healthcare   health  care   healthcare  
Tax  credits  to  small   Employers  must  
Employer  Mandate   No   businesses  for   No   No   No   No   Yes   provide  health  care  
providing  health  care   or  pay  into  HSF  
Guaranteed  Issue   Yes   Yes   No   No   N/A   N/A   Yes   N/A  
0%  (for  non-­‐
Insurance  Company   15-­‐20%  (80-­‐85%  
supplementary   No   No   N/A   N/A   No   N/A  
Profits  Capped   Medical  Loss  Ratio)  
plans)  
By  State  or  by   By   By   By  State  or  by  
Risk  Pooling   By  Canton  (state)   Nationwide  (N/A)   Nationwide  (N/A)   By  City  
employer   Employer/Individual   Employer/Individual   employer  
Premium  Variation   By  Location  and  age  
By  Location  Only   Unregulated   Unregulated   N/A   N/A   By  age  (2:1  max)   N/A  
factors  allowed   (3:1  max)  
Not  defined  for  
"Bronze,"  (60%)  
employer  plans,  
"Silver,"  (70%)  
defined  by   Most  services  but  
Defined  by  law,   "Gold,"  (80%)  and  
Required  benefits   None   None   Comprehensive   Comprehensive   Commonwealth   only  within  San  
comprehensive   "Platinum"  (90%)  
Health  Insurance   Francisco  
actuarial  levels  
Connector  Authority  
defined  
for  Connector  plans  
Medicaid  for  all  
persons  ≤133%  FPL,   Medicaid  coverage   Premiums  vary  from  
Direct  government  
refundable  tax   varies  by  state   No  premiums  for   $0  to  $150  a  month  
Low-­‐income   rebate  after  8%  of   No  guarantee  of  
credits  based  on   (usually  only  women   N/A   N/A   ≤150%  FPL,  sliding   depending  on  
Subsidies   income  spent  on   Medicaid  Coverage  
Bronze  plan  and   with  children  and   scale  up  to  300%  FPL   income,  up  to  500%  
healthcare  
income  up  to  400%   their  spouses)   FPL  
FPL  
Preventative  
Yearly  deductible  
medicine  free,  yearly  
(varies  with  
deductible  (varies  
premium)  and   Flat  copay  depending  
with  actuarial   Defined  by  private   Defined  by  private   Defined  by  private  
Cost-­‐sharing   percentage  cost   N/A   N/A   on  income  ($0  for  
coverage)  and  flat   insurance   Insurance   insurance  
sharing  up  to  a   ≤100%  FPL)  
cost  sharing  (copay)  
maximum  out-­‐of-­‐
up  to  a  maximum  out  
pocket  cost  
of  pocket  cost.  
Universal  coverage,   Universal  coverage,  
percentage-­‐based   flat-­‐fee  cost  sharing,   Costs  shifted  on  to  
cost  sharing,   excise  tax  on  medical   consumer.  Federal   Universal  coverage,   Universal  coverage,  
Medicare  fees   Reimbursement  
Cost  Control   prescription  drug   devices,  tax  on   government  costs   Medicare   All  health  providers  
directly  set  by   Universal  coverage   rates  set  by  city  
Measures   costs  regulated,  lab   "Cadillac  plans,"   are  flat  for  both   reimbursement  rates   are  government  
Congress   council  
test  and  medical   Medicare  fees   Medicare  and   set  by  government   employees  
device  costs   directly  set  by   Medicaid  
regulated   Congress  
 Medicare  provided   Medicare  provided  
None,  private   Private  insurers  
by  Federal   by  Federal  
insurers  and  medical   provide  bids  for  low-­‐
Government  for   Government  for  
providers  heavily   income  insurance  
Government-­‐Run   people  over  65,   people  over  65,  
regulated  (non-­‐profit   None   Yes   Yes   contracts,  Medicaid   Yes  
Insurance   Medicaid  provided   Medicaid  provided  
insurance,  price-­‐ rolled  into  
by  individual  states   by  individual  states,  
setting  for  medical   Commonwealth  Care  
for  people  under  133   though  eligibility  
devices,  etc.)   plans  
FPL   varies  
Prescription  drugs  
Prescription  drugs   covered  by  Medicare  
Prescription  costs  set   Private  insurance   Covered,  prices   Covered,  costs  
Prescription  Drugs   covered,  prices   part  D  and  private   Covered   Covered  
by  government   only   unregulated   unregulated  
unregulated   insurance,  prices  
unregulated  
Insurance  companies  
allowed  to  offer  
supplemental  plans  
Higher  actuarial  
at  a  profit,  providing  
coverage  levels  
better  amenities   Allowed,  not   Allowed,  not   Allowed,  not   N/A  (Insured  do  not  
Supplemental  Plans   offered,  not   N/A   N/A  
(required  non-­‐profit   subsidized   subsidized   subsidized   qualify  for  HSF)  
subsidized  beyond  
coverage  is  
Bronze  level.  
comprehensive),  
dental,  etc.  Not  
subsidized.  
State  Children’s'  
Insurance  companies  
Health  Insurance  
required  to  offer   SCHIP  rolled  into  
Program  (SCHIP)   Covered  by  SCHIP  
Children   No  special  coverage   coverage  to   No  special  coverage   No  special  coverage   No  special  coverage   Commonwealth  Care  
provides  low-­‐income   (California  Medicaid)  
dependents  up  to   plans  
children  health  care  
the  age  of  26  
through  Medicaid  
Health  plans  tax-­‐
Tax  credit  for  
exempt  (up  until   Health  plans  tax-­‐
purchasing  health   Health  plans  tax-­‐
Tax  Incentives   None   "Cadillac  plans"),   exempt,  Flexible   N/A   N/A   N/A  
care,  health  plans   exempt  
Flexible  Spending   Spending  Accounts  
not  tax-­‐exempt  
Accounts  
Cantons  redistribute   Medicare  (federal   Medicare  (federal  
Federal  government  
insurance  company   government)   government)  
assumes  riskiest  
Risk  Equalization   funds  based  on   assumes  riskiest   None   assumes  riskiest   N/A   N/A   N/A  
groups  (65+,  
riskiness  of  individual   groups  (65+,   groups  (65+,  
disabled)  
insurer's  pool   disabled)   disabled)  
Medicare  Advantage  
overpayments   Federal  Medicaid  
San  Francisco  
phased  out,   match,  
Swiss  government   Medicare  Payroll  Tax,   General  Fund,  
Medicare  tax  base   US  Federal   Canadian   Massachusetts  
Funding   pays  subsidies  for   General  Fund,  State   UK  Government   Employers  pay  into  
broadened,  taxes  on   Government   Government   general  fund,  former  
low-­‐income   funds  (Medicaid)   HSF  if  they  do  not  
insurance   uncompensated  care  
provide  insurance  
companies,  "Cadillac   pool  sources  
plan"  tax,  etc.  
 
compiled by albert wu
aonicc@gmail.com