Congress has 3 health reform bills to debate
At the moment, three health care reform bills have been announced by several different Congressional committees. There are 3 main bills which will come up for debate in the House and the Senate after the August recess.
The House Committees on Education and Labor, Ways and Means, and Energy and Commerce have been working together in an unprecedented way as one committee to develop the proposal for health care reform. The bill, H.R. 3200 has passed two of the committees and is being marked up by Energy and Commerce. As written the bill comprises 1018 pages and can be read here.
The Health, Education, Labor and Pension (HELP) bill has also been published at 615 pages. You can read the bill here.
Finally, the Senate Finance Committee is still working on its own more bipartisan bill. It has not yet been published but we can draw some reasonable inferences as to how it is structured. While the bill has not yet been published, a summary has been provided by Max Baucus, Chairman of the Committee. You can read the summary here.
In an effort to clarify exactly what each bill proposes and how they relate to each other, the following chart has been constructed highlighting some of the major provisions.
| House Bill H.R. 3200 |
Senate HELP bill |
Senate Finance Bill |
|
| Public plan | Yes Creates a health insurance exchange, with public health insurance option alongside private plans |
Yes | No But the discussion centers around the likely creation of nonprofit, consumer-run insurance cooperatives. |
| Individual mandates | Yes. Individuals must purchase insurance or pay a penalty based on income. | Yes. Employers must pay 60% of family premiums or pay $750 for each employee who is not offered coverage. | Probably. Will very likely require Individuals to purchase insurance or pay a penalty based on the average cost of insurance. |
| Employer mandates | Yes. Employers must pay 65% of family premiums or pay a penalty based on payroll. Small businesses with less than $500,000 on payroll are exempt. Payrolls up to $750,000 have a reduced contribution. | Yes. Employers must pay 60% of family premiums or pay $750 for each employee who is not offered coverage. | No. Will likely include a free-rider provision that would require employers who currently offer coverage to reimburse the government for employees who switch to insurance purchased through an exchange. |
| Basic plan requirements | The public health insurance option (A) shall offer basic, enhanced, and premium plans; and (B) may offer premium-plus |
It is the purpose of this section [143] to facilitate the establishment of Affordable Health Benefit Gateways in each State, with appropriate flexibility for States in establishing and administering the Gateways. | The policy options would create four benefit categories which would be permissible in the reformed market: lowest, low, medium, and high. No policies (except grandfathered policies) would be issued that do not comply with one of the four categories. All insurers would have to offer coverage in each of the four categories. |
| Preventive services included | Title III addresses prevention and wellness, among other provisions of this Title says that…the Secretary shall submit to the Congress within one year after the date of the enactment of this section, and at least every 2 years thereafter,a national strategy that is designed to improve the Nation’s health through evidence-based clinical and community prevention and wellness activities (in this section referred to as prevention and wellness activities, including core public health infrastructure improvement activities | SEC. 2708. COVERAGE OF PREVENTIVE HEALTH SERVICES.a) IN GENERAL.—A group health plan and a health insurance issuer offering group or individual health insurance coverage shall provide coverage for and shall not impose any cost sharing requirements (other than minimal cost sharing in accordance with guidelines developed by the Secretary | All plans would be required to provide primary care and first dollar coverage for preventive services, emergency services , medical and surgical care, physician services, hospitalization,outpatient services, day surgery and related anesthesia, diagnostic imaging and screenings,including x-rays, maternity and newborn care, prescription drugs, radiation and chemotherapy,and mental health and substance abuse services. Also considering extending preventive services for Medicare and Medicaid |
| Changes to current insurance laws | Yes. A qualified health benefits plan may not impose any pre-existing condition exclusion (as defined in section 22 2701(b)(1)(A) of the Public Health Service Act) or other wise impose any limit or condition on the coverage under the plan with respect to an individual or dependent based on any health status-related factors | Yes. Bans rejection based on preexisting conditions. | Probably. Will likely ban rejection based on preexisting conditions. |
| Medicaid expansion | Yes. Medicaid expanded to cover households earning less than 133 percent of the federal poverty level. | Yes. Medicaid will be expanded to include individuals earning up to 150 percent of the federal poverty level. | Probably. Will likely expand Medicaid to cover everyone earning under 133 percent of the federal poverty level. |
| Government subsidies | Yes. Available to households earning up to 400 percent of the poverty level. | Yes. Available to households earning up to 400 percent of the poverty level. | Probably. Will likely be available to households earning up to 300 percent of the poverty level |
| How to fund the bill | The original proposal imposed a surcharge on families with incomes above $350,000 and individuals with incomes above $280,000, but House leaders are considering limiting the surtax to singles who earn more than $500,000 and families who earn more than $1 million. |
The Senate HELP Committee does not have authority over raising revenue. Funding would be the responsibility of other Senate Committees |
Considering imposing an excise tax on insurance companies that sell policies in excess of $21,000 a year for family coverage. |
| Total Cost | $1.04 trillion over 10 years | $1.34 trillion over 10 years | Estimated to be $900 billion over 10 years |
| Net increase to deficit | $239 Billion | $1.04 Trillion | Not yet estimated |
As all of these bills are still in progress, the numbers and the provisions are likely to change during the floor debates. This chart will help our readers keep up with the changes as they occur.
Comments
Ms. Guilloton,
Very informative piece but you refer to "preventative" services and there is no such word. The correct word is "preventive".
Thanks Rob
I did look up the words and both are in the dictionary but preventive is the preferred form so I made the change. Thank you for reading.
Thank you. Thus far, the best analysis I've read.
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