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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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