Below is an analysis by CAPAF’s Igor Volsky on the differences between the Senate health care bill and the manager’s amendment Leader Reid introduced this morning.
The Congressional Budget Office’s analysis of the merged Senate health care bill, incorporating the manager’s amendment, concludes that the legislation would cost $871 billion over 10 years, reduce the deficit by $132 billion over 10 years and by $1.3 trillion over 20 years. The bill would extend insurance to 31 million individuals, covering approximately 94% by 2019.
Here is how the new merged bill compares to the earlier version:
| |
Senate Bill |
New Managers Amendment |
Difference |
| Costs |
Reduce deficits: $130B/10yrs
Cost: $848B/10yrs
Spends on subsidies: $447B/10yrs
On Medicaid/CHIP: $374B/10yrs
On Small Employer Credit: $27B/10yrs |
Reduce deficits: $132B/10yrs
Cost: $871B/10yrs
Spends on subsidies: $436B/10yrs
On Medicaid/CHIP: $395B/10yrs
On Small Employer Credit: $40B/10yrs |
Reduce deficits: +$2B/10yrs
Cost: +$23B/10yrs
Spends on subsidies: -$11B/10yrs
On Medicaid/CHIP: +$21B/10yrs
On Small Employer Credit: +$13B/10yrs |
| Insured |
Uninsured reduced by: 31M
Uninsured in 2019: 24M
In Exchanges: 25M | Public Plan: 3-4M
In Medicaid: 15M |
Uninsured reduced by: 31M
Uninsured in 2019: 23M
In Exchanges: 26M
In Medicaid: 15M |
Uninsured reduced by: No Change
Uninsured in 2019: -1M
In Exchanges: +1M
In Medicaid: No Change |
| Revenue |
Mandate penalty: $8B/10yrs
Free rider penalty: $28B/10yrs
New taxes: $238B/10yrs
Excise tax: $149B/10yrs
Payroll tax: $54B/10yrs |
Mandate penalty: $15B/10yrs
Free rider penalty: $28B/10yrs
New taxes: $264B/10yrs
Excise tax: $149B/10yrs
Payroll tax: $87B/10yrs |
Mandate penalty: +$7B/10yrs
Free rider penalty: No Change
New taxes: +$26B/10yrs
Excise tax: No Change
Payroll tax: +$33B/10yrs |
Medicare
and
Medicaid |
Total savings: $491B/10yrs
Medicare Advantage: $118B/10yrs
Medicare Commission (IMAB): $23B/2015–2019 |
Total savings: $483B/10yrs
Medicare Advantage: $118B/10yrs
Medicare Commission (IMAB): $28B/2015–2019 |
Total savings: -$8B/10yrs
Medicare Advantage: No Change
Medicare Commission (IMAB): +$5B/2015–2019 |
Some of the changes include:
– Holding Insurers Accountable: Insurers in large group market have to maintain a medical loss ration of 85%. Insurers in the small group market have to maintain a medical loss ration of 80%. Insurance companies who jack up their rates will be barred from competing in the exchange.
– Regulations For Children: Starting immediately children cannot be denied health coverage due to pre-existing conditions.
– Nonprofit Insurers Excluded From Tax: Nonprofit insurers are excluded from the tax on the insurance industry.
– Employers Can Offer Vouchers: Individuals and families under 400% of the federal poverty line who receive employer-sponsored coverage and spend 8-9.8% of their income on premiums, could “convert their tax-free employer health subsidies into vouchers that they can use to choose a health insurance plan in the new health insurance exchanges.
– Changes To Medicare Commission: The Medicare Commission will now examine the effect programs have on National Health Expenditures and will be prohibited from increasing premiums. The committee will make non binding recommendations if the Medicare spending rate is below or on target.
– New Choice Of Coverage From Nonprofits: Individuals could enroll in a national health insurance plan managed by the Office of Personnel Management, the same entity that oversees health plans for Members of Congress.
– Investment In Community Health Centers/Rural Areas: A substantial investment in Community Health Centers and more funding for rural health care providers and training programs for physician and other types of health care providers.
– Expands Small Business Tax Credit: The credits begin a year earlier – in 2010 and small businesses are eligible for up to six years. The wage thresholds for small business tax credits is also increased.
– Satisfying Gun Owners: Does not require individuals to disclose whether they own a gun. Gun ownership cannot be factored into premiums or coverage decisions.
– New Taxes: Increases the payroll tax on high income earners from 0.5% to 0.9%; the tax begins in 2013. A 10% tax is imposed on indoor tanning services and the ‘botox tax’ is removed.
Majority Leader Reid will file three cloture motions tonight and the Senate could pass the final legislation on Thursday, December 24th at 7pm. The Senate is expected to vote for cloture on the manager’s amendment Monday at 1am. The second cloture vote on the substitute is scheduled for Tuesday morning and the final cloture vote on the underlining bill could occur Wednesday afternoon.
Note: my colleague Emma Sandoe of DC Progressive contributed greatly to this post.
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