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A Look at Health Care Plans in Congress

A Look at Health Care Plans in Congress

Associated Press/AP Online

October 05, 2009

WASHINGTON – Health care legislation is taking shape in the House and Senate as President Barack Obama pushes to overhaul the system to cover millions of uninsured Americans and contain rising costs.

Details are still being negotiated and any final health care bill would have to meld proposals from the House and Senate.

The Associated Press takes a look at various proposals:

The Senate Finance Committee’s bill:

WHO’S COVERED: Around 95 percent of Americans. Illegal immigrants would not receive government benefits.

COST: Nearly $900 billion over 10 years.

HOW IT’S PAID FOR: Fees on insurance companies, drugmakers, medical device manufacturers. Additional tax levied on insurance companies, equal to 40 percent of total premiums paid on insurance plans costing more than $8,000 annually for individuals and $21,000 for families. Cuts to Medicare and Medicaid. A fee on employers whose workers receive government subsidies to help them pay premiums. Fines on those individuals who fail to purchase affordable coverage.

REQUIREMENTS FOR INDIVIDUALS: Everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship.

REQUIREMENTS FOR EMPLOYERS: Not required to offer coverage, but companies with more than 50 full-time workers would pay a fee if the government ends up subsidizing employees’ coverage.

SUBSIDIES: Tax credits for individuals and families making up to 400 percent of the federal poverty level, which computes to $88,200 for a family of four. Tax credits for small employers.

BENEFITS PACKAGE: All plans sold to individuals and small businesses would have to cover basic benefits, including primary care, hospitalization and prescription drugs. The government would set four levels of coverage, the least generous of which would pay an estimated 65 percent of health care costs per year; and the most generous of which would cover an estimated 90 percent.

INSURANCE INDUSTRY RESTRICTIONS: No denial of coverage based on pre-existing conditions. No higher premiums allowed on basis of pre-existing conditions or gender. Limits on higher premiums based on age and family size. Limits on allowable co-pays and deductibles.

GOVERNMENT-RUN PLAN: None. Would create nonprofit, member-owned co-ops to compete with private insurers.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Self-employed people and small businesses could pick a plan offered through new state-based purchasing pools. Employees would be generally allowed to keep their work-provided coverage.

CHANGES TO MEDICAID: Income eligibility levels standardized to 133 percent of poverty ($30,000 a year for a family of four) for all parents, children and pregnant women. Childless adults making up to 133 percent of poverty ($14,400 for an individual) would be eligible for the first time. The expansion would be delayed until 2014.

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