As Congress prepares to revamp the nation’s health care, The Daily Beast goes inside the six proposals under consideration, from the House Democrats’ offering (left to decide: how to pay for it all) to the Republicans’ notes (mostly limited to criticizing their opponents).
While House Democrats are still working out some of the kinks, the basic outline of the plan includes:
• A new national insurance exchange (or federally approved state ones) that would offer uninsured people and businesses coverage through work or federal programs.
• A new public health plan that would offer multiple levels of coverage.
• A mandate for individuals to purchase health insurance
• A penalty of up to 2.5 percent of gross income for people who disregard the mandate.
• Subsidies for families below four times the poverty level.
• A ban on insurance companies’ denying coverage based on pre-existing conditions.
• Medicaid expansion to include those with incomes up to 133 percent of the poverty level.
• A $1 trillion price tag over 10 years overall for the subsidies and Medicaid expansion.
Not everything is settled, however: namely, how to pay for it. House Democrats proposed a surtax of 1 to 5.4 percent on three tiers of incomes between $280,000 and $800,000 for individuals and $350,000 to $1 million for joint filers. That plan would raise a projected $544 billion over 10 years, but House Speaker Nancy Pelosi has indicated she prefers that the taxes only affect those in the highest income bracket and that more money be saved within the health-care industry. In addition, Blue Dog Democrats are pushing to include more cost-saving features, like taking Medicare payments out of Congress’ hands and putting them in the hands of an independent commission—a compromise that appears to have won President Obama’s support.
Senate Health Committee
Broadly speaking, the Senate Health Committee’s plan is similar to the House Democrats’ plan. Both would require individuals to purchase insurance and impose fines on those who do not, which, in the case of the Health Committee’s plan, would be at least $750. Companies that don’t offer insurance would also have to pay fines for each uninsured employee. The Senate Health Committee plan also creates a national health-insurance exchange and a new public-insurance option. But how to pay for the plan is under the jurisdiction of the Senate Finance Committee, which is in negotiations over its own proposal.
Senate Finance Committee
All eyes are on the Senate Finance Committee, which more than any other player in the health-care debate is slowing down the pace of legislation. The committee’s chairman, Max Baucus, has placed significantly more emphasis on obtaining bipartisan support for the committee’s proposal, in contrast to House Democrats and the Senate Health Committee, which largely took a partisan approach. The Republican senator most involved in talks, Chuck Grassley, has suggested that the House’s plan to use a surtax on wealthy Americans is “definitely” off the table. One possibility would be to tax employer-provided health-care benefits, a move that has drawn strong opposition from Democratic lawmakers, but could help bring down health-care costs.
Wyden-Bennett Healthy Americans Act
As Jon Cohn explains at The New Republic, the Wyden-Bennett plan—named for its creators, Sen. Ron Wyden, Democrat of Oregon, and Sen. Bob Bennett, Republican of Utah—is likely to run into both political and policy roadblocks. What the plan’s “Free Choice Proposal” would do is create regulated insurance exchanges that, unlike most of the other proposals, would be open even to people who already have employer-provided insurance. Moreover, employers would have to give employees a voucher to use in the exchange. Wyden told The Washington Post’s Ezra Klein, “If the Congress passes a bill and most people continue to see double-digit premium hikes and are told they’ll have more choices but don’t, then that won’t be helpful to the cause of reform.”
You know your plan’s in trouble when Dennis Kucinich is behind it, even if the single-payer model is the one preferred throughout most of the industrialized world. All Americans would receive health-care coverage paid for by the same central fund. The Kucinich plan is picking up some support because it would allow states to offer their own single-payer plans, if they so choose. At his July 22 press conference, Obama seemed to concede that the option was off the table. “I want to cover everybody,” he said. “Now the truth is unless you have what’s called a single-payer system in which everybody’s automatically covered, you’re probably not going to reach every single individual.” In the past, Obama has said the option might be preferable, but only if we were starting the health-care system from scratch.
The GOP has spent most of its resources trying to obfuscate the Democratic effort. South Carolina Sen. Jim DeMint told reporters that stopping health care progress would “break” the president and be his “Waterloo.” Bill Kristol has written that the Republicans should not compromise; they should “kill” any bill instead. Back in June, Republican leaders said a complete overhaul was unnecessary but called for improvements in Medicaid and the State Children’s Health Insurance Program.
Benjamin Sarlin is a reporter for The Daily Beast. He previously covered New York City politics for The New York Sun and has worked for talkingpointsmemo.com.