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Choose Your Own Senate Health Care Adventure

October 6, 2009 - by Donny Shaw

Now that the committees in the Senate have finished their work on the health care legislation, the process moves behind the scenes to negotiations between the White House and the Democratic leadership. The negotiators have already begun making decisions about what will be included in the final bill that will come to the Senate floor in the coming weeks.

This is one of the most important stages in Congress’ health care reform process, but it’s happening in complete secrecy. The negotiations are basically an informal process of arm twisting and deal making that are taking place in closed-door discussions beyond the public’s view. The only chances we’ll get to see in will be from anonymous “inside sources” and prepared statements from the people involved. For one of the most important parts of the most contentious national policy debate in recent history, that’s not good enough.

Below, I’ve put together a table showing the major differences between the bill approved by the Health, Education, Labor and Pensions (HELP) Committee and the bill as amended (soon to be approved) by the Finance Committee that are being ironed out by the negotiators. It’s not meant to be comprehensive – it only covers the areas of health care reform that were addressed by both committees. Financing and Medicare provisions, for example, which fall solely under the jurisdiction of the Finance Committee, are not included.

Take a look for yourself and start thinking about what you would keep from each bill and what you would leave out. This is far from an ideal scenario for public involvement in this crucial stage of the legislative process, but it’s a first step at using the tools and information available to us to start building awareness of the decisions being made by Congress behind the scenes.

HELP Committee bill Finance Committee bill
Competition for private insurers Public option – establishes a voluntary government-run insurance plan with reimbursement rates to be negotiated by the HHS Secretary. [link] CO-OP program – sets aside start-up money for private organizations to establish non-profit, member-run health insurance companies. [link]
State Basic Health Plan Not included. Sets aside money for states to use to negotiate more affordable health care plans for individuals earning between 133 and 200 percent of the federal poverty level. These plans would be privately run, but would be subject to more stringent regulations. [link]
Congress’ Health care No changes – Congress keeps their Federal Employees Health Benefits Plan insurance Requires Members of Congress to give up their Federal Employees Health Benefits Plan and buy insurance through the new exchanges instead. [link]
Pre-existing conditions Bans insurance companies from denying coverage based on pre-existing medical conditions. [link] Bans insurance companies from denying coverage based on pre-existing medical conditions. Provides immediate financial assistance for individuals with pre-existing conditions until the ban takes effect in 2013. [link]
Individual Responsibility Requires all individuals to get insurance or pay a penalty of no more than $750/year. [link] Requires all individuals to get insurance or pay a penalty of no more than $950/year. [link]
“Young Invincibles” No special treatment Allows for a special catastrophic-only plan for individuals under the age of 25 to be sold on the exchange. This would satisfy the individual requirement to get insurance coverage. [link]
Employer Responsibility Employers with more than 25 employees must provide insurance or pay a tax penalty of $750 per uninsured full-time employee and $375 per uninsured part-time employee [link] Does not require employers to provide insurance, but says employers with more than 50 full-time employees would pay a tax penalty of $400 for every uninsured employee that is eligible for the health care subsidies provided by the bill. Requires employers with 200 or more employees to automatically enroll employees into health insurance plans offered by the employer. Employees would be able to opt-out if they have other insurance already. [link]
Medicaid Expansion Not included Expands eligibility for Medicaid coverage to all individuals earning less than 133 percent of the Federal Poverty Level. [link]
Subsidies for Buying Insurance Provides sliding-scale credits for purchasing insurance through the exchanges for people earning up to 400 percent of the Federal Poverty Level.[link] Provides sliding-scale credits for purchasing insurance through the exchanges for people earning between 133 and 300 percent of the Federal Poverty Level. [link]
Treatment of abortion coverage Prohibits insurers selling through the exchange from considering abortion coverage when contracting with health care providers. [link] Prohibits insurers selling through the exchange from considering abortion coverage when contracting with health care providers. Requires all exchanges to have at least one plan that covers abortions and at least one plan that does not. Requires a segregation of federal funds for plans that do cover abortions. [link]
Treatment of dependents Allows all children to stay on their parents’ insurance plans as dependents until they are 26 years old. Current law differs state-by-state, but children are generally cut off at 19, or 23 if they are full-time students.[link] No changes to current law.

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Comments

LucasFoxx 11/10/2009 4:35pm
in reply to Anonymous Oct 14, 2009 6:34am

It depends on what ends up on the final bill. They certainly should, as a matter of principle.

frankd 11/02/2009 8:07am
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+ -1

“Individual Responsibility Requires all individuals to get insurance or pay a penalty of no more than $750/year. [link] Requires all individuals to get insurance or pay a penalty of no more than $950/year. [link]”

I do not think dictatorial requirements like this one are a good idea for USA citizens. Arrogantly assumes citizens’ basic incompetence; smacks of creeping totalitarianism?

