Published: 2009-07-16 23:55:47
Author: Associated Press | July 6, 2009
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 reduce 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.
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HOUSE DEMOCRATS
WHO'S COVERED: Around 95 percent of Americans would be covered. Illegal immigrants would not receive coverage.
COST: Unknown.
HOW'S IT PAID FOR: Cuts to Medicare and Medicaid; $600 billion in unspecified new taxes, likely including new levies on upper-income Americans.
REQUIREMENTS FOR INDIVIDUALS: Individuals required to have insurance, enforced through tax penalty with hardship waivers.
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Certain small businesses are exempt.
SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level ($88,000 for a family of four) would get subsidies to help them buy coverage.
BENEFIT PACKAGE: A committee would recommend an "essential benefits package" that includes hospitalization, doctor visits, prescription drugs and other services. Out-of-pocket costs limited to $5,000 a year for individuals, $10,000 for families. Health insurance companies can offer several tiers of coverage, but all plans must include the core benefits. Insurers wouldn't be able to deny coverage based on pre-existing conditions.
GOVERNMENT-RUN PLAN: Plan with payment rates initially modeled on Medicare to compete with private insurers.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Through a new National Health Insurance Exchange open to individuals and, initially, small employers; it would be expanded to large employers over time.
CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals with incomes up to 133 percent of the federal poverty level ($14,404). Currently Medicaid eligibility varies by state, but childless adults are ineligible no matter how poor, and in some states parents with incomes well under the poverty line still aren't covered.
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SENATE HEALTH, EDUCATION, LABOR AND PENSIONS COMMITTEE
WHO'S COVERED: Aims to cover 97 percent of Americans.
COST: About $600 million over 10 years, but it's only one piece of a larger Senate bill.
HOW'S IT PAID FOR: Another committee is responsible for the financing.
REQUIREMENTS FOR INDIVIDUALS: Individuals required 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 per full-time worker. Businesses with 25 or fewer workers are exempted.
SUBSIDIES: Up to 400 percent poverty level.
BENEFIT 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 can purchase insurance through state-based American Health Benefit Gateways.
CHANGES TO MEDICAID: Medicaid would be available to individuals with incomes up to 150 percent of the federal poverty level.
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SENATE FINANCE COMMITTEE
WHO'S COVERED: Around 97 percent of Americans. Illegal immigrants would not receive coverage.
COST: Around $1 trillion over 10 years.
HOW'S IT PAID FOR: Possible sources include cuts to Medicare and Medicaid; about $300 billion in revenue from taxing employer-provided health benefits above a certain level; and about $300 billion in revenue from a requirement for employers to pay into the Treasury for employees who get their insurance through public programs.
REQUIREMENTS FOR INDIVIDUALS: Expected to include a requirement for individuals to get coverage.
REQUIREMENTS FOR EMPLOYERS: In lieu of requiring employers to provide coverage, lawmakers are considering penalties based on how much the government ends up paying for workers' coverage.