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Medicaid/Medicare

	House Bill	Senate Bill	NCSL
Boren Amendment	Phases out Boren Amendment over 18 months beginning 10/1/97; adds new public notice and rate review process.	Repeals Boren Amendment outright; adds new public notice and rate review process.	Supports Senate's repeal.
DSH Payments	Reduces state DSH payments by $15.3 billion over 5 years with additional caps on state allotments. Establishes consumer protection requirements.	Reduces state DSH payments by $16 billion over 5 years with additional caps on allotments; states must report DSH spending priorities. Imposes limitations on payments to Institutes for Mental Disease (IMDs).	Opposes deep cuts in DSH and IMD limitations.
Managed Care	Allows states to enroll Medicaid beneficiaries in managed care or primary care management plans without a waiver, as long as more than one plan option.	Similar provision.	Supports managed care without a waiver and House consumer protections.
Disabled Children	Allows states to provide Medicaid benefits to children who lost SSI benefits through definitional changes in 1996 welfare legislation.	No provision.	Supports House bill.
Federally Qualified and Rural Health Centers	Phases out cost-based reimbursement for FQHCs and RHCs over 5 years.	No provision.	Supports House bill.
Association Health Plans/Multiple Employer Welfare Associations	Creates new category of ERISA plans, certified Association Health Plans (AHPs), that would be exempt from state insurance regulation. Also exempts some entities currently defined as MEWAs from state regulation. Weakens current legal standards of affiliation between group sponsors and members.	No provision.	Supports Senate bill.
Medical Liability Reforms	Establishes Federal standards in health care liability actions brought in State or Federal court. Prohibits awarding punitive damages agaisnt a manufacturer or product seller in cases where a drug or device was subject to pre-market approval by the FDA.	No provision.	Opposes provision on manufacturer’s product liability.
Medicare Part B Premium Protection	Provides $1.5 billion over 5 years on premium assistance for seniors with incomes up to 135% of poverty. For 135% to 175% of poverty, assistance covers portion of premium increase due to the home health spending transfer.	Provides $1.5 billion over 5 years in a block grant to states for premium assistance to beneficiaries between 120% and 150% of poverty.	Supports federal coverage of Medicare beneficiaries.
QMB’s and Dual Elilgibiles	No provision.	Allows states to use Medicaid payment rates for determining cost-sharing for QMB’s and dual eligibles.	Supports Senate bill.

Welfare Reform

	House Bill	Senate Bill	NCSL
Welfare-To-Work	(Ways and Means) 50% of annual distribution to be distributed to states on a formula basis; 50 % to be distributed to PICS and political subdivisions on a competitive basis. (Education) 95% distributed to states on formula basis. 85% of formula funds distributed through PICs in both versions. $3 billion over 3 years. States must meet an 80% MOE under TANF to receive funds in W&M version: requires a 33% match of federal funds to be eligible. (There is no MOE in Education version).	75% of annual distribution to be distributed to states on a formula basis; 25% to be distributed to political subdivisions on a competitive basis. Use of PICs not required. $3 billion over 3 years. States must meet an 80% MOE under TANF to receive funds, reduced to 75% if states meet work requirement: requires a 33% match of federal funds to be eligible.	Supports a larger percentage of funds distributed to states (House Education and Senate). Prefers flexibility in Senate version- the service delivery system is not mandated. Supports the 75% MOE in Senate.
SSI State Supplements	Repeals mandatory state SSI supplemental payments.	No provision.	Supports House bill.
Vocational Education Cap	20% (Education) or 30% (Ways & Means) of those counting toward work can be in vocational education training. Teens in school are exempt in W&M version.	20% of TANF caseload can be in vocational education training when calculating work participation rate. Teens in school are exempt.	Supports Senate bill.
Title XX Transfers	States can directly transfer up to 10% of the state TANF block grant into the social services block grant.	No provision.	Supports House bill.
Minimum Wage/ Fair Labor Standards	States are given a choice of either 1) applying FLSA to work or community programs not meeting the trainee exemption or 2) maintaining programs which meet trainee exemptions and not being required to pay recipients the minimum wage.	State calculations of benefits/minimum wage packages do not have to include deductions for decreases in family benefits due to sanctions.	No position.
Penalties	No provision.	Requires HHS Secretary to impose maximum penalty for states failing to meet the work participation rate; some waiver for natural disasters or regional recessions.	Oppose Senate bill.