Anonymous 10/26/2009 11:32am
in reply to BubbaJoeJebediahBuford Oct 07, 2009 4:58pm

You do realize you’re paying for people that are uninsured currently now right? Every unpaid hospital bill b/c of uninsured just get doubled-down in the higher cost of procedures by hospitals & doctors. Then insurance companies charge more b/c the price of procedures go up…they charge $1.40 for every $1 a bill goes up. So RIGHT NOW you’re paying for those that choose NOT to or cannot afford insurance.

Anonymous 10/26/2009 11:29am
in reply to redduke Oct 14, 2009 7:18am

1) Even if they could compete across state lines, employers only offer 1 or 2 different insurance policies b/c they strike deals with these companies. Competition is necessary, hence the Health Insurance Exchange.
2) Frivolous lawsuits will only reduce the budget by approx $50 billion, which is nothing when you compare it to the $900 billion that this bill will eventually cost.

Anonymous 10/26/2009 11:28am
in reply to Anonymous Oct 08, 2009 5:50am

That’s what the Health Insurance Exchange is! The Congresspeople are giving us the same choices they have. But with no public option, then we’re stuck w/the same monopolistic nonsense we have now.

Anonymous 10/24/2009 11:58am

Most Americans show exceptionally shallow understanding of just what the Baucus non reform of healthcare bill represents. We are very disappointed with the leadership especially as our state (Massachusetts) has failed residents miserably with mandated coverage by companies with ZERO competition to control costs. This failure serves as a template for the Baucus bill which endorses this massive extortion of the citizenry. Our mandated coverage premiums increased over 40% -in one year. A friends rose a full 70%. Does Washington even know that All industrial nations that mandate private coverage have the good sense to represent constituents interests by turning private insurers into highly regulated utilities, tying rate increases and CEOs salaries to government-determined cost of living increases. Here and possibly this nation, insurers are free to destroy the mandated populations financial future.

Anonymous 10/22/2009 11:30am
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+ -2

This and the other bills are despotism in the guise of health care reform. None of this has to do with your health care or is in your best interest.

The FPL was changed a second time AFTER the annual increase – it was decreased so lower incomes would have to pay more. This was so the bill would get a lower CBO score.

The original premium cap before you could get a subsidy was 11% in the house bill and 12% in the Baucuc concoction. These caps were changed to 12% and 13% respectively.

Penalties, eligibility and affordability (how much THEY have decided YOU can afford to pay)are based on Modified adjusted gross income. This is your adjusted gross including all tax exempt interested accrued or received in a taxable year.

For those who are dumped into Medicaid which has been expanded, all who are 55 and up will be getting the reversible mortgage from hell, a/k/a estate recovery, instead of health insurance.

dbmalkie6 10/21/2009 5:04am
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+ -1
in reply to redduke Oct 14, 2009 7:18am

Well said redduke!

dbmalkie6 10/21/2009 5:01am
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+ -1
in reply to Anonymous Oct 07, 2009 6:06am

AARP will be gaining a financial wind fall from the Public Option which is why they support it not because of concern for our Seniors. They are already advertising to the millions of Seniors who will lose their advantage programs under this administrations plan. AARP is expecting they will receive all the new memberships for these Seniors who are kicked out of the gap insurance they have today. I cannot blindly follow a government who states their take over of this social process will benefit the American people when history has proven differently. History proves social government programs do not accomplish what was promised and cost a lot more than we were told. This will be no different. I will be electing officials based on who is actually concerned about us and not their lobbyist whether that individual has a D or an R. Corruption goes both ways. Tort reform is not part of this plan because our trial lawyers heavily support the Democratic party.

redduke 10/14/2009 7:18am
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+ -1
in reply to Anonymous Oct 08, 2009 5:50am

Single-payer? Why would you think the Government could possible do anything but completely destroy health care in America by taking over what’s left of a free market system that need some fixes, but works?

The government failed at running a railroad.
The Government failed at running a Post Office
The Government failed at running two mortgage companies
The Government failed at running a rescue and recovery effort.
The Government failed at running an acquisition organization.
The Government faield at running an educational system (even though it is not their responsibility)
The Government is failing at running an automobile company.
The Government is failing at promoting an economy.

NONE of the bills fix the problems.

1. eliminate health care monopolies by allowing insurances to compete across state lines.

2. reduce frivolous lawsuits.

Anonymous 10/14/2009 6:34am
in reply to Anonymous Oct 07, 2009 12:38pm

Did you read the above?
“Requires Members of Congress to give up their Federal Employees Health Benefits Plan and buy insurance through the new exchanges instead.”

pinky 10/08/2009 8:38pm

I’m choosing option C., S. 703, the single-payer bill introduced by Bernie Sanders, and its House counterpart HR 676. Both of the above bills are crappola as is HR 3200. These are the bills that will actually cover ALL Americans and will also save the most money. Everybody In, Nobody Out!!

