Compare the 3 healthcare bills in Congress

By Lee Bowman
Scripps Howard News Service


Three proposals are working their way through Congress.  Here are the major components of each:

GENERAL APPROACH:

Senate Health:  Requires individuals to get health coverage. Creates state-based health benefit gateways. Requirers employers to cover or pay fee.

Senate Finance:  Requires most citizens and legal residents to get coverage. State-based insurance exchanges; employers cover or pay fee.

House: Requires individuals to be covered.  Sets up health exchanges.  Employers cover or pay fee to opt out, with some small firms excluded.

ESTIMATED COST:

Senate Health: $615 billion - excludes tax provisions

Senate Finance:  $829 billion

House:   $1.5 trillion

COVERAGE LEVEL:

Senate Health:  97 pct target

Senate Finance:  94 pct

House:   97 pct

 

ILLEGAL IMMIGRANTS COVERED:

Senate Health:  No - limits subsidies/credits to citizens and lawfully-residing immigrants

Senate Finance:  No - limits subsidies/credits to citizens and lawfully-residing immigrants

House:   No - limits availability of premium/cost sharing credits to citizens and legal immigrants

 

INDIVIDUALS:

Senate Health:  Must be covered or pay tax penalty

Senate Finance:  Must be covered or have employer coverage; exemption if cost is more than 8 pct of income

House:  Must have insurance or pay tax penalty; hardship exemptions to 2.5 pct penalty

 

EMPLOYERS:

Senate Health:  Cover workers or pay penalty of $750/worker; firms with fewer than 25 employers exempt

Senate Finance: Not required to cover workers; firms with more than 50 employees pay fee if workers get subsidy

House:   Must cover workers or pay penalty of 8 pct of payroll; small firms exempt.

 

SUBSIDIES:

Senate Health:  For families with income up to 400 pct of poverty line, $88,000 for family of 4.  Tied to average of 3 lowest-cost basic plans.

Senate Finance: For families with income up to 400 pct of poverty line, $88,000 for family of 4.  Tied to 2nd-lowest-cost plan in area.

House:  For families with income up to 400 pct of poverty line, $88,000 for family of 4.  Tied to average of 3 lowest-cost basic plans.

 

TAX/PENALTY:

Senate Health:  $750/year for individuals without qualifying coverage; maximum family penalty $3,000

Senate Finance:  $750/year for adults without qualifying coverage; excise tax on high-value plans worth more than $8,000 for individuals/$21,000 for family

House:  Tax of 2.5 pct of modified adjusted gross income on individuals without qualifying coverage

 

BENEFITS:

Senate Health: All health plans would have to offer at least the benefits ordered by the Medical Advisory Council. 3 benefit tiers cover 76-93 pct of costs.

Senate Finance:  All plans cover basic benefits -- primary care and hospitalization.  4 levels of coverage covering 65-90 pct of costs.

House:  Experts recommend a basic package that would cover about 70 pct of costs. Out-of-pocket limit $5,000 for individuals, $10,000 for families.  No annual or lifetime limits.  4 levels of benefits.

 

INSURANCE RULES:

Senate Health: No denials of coverage based on health. Insurers could take away coverage only in cases of fraud.    Premiums could differ only due to family structure, location, with limited higher premiums due to age, tobacco use.

Senate Finance: No denial of coverage based on existing conditions.  Premiums could not go higher due to health or gender. Limits on higher premiums due to age, family size, location and tobacco use.  Temporary pool for those with health problems.

House:  No denials or refusals to renew based on health.  Premiums could vary only due to location, family structure, and (with limits) age.

 

WHERE TO CHOOSE A PLAN:

Senate Health:  State-based American Health Benefit Gateways

Senate Finance: State-based exchanges, individuals and small businesses

House:  National Health Insurance Exchange for individuals and small employers

 

PUBLIC PROGRAMS:

Senate Health: Expand Medicaid to open coverage to anyone up to 150 pct of poverty level

Senate Finance: Expand Medicaid to open coverage to anyone up to 133 pct of poverty level.  Some could get coverage through exchanges.

House:  Expand Medicaid to open coverage to anyone up to 133 pct of poverty level.  Use as safety net for newborns, people with HIV.

 

PUBLIC OPTION:

Senate Health: Creates a community health-insurance option, to be offered through state gateways, financed through premiums

Senate Finance: Creates program to set up non-profit, member-run health-insurance companies in all 50 states. Must not be an existing organization.

House:  Creates new public health insurance option to be offered through exchanges; keys most aspects of program to Medicare.