TOPICS > Health

Compare the House and Senate Health Bills

BY Lea Winerman  November 19, 2009 at 2:52 PM EST

U.S. Capitol; file photo

The House and Senate bills match up on many broad concepts– both would require most Americans to buy health insurance, and would set up new marketplaces called exchanges where people without employer-sponsored insurance could shop for coverage. Each is a product of political compromise. However, they differ on some important details.

Learn more about the bills below.

HouseSenate
NameAffordable Health Care for America ActPatient Protection and Affordable Care Act

How many are covered?

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

About 94 percent of legal U.S. residents under age 65 will 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 .

Individual Requirements

Most people will be requir ed 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 will pay a penalty fee of 2.5 percent of adjust gross income over a certain level.

Most people will 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 will pay a fine of $95 in 2014, which will rise to $750 by 2016.

Employer Requirements

Employers with payrolls over $500,000 will 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 will 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.

Insurance Marketplace

The U.S. 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. The exchanges could include both private insurance and a public plan.

Illegal Immigrants

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

Illegal immigrants could not participate in the exchange.

Public Plan

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

The government would negotiate payment rates with medical providers.

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

The government would negotiate payment rates with medical providers.

However, states could choose to opt out of the public plan.

Subsidies

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 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 subsidieson a sliding scale, to purchase insurance on the exchange.

Insurance Regulations

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

There would be limits placed on charging higher premiums based on age.

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.

There would be limits placed on charging higher premiums based on age and family size.

Children will be able to stay on their parents’ insurance until age 26.

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.

The Medicare payroll tax would increase from 1.45 to 1.95 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

A new 5 percent tax would be levied on elective cosmetic surgeries.

Cost

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

The bill would cost $848 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 $109 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 $130 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 subsidized customers.

The public plan would not cover abortion services.

Private plans offered on the exchange are allowed to cover abortion services, but must keep a “firewall” between federal subsidy money and privately-paid premiums, and use only the private money to pay for abortion services.

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).

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