The Public Option
The House bill offers a public option; insurance would be available through a government managed program and would be available for purchase through a national insurance exchange. The Senate bill does not offer the public option.
Exchanges
Both bills offer insurance exchanges; a market place where individuals not covered by employers can shop for a policy.
The House bill sets up a national exchange, the Senate a State-based exchange giving States the option not to participate.
The Senate bill charges the White House Office of Management and Budget, the agency that oversees healthcare plans for Federal workers, with managing insurance offerings by companies wishing to do business across state lines.
Revenues
The House bill levies a 5.4 percent surtax on individual earnings over $500,000 a year and couples earning over $1 million yearly.
The House bill levies a 2.5 percent excise tax on certain medical device manufacturers. The Senate bill also levies a tax on medical device manufacturers.
The Senate bill levies a 40 percent excise tax on high-cost health insurance plans known as 'Cadillac' plans such as those offered by some unions and large companies.
Under the Senate bill payroll taxes for Medicare would increase from 1.45% to 2.35% for higher earners in the $200,000 bracket. Couples earning over $250,000 would also be subject to the 40% increase.
The Senate bill imposes fees on insurers and drug manufacturers.
The Senate bill levies a 10% tax on indoor tanning facilities.
Abortion
Both bills prohibit spending Federal funds on abortion.
The House bill allows insurers to cover abortions but it must be done through a separate policy provision that the purchaser pays for out-of-pocket.
The Senate bill follows suit with the House bill and requires that States must opt out of allowing abortion services from being offered through the exchanges and requires that State legislatures pass laws establishing the State's position to prohibit abortions as such.
Medicaid and Medicare
The Senate provides Medicaid, to those with incomes up to 133% of the poverty level. The House bill sets the cut-off income at 150% of the poverty level. The poverty level for a family of four is $22,000.
Neither bill lowers the participation age for Medicare below age 65.
Policy reform
The House and Senate both require that insurers may not reject those with preexisting conditions.
Under the House bill insurers may charge older people up to twice the amount they charge younger people. The Senate bill allows insurers to charge older people up to three times what they charge younger people.
Both bills allow children to stay on their parent's policy' the Senate bill to age 26, the House bill to age 27.
Both bills require insurers to spend specific amounts on providing healthcare. The Senate requires that 85% of each premium dollar be spent in small markets and 80% in large (group) markets. The House bill requires that 85% of each premium dollar is spent on providing care.
Both bills would require mandatory purchasing of health insurance or risk financial penalties. The House bill fine is 2.5% on income up to the cost of an insurance policy. The Senate bill imposes a $750-per-person annual penalty up to $2,250 per family or a penalty of 2% of taxable income, whichever is greater. The Senate phases in the fine amounts over 6 years.
Employers
Under the House bill employers with payrolls above $750,000 must provide health insurance to workers or face an 8% of payroll penalty. Employers with a payrolls between $500,000 and $750,000 would be fined 2% to 6% of payroll depending on the payroll totals.
The Senate bill does no impose employer mandates but imposes an annual, per-person fine of $750 on employers with more than 50 employees on the books if an employee purchases federally subsidized coverage through the State exchanges. If the employer-offered plan cost the employee more than 9.8% of his or her salary, the employee may drop that insurance and purchase subsidized coverage through the exchanges. In that case the employer would be fined $3,000 per employee.
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