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A look at health care plans in Congress

September 16, 2009

WASHINGTON (AP) -- Here's a look at health care legislation taking shape in the House and Senate as President Barack Obama pushes to overhaul the system, cover nearly 50 million 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.

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Baucus proposal



A look at a health care overhaul plan proposed by Senate Finance Committee Chairman Max Baucus, D-Mont., on Wednesday.

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

COST: $856 billion over 10 years.

HOW IT'S PAID FOR: Fees on insurance companies, drug makers, medical device manufacturers and insurers. Tax of 35 percent on premiums paid on insurance plans costing more than $8,000 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 get coverage.

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

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 300 percent of the federal poverty level, which computes to $66,150 for a family of four. Households up to 400 percent of poverty line could also get some relief. Tax credits for small employers.

BENEFITS PACKAGE: The government would set four benefit categories ranging from coverage of around 65 percent of medical costs to about 90 percent. No denial of coverage based on pre-existing conditions. All plans sold to individuals and small businesses would have to cover basic benefits, including primary care, hospitalization and prescription drugs.

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. No changes for people working in larger companies.

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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Senate health panel's bill



The Senate Health, Education, Labor and Pensions Committee's bill:

WHO'S COVERED: Aims to cover 97 percent of Americans.

COST: About $615 billion over 10 years, but it's only one piece of a larger Senate bill.

HOW IT'S PAID FOR: Another panel -- the Senate Finance Committee -- is responsible for figuring out how to cover costs.

REQUIREMENTS FOR INDIVIDUALS: Individuals will have to have insurance, enforced through tax penalties with hardship waivers.

REQUIREMENTS FOR EMPLOYERS: Employers who don't offer coverage will pay a penalty of $750 a year for each full-time worker. Businesses with 25 or fewer workers are exempt.

SUBSIDIES: Available up to 400 percent poverty level, or $88,000 for a family of four.

BENEFITS PACKAGE: Health plans must offer a package of essential benefits recommended by a new Medical Advisory Council. No denial of coverage based on pre-existing conditions.

GOVERNMENT-RUN PLAN: A robust new public plan to compete with private insurers. The plan would be run by the government and negotiate payment rates with providers.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Individuals and small businesses could purchase insurance through state-based purchasing pools called American Health Benefit Gateways.

OTHER PROVISIONS: Creates a new voluntary insurance program that would provide a modest daily cash benefit to help disabled people stay in their own homes instead of going into nursing homes.

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House Democrats' plan



The House Democratic bill (three committees have approved slightly different versions that still must be merged):

WHO'S COVERED: Around 94 percent of non-elderly residents (those not covered by Medicare, which kicks in at age 65) would be covered -- compared with 81 percent today. Nearly half the 17 million non-elderly residents who remain uninsured would be illegal immigrants.

COST: About $1.5 trillion over 10 years.

HOW IT'S PAID FOR: Revenue-raisers include $544 billion over the next decade from new income taxes on single people making more than $280,000 a year and couples making more than $350,000; $37 billion in business tax increases; about $500 billion in cuts to Medicare and Medicaid; sizable penalties paid by individuals and employers who don't obtain coverage.

REQUIREMENTS FOR INDIVIDUALS: Individuals must have insurance, enforced through tax penalty with hardship waivers. The penalty is 2.5 percent of income.

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