A Side-by-Side Comparison of the House and Senate Bills

Now that the Senate health care reform bill has passed, both the House and Senate versions of the legislation will be sent to a Conference Committee for them to be reconciled into one bill, which will be sent back to the floor for debate. How difficult will the Conference Committee have it? Here’s a side-by-side comparison of some of the key points of each version of the bill to help you find out.

House Bill: The Affordable Health Care for America Act (passed Nov. 7, 2009) Senate Bill: The Patient Protection and Affordable Care Act (passed Dec. 24, 2009)

Requires most U.S. citizens and legal residents to have health insurance. Penalty for not having coverage is a flat fee or percentage of income. Exemptions granted to those with financial hardships, religious obligations, American Indians, those without coverage for less than three months, undocumented immigrants and incarcerated individuals.

Requires most individuals to have health insurance. Penalty for not having coverage is a percentage of your income. Exemptions granted for those with financial hardships and religious obligations.
Insurance exchange through which individuals can buy insurance is state-based, with separate exchanges for businesses and individuals. Business and individuals participate in the same national insurance exchange.
Expands Medicaid to 133% of poverty level. Expands Medicaid to 150% of poverty level.
Employers with fewer than 50 employees are exempt from penalties. Employers with more than 200 employees must automatically enroll all employees (though they can opt-out). Employer penalty exemption is based on payroll amount, not number of employees, with employers with annual payrolls less than $500,000 totally exempt.
No public plan option, but each state insurance exchange must include at least two multi-state exchanges. Public plan option is available through the insurance exchange, but must meet the same requirements as private plans in terms of benefit levels, provider networks, consumer protections, and cost-sharing.
Require guarantee issue and renewability and allow rating variation based only on age (limited to 3 to 1 ratio), premium rating area, family composition, and tobacco use (limited to 1.5. to 1 ratio). Require guarantee issue and renewability; allow rating variation based only on age (limited to 2 to 1 ratio), premium rating area, and family enrollment.
Temporary high-risk pool to cover those who are difficult to cover will take effect within 90 days after enactment and last until Jan. 1, 2014. Temporary high-risk pool to cover those who are difficult to cover will take effect Jan. 1, 2010 and last until the national insurance exchange is established.
Dependent coverage for children will be provided until age 26. Dependent coverage for children will be provided until age 27.
Create a Web site to help consumers navigate health care choices and develop uniform policy presentation standards. Develop uniform marketing and policy presentation standards.
CLASS Act national long term care program CLASS Act national long term care program
Effective date for most provisions is Jan. 1, 2014. Effective date for most provisions is Jan. 1, 2013.

For an extremely comprehensive look at the differences in the legislation, visit the Kaiser Family Foundation Web site.