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These two laws at face value have many similarities, but it is difficult to spot the differences. How are these two bills alike, and how are they different?

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    One is 50 pages long, the other 900 pages. This is probably the main reason the differences are hard to spot. :-) – Lennart Regebro Dec 5 '12 at 7:17
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    The most blatant one - Obamacare is federal, and Romneycare is not. From a legal standpoint, this is a major distinction. – Snakes and Coffee Jan 5 '13 at 4:13
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The following list from A Tale Of Two Health Plans: Romney Versus Obama answers this question pretty well.

Similarities

  • Both have individual mandates that impose a tax penalty on people who have the financial ability to buy insurance but don't. Federal penalties start at $695 annually, or 2.5 percent of income, whichever is higher. In Massachusetts, penalties range from $228 to $1,212, depending on family size and income.

  • Both require health care "exchanges" (in Massachusetts, the exchange is called the "connector") designed to create a competitive health insurance market that gives individual and small business consumers a choice of private plans, rules that facilitate price comparison and plan transparency.

  • Both leave intact employer-provided insurance systems — Medicare plans for the nation's seniors, and Medicaid for poor and low-income citizens.

  • Both would fine companies that don't offer employee heath insurance, with exceptions for small businesses. Massachusetts requires companies with more than 10 employees to offer insurance; the national law sets the limit at 50 employees.

  • Both provide subsidies to low-income individuals and families to help pay for health insurance coverage.

Differences

  • The federal plan has a stated goal of attempting to lower health care costs; Massachusetts had no such stated goal.

  • The federal plan includes a patients' bill of rights, and provisions designed to promote public health.

  • The federal plan includes the so-called CLASS Act, a voluntary insurance program offered to workers for long-term care in the event that they become disabled when they get older. (The Obama administration last week delayed the program's rollout because it isn't financially self-sustaining as designed.)

  • The federal plan would expand Medicaid to cover poor, able-bodied adults who are not parents in addition to poor children, elderly, pregnant women and those with disabilities. The Massachusetts plan expands Medicaid coverage to more children.

  • To pay for the new coverage, the federal plan imposes taxes on a variety of sectors, from drug and medical device makers to health insurers. Massachusetts relies largely on federal matching funds.

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