| House Bill: The Affordable Health Care for America Act (passed Nov. 7, 2009) | Senate Bill: The Patient Protection and Affordable Care Act (passed Dec. 24, 2009) |
| Requires most U.S. citizens and legal residents to have health insurance. Penalty for not having coverage is a flat fee or percentage of income. Exemptions granted to those with financial hardships, religious obligations, American Indians, those without coverage for less than three months, undocumented immigrants and incarcerated individuals. | Requires most individuals to have health insurance. Penalty for not having coverage is a percentage of your income. Exemptions granted for those with financial hardships and religious obligations. |
| Insurance exchange through which individuals can buy insurance is state-based, with separate exchanges for businesses and individuals. | Business and individuals participate in the same national insurance exchange. |
| Expands Medicaid to 133% of poverty level. | Expands Medicaid to 150% of poverty level. |
| Employers with fewer than 50 employees are exempt from penalties. Employers with more than 200 employees must automatically enroll all employees (though they can opt-out). | Employer penalty exemption is based on payroll amount, not number of employees, with employers with annual payrolls less than $500,000 totally exempt. |
| No public plan option, but each state insurance exchange must include at least two multi-state exchanges. | Public plan option is available through the insurance exchange, but must meet the same requirements as private plans in terms of benefit levels, provider networks, consumer protections, and cost-sharing. |
| Require guarantee issue and renewability and allow rating variation based only on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5. to 1 ratio). | Require guarantee issue and renewability; allow rating variation based only on age (limited to 2 to 1 ratio), premium rating area, and family enrollment. |
| Temporary high-risk pool to cover those who are difficult to cover will take effect within 90 days after enactment and last until Jan. 1, 2014. | Temporary high-risk pool to cover those who are difficult to cover will take effect Jan. 1, 2010 and last until the national insurance exchange is established. |
| Dependent coverage for children will be provided until age 26. | Dependent coverage for children will be provided until age 27. |
| Create a Web site to help consumers navigate health care choices and develop uniform policy presentation standards. | Develop uniform marketing and policy presentation standards. |
| CLASS Act national long term care program | CLASS Act national long term care program |
| Effective date for most provisions is Jan. 1, 2014. | Effective date for most provisions is Jan. 1, 2013. |
