Health Care Reform Bills: To Provide or Impose?

It all depends on your point of view. If you want health insurance but cannot afford it, the two health care reform bills being considered by Congress will "provide" it to you. But if you simply do not want health insurance, the bills will "impose" it on you.

Under both the Senate (the Patient Protection and Affordable Care Act) and House (the Affordable Health Care for America Act) health care reform bills, virtually all American citizens will be required to have health insurance coverage. That, say lawmakers, President Obama and many doctors, is the key to reducing the cost of health care. The two bills differ in how they hope accomplish health insurance for all and those differences are important to you.

You Cannot Afford Health Insurance
Want health insurance, but cannot afford it? You're in luck, because both the House and Senate health care reform bills include provisions to help you buy it.

House Bill

Insurance Exchanges: The House bill would create state-administered health insurance "exchanges" from which employers and individuals could shop for insurance. The House bill also creates the so-called "public option" plan, which amounts to a government-run health insurance plan similar to Medicare. The public option plan would be available though the exchanges, where it would compete with private insurance plans.

Medicaid Expanded: The House bill would expand access to state Medicaid by extending coverage to people earning up to 150 percent of the poverty level, or roughly $33,000 for a family of four.

Government Subsidy: For people who cannot afford health insurance, including the public option plan, the House bill would offer a subsidy for individuals and families whose annual incomes fall between 133- to 400-percent of the poverty level.

Senate Bill

Insurance Exchanges: The Senate bill also establishes the state-run insurance exchanges but drops the public option plan. Instead, it would allow people buying insurance through an insurance exchange to sign up for nationwide, non-profit cooperative insurance plans to be overseen by the government and similar to the insurance offered to government employees and members of Congress.

Medicaid Expanded: The Senate bill would extend Medicaid coverage to people making up to 133 percent of the poverty level, or just over $29,000 for a family of four.

Government Subsidy: Under the Senate bill, families with annual incomes of up to $88,000 would be eligible for a government subsidy to help them buy health insurance.

You Do Not Want Health Insurance
Lots of young, healthy people - the Young Invincibles -- simply choose not to spend their money on health insurance. For them and other Americans who choose not to buy insurance, the news is not so good. Both bills require them to buy it and will penalize them if they don't.

House Bill

Fines for Individuals: On persons who fail to buy health insurance, the House bill would impose a fine of up to 2.5 percent of their annual income.

Low-Income Exemption: Persons with annual incomes below the IRS filing threshold and those with qualifying religious objections would be exempted. In 2009, the IRS filing threshold for taxpayers under age 65 is $9,350 for singles and $18,700 for couples.

Fines for Employers: Employers with payrolls of more than $500,000 would be required to provide health insurance for their employees or pay a penalty of up to 8 percent of their payroll.

Senate Bill

Fines for Individuals: Health insurance resistors would face a fine of up to $750 or 2 percent of their income under the Senate bill.

Low-Income Exemption: An exemption would be granted for persons whose annual required health insurance payments would exceed 8 percent of their annual household income. Exemptions for religious objections would also be allowed.

Fines for Employers: Companies with more than 50 employees could be fined up to $750 for each employee forced to take a government subsidy in order to purchase required health insurance.

Bills Must Still Be Merged
As required by the legislative process, differences in the House and Senate health care reform bills must be reconciled and a single, merged version of the bills approved by both the House and Senate. A joint House-Senate conference committee will be appointed to take on this task. Debate on a final, reconciled health care reform bill could begin as early as February 2010. Political observers expect the final bill to conform largely to version approved by the Senate.