Side-by-side: House and Senate health bills

Congress has narrowed the debate over health care to two bills, one approved by the House and the other headed toward debate in the Senate.

A comparison of the Senate and House health care bills:

By Brendan Smialowski, Getty Images

By Mark Wilson, Getty Images

WHO’S COVERED

House

• 96% of legal residents under age 65, compared with 83% now. Government subsidies to help buy coverage would start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.

Senate

• 94% of legal residents under age 65, compared with 83% now. Government subsidies to help buy coverage would start in 2014. Illegal immigrants would not receive assistance.

COST

House

• The Congressional Budget Office says the bill’s cost of expanding insurance coverage over 10 years would be $1.055 trillion. The net cost would be $894 billion, factoring in penalties on individuals and employers who don’t comply with new requirements. That’s under President Obama’s $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be about $1.2 trillion.

Senate

• Coverage provisions would cost $849 billion over 10 years.

HOW IT’S PAID FOR

House

• $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million. The original House bill would have taxed individuals making $280,000 a year and couples making more than $350,000, but the threshold was increased in response to lawmakers’ concerns that the taxes would hit too many people and small businesses.

Senate

• Fees on insurance companies, drugmakers, medical device manufacturers. Medicare payroll tax would increase to 1.95% on income of more than $200,000 a year for individuals; $250,000 for couples. New 5% tax on elective cosmetic surgery. Cuts to Medicare and Medicaid. Excise tax on insurance companies, keyed to premiums paid on health care plans costing more than $8,500 annually for individuals and $23,000 for families. Fees on employers whose workers receive government subsidies to help them pay premiums. Fines on people who fail to purchase coverage.

REQUIREMENTS FOR INDIVIDUALS

House

• Individuals would have to have insurance, enforced through a tax penalty of 2.5% of income. People could apply for hardship waivers if coverage was unaffordable.

Senate

• Almost everyone would have to get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those obligated to buy coverage who refused to do so would pay a fine starting at $95 in 2014 and rising to $750.

REQUIREMENTS FOR EMPLOYERS

House

• Employers would have to provide insurance to their employees or pay a penalty of 8% of payroll. Companies with payrolls less than $500,000 annually would be exempt — a change from the original $250,000 level to accommodate concerns of some Democrats — and the penalty would be phased in for companies with payrolls of $500,000 to $750,000.

Senate

• Not required to offer coverage, but medium and large companies would pay a fee if the government ended up subsidizing employees’ coverage.

SUBSIDIES

House

•  Individuals and families with annual income up to 400% of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.

Senate

• Tax credits for individuals and families probably making up to 400% of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.

BENEFITS PACKAGE

House

• A committee would recommend a so-called essential benefits package including preventive services. Out-of pocket costs would be capped. 

Senate

• All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage: The least generous would pay about 60% of health care costs per year; the most generous would cover about 90%.

INSURANCE INDUSTRY RESTRICTIONS

House

• Starting in 2013: No denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.

Senate

• Starting in 2014: No denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Starting upon enactment of legislation: Children up to age 26 could stay on parents insurance. No lifetime limits on coverage.

GOVERNMENT-RUN PLAN

House

• A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. Democrats originally designed the plan to pay Medicare rates plus 5% to doctors. The final version preferred by moderate lawmakers would let the HHS secretary negotiate rates with providers.

Senate

• A new federal insurance plan would be offered to compete against private carriers. The government would negotiate — not dictate — payment rates for medical providers. Unlike the House bill, states could opt out of the plan. It’s not clear the proposal commands enough votes to survive, and it could be replaced by a standby system pushed by moderates that would not go into effect until it was clear individual states were experiencing a lack of competition among private companies.

DRUGS

House

• Would grant 12 years of market protection to high-tech drugs used to combat cancer, Parkinson’s and other deadly diseases. Would phase out the gap in Medicare prescription drug coverage by 2019. Would require the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.

Senate

• Would grant 12 years of market protection to high-tech drugs used to combat cancer, Parkinson’s and other deadly diseases. Drug companies would contribute $80 billion over 10 years. The majority of the money would be used to limit the prescription coverage gap in Medicare.

LONG-TERM CARE

House

• New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and people with disabilities avoid going into nursing homes.

Senate

• New voluntary long-term care insurance program would provide a basic benefit designed to help seniors and people with disabilities avoid going into nursing homes.

ANTITRUST

House

• Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price-fixing and bid rigging. The bill would give the Federal Trade Commission authority to look into the health insurance industry at its own initiative.

Senate

• Amendment likely to be offered on the Senate floor that would strip the health insurance industry of its antitrust exemption.

Source: Associated Press