Fri, December 25, 2009
World > Americas > U.S. health care reform

Backgrounder: Key differences in Senate, House versions of healthcare bill

2009-12-24 16:27:03 GMT2009-12-25 00:27:03 (Beijing Time)  Xinhua English

WASHINGTON, Dec. 24 (Xinhua) -- The U.S. Senate on Thursday approved a landmark healthcare reform bill, a key step toward a healthcare overhaul.

Before the bill could be signed into law, the Senate version still has to be reconciled with that of the House of the Representatives, which was passed last month.

Following are key differences between the two versions.


-- The Senate bill would cost 871 billion U.S. dollars over a decade, reducing the deficit by 132 billion dollars, and possibly an additional reduction of as much as 1.3 trillion dollars over the second decade.

-- The House bill costs 1.1 trillion dollars over a decade, surpassing Obama's spending cap of 900 billion dollars on healthcare.


-- The Senate bill does not include a public option. Instead, the Office of Personnel Management, which supervises health plans for federal workers, would oversee national plans offered in the health insurance exchanges.

-- The House bill creates a government-run insurance program that offers plans in competition with the private market. The government would negotiate rates with healthcare providers.


-- The Senate bill requires most people to have health insurance or pay a penalty, which starts at 95 dollars in 2014 and reaches 750 dollars two years later. It extends coverage to 94 percent of Americans.

-- The House bill requires most people to get health insurance or pay a penalty of up to 2.5 percent of their income. It extends coverage to 96 percent of Americans.


-- The Senate bill does not require employers to provide health insurance. The bill would charge companies with over 50 employees a penalty for any employee whose health insurance the government ends up subsidizing.

-- The House bill requires employers to contribute to health insurance for employees. But businesses with payrolls under 500,000 dollars are exempted. Such businesses account for about 86percent of all American enterprises.


-- The Senate bill 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.

-- The House bill also creates "insurance exchanges," and until exchanges are set up, the bill immediately offers assistance to those who have been uninsured for several months or denied a policy because of pre-existing conditions.


-- The Senate bill includes subsidies to help cover those making up to 400 percent of federal poverty level -- currently 88,000 dollars per year for a family of four -- and expands the Medicaid program to include those making 133 percent of the federal poverty level.

-- The House bill also includes subsidies to help those making up to 400 percent of the federal poverty level pay for health insurance premiums. It would expand Medicaid eligibility for low-income individuals and families, cover new preventive services, and increase payments for check-ups.


-- The Senate bill imposes a 40 percent tax on high-cost health insurance plans -- those valued over 8,500 dollars per individual or 23,000 per family. It charges a 10 percent tax on indoor tanning services and also increases Medicare payroll taxes -- from1.45 to 2.35 percent -- on individuals earning 200,000 dollars or more a year and couples earning 250,000 dollars or more.

-- The House bill would tax the wealthiest Americans, with individuals making over 500,000 dollars and families making above 1 million dollars paying a surcharge on a portion of their income.


-- The Senate bill would create a "firewall" to prevent federal subsidies from going toward abortion coverage. In plans that do cover abortion, beneficiaries would have to pay for it separately, and those funds would have to be kept in a separate account from taxpayer money.

-- The House bill would ban abortion from being covered in the new public plan except in cases of rape, incest, or threat to the life of the pregnant woman. It also bans people from using government subsidies to purchase private plans with abortion coverage on the exchange.

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