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WASHINGTON – Here is a comparison of the health care bill that passed in the House late Saturday the one taking shape in the Senate.
The Senate Democrats’ bill has not yet been made public, and amendments can still be made, so some specifics are unknown.
Who’s covered: About 96 percent of legal residents under age 65 – compared with 83 percent now. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.
Cost: Just over $1 trillion over 10 years, the Congressional Budget Office says. The net cost is $894 billion, factoring in penalties on individuals and employers who don’t comply with new requirements. But those figures leave out such costs as increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.
How it’s paid for: $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.
There are also more than $400 billion in cuts to Medicare and Medicaid; a $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don’t obtain coverage; and other corporate taxes and fees.
Requirements for individuals: Individuals must have insurance, or face a tax penalty of 2.5 percent of income. People can apply for hardship waivers.
Requirements for employers: Employers must provide insurance or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt – a change from the original $250,000 level to accommodate concerns of moderate Democrats – and the penalty is phased in for companies with payrolls between $500,000 and $750,000. Small businesses – those with 10 or fewer workers – get tax credits to help them provide coverage.
Subsidies: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies, beginning in 2013.
How you choose your health insurance: Beginning in 2013 through a new Health Insurance Exchange open to individuals and, initially, small employers. It could be expanded to large employers over time. States could opt to operate their own exchanges.
Benefits package: A committee would recommend an essential benefits package including preventive services. Out-of-pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange.
Insurance industry restrictions: No denial of coverage for pre-existing conditions. No higher premiums for pre-existing conditions or gender. Limits on higher premiums based on age.
Government-run plan: Would be set up and run by the secretary of Health and Human Services, who would negotiate rates with providers.
Changes to Medicaid: Expanded to cover everyone under age 65 with an income up to 150 percent of the federal poverty level, or $33,075 a year for a family of four. After 2014, the federal government would pay 91 percent and states 9 percent.
Who’s covered: The Senate Finance version covered an estimated 94 percent of Americans. Illegal immigrants would not receive government benefits.
Cost: Senate leaders aim to keep it under $900 billion over 10 years.
How it’s paid for: Fees on insurance companies, drug makers, medical device manufacturers. Tax levied on insurance companies, equal to 40 percent of total premiums paid on insurance plans costing more than $8,000 annually for individuals and $21,000 for families. But that number may rise to $23,000. Retirees over age 55 and people in high-risk professions may be allowed to have somewhat more valuable plans before they’re taxed. Cuts to Medicare and Medicaid. A fee on employers whose workers receive government subsidies. Fines on people who fail to buy coverage.
Requirements for individuals: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse would face a fine.
Requirements for employers: Not required to offer coverage, but companies with more than 50 full-time workers would pay a fee as high as $750 multiplied by the total size of the work force if the government ends up subsidizing employees’ coverage.
Subsidies: Tax credits for individuals and families making up to 400 percent of the federal poverty level. Tax credits for small employers.
Benefits package: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage.
Insurance industry restrictions: Similar to House version.
Government-run plan: Senate Majority Leader Harry Reid proposed a new federal insurance plan this week with payment rates to providers negotiated by the health and human services secretary. Unlike the House bill, states could opt out of the plan. Would create nonprofit, member-owned co-ops to compete with private insurers.
How you choose your health insurance: Self-employed people, uninsured individuals and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally encouraged to keep their work-provided coverage.
Changes to Medicaid: Income eligibility levels likely to be 133 percent of poverty, or $29,327 a year for a family of four, for all parents, children and pregnant women. States could negotiate with insurers to arrange coverage for people with slightly higher incomes.
