Senate Unveils Health Care Bill

Earlier this week Senate Majority Leader Harry Reid unveiled the Senate’s health care reform bill, the Patient Protection and Affordable Care Act. This is an $848 billion health-care overhaul package that extends coverage to 31 million Americans and reforms insurance practices. The Congressional Budget Office has determined that the Senate bill would cut federal deficits by $130 billion over the next decade, which is the largest cost saving so far from a health care proposal (the House bill would cost $1.05 trillion to extend coverage to about 36 million Americans and reduce deficits by about $109 billion by 2019). The effective date of the Senate bill was pushed back a year from 2013 to 2014, as compared to the House bill.

It is expected that the procedural vote required to start the debate on the bill will occur on Friday or Saturday of this week.

Below is a side-by-side comparison of provisions in the House and Senate health care bills:

House Bill	Senate Bill
Exchange/Subsidies:
The bill would set up new insurance marketplaces, called exchanges, where people without access to affordable coverage through an employer could purchase comprehensive plans. Subsidies would be available to households earning up to 400 percent of the poverty level ($88,200 for a family of four).	The bill would set up new insurance marketplaces, called exchanges, where people without access to affordable coverage through an employer could purchase comprehensive plans. Tax credits would be available on a sliding scale for individuals and families who earn up to 400 percent of the federal poverty level ($88,200 for a family of four).
Public Option:
A public plan would be created and made available through the insurance exchanges would be set up and run by the Secretary of Health and Human Services, who would negotiate rates with providers.	A public insurance option would be made available, but states that do not want to participate can opt out. The federal government would negotiate payment rates with medical providers.
Mandates:
Individuals must purchase insurance or pay a penalty of 2.5 percent of income.	Individuals must purchase insurance or pay a fine starting at $95 in 2014 and rising to $750 by 2016.
Employers must pay 65% of family premiums or pay a penalty based on their payroll. Small businesses with less than $500,000 on payroll are exempt and payrolls up to $750,000 would have a reduced contribution.	Employers are not required to offer health insurance, however, if even one employee receives a subsidy through the new exchanges, firms with more than 50 employees would have to pay a fine equal to $750 for every person on their payroll.
Abortion:
Abortion may not be covered in the public option or in private health insurance plans for women receiving public subsidies. There is an exception if a woman's life is in danger or in cases of rape or incest.	Federal funds cannot be used for abortion, however, the bill requires that at least one plan in the exchange offers abortion and at least one plan does not.
Revenue:
Includes a surcharge on taxpayers who earn more than $500,000 a year, or $1 million a year for families.	Includes a tax on high-cost insurance plans and would raise Medicare payroll taxes for the wealthiest Americans. The bill also levies a 5 percent tax on elective cosmetic surgery.
Insurance Reforms:
Includes bans on: · lifetime limits · premium disparity based on health status and sex · coverage denials based on preexisting conditions. The bill also would end a federal antitrust exemption that has protected firms from federal investigations.	Includes bans on: · lifetime limits · premium disparity based on health status and sex · coverage denials based on preexisting conditions.
Medicaid Expansion:
Medicaid would expand to provide free health care to all Americans with incomes below 150 percent of the federal poverty level ($33,070 for a family of four).	Medicaid would expand to cover everyone earning under 133 percent of the federal poverty level ($29,327 for a family of four).