House Releases Health Care Reform Legislation (UPDATED TABLE)

Today, three separate House committees — Ways and Means Committee, Energy and Commerce Committee, Education and Labor Committee — released a single health care reform bill, the Tri Committee Proposal. In a press release announcing the legislation, the three panels with jurisdiction over health policy in the House announced that they had developed “a single bill that fulfills President Obama’s goals of reducing health care costs, protecting and increasing consumers’ choices, and guaranteeing access to quality, affordable health care for all Americans.”

Unlike the HELP bill and the draft (leaked) language of the Senate Finance Committee, the Tri-Committee proposal seems to contain a fairly robust public insurance option. While details are still being worked out, the proposal establishes a public plan in 2013 that will compete with private insurers, within the Exchange, on a level playing field. The public option will be required to abide by all marketing, operations, and rating rules and would initially be allowed to use Medicare plus rates. After some time, the plan would have to independently negotiate fees with providers.

On the whole, the bill’s affordability measures are impressive. Full details are after the jump but the plan offers subsidies on a sliding scale (up to 400 percent of poverty) and opens up Medicaid to Americans at or below 133% of the federal poverty level. While I haven’t seen the cost-sharing details, the robust public plan that could use Medicare plus rates would be able to force private insurers to aggressively negotiate with providers and pass on savings to consumers.

Below is a comparison table of all three bills, full details of the Tri Committee’s proposal are after the jump:

HELP Bill (About $1 trillion/10 years)Senate Finance Draft ($774 billion/10 years)Tri House Bill($1.04 trillion/10 years)Individual MandateYesYesYesEmployer MandateYes (Large employers would pay $750 per full-time employee, $375 for each part-time employee or provide adequate coverage.)No, but employers with workers at or below 300% FPL have to payYesMedicaid Expansion150% FPL, but still unclear133% FPL 133% FPLSubsidiesbetween 150–400% FPL on sliding scalebetween 133–300% FPL on sliding scale; flat rate for 300%-400%between 133–400% FPL on sliding scalePublic OptionYes (Will have to compete on a level playing field with private providers and offer competitive rates and premiums. )No (Conrad’s co-op compromise)Yes, Medicare + 5%Insurance RegsGuarantee issue, modified community rating (2:1), no rescissionsGuarantee issue, modified community rating (7.5:1), no rescissionsGuarantee issue, modified community rating (2:1), no rescissions


Next week, all three committees will hold hearings on the legislation. Mark-up (each committee will hold three markups on the same bill) will begin in mid-July and the bill will likely go to the floor of the House before the August recess.

Details on the Tri-Committee bill:

The bill establishes a National Exchange in 2013 and phases in participation for individuals and employers. If states and regions establish their own exchanges, they would substitute for the National Exchange, but would have to follow the rules established by it. After 2015, employers may choose to offer coverage through the Exchange and would have to finance their employees’ plans.

Under the legislation, all insurance companies would have to offer coverage to everyone who applies, and can offer rates that vary based on family status, geography and age (insurers would only be able to charge and older person twice as much as they charge a younger person). Families with incomes between 133% and 400% of Federal poverty level will be offered subsidies on a sliding scale and Medicaid subsidies will be available to Americans 133% of poverty. Individuals would be required to purchase coverage once the Exchange is operating (in 2013) and employers would have to either provide credible coverage or finance their employees in the Exchange. Small employers (definition yet to be determined) are exempt from providing coverage and will receive a tax credit up to 50 percent of basic premiums.


AP has the financing options:

– Increasing the price of soda and other sugary drinks by 10 cents a can.

– Applying a potential 2 percent income tax increase to single taxpayers earning more than $200,000 a year and households earning more than $250,000.

– A new employer payroll tax could target 3 percent of employers’ health care expenditures.

– Taxing employer-provided health insurance benefits above certain levels — a less likely option but one that still is in the running.