A House Divided

How the House and Senate Reform Bills Stack Up


Public Option

House: Creates government-run health-insurance plan that would negotiate rates with doctors and hospitals.

Senate: Same except states would have right to opt out.

Winners/Losers: This could be a good thing for doctors. Doctors likely to get higher payments than they would if public plan rates were tied to Medicare. Insurers could lose because they'll face a new competitor, with whom losses and profit are no object.

Employer Mandate

House: Employers must provide health-insurance coverage or pay fine of 8% of payroll (for those with payroll greater than $750,000).

Senate: Penalty for employers who don't provide coverage is up to $750 per employee, if employees get government subsidies.

Winners/Losers: Employers generally fare better under Senate plan.

Taxes

House: Surtax of 5.4% on married couples earning more than $1 million a year or individuals making more than $500,000 a year.

Senate: No surtax on the wealthy. Tax on certain high-value health-insurance plans.

Winners/Losers: Unions prefer the House bill because some union members have high-value or "Cadillac" health plans

Individual Mandate

House: Those who go without insurance would pay fine of up to 2.5% of adjusted gross income.

Senate: Finance Committee bill would levy fines of up to $1,500 per family if people refuse to purchase health insurance.

Winners/Losers: Lower-income people get subsidies to buy coverage. Those who feel they still can't afford health insurance would lose, because they have to pay a fine.


Bottom-line

Too early to tell what final bill will be, or indeed, if it will even pass. If it passes, the following is likely:

1) extension of coverage benefits to perhaps 25 million to 35 billion people either uninsured or under insured

2) cost of $1 trillion or more, unlikely to be offset by “savings” and likely to increase national debt

3) tax hikes to the “rich”, drug companies, device manufacturers and holders of “Cadillac” health plans

4) increased expenses of doing business for hospitals and doctors to meet new regulations and electronic medical record requirements

5) enhanced premium costs, perhaps double, over the next ten years

6) Medicare cuts in the name of “savings” and “increased efficiencies”

7) Little substantial movement on rebuilding primary care base

8) No action on tort reform or extending access to health plans across state lines.

9) a public option by some name, with or without teeth.

10) Employer and individual mandates, both of which will resisted by business and physician establishment