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Health Reform Faces Difficult Senate Tests

Broad Disagreements Over Public Option, Cost, and Policies

WebMD Health News

Nov. 9, 2009 -- The health overhaul bill that passed the House of Representatives late Saturday night contains lots of reforms to the medical system. But many of them are likely to change substantially before they are ever signed into law.

The Senate is also working on a health bill, and, while it is similar in many ways to the bill passed by the House of Representatives, some of the differences are fundamental. It is also an open question whether Democrats in the Senate will be able to reach a compromise at all on President Barack Obama’s top domestic priority.

The $1.2 trillion House bill tries to make insurance more accessible by creating a national insurance marketplace, called an "exchange," where private plans can offer coverage to individuals and small businesses who can’t find it elsewhere. The coverage on the exchange has to meet government-mandated coverage minimums.

In addition, the House approved a government-run public option plan that would compete with private plans on the national exchange. Government analysts predicted the public plan in the House bill would attract about 6 million members. Analysts also warned it could have higher premiums because those members may tend to be older and sicker than average.

The House bill also includes:

  • A mandate requiring individuals to carry health insurance starting in 2013. Those who don’t buy coverage would have to pay a fine unless they can show financial hardship or religious objections.      
  • A mandate requiring employers to purchase at least basic insurance coverage for their workers. Employers with a total payroll under $500,000 are exempt from the requirement. Businesses that don’t buy coverage would have to pay fees into a coverage pool.
  • Subsidies to help people buy coverage. The bill expands the Medicaid health insurance program for the poor to cover more people, and also offers tax credits and cash assistance to help millions of individuals and families buy coverage. The subsidies are on a sliding scale: Individuals making up to about $43,000 per year and families making up to about $88,000 would qualify for assistance. Those subsidies and credits are only available to U.S. citizens and legal residents.
  • Limits on insurance companies. Insurers would no longer be able to deny coverage based on pre-existing conditions and would not be able to drop policy holders who get sick (a policy called “rescission”).  Insurers could still charge older policy holders higher premiums, however.
  • Requirements that insurance plans cover preventive health care services.
  • Prohibitions preventing any private plan offering insurance on the exchange from covering abortions. Customers wanting coverage for abortions would have to buy a separate rider. 

The bill squeaked by in the House Saturday in a 220-215 vote.

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