We focus so much on Senator Baucus and the Senate Finance Committee bill that we sometimes forget that there is a whole other committee in the Senate which has also written a bill. The HELP (Health, Education, Labor and Pensions) Committee is represented by Senator Dodd in the negotiation process at this time.
How do the bills differ? Jeffrey Young at The Hill has done the heavy lifting:
AFFORDABILITY
The HELP Committee offers subsidies on a sliding scale for people with incomes between 150 percent and 400 percent of the federal poverty level and caps premiums at a maximum of 12.5 percent of income. The Finance Committee bill’s subsidies range from 133 percent of poverty to 400 percent with a maximum premium of 12 percent of income.
PUBLIC OPTION
The HELP Committee approved a public option, and most Democrats view it as the only way to place a check on private insurers in the marketplace, to give people an alternative to unstable private coverage, and as a way to save healthcare costs through efficiencies. The HELP Committee’s public option would negotiate payment rates with medical providers and have to follow the same rules as private insurers in the exchange.
The Finance bill includes funding for nonprofit healthcare cooperatives and enacted language permitting states to establish public plans for people between 133 percent and 200 percent of poverty.
INDIVIDUAL RESPONSIBILITY
The HELP Committee bill includes an individual mandate that requires nearly everyone to obtain some form of health coverage or pay a $750 penalty, with a maximum of $3,000 for a family.
The Finance Committee started out with a very similar proposal, but it was watered down because of worries that people would be punished if they simply could not afford insurance. More people were exempted and penalties scaled back.
EMPLOYER RESPONSIBILITY
The HELP Committee bill includes a strict “play or pay” employer mandate: All companies with 25 or more employees must provide health benefits and pay 60 percent of the cost. If not, they face a $750 penalty for each uninsured full-time worker and $375 for each part-timer.
The Finance Committee eschewed a legal requirement for employers but did not let companies with more than 50 workers off the hook.
Most of the financing language comes, well, from the Finance Committee. If you want my opinion, the biggest fights will come out of the subsidy levels, the specifics of the employer mandate, and the excise tax on expensive plans. It’s closed door negotiations, so the outcome is anyone’s guess.
