November 9th, 2009
04:04 PM ET
5 years ago

House, Senate differ sharply on health care reform

President Barack Obama now stands closer to realizing the Democratic dream of universal coverage.
President Barack Obama now stands closer to realizing the Democratic dream of universal coverage.

WASHINGTON (CNN) – Where does the battle for health care reform go from here? More importantly, what does it mean for you?

Democrats made history over the weekend when the House of Representativesapproved the biggest expansion of medical coverage since Medicare was enacted over four decades ago. President Barack Obama now stands closer to realizing the Democratic dream of universal coverage than any of his White House predecessors since Harry Truman after World War II.

But top Democrats know that it is far too early to celebrate. The road to final passage of health care legislation is still long and bumpy.

The more conservative Senate - where it is much easier for the GOP minority to stifle the will of the Democratic majority - has yet to pass its own version of a health care bill. Senate Majority Leader Harry Reid of Nevada last week signaled uncertainty over whether that will happen this year.

If the Senate manages to pass a bill, a congressional conference committee will need to merge the House and Senate proposals into a consensus version requiring final approval from each chamber before moving to Obama's desk to be signed into law.


That said, Democratic leaders in the House and Senate have already reached agreement on a broad range of changes that could impact every
American's coverage.

Among other things, they have agreed to subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.

They have also agreed to create health insurance exchanges designed to make it easier for small businesses, self-employed and the unemployed to pool resources and purchase less expensive coverage. Both the House plan and a plan approved by the Senate Finance Committee would limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Insurers would also be barred from charging higher premiums based on a person's gender or medical history.

Medicaid - the government-run health care plan for the poor - would be significantly expanded under both proposals. The House bill would extend coverage to individuals earning up to 150 percent of the poverty line, or roughly $33,000 for a family of four; the Senate Finance Committee plan ensures coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.

Democratic leaders in both chambers agree on establishing non-profit health care cooperatives and stripping insurance companies of an anti-trust exemption that has been in place since the end of World War II.

What are the major differences?

For starters, the House bill is more expansive - and hence expensive - than the Senate Finance Committee bill. The House bill, projected to guarantee coverage for 96 percent of Americans, will cost more than $1 trillion over the next ten years, according to the non-partisan Congressional Budget Office.

The Senate Finance Committee bill, estimated to cover 94 percent of Americans, comes with a smaller $829 billion price tag, according to the CBO.

One of the biggest divides between House and Senate Democrats is over how to pay for the plans. The House package is financed through a combination of a tax surcharge on wealthy Americans and new spending constraints in Medicare and
Medicaid.

Specifically, individuals with annual incomes over $500,000 - as well as families earning more than $1 million - would face a 5.4 percent income tax surcharge.

The Finance Committee measure also trims entitlement programs such as

Medicare and Medicaid. It does not include a tax surcharge on the wealthy, however. It would instead impose a new tax on so-called "Cadillac" health plans valued at more than $8,000 for individuals and $21,000 for families.

Proponents of the tax on high-end plans argue it's one of the most effective ways to curb medical inflation. A large number of House Democrats are adamantly opposed to taxing such policies, arguing that such a move would hurt union members who traded higher salaries for more generous benefits.

Another key sticking point: the dispute over a government-run public option. The House plan includes a public option, while the Senate Finance Committee plan does not. Reid has pledged to add a version of the public option to the Senate measure, but would give individual states until 2014 to decide whether they want to opt out.

Individuals under both plans would be required to purchase coverage, but the House bill includes more stringent penalties for most of those who fail to comply. The Finance Committee plan would require individuals to purchase health insurance coverage or face a fine of up to $750. The House bill would impose a fine of up to 2.5 percent of an individual's income.

Both versions include a hardship exemption for poorer Americans.

Employers also face a much stricter mandate under the House legislation, which would require companies with a payroll of more than $500,000 to provide insurance or pay a penalty of up to 8 percent of their payroll.

The Finance Committee bill would require companies with more than 50 employees to pay a fee of up to $750 per worker if its employees rely on government subsidies to purchase coverage.

Abortion also promises to remain a major obstacle for both chambers. A late compromise with Catholic and other conservatives in the House led to the adoption of an amendment banning most abortion coverage from the public option.

It would also prohibit abortion coverage in private policies available in the exchange to people receiving federal subsidies.

Colorado Rep. Diana DeGette and New York Rep. Louise M. Slaughter, co-chairs of the Congressional Pro-Choice Caucus, released a letter Monday signed by over 40 House members pledging to vote against final passage of the bill if the current language in the House bill is not changed.

Both DeGette and Slaughter voted to approve the House bill Saturday night despite its strengthened abortion restrictions.

