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Compare the Senate and House Health Reform Bills

BY Lea Winerman  December 21, 2009 at 10:08 AM EDT

Many of the key provisions in the Senate bill remain the same as in the version Majority Leader Harry Reid originally submitted in November. But Reid did have to make some significant changes to the bill to win the votes of Democratic moderates, including dropping a public insurance option.

If the bill passes the Senate before Christmas, as Democratic leaders hope, it will still need to be reconciled with the House bill in a joint conference committee after the New Year. Compare the final House and Senate bills below.

House

Senate

Name

Affordable Health Care for America Act

Patient 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 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 penalty fee of 2.5 percent of adjusted 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 or 2 percent of income, whichever is higher, 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 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.

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.

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.

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 subsidies on 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.

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.

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.

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.

Federal Deficit Impact

Counting savings from Medicare cuts and other areas, the bill would reduce the federal deficit by $138 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 $132 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.

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).

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.

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