House, Senate Health-care Legislation: Side-by-side Comparison
While the House passed its measure on Nov. 7, the Senate plans soon to vote on its bill and an amendment put forth yesterday by Senate Majority Leader Harry Reid.
Only one Republican, Representative Joseph Cao of Louisiana, supported the House measure. And Maine Senator Olympia Snowe is the only Republican who has voted for a Senate plan, the one passed on Oct. 13 by the finance panel. Neither Snowe, nor any other Republicans, have said they will support the current Senate version.
The following outlines some of the biggest similarities and differences in the House and Senate plans:
Common Ground
INDIVIDUAL MANDATE: The House and Senate plans require individuals to get health insurance or pay a penalty. They also include government aid to help people with lower incomes purchase coverage. New online exchanges would be created so people can shop for policies at more affordable group rates. About 15 percent of U.S. residents, or some 46 million, lacked health insurance in 2008, according to the U.S. Census Bureau.
EXPANDING COVERAGE: President Barack Obama and top Democrats in Congress say they want to cover all Americans, yet the proposals would still leave uninsured millions of people not eligible for Medicare, according to the nonpartisan Congressional Budget Office. The Senate bill would leave about 23 million non-elderly people uninsured, about a third of them illegal immigrants, the CBO estimated. The House bill would leave about 18 million uninsured, also about one-third of them illegals, the CBO said.
INSURER REQUIREMENTS: Insurers would no longer be able to reject new customers with pre-existing medical conditions; new restrictions 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, a change that proponents argue will save money by keeping people from developing illnesses that are more costly to treat. They also call for more use of electronic systems to promote better record-keeping and reduce overhead costs.
BIOLOGICS: Biologic drugs, made from living cells by companies such as Thousand Oaks, California-based Amgen Inc., would get 12 years of protection from generic competition. The White House had sought to limit the exclusivity to seven years as a way of bringing prices down.
COMPARING TREATMENTS: Legislation in both the House and Senate would create research centers to examine the efficacy of various health-care services, devices, treatments and procedures. Neither bill requires the research be used to force health providers to adopt new procedures or policies to cut costs, which is an administration priority. Obama provided $1.1 billion in the February economic-stimulus act to fund so-called comparative effectiveness research.
HELPING SENIORS AFFORD MEDICINES: Both the House and Senate legislation do more to help participants in the Medicare program for the elderly afford prescription drugs. The pharmaceutical industry in June agreed to spend as much as $80 billion over 10 years, in part to help fill in a so-called doughnut hole, or gap, in coverage in the prescription program.
Differences
PUBLIC OPTION: The House would create a government-run insurance program designed to compete with private companies such as Minnetonka, Minnesota-based UnitedHealth Group Inc. and help reduce prices for insurance in the market. The plan requires that the new entity negotiate rates with medical providers as private insurers do, instead of pegging rates to the lower fees paid by Medicare.
Reid dropped that idea after opposition from fellow Democrats. As an alternative, the U.S. Office of Personnel Management, which oversees benefits for all civilian federal workers and members of Congress, would contract with private insurers to offer multistate plans on the insurance exchange.
HOW TO PAY FOR IT: The House version would add a surtax on the wealthiest Americans, starting with couples who earn more than $1 million a year. The chamber also has other revenue- raising provisions including one designed to bring in $20 billion over 10 years from medical device makers. A similar Senate proposal would start assessing $2 billion a year on device makers in 2011, rising to $3 billion annually in 2018.
The Senate took other industry fees a step further as well, assessing $2.3 billion a year on drugmakers and fees starting at $2 billion a year graduating to $10 billion on health insurers. The levies would be imposed based on market share and exempt some nonprofit insurers.
The Senate version would also tax the most generous, so- called Cadillac benefit plans, with higher thresholds for high- risk jobs and costly states. In addition, it has a 10 percent tax on indoor tanning salons and raises the Medicare payroll tax on couples earning more than $250,000 a year.