Health Care Legislation: House v. Senate
A Comparison of House and Senate Health Care Legislation
Public Insurance Option
| House | Senate Finance Committee | Senate Health, Education, Labor, and Pensions Committee |
| Creates a federally run government insurance program to compete with for-profit insurance plans. |
Instead of a government insurance program, creates non-profit, consumer owned health plans to compete with for-profit insurance plans. | Similar to House bill. |
Individual Mandate
| House | Senate Finance Committee | Senate Health, Education, Labor, and Pensions Committee |
| Individuals must have insurance, a requirement enforced through a tax penalty (2.5% of income) with hardship waivers. |
With certain exceptions, would penalize people who choose to not buy health insurance, with a maximum penalty of $3,800 per family. | Imposes a minimum annual penalty of $750 on individuals who do not buy coverage. |
Subsidies to Buy Insurance
| House | Senate Finance Committee | Senate Health, Education, Labor, and Pensions Committee |
| Offers subsidies to families with incomes of up to 400 percent of the federal poverty level, which is now $88,200 for a family of four, to buy insurance. | Offers subsidies to families with incomes of up to 300 percent of the federal poverty level, which is now $66,150 for a family of four, to buy insurance. | Similar to House bill. |
Tax Increases, Fees, and Penalties
| House | Senate Finance Committee | Senate Health, Education, Labor, and Pensions Committee |
| Imposes tax increases of $544 billion over 10 years on people with incomes over $350,000. Penalizes employers who do not offer health insurance to their workers—an amount equal to 8% of their total payroll costs. | Imposes a 35% tax on insurance companies for any health insurance plan that costs more than $21,000 for families or $8,000 for singles. Imposes annual fees of $6 billion on insurance companies, $4 billion on medical device manufacturers, and $2.3 billion on pharmaceutical manufacturers. | Requires employers who do not offer health coverage to their workers to pay $750 for each uninsured full-time employee. |
Expansion on Medicaid
| House | Senate Finance Committee | Senate Health, Education, Labor, and Pensions Committee |
| Creates a uniform national eligibility standard of 133% of the federal poverty level, which is now $29,326.50 for a family of four. This would cost about $440 billion in the first 10 years. | Similar to House bill. | No provisions on Medicaid. |
Cuts in Medicare Spending
| House | Senate Finance Committee | Senate Health, Education, Labor, and Pensions Committee |
| Would cut payments to hospitals and other providers and would cut spending on the Medicare Advantage Program. According to the Congressional Budget Office, these cuts would amount to at least $350 billion over 10 years. | Takes steps to move away from fee-for-service payments to doctors and hospitals and toward payments based on quality of care. Would make cuts in payments to Medicare Advantage plans, home health providers, and others. No CBO estimate yet on total amount of cuts. | Creates grant program to award money to states and local health departments to conduct programs to monitor and improve health of the 55-64 year-old population to prevent larger Medicare spending later. |
Employer Mandate
| House | Senate Finance Committee | Senate Health, Education, Labor, and Pensions Committee |
| Employers must provide insurance to their employees or pay a penalty of 8 percent of their payroll cost. Companies with payroll costs under $250,000 annually are exempt. | No requirement that employers offer health insurance to their workers. | Employers with more than 25 employees who do not offer coverage or who pay less than 60% of their employees' monthly premiums must pay a $750 annual fee per uninsured full-time employee. |
