A look at health care plans in Congress

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Associated Press

Posted on October 7, 2009 at 5:11 PM

WASHINGTON (AP) — Health care legislation is taking shape in the House and Senate as President Barack Obama pushes to overhaul the system to cover millions of uninsured Americans and contain rising costs. Details are still being negotiated and any final health care bill would have to meld proposals from the House and Senate. A look at various proposals:

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The Senate Finance Committee's bill:

WHO'S COVERED: An estimated 94 percent of Americans. Illegal immigrants would not receive government benefits.

COST: $829 billion over 10 years.

HOW IT'S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Additional tax levied on insurance companies, equal to 40 percent of total premiums paid on insurance plans costing more than $8,000 annually for individuals and $21,000 for families; retirees over age 55 and people in high-risk professions would be allowed to have somewhat more valuable plans before they're taxed. Cuts to Medicare and Medicaid. A fee on employers whose workers receive government subsidies to help them pay premiums. Fines on those individuals who fail to purchase affordable coverage.

REQUIREMENTS FOR INDIVIDUALS: Everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. The bill requires individuals and families to buy coverage as long as it costs no more than 8 percent of their income.

REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but companies with more than 50 full-time workers would pay a fee if the government ends up subsidizing employees' coverage.

SUBSIDIES: Tax credits for individuals and families making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.

BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits, including primary care, hospitalization and prescription drugs. The government would set four levels of coverage: The least generous would pay an estimated 65 percent of health care costs per year; the most generous would cover an estimated 90 percent.

INSURANCE INDUSTRY RESTRICTIONS: No denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age and family size. Limits on allowable copays and deductibles.

GOVERNMENT-RUN PLAN: None. Would create nonprofit, member-owned co-ops to compete with private insurers.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally allowed to keep their work-provided coverage.

CHANGES TO MEDICAID: Income eligibility levels standardized to 133 percent of poverty ($30,000 a year for a family of four) for all parents, children and pregnant women. Childless adults making up to 133 percent of poverty ($14,400 for an individual) would be eligible for the first time. The expansion would be delayed until 2014. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.

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The Senate Health, Education, Labor and Pensions Committee's bill:

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 penalties 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 of 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 and negotiate payment rates with providers.

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.

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The House Democratic bill (three committees have approved slightly different versions that still must be merged):

WHO'S COVERED: Around 94 percent of residents under age 65 would be covered — compared with 81 percent today. Nearly half the 17 million residents under 65 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; sizable penalties paid by individuals and employers who don't obtain coverage.

REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a 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, although fiscally conservative Democrats have pushed for that level to rise to $500,000.

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 affect their communities.

SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $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. Democrats originally designed the plan to pay Medicare rates plus 5 percent to doctors, but the version that passed the Energy and Commerce Committee instead would let the HHS secretary negotiate rates with providers.

CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded starting in 2013 to cover all non-elderly individuals with incomes up to 133 percent of the federal poverty level, which is $14,404.

DRUGS: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson's and other deadly diseases.

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The House Republican outline:

WHO'S COVERED: Aims to make insurance affordable and accessible to all. There aren't estimates about how many additional people would be covered.

COST: Unknown.

HOW IT'S PAID FOR: No new taxes are proposed, but Republicans say they want to reduce Medicare and Medicaid fraud.

REQUIREMENTS FOR INDIVIDUALS: No mandates.

REQUIREMENTS FOR EMPLOYERS: No mandates; small business tax credits are offered. Employers are encouraged to move to "opt-out" rather than "opt-in" rules for offering health coverage.

SUBSIDIES: Tax credits are offered to low- and modest-income Americans. People who aren't covered through their employers but buy their own insurance are allowed to take a tax deduction. Low-income retirees younger than 65, which is the eligibility age for Medicare, would be offered assistance.

BENEFIT PACKAGE: Insurers would have to allow children to stay on their parents' plan through age 25.

GOVERNMENT-RUN PLAN: No public plan.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: No new purchasing exchange or marketplace is proposed. Health savings accounts and flexible spending plans would be strengthened.

CHANGES TO MEDICAID: People eligible for Medicaid would be allowed to use the value of their benefit to purchase a private plan.

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Obama's proposal:

WHO'S COVERED: Obama says he wants to cover all Americans.

COST: Estimates on the plan Obama offered during the presidential campaign ran as high as $1.6 trillion over 10 years. In a speech last month laying out his health overhaul goals he said his plan would cost around $900 billion over a decade.

HOW IT'S PAID FOR: During his presidential campaign Obama proposed raising taxes on households making more than $250,000 annually. He has now embraced the Finance Committee's proposal to tax high-value insurance plans but says most of the cost would be paid by cuts to Medicare.

REQUIREMENTS FOR INDIVIDUALS: Unlike his Democratic primary opponent Hillary Rodham Clinton, Obama did not propose an individual mandate during the campaign. Instead he would have required all children to be insured, making it the parents' responsibility. He now supports an individual mandate as long as hardship waivers are provided.

REQUIREMENTS FOR EMPLOYERS: Businesses with more than 50 workers would be required to offer their workers coverage or pay a fee.

SUBSIDIES: Obama supports sliding-scale subsidies for low-income people but hasn't specified at what income level they should be offered.

BENEFIT PACKAGE: Obama hasn't described a specific benefit package that should be offered. He wants insurance market reforms including preventing insurers from denying coverage to people with pre-existing conditions; limiting premium variation based on age; and stopping insurers from dropping people when they get sick.

GOVERNMENT-RUN PLAN: Obama has said since the presidential campaign that he supports a new public plan, and after becoming president he occasionally cast it as a requirement for any bill he would sign. Obama still says he supports it but has signaled that he's open to compromise on the issue.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses and people without access to affordable insurance through their employer or elsewhere would have access to a new exchange starting in 2013. Illegal immigrants would not be able to shop in the exchange.

CHANGES TO MEDICAID: None specified.

OTHER PROVISIONS: Before the exchange begins to operate, Obama would offer insurance plans meant to cover catastrophic costs to people who can't get covered because of pre-existing conditions.

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Sources: Associated Press research, Kaiser Family Foundation.

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