Senate, House Health-Care Legislation: Side-by-Side Comparison
Nov. 8 (Bloomberg) -- The House of Representatives lastnight became the first U.S. legislative chamber to pass anoverhaul of the health-care system, with the aim of expandingcoverage to tens of millions of uninsured Americans andcurtailing costs.
The House voted on a combined measure based on versionsfrom three committees and now will wait for the Senate to finishand vote on legislation before starting talks on a compromisebetween the two chambers. Senate leaders are still struggling toreach consensus on the work of two different committees.
Only one Republican, Representative Joseph Cao ofLouisiana, supported the House measure. And Maine SenatorOlympia Snowe is the only Republican who has voted for a Senateplan, the one passed on Oct. 13 by the finance panel. Snowe isnow withholding her support as Senate Majority Leader Harry Reidpushes for the creation of a government-run insurance program,commonly known as the public option.
The following outlines some of the biggest similarities anddifferences in the plans:
Common Ground
INDIVIDUAL MANDATE: The House and Senate plans requireindividuals to get health insurance, with varying penalties forfailing to do so. They also include government subsidies orexpanded programs to help people with lower incomes purchasecoverage. New online exchanges would be created so people canshop for policies at more affordable group rates. About 15percent of U.S. residents, or some 46 million, lacked healthinsurance in 2008, according to the U.S. Census Bureau.
EXPANDING COVERAGE: President Barack Obama and topDemocrats in Congress say they want to cover all Americans, yetthe proposals would still leave millions of people not eligiblefor Medicare uninsured, according to the nonpartisanCongressional Budget Office. Under the House proposal, about 18million non-elderly people, including millions of illegalimmigrants, would lack coverage, the CBO estimated. The SenateFinance Committee plan would leave about 25 million uninsured, athird of them illegal immigrants, the CBO said on Oct. 7.
INSURER REQUIREMENTS: Insurers would no longer be able toreject new customers with pre-existing medical conditions; newrestrictions would be placed on their ability to set premiums.
REDUCING COSTS: The legislation is intended to lower long-term health-care costs for consumers and the government.
All the plans call for greater access to preventive care,either with new programs or the elimination of co-payments, achange that proponents claim will save money by keeping peoplefrom developing illnesses that are more costly to treat. Theyalso call for more use of electronic systems to promote betterrecord-keeping and reduce overhead costs.
Obama favors a new independent commission to setreimbursement rates for providers who treat patients inMedicare, the federal program for the elderly. The SenateFinance Committee embraced a version of this idea. The Housebill establishes the Center for Medicare Innovation “to pursueadditional payment and delivery system reforms.”
BIOLOGICS: Biologic drugs, made from living cells bycompanies such as Thousand Oaks, California-based Amgen Inc.,would get 12 years of protection from generic competition underplans passed by the House and the Senate health committee. TheWhite House had sought to limit the exclusivity to seven yearsas a way of bringing prices down.
COMPARING TREATMENTS: Legislation in both the House andSenate would create research centers to examine the efficacy ofvarious health-care services, devices, treatments andprocedures. None of the bills require the research be used toforce health providers to adopt new procedures or policies tocut costs, which is an administration priority. Obama provided$1.1 billion in the stimulus act to fund so-called comparativeeffectiveness research.
THE DEFICIT: House and Senate leaders pledged to come upwith legislation that doesn’t add to the federal budget deficit,a requirement set by Obama. The CBO estimated that the SenateFinance Committee plan would meet that goal and cost $829billion over 10 years. The House would also meet the goal at acost of more than $1 trillion, the CBO said.
Differences
PUBLIC OPTION: The House would create a new government-runinsurance program designed to compete with private companiessuch as Minnetonka, Minnesota-based UnitedHealth Group Inc. andhelp reduce prices for insurance in the market. The planrequires that the new entity negotiate rates with medicalproviders as private insurers do, instead of pegging rates tothe lower fees paid by Medicare.
In the Senate, Reid is also pushing for a public option,though his proposal would allow states to opt out of theprogram. The Nevada Democrat also may not have the votes to pushit through after the two committees split in his chamber.
The Senate health panel supported the public option and thefinance committee voted against it in favor of nonprofitcooperatives, or networks of health-insurance plans owned by thecustomers they serve, that would get government seed money.
EMPLOYER MANDATE: The House requires that employers covertheir workers or pay a penalty, with potential exemptions forsome businesses because of size or hardship. The measure underconsideration by Reid, tracking the Senate finance panel’s work,would instead require that employers with more than 50 full-timeworkers pay a fee for every lower-income employee who qualifiesfor a new tax credit to obtain care.
HOW TO PAY FOR IT: The House version would add a surtax onthe wealthiest Americans, starting with couples who earn morethan $1 million a year. The chamber also has other taxesincluding one designed to raise $20 billion over 10 years frommedical device makers.
The Senate version would tax insurers on the most generous,so-called Cadillac benefit plans. It also includes new annualfees on insurers, medical-device manufacturers, drugmakers andclinical laboratories beginning in 2010 and imposed based onmarket share. Because only the finance committee hasjurisdiction over funding in the Senate, there’s no conflictbetween panels.
What’s Next
Reid is waiting for CBO cost estimates before bringing acombined measure to the full chamber, controlled 60-40 byDemocrats and the two independents who caucus with them.
Senate leaders are still working to win Republican backingbecause 60 votes is the minimum needed to overcome a legislativemaneuver known as a filibuster that’s likely to come fromopponents, and there’s no assurance the Democrats will sticktogether. Otherwise, Democratic leaders could resort to a budgetprocess known as reconciliation, whose rules require only amajority for passage yet might force a scaled-back measure.
If measures pass both chambers, the House and Senate wouldwork together to fashion a compromise for another round ofvotes. The final legislation would go to Obama to be signed intolaw. Obama and Democratic leaders in Congress say they want thebill signed by the end of this year.
That deadline may slip.
“We’re not going to be bound by any timelines,” Reid toldreporters on Nov. 3.
To contact the reporters on this story:Kristin Jensen in Washington at kjensen@bloomberg.net;Nicole Gaouette in Washington at ngaouette@bloomberg.net
Last Updated: November 8, 2009 01:10 ESTSource: Bloomberg
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