Health-Care Overhaul Proposals
Compare the health-care bill that passed in the House Nov. 7 with the Senate's answer, as President Barack Obama pushes to overhaul the system. Details are still being negotiated and any final health care bill would have to meld proposals from the House and Senate.
| Who is covered | • The bill would ensure that 94% of legal residents have insurance coverage. • Illegal immigrants would not receive government benefits. | • About 96% of legal residents under age 65 -- compared with 83% now. • About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants. | • Says he want to cover all Americans. |
| Cost | • The Congressional Budget Office estimates the bill to cost $848 billion and to reduce the federal budget deficit by $130 billion over 10 years | • The CBO says the bill's cost is $1.05 trillion and reduces the deficit by $109 billion over 10 years. • The net cost is $894 billion, factoring in penalties on individuals and employers who don't comply with new requirements. But after adding up a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, the cost is around $1.2 trillion. | • In a speech in early September laying out health overhaul goals Mr. Obama said his plan would cost around $900 billion over a decade. |
| How it's paid for | • $149.1 billion over seven years from a new excise tax on high-premium insurance plans, equal to 40% of premiums paid on plans costing more than $23,000 annually for families, $8,500 for an individual; • Cuts to Medicare and Medicaid • A fee on employers whose workers receive government subsidies to help them pay premiums; Fines on people who fail to purchase coverage; • $54 billion over 10 years from a Medicare payroll taxes hike on couples with income of more than $250,000 a year. For those families, the levy would be raised to 1.95%, up from 1.45% • $5 billion over 10 years from a new tax on elective cosmetic surgery • $102.3 billion over ten years from fees on insurance companies, drug makers and medical device manufacturers | • $460 billion over the next decade from new income taxes on single people making more than $500,000 a year and couples making more than $1 million -- the threshold was increased from $280,000 and $350,000, in response to lawmakers' concerns that the taxes would hit too many people and small businesses; • More than $400 billion in cuts to Medicare and Medicaid • A new $20 billion fee on medical device makers • $13 billion from limiting contributions to flexible spending accounts; • Fines paid by individuals and employers who don't obtain coverage and a mix of other corporate taxes and fees. | • Would tax high-value insurance plans. • Said most of the cost would be paid for by cuts to Medicare. • Dedicated $630 billion over 10 years toward a Health Reform Reserve Fund in budget outline released in February. |
| Requirements for individuals | • Nearly every American would be required to obtain insurance, through either an employer, the exchange or other program. • Those who are obligated to buy coverage and refuse could face a penalty up to $750. • The maximum amount workers would be required to spend on premiums would be capped at 9.8% of income. • Exemptions for economic hardship. | • Individuals must have insurance • People who fail to purchase coverage would face a tax penalty of 2.5% of income. • People can apply for hardship waivers if coverage is unaffordable. | • Did not propose an "individual mandate" during the campaign. He now supports an individual mandate as long as hardship waivers are provided. |
| Requirements for employers | • Companies with more than 200 employees are required to automatically enroll employees in plans. • Companies with more than 50 full-time workers that do not offer coverage would pay a fee as high as $750 multiplied by the total size of the work force if the government ends up subsidizing employees' coverage. • Tax credits for small employers. | • Employers must provide insurance to their employees or pay a penalty of 8% of payroll. • Companies with payrolls under $250,000 annually are exempt and the penalty is phased in for companies with payrolls between $500,000 and $750,000. • Businesses with 10 or fewer workers get tax credits to help them provide coverage. | • Businesses with more than 50 workers would be required to offer their workers coverage or pay a fee. |
| Subsidies | • Tax credits for individuals and families likely making up to 400% of the federal poverty level, which computes to $88,000 for a family of four. | • Individuals and families with annual income up to 400% of poverty level, or $88,200 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013. | • Supports sliding-scale subsidies for low-income people but hasn't specified at what income level they should be offered. |
| Benefits package | • All plans sold to individuals and small businesses would have to cover basic benefits. • The government would set four levels of coverage: Under legislation passed by the Senate Finance Committee the least generous would pay an estimated 65% of health care costs per year; the most generous would cover an estimated 90%. Those numbers could change. | • A committee would recommend a so-called essential benefits package including preventive services. • Out-of pocket costs would be capped. • The new benefits package would be the basic benefits package offered in the exchange. | • Hasn't described a specific benefit package that should be offered. • Wants to prevent insurers from denying coverage to people with pre-existing conditions; limit premium variation based on age; and stop insurers from dropping people when they get sick. |
| Government-run plan | • It would include a public option, but unlike the House version, states would have the option of not participating. • The public plan would negotiate payment rates directly with health-care providers, rather than tying payments to Medicare's low rates. The proposal could be replaced by a less sweeping version of a public plan. • The bill also would create nonprofit, member-owned co-ops to compete with private insurers. | • 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% to doctors. But the final version would let the HHS secretary negotiate rates with providers. | • Supports a new public plan. Has lately signaled that he's open to compromise on the issue. |
| How you choose your plan | • 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. | • Beginning in 2013 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. | • 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 | • Income eligibility levels likely to be standardized to 133% of poverty ($30,000 a year for a family of four). • States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid. | • The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 133% of the federal poverty level, which is $29,326 per year for a family of four. • The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 90% and states would pay 10%. | • None specified. |
| Read more | Patient Protection and Affordable Care Act | Affordable Health Care for America Act | Obama on Health Care |
Sources: Associated Press research, Kaiser Family Foundation.
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