Increase spending caps for the territories.

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Reduce states’ Medicaid Disproportionate Share Hospital (DSH) allotments.

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Expand Medicaid to all non-Medicare eligible individuals under age 65 (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% FPL based on modified adjusted gross income (MAGI) and provides enhanced federal matching for new eligibles.

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Require Medicare Advantage plans to have medical loss ratios no lower than 85%.

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Reduce Medicare Disproportionate Share Hospital (DSH) payments initially by 75% and subsequently increase payments based on the percent of the population uninsured and the amount of uncompensated care provided.

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The Independent Payment Advisory Board, unaccountable to Congress, will be empowered to set reimbursement rates for government health programs.

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Reduce the out-of-pocket amount that qualifies an enrollee for catastrophic coverage in Medicare Part D (effective through 2019).

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Provide refundable and advanceable premium credits and cost sharing subsidies to eligible individuals and families with incomes between 133-400% FPL to purchase insurance through the Exchanges.

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Require qualified health plans to meet new operating standards and reporting requirements.

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Create a temporary reinsurance program to collect payments from health insurers in the individual and group markets to provide payments to plans in the individual market that cover high-risk individuals.

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