–CNN's Tom Cohen, Lisa Desjardins and Deirdre Walsh contributed to this report.


Filed under: Health care • House of Representatives • Senate
soundoff (32 Responses)
  1. victim of republican greed

    While democrats continue to try to do things for Americans, the do nothings in the GOP continue to party at taxpayer's expense, completely unaware of reality.

    November 9, 2009 04:47 pm at 4:47 pm |
  2. Randolph Carter, I'm no expert but...

    That's because representation is apportioned by population size in the house so their decisions reflect the "will of the people" more accurately than the senate where each state gets 2 votes regardless of population. So basically, progress is being held back once again by a few hick states. And a bunch of corporate tool democrats. Have a nice day!

    November 9, 2009 04:48 pm at 4:48 pm |
  3. Henry Miller, Libertarian

    Unlike Nancy Pelosi, Harry Reid isn't a politically suicidal fanatic. He knows perfectly well that whatever percentage of American voters say they want some kind of health care "reform," nowhere near a majority are willing to pay a trillion bucks to get it.

    November 9, 2009 04:48 pm at 4:48 pm |
  4. m jeff

    The more conservative senators have already been bought by the Insurance Companies, of course they don't want change.

    November 9, 2009 04:50 pm at 4:50 pm |
  5. Dutch/Bad Newz, VA

    Let's make this clear to the Senate that whatever is in their bill, there better be a public option in it. I'm not worried about House members losing seats in the democratic caucus because in each of their bills they proposed a public option. Whereas in the Senate, these guys don't have any backbone to stand strongly behind a public option.

    WARNING BLUE DOGS WARNING BLUE DOGS WARNING BLUE DOGS

    The democratic party should not succumb to your conservative ideals when you only represent a small minority of constituents. Take those conservative values and shove them where the sun don't shine.

    November 9, 2009 04:50 pm at 4:50 pm |
  6. Matt

    I know the majority is happy that the House passed a bill this weekend, but I will wait to hear that the president has signed a STRONG bill with the public option before I celebrate.
    It's still a long way to go.

    November 9, 2009 04:51 pm at 4:51 pm |
  7. annie s

    The Senate sickens me. And every Senator who opposes this reform, starting with Joe Lieberman, needs to be kicked to the curb next election day.

    November 9, 2009 04:56 pm at 4:56 pm |
  8. Billy J..Texas..

    That's because the Senators are in longer, so K street has more invested in them. Crooks.. liars..... basic traitors to their constituency. With the exception of a very few, both sides of the aisles are a bunch of untrustworthy, lazy bums. I am not even talking about ideology, it is pure sellout on both sides.

    November 9, 2009 04:57 pm at 4:57 pm |
  9. carlos, THAT one

    just pass the reform without the repugnants, they are anti American.....we will take care of them at election time when latinos voices will be heard and very loud!

    November 9, 2009 05:00 pm at 5:00 pm |
  10. Brian

    This is the shining moment for Senate Democrats to show what muscle they have and get this bill through. For too long (at least until Sunday night), the Democratic Party has acted like they're in the minority and the Republican Party has acted like they're in the majority. It's time the Democrats realize their numbers in the Senate and the fact that the American people voted them in for a reason. The bill is half of the way to becoming law – don't stop now!

    November 9, 2009 05:01 pm at 5:01 pm |
  11. DJ

    Throw the GOP some bones with no abortion $ and cap lawsuits...

    Then stick to your guns, grow a spine and support a strong public option.

    November 9, 2009 05:05 pm at 5:05 pm |
  12. Randy in PA

    I hope someone in the Senate will grow a pair and do what is right for this country.
    Take out the crap and the gifts to special interest. Put in actual cost reductions. Do what is right and not what will make certain groups happy.
    How about creating reform based on real values (ie: taking care of each other and not having people die or go bankrupt if struck with illness).

    We should not be spending billions/trillions on killing people around the world and start spending that money on making people healthy and productive.

    November 9, 2009 05:09 pm at 5:09 pm |
  13. dave g, minneapolis

    The bill passed by the House is scary. First (i've only read the first 50 pages) it says that insurers cannot increase premiums, deny care, drop care or refuse due to pre-existing conditions....BUT then it goes on to say regarding what the government can do if it's own costs cant be covered..." the Secretary shall make such adjustments as are necessary to eliminate such deficit, including reducing benefits, increasing premiums, or establishing waiting lists."
    No matter what party you're in, you should be afraid that the Sec'y of HHS has this much control. What happens when party affiliations change?? They're already holding companies to a standard that the government is not obligated to.

