The Democratic-controlled House passed its legislation Saturday night. In the Senate, legislation is being finalized to merge the work of two committees and make other changes.
THE HOUSE BILL
WHO'S COVERED: About 96 percent of legal residents under age 65 — compared with 83 percent now. Illegal immigrants would be about one-third of the remaining 18 million people.
COST: The Congressional Budget Office says the net cost of the bill over 10 years is $894 billion.
HOW IT'S PAID FOR: $460 billion over the next decade from additional income taxes on single people making more than $500,000 a year and couples making more than $1 million. There also are more than $400 billion in cuts to Medicare and Medicaid; a $20 billion fee on medical device makers; $13 billion from limiting contributions to flexible spending accounts; sizable penalties paid by individuals and employers who don't obtain coverage; and a mix of other corporate taxes and fees.
REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers.
REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually exempt. Penalty phased-in for companies with payrolls between $500,000 and $750,000. Businesses with 10 or fewer workers get tax credits for coverage.
SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level, or $88,000 for a family of four, would get sliding-scale subsidies to help them buy coverage. The subsidies would begin in 2013.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Beginning in 2013, through a new Health Insurance Exchange open to individuals and small employers.
BENEFITS PACKAGE: A committee would recommend a so-called essential benefits package including preventive services. Out-of-pocket costs would be capped.
INSURANCE INDUSTRY RESTRICTIONS: No denial of coverage based on pre-existing conditions. No higher premiums allowed for pre-existing conditions or gender. Limits on higher premiums based on age.
GOVERNMENT-RUN PLAN: A public plan available through the insurance exchanges, set up and run by the secretary of Health and Human Services, who would negotiate rates with providers.
CHANGES TO MEDICAID: The federal-state insurance program for the poor, known as Medi-Cal in California, would be expanded to cover everyone under age 65 with incomes up to 150 percent of the federal poverty level, $33,075 per year for a family of four.
DRUGS: Grants 12 years of market protection to high-tech drugs used to combat key diseases. Phases out the gap in Medicare prescription drug coverage by 2019.
ANTITRUST: Would strip the health insurance industry of a long-standing exemption from antitrust laws covering market allocation, price fixing and bid rigging.
SENATE DEMOCRATIC BILL:
WHO'S COVERED: The Senate Finance version covered an estimated 94 percent of Americans, excludes illegal immigrants.
COST: The goal is to keep it under $900 billion over 10 years.
HOW IT'S PAID FOR: Fees on insurance companies, drug makers, medical device manufacturers. Tax levied on insurance companies on higher-cost plans. Cuts to Medicare and Medicaid. A fee on employers whose workers receive government subsidies for premiums. Fines on people who fail to purchase coverage.
REQUIREMENTS FOR INDIVIDUALS: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship.
REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but companies with more than 50 full-time workers would pay a fee as high as $750 multiplied by the total work force if the government must subsidizes employees' coverage.
SUBSIDIES: Tax credits for individuals and families making up to 400 percent of the federal poverty level, which is $88,200 for a family of four. Tax credits for small employers.
BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits. The government would set four levels of coverage ranging from 65 percent of health care costs per year to 90 percent.
INSURANCE INDUSTRY RESTRICTIONS: No denial of coverage or higher premiums based on pre-existing conditions. No higher premiums allowed for gender, and limits on higher premiums based on age and family size.
GOVERNMENT-RUN PLAN: One proposal envisions payment rates to providers negotiated by the HHS secretary. Second plan would not offer government option initially, but would create nonprofit co-ops to compete with private insurers.
HOW YOU CHOOSE YOUR HEALTH INSURANCE: Plans offered through state-based purchasing pools.
DRUGS: Grants 12 years of market protection to drugs for key diseases. Trims the prescription coverage gap in Medicare.
CHANGES TO MEDICAID: Income eligibility levels likely to be standardized to 133 percent of poverty for all parents, children and pregnant women.
ANTITRUST: Amendment expected to be offered on the Senate floor to strip the health insurance industry antitrust exemption.