Thread: House, Senate Health-Care Legislation: Side-by-Side Comparis

House, Senate Health-Care Legislation: Side-by-Side Comparison


By Kristin Jensen and Nicole Gaouette

Nov. 20 (Bloomberg) -- The Senate and House have released different versions of legislation to overhaul the U.S. health- care system, with the goal of expanding coverage to tens of millions of uninsured Americans and curtailing medical costs.

While the House passed its measure on Nov. 7, the Senate has yet to begin debate and may end up making significant changes to its bill. Senate Majority Leader Harry Reid is struggling to reach consensus on a variety of issues in the legislation, including the government-run insurance option.

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. Snowe is now withholding her support because Reid included the government program, or public option, in his legislation.

The following outlines some of the biggest similarities and differences in the 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 millions of people not eligible for Medicare uninsured, according to the nonpartisan Congressional Budget Office. The Senate bill would leave about 24 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.

THE DEFICIT: House and Senate leaders pledged to come up with legislation that doesn’t add to the federal budget deficit, a requirement set by Obama. The CBO estimated that the Senate plan would meet that goal and cost $848 billion over 10 years. The House would also meet the target at a cost of more than $1 trillion, the CBO said.

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

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 taxes including one designed to raise $20 billion over 10 years from medical device makers, similar to a Senate proposal.

The Senate took industry fees a step further, assessing $2.3 billion a year on the drug industry and $6.7 billion a year on the health insurance industry. The levies would begin in 2010 and be imposed based on market share.

The Senate version would also tax the most generous, so- called Cadillac benefit plans, with higher thresholds for high- risk jobs and costly states. And it has a 5 percent tax on elective cosmetic surgery and raises the Medicare payroll tax on couples earning more than $250,000 a year.

PUBLIC OPTION: Both the House and Senate would create a new 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.

The main difference between the plans is that Reid’s proposal would allow states to opt out. And while the House has already approved this program with its vote on the legislation, Reid may not have the votes to push it through his chamber.

EMPLOYER MANDATE: The House requires that employers cover their workers or pay a penalty, with potential exemptions for some businesses because of size or hardship. Under the Senate bill, if an employer doesn’t offer coverage and has just one employee who qualifies for a new tax credit, the company must pay a fee for every full-time employee on its roster.

ABORTION FUNDING: While both the House and Senate bills bar federal funds from being used for abortion, the House restrictions go further and might discourage insurers from offering any abortion coverage in the new purchasing exchanges, abortions rights supporters say. House Speaker Nancy Pelosi says she believes the amendment passed in her chamber “goes beyondâ€

I haven't read in any bill that If illegals go to the ER they won't be treated unless they pay for treatment. So of course illegals are covered.

Thats because nothing about them is going to change.