    November 9, 2009 05:09 pm at 5:09 pm |
  14. frodeo

    People are twisting the issue about healthcare needing to be reformed due to "higher costs".
    If i build cars, and say one year i build one, but next year i build 10, my costs to build those cars has roughly gone up 10times!!!! OMG we better reduce costs!!! Let's let the govermnemt step in and force us to sell the cars for less and to deny no one with bad credit or no money. You also can't force the new owner to return the car if they stop paying for it.
    Now apply this analogy to healthcare. As a whole, we have more, and better services available. THis all costs more. But government is stepping in and forcing pricing practices...it's a recipe for disaster. We've already seen the houseing market collapse, then the car makers. Now it's only up to the Senate to crash the healthcare system....

    November 9, 2009 05:09 pm at 5:09 pm |
  15. File under "Sarcasm"

    Doesn't the phrase "stifle the will of the Democratic majority" sound a little partisan.

    I also noticed the fine print at the end which implies that any reconciled bill out of the Senate and House will have to include abortion coverage to satisfy the liberal left "Pro-Choice Causus". I guess if they form enough caucuses we can never pass any bill in the House.

    November 9, 2009 05:12 pm at 5:12 pm |
  16. Proud Member..Party of No

    Let's not forget this little gem:

    U.S. Representatives John Carter (R-TX) and Steve King (R-IA)
    had announced they would discuss Democrat Majority Leader Steny Hoyer’s (D-MD) statement that the upcoming health care reform effort would fail if Members were required to read the legislation. House Democrats accordingly silenced floor debate on the issue by voting to close early.

    November 9, 2009 05:13 pm at 5:13 pm |
  17. freddie

    Thank goodness we have a few senators who understand what damage the public option will do to america. THANK YOU JOE keep up the good work. We will work hard for you in the next election.

    November 9, 2009 05:16 pm at 5:16 pm |
  18. howie

    I need a list of the democrats who voted NO in the house, I want to send them a thank you note.

    November 9, 2009 05:18 pm at 5:18 pm |
  19. reform not nationalization

    Liberty is a fading commodity in this country. I hope every congressman that votes for this knows we are coming after them on election day.

    November 9, 2009 05:18 pm at 5:18 pm |
  20. Paul

    The unscientific CNN poll on whether or not people would vote for the latest health care bill is indicative of its liberal consumer base. Interesting that its only a 6 percentage point spread indicating that there are sensible liberals out there who realize that this thing comes with a hefty price tag and certain tax increase that will be felt for generations.

    November 9, 2009 05:19 pm at 5:19 pm |
  21. William

    I can't believe that these folks still don't get it. After all the months of debate, they still don't have a clue. If the Senate waters down the healthcare bill just for passage, there will be hell to pay at the polls in 2008. I don't care if they are republican, democrat or other. All of them can take a walk off a short pier.

    November 9, 2009 05:22 pm at 5:22 pm |
  22. New Father

    A bill that can't even win all the votes of the left. When it doesn't get done this year, oh wait that doesn't matter it doesn't start til after the 2012 election. What a plan tax for 3 years and than look into providing coverage. I just hope businesses wait until a plan passes to start hirong again. Never mind real unemployment is 17% guess they already are waiting. I hope the plan taxes all these greedy companies right out of the US, America doesn't need these rich people anyway the middle class can support the poor on thier own. I'll pay 50+% in taxes my son doesn't need a college fund.

    November 9, 2009 05:24 pm at 5:24 pm |
  23. Candide

    Abortion funding wasn't my biggest concern with this mish mash of nonsense that passed the house Saturday night. I contacted my representative, whom I admire, and let him know how disappointed I am in him for swallowing this baloney hook, line and sinker. Since my Senators are useless parasites, I don't expect them to do anything except what they think will win them votes. I will be voting against both of them when they are up for re-election and I'll be looking long and hard at what my congressman does in the future. This bill is an abomination in its current state, and no one can predict how much worse it will be after they fiddle around with it before final passage. It will cost them.

    November 9, 2009 05:24 pm at 5:24 pm |
  24. Tester

    This is only a test

    November 9, 2009 05:25 pm at 5:25 pm |
  25. Jay T.

    Unions are evil? I've never seen a Union get a bailout. But, the corporate pigs Unions fight on behalf of the worker sure suck the taxpayer dry with bailouts. It's a simple choice- Unions or Corporate suits. The former is a democratic group of citizens fighting for worker's rights, the latter is wealthy CEO's seeking golden parachutes and a feudal system. Conserva-bots, Instead of rehasing Right Wing talking points, try to come up with your own ideas.

    November 9, 2009 05:26 pm at 5:26 pm |
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