参议院医改法案 Senate (Patient Protection and Affordable Care Act)

众议院医改法案 House (Affordable Health Care for America Act)

WHO'S COVERED:

两院版本都寻求让医疗保险覆盖百分之 94 到百分之 96 之间的美国人，目前的覆盖率只有百分之 83 ，这意味着多覆盖大约 3 千万人。

About 94 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Of the remaining 24 million people under age 65 left uninsured, about one-third would be illegal immigrants.

健康保险覆盖面将达到 94% 。政府补贴从 2014 年开始，不资助非法移民。

About 96 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.

健康保险覆盖面将达到 96% 。

政府补贴从 2013 年开始，不资助非法移民。

COST:

参众两院医改立法耗资都在 8 千亿美元以上

Coverage provisions cost $871 billion over 10 years.

参议院医改法案 10 年将耗资 8,710 亿美元。

The Congressional Budget Office says the bill's cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. That's under President Barack Obama's $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion

众议院版本 10 年的花费投入超过 1 万亿美元，突破奥巴马医改议案支出上限 9000 亿美元。

HOW IT'S PAID FOR:

两院版本都将采取向高收入美国人增税，征收其它各种税种，降低向得到政府联邦医疗保险和州医疗辅助项目支持的医疗服务提供者支出的费用，来弥补增加的保险费用的开支。

Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax increased to 2.35 percent on income over $200,000 a year for individuals, $250,000 for couples. A 10 percent sales tax on tanning salons, to be paid by the person soaking up the rays. Cuts to Medicare and Medicaid. Forty percent excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees for employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.

参议院医改法案中，首先对医保公司，制药商，医医保器材公司收费，二是对年收入超过 20 万美元的单身人士、超过 25 万美元的夫妇，其老年医保工薪税将提高至 2.35% ；三是对于每年医保保费超过 8500 元的单身人士、超过 2.3 万美元的夫妇，就其高额保单征收 40% 的消费税；四是对有超过 50 个员工并使用政府健康保险补贴的企业收取罚金。

$460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million.

There are also more than $400 billion in cuts to Medicare and Medicaid; a new $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.

众议院医改法案对最富有的人收税，对于收入超过 500,000 元的单身人士、收入超过一百万美元的夫妇，依照他们的收入的一部分收税。

REQUIREMENTS FOR INDIVIDUALS: 绝大多数美国人将被要求获得某种形式的保险，否则将面临罚金。

Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750.

参议院医改法案要求大多数人参加健康保险否则交罚金，罚金金额从 2014 年的 95 美元开始，在 2016 年将增加到 750 美元。

Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.

众议院医改法案要求大多数人参加健康保险否则交罚金，罚金金额是个人收入的 2.5% 。

REQUIREMENTS FOR EMPLOYERS:

对雇主的要求

Not required to offer coverage, but companies with more than 50 employees would pay a fee of $750 per employee if the government ends up subsidizing employees' coverage.

参议院医改法案没有要求雇主提供健康保险，对有超过 50 个员工并使用政府健康保险补贴的企业收取罚金。

Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt.

Small businesses — those with 10 or fewer workers — get tax credits to help them provide coverage.

众议院医改法案要求雇主提供健康保险，但公司总工资支出低于 500,000 美元的企业被除外。

SUBSIDIES:

补贴

Tax credits for individuals and families likely making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.

参议院医改法案的健康保险补贴范围包括了在联邦贫困线收入的 4 倍（对一个四口的家庭现在是年收入 88,000 美元）。扩展了医疗补助项目联邦贫困线收入的 133% 标准。

Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.

众议院医改法案的健康保险补贴范围也包括了在联邦贫困线收入的 4 倍（对一个四口的家庭现在是年收入 88,000 美元）。它将帮助医疗补助项目低收入个人和家庭支付预防费用和体检费用。

BENEFITS PACKAGE:

保险产品基本标准

All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage. The least generous would pay an estimated 60 percent of health care costs per year; the most generous would cover an estimated 90 percent

保险产品必须涵盖最基本的保险标准，政府制订四个保险支付水平（支付 60% 到 90% 不等）。保险公司出保险产品。

A committee would recommend a so-called essential benefits package including preventive services. Out-of-pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.

