Senate, House Health Bills Have Much In Common
MELISSA BLOCK, host:
Besides the price tag, much of the recent discussion about a health care overhaul has focused on the differences between the House and Senate bills. But the bills actually have much in common, big ideas that may have once seemed controversial, but are now overshadowed by disagreements over a public option and abortion. We've asked NPR health policy correspondent Julie Rovner to lay out where the bills agree and how that might change health care for the average American. Julie, hi.
JULIE ROVNER: Hi, Melissa.
BLOCK: And let's talk first about people who already have health insurance. What do these bills have in common?
ROVNER: Well, for everyone who has insurance, there is a real emphasis on not letting insurance companies do some of the things that really bother people. So, no more: Could they cap the amount that people could get in annual benefits or in lifetime benefits? So that you can't say insurance would only cover a million dollars over your lifetime. There would be bans on preexisting condition exclusions. This is a big deal for both Republicans and Democrats.
There would be bans on something called rescission. So insurers could not come back at you later and say you forgot to declare that you had - were treated for acne when you were 18. So we're going to cancel your insurance. Insurers would no longer be able to charge women more than men because women use more health care. Young adults would be allowed to stay on their parents' policies after they graduate college. In the Senate bill they can stay until their age 26. In the House, it's age 27.
BLOCK: And for people, Julie, who do not have health insurance now.
ROVNER: Well, obviously that is the heart of these proposals. In both bills, millions more low-income people would become eligible for the Medicaid program. That's significant because for the first time you could qualify for Medicaid solely on the basis of having a low income. Right now you have to have a low income and be something else, either a child or a pregnant woman or disabled or fit into some other category.
Now, for people with slightly higher incomes, both bills would create new marketplaces called insurance exchanges. They'd be open to individuals who are self-employed or unemployed or don't get insurance at work and also to small businesses. There would be a choice of plans. One of those choices would be a government-run public option. Of course, in the Senate bill states could opt out of offering that public option if they want to. And there's no guarantee that even that weakened form of public option will pass the Senate. But for now it's still in there.
BLOCK: And in both bills, Julie, what do they say about requirements for individuals and businesses?
ROVNER: Well, to back up just a little bit, the only way you can require insurance companies to stop discriminating against people with preexisting conditions is to make sure that people can't wait until they get sick to buy insurance. So that means everyone has to be covered. So, both bills have what's called an individual mandate, requiring everyone who doesn't get insurance at work to buy it. And, of course, there'll be government subsidies to help people afford that insurance in both bills for families earning up to about $88,000. That's four times the poverty level.
Both bills also require some sort of employer participation. But only the House bill actually has an employer mandate. The Senate bill has a more complicated mechanism where businesses don't have to offer insurance, but if their workers end up buying their own insurance and getting the government help, the employers would basically have to pay back the government.
Now, I should add that in both bills small businesses would not have to buy insurance for their workers. But they would get access to better rates than they have now because of these new exchanges. And they would get tax credits to help them. So if small businesses want to help buy insurance for their workers, which many do, it would be much cheaper.
BLOCK: Now, Julie, we just heard from Doug Elmendorf talking about costs of health care overhaul to the government. What do we know about how the bills stack up in terms of how much this will cost families?
ROVNER: Well, we don't know exact dollar amounts, of course. But we do know there will be limits on what people can be required to spend on premiums. For example, low-income people who earn too much to qualify for Medicaid won't have to spend more than two percent of their income on premiums. People at roughly four times poverty, those are the families earning $88,000 we talked about, won't have to spend more than about 10 percent of their incomes on premiums.
But I should point out that one of the places where the bills do diverge significantly is what you get for those premiums. In the House bill the benefit package is much more generous. So you'd pay less in deductibles and co-payments. You'd basically get more for your money. The Senate bill provides considerably less in the way of benefits. That's a big reason why the Senate bill costs so much less than the House bill overall.
A lot of health economists and advocates worry that if the Senate bill structure ultimately prevails, there might be a backlash from people who won't think the coverage that they have to buy is worth that money.
BLOCK: Okay, Julie. Thanks.
ROVNER: You're welcome.
BLOCK: That's NPR's health policy correspondent Julie Rovner.
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