WHERE THEY AGREE
Individual mandate: Both plans would require individuals to get health insurance or pay a penalty. Both would help lower-income people do that with government aid. Both would set up online exchanges so people could shop for coverage at group rates.
Covering more people: Though backers say insurance for all is the goal, both bills would still leave millions uninsured, says the nonpartisan Congressional Budget Office: The Senate bill would miss 24 million, the House bill 18 million, in each case a third of them the nation’s illegal immigrants.
Limiting insurers: Insurance firms no longer could reject new customers with pre-existing medical conditions. Their ability to set premiums also would be restricted.
Reducing costs: Both bills seek to restrain costs for consumers and the government, by calling for more preventive care and the use of more efficient electronic record-keeping. Biologic drugs, made from living cells, would get 12 years of protection from cheaper generics (the White House urged seven years).
Comparing treatments: Both would create research centers to judge how well various treatments, devices and procedures work. But neither bill would require health providers to use the results.
Bottom lines: According to the CBO, both bills would meet the Obama goal of not adding to the federal budget deficit. The Senate plan’s estimated cost for the first 10 years is $848 billion, the House’s $1 trillion.
Drugs for seniors: Both bills would do more to help Medicare participants afford prescription drugs.
WHERE THEY DIFFER
Paying for it: The House bill would put a surtax on the wealthiest Americans (starting with couples earning $1 million a year) and impose other taxes, including one on medical device makers. The Senate bill would go further in taxing the industry, to the tune of $2.3 billion a year on the drug sector and $6.7 billion a year on health insurers. It also would tax the most generous “Cadillac” health plans, put a 5 percent tax on elective cosmetic surgery and raise the Medicare payroll tax for couples earning over $250,000.
Public option: Both bills would set up a government-run insurance program to compete with private ones. But the Senate bill would let states opt out of the program.
Employer mandate: The House bill would require employers to cover their workers or pay a penalty (with some exemptions for size or hardship). Under the Senate bill, an employer — if it didn’t offer coverage and had even one employee qualify for a new tax credit — would have to pay a fee for all its employees.
Abortion: Both bills forbid using federal funds directly for abortion, as has been government policy for 33 years. The House bill would go further, by banning abortion coverage from the public option and any private insurance plan accepting government-subsidized participants. Currently, about half of private health plans cover abortion.
Drug negotiations: The House bill, but not the Senate’s, would require the Health and Human Services secretary to negotiate prices for people in the Medicare prescription-drug program. The pharmaceutical industry has fended off this proposal for years.
Effective dates: Many provisions in the Senate bill wouldn’t take effect until 2014, giving the government more time to take in revenue before creating new services. The House bill would start the insurance exchange in 2013.
Medicare commission: The Senate bill, but not the House’s, would create an Independent Medicare Advisory Board, with responsibility for recommending ways to keep program spending within preset targets. Both House and Senate bills would establish a Center for Medicare and Medicaid Innovation, to test ways of curbing spending.
— Bloomberg News
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