How 3 Healthcare Reform Bills Now Before Congress Compare

August 10, 2009

Lawmakers in Congress are working on three versions of proposals to overhaul the U.S. healthcare system. Many of these changes would be phased in over a number of years.

In the House of Representatives, three committees have each approved changes to one House bill. The changes will be melded by House leaders into final legislation before a floor vote expected in September.

In the Senate, the Health, Education, Labor and Pensions Committee has approved its version and the Senate Finance Committee is working on a separate healthcare overhaul bill.

The following is a comparison of major points in the various proposals.

INSURANCE MARKET REFORMS
All bills include the following:

  • Bar discrimination based on gender or pre-existing medical condition.
  • Coverage is guaranteed and benefits could not be rescinded after coverage is issued.
  • No annual or lifetime caps on benefit payments.

The Senate Health Committee and Finance Committee bill:

  • Premiums could vary only on family size, geographic region, tobacco use, age and benefits provided.
  • Coverage is guaranteed and benefits could not be rescinded after coverage is issued.
  • Insurers must provide financial incentives for quality and preventive care.

House bill:

  • Would eliminate co-pays for preventive care.

COVERAGE
Senate Health Committee bill:

  • Individuals are required to obtain coverage or pay a penalty of up to $750 per year. To help people pay for it, credits would be available up to an income of $88,000 a year for a family of four.
  • Employers are required to pay 60 percent of coverage for workers or pay $750 per year penalty. First 25 employees are exempt.
  • Health and Human Services Department would decide what is in a basic insurance plan required to be offered to all.
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    Senate Finance Committee bill:

    • An individual mandate is likely. No employer mandate is expected to be included but employers whose workers obtain subsidized coverage through an insurance exchange would have to cover some of the cost of those subsidies.

    House bill:

    • Individuals would be required to obtain coverage or pay a penalty based on income.
    • Employers would be required to contribute 65 percent of workers’ family insurance premiums or pay an 8 percent penalty. No penalty for small businesses but competing versions define small business as either under $250,000 or $500,000 annual payroll.

    INSURANCE OPTIONS
    Senate Health Committee bill:

    • Insurance “gateway,” or exchange, would serve as a clearing house for private insurers and a new public insurance option run by the government to sell policies to those who do not have coverage elsewhere.
    • New government-run insurance system would negotiate with providers for payments not more than the average of private insurers in the gateway system.
    • Those who have insurance would be permitted to keep their current plans and health insurers could sell policies outside the gateway system.
    • Health and Human Services Department would set out essential health benefits and minimum coverage for individuals.
    • Temporary aid for employers to cover retirees between ages 55 and 64 until the gateway system is in place.
    • Dependents would be covered until age 26.

    Senate Finance Committee bill:

    • Expected to provide for non-profit co-operatives rather than a government-run insurance plan.
    • Establishes state insurance exchanges for small businesses and individuals without employer-sponsored insurance.
    • The proposed new government-run plan or co-op insurance plans would be offered through these exchanges.

    House bills:

    • Would set up a public insurance option similar to the Senate Health Committee bill.
    • State insurance exchanges would offer individuals and small businesses insurance from private insurers or the government-run plan.
    • Insurance co-operatives would be allowed.

    INSURANCE SUBSIDIES
    Senate Health Committee and House bills:

    • Provide various forms of individual subsidies on a sliding scale up to 4 times the poverty level ($88,000 for a family of four).
    • The bills provide for some form of premium credit or tax subsidy for small businesses.

    Senate Finance proposal

    • Expected to provide refundable tax credit for individuals up to 3 times the poverty level.
    • To provide a small business tax credit.

    MEDICAID

    • Millions more people would become eligible for state Medicaid health plans for the poor.

    Senate Health bill:

    • Expansion to those with incomes up to 150 percent of the poverty level.

    Senate Finance bill:

    • Expansion to be determined. Federal government would bear added costs for a number of years, expected eventually to shift those costs to states.

    House bills:

    • Expansion of coverage to 133 percent of poverty. Requires states to enroll those newly eligible.

    MEDICARE

    • All bills include provisions to improve quality of healthcare in the Medicare program for the elderly. Payments to be designed to encourage quality, not quantity of services.

    House bill:

    • Requires government to negotiate prices with drug companies.
    • Eliminates the drug coverage gap over 15 years.
    • Will cover the cost of voluntary discussions with healthcare providers on end-of-life care.

    (Compiled by Jackie Frank and Donna Smith, editing by Eric Beech)

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