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Rx for Reform  Updated: March 19, 2010, 4:06 p.m. ET

Compare the House, Senate and Reconciliation Bills

President Obama speaks to reporters, March 18, 2010/Getty Images.
BY LEA WINERMAN

House Democrats on Thursday unveiled a package of amendments to the Senate version of health care reform legislation. This reconciliation bill is aimed at bringing the Senate bill closer to the version the House passed last November. It includes some key changes, such as increasing subsidies for low- and middle-income Americans to purchase insurance. The House may vote on the Senate bill, along with the reconciliation bill, as early as Sunday afternoon. Compare the House, Senate and Reconciliation bills below.

House

Senate

Reconciliation

Name

Affordable Health Care for America Act

Patient Protection and Affordable Care Act

The Health Care and Education Affordability Reconciliation Act of 2010

How many are covered?

About 96 percent of legal U.S. residents under age 65 would be covered, compared with 83 percent now, according to the Congressional Budget Office.

About 94 percent of legal U.S. residents under age 65 would be covered, compared with 83 percent now, according to the Congressional Budget Office.

About 95 percent of legal U.S. residents under age 65 would be covered, compared with 83 percent now, according to the Congressional Budget Office.

Timeline

Most provisions would take effect in 2013.

Most provisions would take effect in 2014.

As in the Senate bill, most provisions would take effect in 2014.

Individual Requirements

Most people would be required to obtain health insurance, though some, including those with religious objections and those who cannot afford it, can apply for waivers.

People who do not get coverage would pay a penalty fee of 2.5 percent of adjusted gross income over a certain level.

Most people would be required to obtain health insurance, though some, including those with religious objections and those who cannot afford it, can apply for waivers.

People who do not get coverage would pay a fine of $95 in 2014, which would rise to $750 or 2 percent of income, whichever is higher, by 2016.

Same as the Senate bill, except that the penalties for not buying insurance are reduced.

People without coverage would pay a fine of $95 in 2014, which would rise to $695 or 2.5 percent of income, whichever is higher, by 2016.

Employer Requirements

Employers with payrolls over $500,000 would be required to provide health insurance for their employees. 

Those with payrolls over $750,000 must pay at least 65 percent of premium costs, those with payrolls between $500,000 and $750,000 would have to pay a smaller percentage.

Employers are not required to provide health insurance for their employees.

However, companies with more than 50 employees must pay a fee of $750 for every employee, if even one employee qualifies for federal subsidies.

Similar to the Senate bill, but raises the fee that employers must pay if they don't provide insurance to $2,000 per employee.

Also, exempts companies from paying the fee for the first 30 employees. So, for example, a company with 51 employees would pay the fee for 21 employees.

Insurance Marketplace

The bill would set up a national health insurance exchange where the self-employed, small businesses and other people without insurance could shop for coverage. The exchange could include both private insurance and a public plan. 

States could run their own exchanges under federal guidelines.

The bill would create state-based insurance exchanges where the self-employed, small businesses and other people without health insurance could shop for coverage.

Same as the Senate bill

Illegal Immigrants

Illegal immigrants could participate in the exchange, but could not receive federal subsidies.

Illegal immigrants could not participate in the exchange.

Same as the Senate bill

Public Plan

A new government-run public plan would be offered on the exchanges to compete with private insurers.

The government would negotiate payment rates with medical providers.

The bill does not include any public insurance option.

Instead, the federal Office of Personnel Management, which administers federal employees' health insurance plans, would contract with private insurers to offer at least two national health plans on the exchange, at least one of which would have to be a non-profit plan.

Same as the Senate bill

Subsidies

People with incomes up to 400 percent of the federal poverty level -- $88,200 for a family of four -- would be eligible for premium and cost-sharing subsidies on a sliding scale, to purchase insurance on the exchange.

People with incomes up to 400 percent of the federal poverty level -- $88,200 for a family of four -- would be eligible for premium subsidies on a sliding scale, to purchase insurance on the exchange.

People with incomes up to 200 percent of the federal poverty level would be eligible for cost-sharing subsidies.

As in the House and Senate bills, people with incomes up to 400 percent of the federal poverty level ($88,200 for a family of four) would be eligible for subsidies on a sliding scale to purchase insurance in the exchange. 

The premium subsidies are more generous than in the Senate bill, and cost-sharing subsidies are extended to people who earn up to 400 percent of the poverty level.

Insurance Regulations

Insurers would no longer be able to deny coverage or charge higher premiums based on pre-existing conditions or gender. 

Premiums could vary by age, but premiums for the oldest customers could not cost more than twice premiums for the youngest. 

