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Differences in Senate, House health care bills

The Senate and House have different versions of legislation to overhaul health care. If the Senate bill passes Thursday, as is expected, the bill will have to be reconciled with the House version. Many observers are predicting - whether they like it or lump it - that some compromise health care legislation will be voted on next year.

There are major areas of agreement between the two bills, namely that health care coverage will be expanded to include at least 30 million more Americans, insurers can't reject customers because of pre-existing conditions and people will be required to have some health insurance or pay a fine.

But there also remain significant areas that need to be resolved between the two bills: Will there be a public option? How will this expanded health care be paid for? Should medium-sized and large companies be fined if they don't provide health care for employees?

Here is a look at differences in how the current bills would affect certain groups, according to local health care experts, industry groups and advocates.


The Senate bill would offer coverage to about 94 percent of legal residents under age 65, compared with 83 percent now. The House bill would cover about 96 percent. And the House bill would offer Medicaid to more people - those with incomes up to 150 percent of the federal poverty level. The Senate version would expand it to 133 percent.

The House version also includes the so-called public option, in which a government-sponsored health insurance plan would compete with private health insurers, while the Senate does not.

Although the differences between the bills are not great, the House bill "does a better job extending coverage to more people," said Gwen O'Shea, president of the Health and Welfare Council of Long Island, a health advocacy organization.

O'Shea said a public option would encourage competition with private insurers and thus help keep insurance costs down for low-income people.

But Arthur Gianelli, chief executive of Nassau University Medical Center in East Meadow, said he believes there is little chance the public option will survive a compromise bill. "My own personal view is that it's not the most important thing in health care reform," he said.


The House plan requires companies with a payroll of more than $500,000 to provide insurance or pay a penalty on a portion of their payroll; businesses with an annual payroll under $500,000 are exempt.

The Senate version, starting in 2013, requires companies with more than 50 employees to pay a fee per worker if its employees rely on government subsidies to purchase coverage; those with fewer employees are exempt.

The plans are similar and neither helps those in business, said Fred Barba, executive vice president for the Long Island Association Health Alliance, a health insurance purchasing cooperative. That, he said, is because neither comes up with real reforms that would lower the costs and improve the quality of health care.

But David Sandman, senior vice president of the Manhattan-based New York State Health Foundation, a nonprofit that aims to expand health insurance, said both bills will help small businesses.

In a recent report done with the Small Business Majority, the foundation found that under the current health care system, New York's small businesses would spend $155.6 billion on health insurance costs and lose $2.4 billion in profits over the next 10 years if no major health care overhaul is enacted.

But the report found that a model that resembles both the Senate and House bills would cut costs over 10 years by about one-third and reduce the amount of profits lost by 60 percent.



The biggest difference between the two bills, said Joe Baker, president of the nonprofit Medicare Rights Center in Manhattan, is that the House bill would eventually get rid of the "doughnut hole" in Medicare prescription drug coverage - that point at which seniors have to pay for the entire cost of prescription drugs until the expense reaches the catastrophic coverage threshold.

The House bill also increases eligibility for Medicare for low-income recipients, which the Senate version does not do.

And Baker said both bills contain pilot projects in how Medicare pays for services that could be "groundbreaking" in eventually saving costs. "My feeling is that for seniors overall this is a good thing," he said.

Both bills also look for savings in Medicare Advantage plans, which are run by private insurers. Studies have found these plans cost 14 percent more than Medicare spends for the same services.

But Leslie Moran, senior vice president for the industry group New York Health Plan Association, said there are nearly 650,000 New Yorkers enrolled in these plans. Cuts "would impact the coverage of these seniors and could ultimately result in many losing their current coverage," she said.


The Senate bill imposes a tax on insurers that provide so-called Cadillac health plans valued at more than $8,500 for individuals and $23,000 for families - one of the ways the bill pays for expanded coverage.

The House bill doesn't tax these plans; instead it would add a surtax on the wealthiest people, starting with couples who earn more than $1 million a year.

Roger Clayman, executive director of the Long Island Federation of Labor, AFL-CIO, says the Senate version would unfairly penalize middle- and working-class union workers, many of whom negotiated for these Cadillac plans in lieu of pay increases.

But Senate Democrats support the tax because they believe it would reduce health care costs by providing an incentive for companies and workers to spend less on insurance packages.



When asked which bill favored hospitals, Kevin Dahill, president of the Nassau-Suffolk Hospital Council, said: "If someone put a gun to my head, I would say the Senate bill." The Senate bill has fewer cuts to hospitals, he said.

But in both bills, Dahill said, hospitals in New York could lose billions of dollars. That is because New York already has fairly expansive health care coverage for low income patients. Thus, local hospitals won't benefit from additional support from the federal government or from a huge surge in new health insurance enrollees, Dahill said.

But Gianelli said that - if pressed - he favors the House bill because it doesn't cut payments to public hospitals as much as the Senate version. He said, however, he believed both contain the tools that could lead to hospitals providing more efficient and cost-effective care.

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