Legal Immigrants

	House Bill	Senate Bill	NCSL
Medicaid and SSI Eligibility	Elderly and disabled legal immigrants receiving SSI or Medicaid benefits before 8-22-96 would remain eligible. $9 billion over 5 years.	Same as House with additional provision for legal immigrants in the country before 8-22-96 who become disabled in the future maintain eligibility for SSI and Medicaid benefits. Prospective legal immigrants too disabled to naturalize are exempt from the SSI ban. $11.4 billion over 5 years.	Supports Senate bill.

Food Stamps

	House Bill	Senate Bill	NCSL
Work Slots	Provides States with $680 million in new funding over 5 years for Education and Training activities within Food Stamps. Funding is for workfare, subsidized slots and other employment and training activities. 80% of funds must be spent on E&T services not including job search. 100% MOE based on FY96 state E&T spending.	Provides $640 million in new funding to create Education and Training activities within Food Stamps. Two different reimbursement rates for States drawing down on these funds that are dependent on type of use. 75% of funds must be spent on workfare or subsidized job slots. 75% state MOE based on FY96 state E&T spending.	Supports flexibility in House funding uses; prefer Senate MOE.
New Exemption	Allows states to continue food stamps benefits for 15% of a state’s able-bodied without dependents who are currently limited to three months of benefits due to last year’s welfare legislation.	Same provision as House.	Supports the 15% exemption.

Children's Health

	House Bill	Senate Bill	NCSL
General Approach and Funding	$15.9 billion over 5 years. States get allotments ot provide health coverage to targeted low income children; to provide health services for improving children’s health; and to conduct outreach activities. States can expand Medicaid, offer group or individual health insurance plans or purchase services directly from providers.	$24 billion over 5 years. States get allotments ot provide health coverage to targeted low income children not eligible for Medicaid as of 6-1-97. States can either expand Medicaid or provide coverage equivalent to Blue Cross and Blue Shield standard option preferred provider plan.	Supports House bill because it offers states more options and flexibility.

Taxes

	House Bill	Senate Bill	NCSL
Aviation Fuel Tax	Transfers 4.3 cents per gallon tax on aviation fuels now going to the general fund to the Airport and Airway Trust Fund.	No provision.	Supports House bill.
Transportation Fuel Tax	No provision.	Redirects 3.8 cents of the 4.3 cents transportation fuels excise tax to the Highway Trust Funds. 0.5 cents earmarked for Amtrak.	Supports Senate bill.
Reciprocal Refunds	Provides for collection of past-due, legally enforceable state tax obligations by the federal government through reductions in amount of overpayment payable to a taxpayer.	No provision.	Supports House bill.
Public Pension Plans	Makes permanent the moratorium on application of certain nondiscrimination rules to state government pensions, profit sharing and stock bonus plans.	Same as House.	Supports both House and Senate bills.
Cigarette Tax	No provision.	$0.20 per pack increase. $8 billion over 5 years to expend on health insurance coverage for children.	No position.
Airline Ticket Tax	Lowers airline ticket tax to 7.5%. International ticket tax increases from $6 to $31.	Reinstates 10% airline ticket tax. International ticket tax increases from $6 to $16.	No position.
Child Tax Credit	$400 per child credit; $500 credit starting in 1999. Taken after the EITC; renders some LI families ineligible. Both phased out at incomes of $75,000 single and $110,000 couple. Deduction up to $100,000 per year on prepaid tuition plans or EIAs.	$500 per child credit to be phased out at incomes of $75,000 single and $110,000 couple. Half of the EITC is counted toward eligibility. Deduction up to $2,500 per year (for 5 years) for interest on student loans.	No position.
HOPE Program	Hope Scholarship credit of 50% of up to $3,000 for families earning less than $100,000. Phased out at incomes of $40,000 single and $80,000 couple.	Hope Scholarship credit phased out at incomes of $40,000 single and $80,000 couple.	No position.
Capital Gains	Capital gains from home sale exemptions, and decrease in tax rate on gains from investments from 28% to 20%.	Capital gains from home sale exemptions, and decrease in tax rate on gains from investments from 28% to 20%.	No position.
Estate Tax	Increase in personal estate exemption to $1 million over 10 years.	Increase in personal estate, small business, and family farm exemption to $1 million over 9 years.	No position.
FUTA Surtax	No provision.	Extends current 0.2% tax and increases the statutory limit on FUTA trust fund from 0.25% of covered wages to 0.5%.	No position.
IRA Provision	Creates American Dream IRA’s. Individuals may make nondeductible contributions of $2000 annually (indexed starting in 1999). No income limitations apply.	Expands deductible IRA’s, increases income limits, and eliminates active spousal participant rule.	No position.
Prorata Disallowance (2% De mimimis Rule)	Extends to non-financial corporations current law disallowing deduction of allocable to tax-exempt bonds.	No provision.	Opposes House bill.

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