Children would be able to stay on their parents' insurance until age 27, beginning in 2010. 

The bill would end the antitrust exemption for the health insurance industry.

Insurers would no longer be able to deny coverage or charge higher premiums based on pre-existing conditions or gender. For children, this new regulation would go into effect immediately. For adults, it would go into effect with the rest of the legislation in 2014. 

Premiums could vary by age, but premiums for the oldest customers could not cost more than three times premiums for the youngest. 

Children would be able to stay on their parents' insurance until age 26, beginning in 2010. 

Insurers would be required to spend at least 80 cents of every dollar received in premiums on providing health care.

Similar to Senate bill. Extends some of the new regulations to already existing, grandfathered-in plans beginning six months after enactment.

New Taxes

A 5.4 percent surtax would be levied on individuals who earn more than $500,000 per year and families that earn more than $1 million. 

A new 2.5 percent excise tax would be levied on medical devices.

The Medicare payroll tax would increase from 1.45 to 2.35 percent for individuals who make more than $200,000 per year and families making more than $250,000. 

A new tax would be levied on high-value insurance plans worth more than $8,500 for individuals and $23,000 for families. There would be an exemption for people in high-risk occupations, such as firefighters and construction workers. 

A new 10 percent tax would be levied on indoor tanning services. 

New annual fees would be levied on health care companies, including drug makers, medical device manufacturers and insurance companies, allocated by market share.

Similar to Senate bill, but delays the implementation of the new tax on high-cost "Cadillac" plans until 2018, and raises the threshold at which the tax kicks in to plans that cost more than $10,200 for individuals and $27,500 for families. The threshold is indexed to inflation and so can change each year. 

Extends the Medicare payroll tax to investment income. Individuals who earn more than $200,000 or families that earn more than $250,000 would pay a 3.8 percent Medicare tax on investment income.

Cost

The bill would cost $1.05 trillion over 10 years, according to the CBO.

The bill would cost $871 billion over 10 years, according to the CBO.

The bill would cost $940 billion over 10 years, according to the CBO.

Federal Deficit Impact

Counting savings from Medicare cuts and other areas, the bill would reduce the federal deficit by $104 billion over 10 years, according to the CBO estimate.

Counting savings from Medicare cuts and other areas, the bill would reduce the federal deficit by $118 billion over 10 years, according to the CBO estimate.

Counting savings from Medicare cuts and other areas, the bill would reduce the federal deficit by $143 billion over 10 years, according to the CBO estimate.

Abortion

Private plans offered on the exchange would not be allowed to cover abortion services if they take any customers who receive federal subsidies.

The public plan would not cover abortion services.

Health care plans could choose whether or not to cover abortion. But states would be allowed to bar plans offered on the state-based insurance exchanges from offering abortion coverage.

People who receive federal subsidies would be allowed to purchase plans that cover abortion in states where those plans were available. But they would be required to write two separate checks for their premiums -- one for abortion coverage, and one for all other coverage. Insurers would be required to keep those funding streams separate.

Same as the Senate Bill

Medicaid Expansion

Medicaid would be expanded to cover everyone who earns up to 150 percent of the federal poverty level ($33,075 for a family of four).

Medicaid would be expanded to cover everyone who earns up to 133 percent of the federal poverty level ($29,327 for a family of four).

Similar to the Senate bill. But, deletes a controversial provision that would have had the federal government cover the entire cost of expanding Medicaid for the state of Nebraska, in perpetuity. Instead, the federal government would pay the full cost for all states for three years, with some additional money for states such as Maine and Vermont that have already expanded Medicaid on their own.

Raises Medicaid pay rates for primary care doctors to equal Medicare reimbursement rates, which have been generally been about 20 percent higher.

Medicare Changes

The legislation would reduce spending on Medicare and other federal programs by $456 billion over 10 years, according to the CBO. Those reductions would come mainly from changes to Medicare provider payment rates and federal subsidies for privately-run Medicare Advantage plans.

The legislation would create an Independent Medicare Advisory Board to make recommendations to reduce Medicare spending, if that spending exceeds targets.

It would also reduce spending on Medicare and other federal programs by $483 billion over 10 years, according to the CBO. Those reductions would come mainly from changes to Medicare provider payment rates and federal subsidies for privately-run Medicare Advantage plans.

Reduces the savings that the new independent Medicare Advisory Board is expected to produce.

Reduces federal spending on the Medicare Advantage program more steeply than the Senate bill.

Closes the Medicare prescription drug "donut hole" gradually over the course of the next decade.

--Sources: The Congressional Budget Office, New York Times, Washington Post, Associated Press, Kaiser Family Foundation.


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