Medical Charts: The Senate vs. the House on Health Care Reform

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Medical Charts: The Senate vs. the House on Health Care Reform
      by Vera H-C Chan

      5 hours ago

      Early Christmas Eve morning, Senators are due to vote aye or nay on the Patient Protection and Affordable Care Act, otherwise known as their vision of how to reform health care in America.

      The House wrangled its version last month. While President Obama says the two proposals are 95% "identical," that 5% difference has spurred some furious negotiations.
          o The bill for the health care reform bill? The House version costs more than a trillion, while the Senate's a tad cheaper at $871 billion.
          o People with comfy incomes will have to pay more taxes to help pay for reform, if the House has its way. The Senate stays away from that, but adds a 10% tax on indoor tanning booths.
          o Funding for abortion and a public option are two of the more heated controversies.
          o A New York congresswoman wrote an op-ed tearing apart the Senate bill for, among other things, letting insurance companies keep enjoying their antitrust status.

      Outlets like AP, Bloomberg, Newsweek, The New York Times, and the Kaiser Family Foundation have taken on the daunting task to compare the two versions. Below, three charts with an overview, key similarities, and key differences between the Senate and House proposals.
      
      Senate vs. House Health Care: Overview
                Senate         House         Notes
      Bill Size         2,074 pages
              1,990 pages
              .
      Reform cost         $871 billion (over 10 years)
              $1.05-$1.2 trillion (over 10 years)
              Health care cost Americans $2.4 trillion in 2008 and could balloon to $4.4 trillion by 2018.
      Where's the money coming from to pay for this?
              Taxes on fancy health plans (40% excise tax); fees on medical-device makers ($2 billion/year starting 2011, then $3 billion/year in 2018); higher Medicare payroll tax for high-income folks; Medicare and Medicaid cuts; fines. Strangest of all—10% tax on indoor tanning.         Surtax on high-earners (5.4% on incomes $500k and up); taxes on Cadillac plans (40% excise tax); Medicare and Medicaid cuts, fees medical-device makers ($20 billion over 10 years); various penalties, corporate taxes and fees; limits on flexible spending account contributions.         The tanning bed tax has pleased some doctors — using fake UV rays before age 30 have been correlated with a huge melanoma cancer risk. Rejected: The "Bo-Tax," a tax on cosmetic surgery.
      Who gets covered?         94% of legal residents under age 65         96% of legal residents under age 65         Currently, 83% of Americans are covered.
      Who gets left out?         24 million people under 65 (including illegal immigrants)         18 million people under 65 (including illegal immigrants)         Currently, 50 million (one in six Americans) are not insured.
      When would reform kick in?         2014, with some protections starting sooner.         2013, although rules for insurance companies would start in 2010         Some worry a later start allows insurance companies to jack up premiums in the meantime.

      

      Senate vs. House Health Care Similarities
                Senate         House         Notes
      Individual mandate (get insurance or pay a penalty)         Small penalties start in 2014 ($95), then hit 2% of taxable income in 2016.         2.5% of adjusted gross income of a certain level.         Both plans have aid for low-income people. Online sites will let consumers shop for group policies.
      Employer mandate (insure employees or pay a penalty)         Optional, but larger companies whose employees get any insurance help from Uncle Sam would pay a penalty.         Payroll size determines the penalty.         Polls shows a divided public, but people generally support the policy that bosses should provide coverage.
      Medicaid (federal program for low-income)
              Expanded, but still leaves 23 million "non-elderly" uninsure         Expanded, but leave 18 million uninsured         California governor Arnold Schwarzenegger, who supports health care reform, sent a letter with Medicaid concerns.
      Pre-existing medical conditions         Insurance companies banned from using pre-existing conditions as a reason to reject coverage. Effective immediately for children.         Bans insurance companies from this tactic.          12.6 million people have been rejected in the past three years for insurance because of "pre-existing" conditions.
      How long are the kids covered (under mom & dad's insurance)?         Up to age 25         Up to age 26         People 19 to 29 make up the biggest chunk of the uninsured.

      

      Senate vs. House Health Care Differences
                Senate         House         Notes
      Abortion funding         Beneficiaries need to pay for coverage separately, and insurers have to keep that moneys separate from federal funds. States can block such health plans.         Public plans don't cover the procedure, but private insurers can offer "rider" policies.         Abortion funding has been the sticking issue for both branches of Congress.
      Pharmaceutical industry drug costs         No change.         Companies would have to dicker over how much they can charge in the Medicare prescription drug program.         Health care lobbyists have spent about $400 million so far on the reform effort.
      Public option (government alternative to private plans)         No. The Office of Personnel Management, which runs policies for federal employees, would partner up with insurers to offer two national plans (with at least one operating as a nonprofit).         Yes, to compete with private plans and encourage lower costs.         Considered dispensable by the president and unlikely by key senators, public option appears doomed.
      Antitrust exemption for insurance companies         Status quo.
              By ending its special status, the feds can penalize companies for price rigging, false advertising, and similar issues.          Health insurance companies have enjoyed the McCarran-Ferguson exemption since 1945.

      

      Of course, these charts cover only what has been proposed. Among the health care professionals who want to see real reform, the National Nurses Union lists 10 fundamental flaws with the Senate proposal. A seasoned physician decries the lack of portability, accountability, and affordability, and the Harvard Medical School dean rates the debate process an F. The American Medical Association, however, has given its thumbs-up.

      The job of reconciling the House and Senate bills will fall to a conference committee. That'll take some time: As Politico notes, there's winter break (ending January 11 for the House, January 17 for the Senate), and the committee will want the White House to weigh in. Then the Congressional Budget Office will do the math, after which the House and Senate vote on the final bill, and Obama must sign off. There may be a holiday truce, but the debate will come back in the new year.

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