Over the last few weeks, all the media focus (as well as here at MCM) has been on the Senate Finance Committee’s health reform legislation, aka the Baucus bill. Now that the eponymous bill has been voted out of committee, it is no longer the only game in town, but rather one of six.
As the most ‘conservative’ of the six bills, it is highly likely the final version’s details will reflect a less ‘conservative’ approach, perhaps with some version of the public option, which the other Senate and all House versions contain.
First, the Senate is going to compare, contrast, and possibly combine it with the bill voted out of the Senate Health Education Labor and Pensions (HELP) committee – the one formerly chaired by the late Senator Kennedy. Among the major differences between the two; the HELP bill includes a public option; phases in the mandate penalty of $750 immediately (Finance doesn’t get to $750 till 2017); has a tougher employer mandate with higher penalties; expands Medicaid to individuals earning up to 150% of the Federal Poverty Level (Finance is 133% and is delayed till 2014); and the HELP bill does not contain the excise taxes that are included in Finance’s effort.
The differences with the House Tri-Committee bill (HB 3200) are even more stark (no pun intended).
HB 3200 has a much stiffer individual (2.5% of adjusted gross income up to the cost fo the average plan premium thru the Exchange) and employer mandate (almost all employers would have to contribute at least 75% of the cost of individual/65% family coverage or pay 8% of payroll into the Exchange; and offers up to 50% premium credit for smaller employers to help pay for insurance; increases Medicaid reimbursement to 100% of Medicare (Medicaid is usually significantly lower). HB 3200 also sets up an Insurance Exchange, is funded thru a higher tax on families making over $350,000 annually, increases rebates from drug companies, and significantly reduces Medicare Advantage subsidies. (there are several version of this bill, see the Kaiser site for additional detail).
CBO estimates HB 3200 will cost slightly over a trillion dollars over ten years, significantly more than Finance’s $850 billion.
These are by no means the only differences; they do serve to illustrate the yawning gap between the Finance bill and the other major bills before Congress.
So, what’s going to happen?
Can it get thru the Senate is the standard by which all revisions and edits will be judged. Just a week ago, that made it highly likely the final bill would look much like the Finance version, but the release of the PwC report by AHIP may have given potentially-wavering Senate Democrats the push they need to adopt some of the provisions from HELP and HB 3200. Democrats are outraged by what they (I think somewhat unfairly) view as a last-minute stab in the back by the health insurance industry, which heretofore had been publicly in favor of reform.
Democrats are also keenly aware that a failure to pass health reform will be a political disaster.
I’ve long doubted the votes are there to pass reform, but of late the odds are moving – slightly – in favor of reform.
The Kaiser Foundation has an excellent tool that enables side-by-side comparison of all of the bills, proposals, and suggestions; the NYTimes has a comparison of the several bills before Congress here.
Oct
15