Anonymous 10/08/2009 5:50am
in reply to Anonymous Oct 07, 2009 8:21am

Or better yet, what if they would rather have the same options as congress and the senate????

oderintdummetuant 10/07/2009 6:30pm
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+ -2

This closed door garbage is ridiculous. What happened to that “transparent” government we were going to get? What happened to not one single dime of new taxes for the middle class? Are we using BC’s dictionary to decide what constitutes a tax? Or the word “is”?
…and the band played on…..

Anonymous 10/07/2009 5:39pm

The HELP Committee bill goes straight to the point and outlines the provisions that practically carries out the reform objectives. But the Finance Committee bill is just beating around the bushes. “CO-OP” and State Basic Plan? Why need these, when 133% and 200% thing make it useless?? It is as good as doing nothing! And then abortion thing?? That’s interesting. And the Medicaid? Funny! Where “they” not the ones who condemned the Medicaid? Now they stick that in to gain political supports?

This will complicates problems even more let alone fix the health care system. This bill should get some applause for it at least “sounds fix” on the paper. Practically, useless. I can foresee that a lot more reforms will have to follow to just fix the messes that the Finance Committee bill would create.

Baccus and others alike should try to pass the bill that “can” fix the broken system not to pass any bill that “might” fix the problem. That’s just playing more political games!

BubbaJoeJebediahBuford 10/07/2009 4:58pm

I think this a power reserved for the states, per Amendment 10 of the Constitution (People still read this document, yes?). The medical needs of a less populous state are going to be very different than a more populous state.

Also, I am not a fan of the “Requires all individuals to get insurance or pay a [financial] penalty” language that seems to be included in all versions of this bill. There are many that do not appreciate the Federal Government poising itself to take more of their hard earned money. There is a belief among some that the penalty money will revert the general revenue and be spent on, say, a military project or to a legislature’s pet project.

Either way, this is a government-mandated forfeiture of money, whether through purchase of a service or through penalty, which my 9th grade Social Studies teacher called a tax.

Anonymous 10/07/2009 12:38pm
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+ -1

yes, make the congress give up their current healthcare program!!!!!!!!!!!!!!

dbmalkie6 10/07/2009 9:51am
in reply to Anonymous Oct 07, 2009 6:06am

You are out of touch. I would also have to say not well educated in government, finances, or health care. You do know AARP and AMA already have side deals that will pay off nicely if a public plan is approved. You do also know the doctors who showed up at the White were fka Doctor’s for Obama and confirmed by a Doctor at the event on radio last night when she was cornered and had no option but to tell the truth. Wake Up!

It’s not about being a Democrat, Republican, or a MAN. It is about being an AMERICAN. The real hero in this country is the individual that will stand up for the people when our elected officials have chosen not to.

donnyshaw 10/07/2009 8:31am
in reply to Anonymous Oct 07, 2009 8:21am

OpenCongress Staff

As I said above in the table, “Employees would be able to opt-out of the automatic enrollment if they already have other insurance.”

Anonymous 10/07/2009 8:21am
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+ -1

“Requires employers with 200 or more employees to automatically enroll employees into health insurance plans offered by the employer.”

What if the employee would rather have the better coverage their spouse’s employer offers?

lbrownusc59 10/07/2009 7:13am

Look at one issue—The Senate Finance Committee "Bans insurance companies from denying coverage based on pre-existing medical conditions. Provides immediate financial assistance for individuals with pre-existing conditions until the ban takes effect in 2013.

Will this be extended to insuring a house in Florida for termite damage without first inspecting for termites? Would you run such an insurance business? If so, not for long.

Anonymous 10/07/2009 6:06am
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+ -3

In 2010 Republicans won’t gain, but DECLINE based on freaks hyping needed health care reform using C. Rove “fear” of Death Camps, Sex Clinics, No Medicare age 65, etc . . Enough now. Lies and “spin” is fine for FOX and Rush; but that small segment of the Republican wing IS damaging the GOP and I am CERTAIN 2010 will be the final nail in our coffin. Rise Up and ACT like AMERICANS and “Solve the Debt” without spin with "Fixing It’. Bravo! Bravo! to the Commander-in-Chief for his attempt ‘vs’ paid-off Republicans in the insurance company pocket. And I am Republican who is tired of sucking the same old line. Truth is the “public option” is needed and won’t hurt insurance companies – absolutely TRUE. Our allies of AARP know it and have called us out to duty, VOTE for PUBLIC OPTION in the health care reform. Be a MAN (not the freaks Baccus & McCaughey) and ‘Just Do It’ I promise all Republicans that the “spin” against public option with hurt, not help Republicans.

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