Comparing the House, Senate health proposals
Source: Denver Post | October 30, 2009
Erica Warner
WASHINGTON — House Democratic leaders presented a new health care overhaul bill Thursday that melds legislation passed by three committees over the summer and makes a series of changes to accommodate lawmakers' concerns. In the Senate, Majority Leader Harry Reid, D-Nev., is finalizing legislation merging the work of two committees and making other changes. Here are details on the two bills. The Senate bill has not yet been made public, so some specifics are unknown.
Who's covered
House: About 96 percent of legal residents under age 65 ? compared with 83 percent now. About one- third of the remaining 18 million non-elderly people left uninsured would be illegal immigrants.
Senate: The Senate Finance version covered an estimated 94 percent of Americans. Illegal immigrants would not receive government benefits.
The cost
House: 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 for individuals and employers who don't comply with the new requirements. That's under President Barack Obama's $900 billion goal. However those figures leave out a variety of new costs, including providing more prescription-drug coverage for seniors, so there's no official estimate on the total cost of the legislation.
Senate: Leaders aim to keep it under $900 billion over 10 years.
How it's paid for
House: $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making $1 million. There's 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 tax-free flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and other corporate taxes and fees.
Senate: Fees on insurance companies, drug makers, medical-device manufacturers. Tax levied on "Cadillac" insurance policies. Cuts to Medicare and Medicaid. A fee on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.
Requirements for individuals
House: Individuals must have insurance, enforced through a tax penalty. People can apply for hardship waivers.
Senate: Almost everyone must get coverage through an employer, on his or her own or through a government plan or face a fine.
Requirements for employers
House: 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 get tax credits to help them provide coverage.
Senate: Employers aren't required to offer coverage, but some companies face substantial fees if the government ends up subsidizing employees' coverage.
Subsidies
House: Individuals and families with annual income up to 400 percent of poverty level would get subsidies to help them buy coverage, beginning in 2013.
Senate: Tax credits for individuals and families. Tax credits for small employers.
How you choose insurance
House: 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.
Senate: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools.
Benefits package
House: A committee would recommend a so-called essential benefits package including preventive services; out-of pocket costs would be capped.
Senate: All plans sold to individuals and small businesses would have to cover basic benefits. The least generous plan would pay an estimated 65 percent of health care costs per year; the most generous would cover an estimated 90 percent.
Insurance industry limits
House: 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.
Senate: The same, plus limits on higher premiums based on family size.
Government-run plan
House: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services.
Senate: A similar version has been proposed, but states could opt out of the plan. The bill also would create nonprofit, member-owned co-ops to compete with private insurers.
Changes to Medicaid
House: The federal-state insurance program for the poor would be expanded to cover all non-elderly individuals with incomes up to 150 percent of the federal poverty level.
Senate: Income eligibility levels are likely to be standardized to 133 percent of poverty for all parents, children and pregnant women. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.
source: http://bulletin.aarp.org/yourhealth/policy/articles/comparing_the_house_senate_health_proposals.1.html
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