How do US Healthcare Proposals Compare?

FACTBOX: How Do U.S. Healthcare Proposals Compare?
Wed Jun 24, 2009 10:53am EDT


(Reuters) - U.S. President Barack Obama said in an interview aired on Wednesday that he "absolutely" will get healthcare reform completed in 2009 but declined to say what the final package would eventually look like.


Lawmakers in Congress are working on at least three draft versions of proposals to overhaul the U.S. healthcare system.


In the House of Representatives, three committees have joined together to produce one draft House bill.


In the Senate, the Health, Education, Labor and Pensions (HELP) Committee has started work on a second Democratic proposal, while the Senate Finance Committee is in closed-door negotiations over a possible third healthcare bill that would win bipartisan support.
Here is a summary comparing the various bills.


INSURANCE MARKET REFORMS


* Both the House and Senate bills call for sweeping insurance market reforms.
*The House bill would set up a new government plan to compete with private companies. The Senate HELP panel bill leaves this open for later consideration.
* The Senate Finance Committee, chiefly to address Republican concerns, is instead looking at creating non-profit medical co-operatives to compete with insurers.
* All individuals would be required to obtain insurance under all of the bills.
*The Senate HELP bill leaves open the issue of employer responsibility. The House bill would require employers to pay an 8 percent of payroll "fee" if they choose not to provide health benefits to workers. The Senate Finance Committee is looking at requiring employers to pay a fee if their workers are insured by Medicaid or obtain federally subsidized coverage in the proposed insurance exchange.
* All the bills bar insurance companies from refusing to cover people or charging them more because of health history or gender. All the bills place some limits on insurance premiums.
* Insurers in all bills would be required to cover some preventive services.
* All the bills include caps on out-of-pocket expenses. The Finance Committee bill is expected to do the same.


INSURANCE GATEWAY OR EXCHANGE


* The House and Senate Finance bills would both create state insurance exchanges to act as clearing houses for individuals and small businesses to buy insurance.
* The Senate HELP committee bill proposes similar exchanges called "gateways."
*The HELP bill includes temporary reinsurance funding to help employers make medical coverage available for retirees between the ages of 55 and 64 until their state establishes a gateway.
* A proposed new public plan, or co-op, would be offered as an option available in the gateway.


OTHER COVERAGE PROVISIONS


* The HELP bill includes a sliding scale of subsidies for the purchase of insurance for people with incomes up to 500 percent of the poverty level. The Senate Finance bill would scale that back to 300 percent of the poverty level, about $66,150 for a family of four.
* Millions more people would become eligible for state Medicaid health plans for the poor. People with incomes up to 150 percent of the poverty level would be able to get Medicaid under Senate HELP bill. The Senate Finance and House bills put the level at 133 percent of poverty.
* A new support service for disabled, homebound and institutionalized people would be set up in the Senate HELP bill.
* All bills include incentives for employers to automatically enroll workers into offered health plans.
* All bills include prevention and wellness incentives.
* All bills include provisions to improve quality of healthcare in the Medicare program for the elderly. Payments to be designed to encourage quality, not quantity of services.


(Compiled by Donna Smith; Editing by Eric Walsh)