特别委员会推荐基本保险标准，公共交换市场上的保险为基本保险。

INSURANCE INDUSTRY RESTRICTIONS:

对保险公司的限制

Starting in 2014: no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: children up to age 26 can stay on parents insurance; no lifetime limits on coverage.

参议院版本将于 2014 年开始完全禁止私人保险公司基于已患病或者性别的原因拒绝向客户提供保险，或者提高保险费用。对基于年龄提高保险费用进行限制。 26 岁以下的子女可留在父母的计划里得到医疗保险的覆盖。

Starting in 2013, no denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.

众议院版本将于 2013 年开始完全禁止私人保险公司基于已患病或性别的原因拒绝向客户提供保险，或者提高保险费用。对基于年龄提高保险费用进行限制。

GOVERNMENT-RUN PLAN:

两院法案版本都包含运用新的公共交换或者市场的特色内容，而众议院议员们在法案中包含了一个政府经营的选项，政府经营保险的费率将由政府协商制定

In place of a government-run insurance option, the estimated 26 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for national plans overseen by the same office that manages health coverage for federal employees and members of Congress. Those plans would be privately owned, but one of them would have to be operated on a nonprofit basis, as many Blue Cross Blue Shield plans are now.

参议院医改法案中没有公共选择计划，却让政府出资提供联邦补贴、美国人事管理局监管来帮助那些中低收入的人支付保险交易市场上的保费。

A new public plan available through the insurance exchanges would be set up and run by the health and human services secretary. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors. But the final version — preferred by moderate lawmakers — would let the HHS secretary negotiate rates with providers.

众议院医改法案设置了公共选择计划，提供保险计划与私营保险公司竞争，政府与医疗服务提供部门协商医疗费用。

HOW YOU CHOOSE YOUR HEALTH INSURANCE:

Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Would generally encourage employees to keep work-provided coverage.

Beginning in 2013, through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.

DRUGS:

Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.

Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.

CHANGES TO MEDICAID:

Income eligibility levels likely to be standardized to 133 percent of poverty — $29,327 a year for a family of four — for parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.

The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent

LONG-TERM CARE:

New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.

New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and disabled people avoid going into nursing homes.

ANTITRUST:

Maintains the health insurance industry's decades-old antitrust exemption.

医疗保险业继续不受反垄断法制约。

Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill also would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.

医疗保险业要受反垄断法制约。

ILLEGAL IMMIGRANTS:

非法移民

Would be barred from receiving government subsidies or using their own money to buy coverage offered by private companies in the exchanges.

非法移民不能得到政府补贴和买政府扶植的交易市场上的健康保险。

Would be barred from receiving government subsidies but permitted to use their own money to buy coverage offered by private companies in the exchange.

非法移民非法移民不能得到政府补贴，但可以买政府扶植的交易市场上的健康保险。

ABORTION:

堕胎

The bill tries to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for the procedure. In plans that do cover abortion, beneficiaries would have to pay for it separately, and those funds would have to be kept in a separate account from taxpayer money. Moreover, individual states would be able to prohibit abortion coverage in plans offered through the exchange, after passing specific legislation to that effect. Exceptions would be made for cases of rape, incest and danger to the life of the mother.

医保如果要覆盖堕胎费用，那么受益人要单独付款，且这些资金需要在一个分开的账户上。众议院指责参议院的堕胎限制有漏洞。

Private companies in the exchange could not offer plans covering abortion if those plans received federal subsidy money. Most plans in the exchange would be affected, because most consumers in the exchange would be using federal subsidy money to buy coverage. The new government plan could not offer abortion coverage. Insurance companies would be permitted to offer supplemental abortion coverage in separate plans that people could buy with their own money. Use of federal money for abortion coverage would be limited to cases of rape, incest or danger to the woman's life.

众议院医改法案禁止支出经费来支付堕胎手术，除非堕胎手术与强奸、乱伦或者孕妇的健康问题有关。