HEALTH-CARE PLANS IN CONGRESS House, Senate proposals at a glance
A look at health-care legislation taking shape in the Democratic-controlled House and Senate as President Barack Obama pushes to overhaul the system, cover nearly 50 million uninsured Americans and contain rising costs. Many of the details are still being negotiated and any final health-care bill would have to meld proposals from the House and Senate.
HOUSE DEMOCRATIC BILL
WHO’S COVERED: Around 94 percent of non-elderly residents (those not covered by Medicare, which kicks in at age 65) would be covered — compared with 81 percent today. Nearly half of the 17 million non-elderly residents who remain uninsured would be illegal immigrants.
COST: About $1.5 trillion over 10 years.
HOW IT’S PAID FOR: Revenue-raisers include: $544 billion over the next decade from new income taxes on single people making more than $280,000 a year and couples making more than $350,000; $37 billion in business tax increases. About $500 billion in cuts to Medicare and Medicaid. About $200 billion from penalties paid by individuals and employers who don’t obtain coverage.
REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through tax penalty with hardship waivers. The penalty is 2.5 percent of income.
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payroll under $250,000 annually are exempt.
Employers could apply for a two-year exemption from the mandate if they can prove the requirements would result in job losses that would negatively impact their communities.
SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level ($88,000 for a family of four) would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Through a new Health Insurance Exchange open to individuals and, initially, small employers; it could be expanded to large employers over time. States could opt to operate their own exchanges in place of the national exchange if they follow federal rules.
BENEFIT PACKAGE: A committee would recommend an “essential benefits package” including preventive services, mental health services, oral heath and vision for children; out-of pocket costs would be capped. The new benefit package would be the basic benefit package offered in the exchange and over time would become the minimum quality standard for employer plans. Insurers wouldn’t be able to deny coverage based on pre-existing conditions.
GOVERNMENT-RUN PLAN: A new public plan available through the insurance exchanges would be set up and run by the secretary of Health and Human Services. On average it would pay Medicare rates plus 5 percent to doctors.
SENATE PROPOSAL
WHO’S COVERED: Aims to cover 97 percent of Americans.
COST: About $615 billion over 10 years, but it’s only one piece of a larger Senate bill.
HOW IT’S PAID FOR: Another panel — the Senate Finance Committee — is responsible for figuring out how to cover costs.
REQUIREMENTS FOR INDIVIDUALS: Individuals will have to have insurance, enforced through tax penalty with hardship waivers.
REQUIREMENTS FOR EMPLOYERS: Employers who don’t offer coverage will pay a penalty of $750 a year for each full-time worker. Businesses with 25 or fewer workers are exempt.
SUBSIDIES: Available up to 400 percent poverty level, or $88,000 for a family of four.
BENEFITS PACKAGE: Health plans must offer a package of essential benefits recommended by a new Medical Advisory Council. No denial of coverage based on pre-existing conditions.
GOVERNMENT-RUN PLAN: A robust new public plan to compete with private insurers. The plan would be run by the government, but would pay doctors and hospitals based on what private insurers now pay.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Individuals and small businesses could purchase insurance through state-based purchasing pools called American Health Benefit Gateways.
OTHER PROVISIONS: Creates a new voluntary insurance program that would provide a modest daily cash benefit to help disabled people stay in their own homes instead of going into nursing homes.
Source: Associated Press