Health care reform: Where the House, Senate agree and disagree
By Alex Leary, Times Staff Writer
In Print: Thursday, November 12, 2009
The House recently passed its version of a massive health care reform bill, shown here. Now the Senate gives it a go. While there are many similarities between the two versions, the House and Senate still don’t see eye-to-eye on several key points.
WASHINGTON — After months of hearing about differences of opinion on reforming health care in America, it may seem as if there is no chance for an agreement. But the bill passed by the House on Saturday already has much in common with what has found favor in the Senate — and some key differences, too.
If you don't have health insurance now, prepare to get some. The House and Senate plans both include a so-called individual mandate, the idea being that if risk is spread to more people, it will drive down cost for all, not to mention make for a healthier America. If you don't get insurance, you may face a tax penalty (2.5 percent of income in the House plan) though hardship waivers would be offered and people with religious objections could opt out.
Insurance market reform
Been denied coverage for a pre-existing condition? Dropped for getting really sick? Face yearly or lifetime coverage limits? Both plans contemplate ending most reasons for rejection and greatly different premiums based on health status. There may be some factors insurers could consider, including age and tobacco use. There could also be an end to the long-standing exemption for insurers from antitrust laws covering price fixing and bid rigging.
Private insurance companies (and the government-run plan, if approved) would operate under a national or state "exchange" that sets minimum standards of coverage and establishes plans people can choose from. Young people could get a "bronze" plan, for example, while older adults could get a more expensive but more comprehensive "gold" plan. Marketing and enrollment forms would be standardized, alleviating the headache and confusion that can come with buying insurance now. The exchange would benefit individuals and families without insurance as well as small businesses. If your employer currently offers insurance, you could only get into the exchange if the cost of the employer-sponsored plan is too high. The House and Senate plans call for a subsidy for low- and moderate-income families. There would also be tax credits for small businesses, though details are still being worked out.
The House and Senate both aim to add millions of people to Medicaid, the federal-state insurance program for the poor. The House calls for covering all people under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The Senate calls for coverages for people with incomes up to 133 percent of poverty. The big unresolved question is how much would the federal government pay and how much would states pay. Politicians in Florida and other states that face huge enrollment numbers are screaming "unfunded mandate." The House plan, for example, covers 100 percent of the additional cost but only until 2015, when the share drops to 91 percent.
More primary care funding
Primary care doctors are in short supply in part because specialists attract higher salaries. The proposals call for increasing Medicare reimbursement rates to attract more doctors and to spur the private market to follow suit. There would also be more doctor residency slots (Florida would be a big winner) to address the shortage.
Nothing has proved more contentious than a government-run insurance option. Republicans hate it for creating competition with the private sector and so do some Democrats who do not want to see the government expand.
The House passed a version of a public option on Saturday that allows the Health and Human Services secretary to negotiate rates with providers. Prospects in the Senate are less clear and any plan would likely allow states to opt-out.
New entitlements come with a cost — a huge cost. The House wants to raise $461 billion in the next decade from a new 5.4 percent income tax on single people making more than $500,000 a year and couples making more than $1 million.
The Senate would tax the most expensive insurance plans with premiums over $8,000 annually for individuals and $21,000 for families. It would raise $201 billion. Both chambers would also make cuts to Medicare and Medicare Advantage, though some Florida lawmakers are trying to minimize those.
Unlike agreement on the requirement for individuals to carry insurance, there is division on whether employers should have to provide coverage. The House says yes to companies with payrolls above $500,000; the Senate calls for penalties only if an employee at a company with 50 or more workers has to resort to government-subsidized coverage.
The House would allow illegal immigrants to buy coverage under the new exchange, but not get a subsidy. The Senate would not allow access to the exchange.
One of the dramatic moments during the House debate Saturday was passage of an amendment that says federal money could not be used to pay for any abortion or any plan that includes abortion except for rape and incest, or when the life of the mother is in danger. The Senate has restrictions that are not as airtight, setting the stage for an emotional debate.
Times staff writer Angie Drobnic Holan contributed to this report. Sources: Times reporting, the Associated Press.