ISSUE

HOUSE

SENATE

Cost

Costs $1.1 trillion over a decade, surpassing President Obama’s $900 billion/10 year spending cap.

Costs $849 billion over a decade, reducing the deficit by $127 billion, and possibly an additional reduction of as much as $650 billion over the second decade, according to preliminary estimates by the Congressional Budget Office.

Public Option

Creates a government-run insurance program that offers plans in competition with the private market. The government would negotiate rates with health-care providers.

Creates a public insurance option, but gives states the right to opt out. Health-care providers would negotiate payment rates with insurance plans.

Employer Mandate

Requires businesses to cover their employees, but businesses with payrolls under $500,000 are exempt.

Does not require employers to provide health insurance but businesses with over 50 employees would be charged a penalty if they have workers who receive subsidies to purchase coverage through the insurance exchange.

Individual Requirements

Requires most people to get health insurance or pay a penalty of up to 2.5 percent of their income. This mandate (along with subsidies for the poor) extends coverage to 36 million Americans - 5 million more than covered by the Senate bill.

Requires most people to have health insurance or pay a penalty, which starts at $95 in 2014 and reaches $750 in 2016.

Insurance Exchange

Creates insurance exchanges. The idea is that insurers will compete with each other in these new marketplaces for people who are not covered by their employers and that this will bring down the cost of policies for the self insured and small businesses. State, regional, or national exchanges would be established to set standards for what benefits would be covered, how much insurers could charge, and the rules insurers must follow in order to participate. Until exchanges are established, the bill offers immediate assistance to those who have been uninsured for several months or denied a policy because of pre-existing conditions.

Also sets up health insurance exchanges to help those newly required to get insurance shop around. Exchanges would open in 2014, a year after the House plan.  Plans offered in the exchange would have to meet minimum requirements set by the government.

Financial Assistance/Low Income Subsidies

Includes subsidies to help those earning up to 400 percent of the federal poverty level pay for health insurance premiums. Includes a sweeping expansion in Medicaid that would provide free health-care to Americans with incomes below 150 percent of the federal poverty level.

Includes subsidies to help cover those making up to 400 percent of the federal poverty level and expands the Medicaid program to include those making 133 percent of the federal poverty level.

New Taxes

Taxes the wealthiest Americans, with individuals earning over $500,000 and families earning above $1 million paying a surcharge on a portion of their income.

Imposes a 40 percent tax on high-cost health insurance plans - those valued over $8,500 per individual or $23,000 per family. Charges a 5 percent tax on elective cosmetic surgery. Also increases Medicare payroll taxes from 1.45 to 1.95 percent on individuals earning $200,000 a year and couples earning $250,000. 

Medicare Changes

Reduces Medicare spending by approximately $40 billion over 10 years, largely by reducing payments to Medicare managed care plans (and are currently paid more than the cost of providing care) and by requiring hospitals and other health-care providers to reduce costs, increase quality and efficiency. Also includes several new benefits for people with Medicare, including coverage of more preventive services.

Reduces Medicare spending by approximately $323 billion over 10 years; includes cuts to Medicare managed care plans (although implemented slightly differently from House bill). Also in 2010, Medicare beneficiaries would receive $500 towards paying for prescription drugs not currently covered because of costs, those that fall into the so-called “doughnut hole.”

Medicare Physician Payment

The House bill did not include a provision to avert the scheduled Medicare physician payment cuts in 2010, but separate legislation (H.R. 3961) that was passed by the House would replace the Medicare formula determining physician payment, block the scheduled cut in 2010, and provide increases for physician payment.

Replaces the scheduled 21 percent payment reduction to the Medicare physician fee schedule for 2010 with a one-year 0.5 percent positive update.

Abortion

Bans abortion from being covered in the new public option except in cases of rape, incest, or threat to the life of the pregnant woman. Also bans people from using government subsidies to purchase private plans with abortion coverage on the exchange.

Prevents federal subsidies from going toward abortion coverage. Abortion could be covered under the public option plan but only if the Secretary of Health and Human Services could certify that no taxpayer funds would be used.