Comparing the Three Main Health Reform Bills

Nobody knows what the final healthcare reform package that emerges from Congress will include. In fact, at this point, nobody knows if anything resembling comprehensive healthcare reform will pass Congress this year.

As Congress goes into August recess, many lawmakers in both parties are saying they intend to hold public meetings with constituents to gauge their support–or disapproval–of the health plans on the table.

Here's a quick look at the three plans now getting the most attention. Keep in mind that there are a lot of moving parts in these plans, and the details can fluctuate dramatically from day to day.

HR 3200, the America's Affordable Health Choices Act, aka The Tri-Conference Bill. This bill is the joint creation of three separate House committees: Education and Labor; Ways and Means; and Energy and Commerce. The bill has passed all three committees, mostly along party lines–with some conservative "Blue Dog" Democrats joining Republicans in opposition because of cost concerns. The bill is expected to be heard by the full House when lawmakers return in September. The most controversial component in the 1,018-page HR 3200 is the creation of a public insurance option and healthcare exchange that would allow consumers the option of choosing either private coverage or a new government-run public plan.

The bill also calls for:

• Expanding access to health insurance
• Standardized benefits packages
• Provisions to end premium increases or coverage denials for "pre-existing" conditions
• Eliminating copays for preventive care
• "Affordability credits" to make premiums affordable
• Caps on out-of-pocket expenses
• Employer mandate, which is being called pay or play
• Guaranteed catastrophic coverage

The Affordable Health Choices Act, aka the Senate HELP Committee bill. The Senate Health, Education, Labor and Pensions Committee passed this package in mid-July, but it's still in mark-up and has yet to receive a bill number. Supporters of this bill boast that it is truly bipartisan, and includes 160 Republican amendments. However, the bill cleared the committee on a 13-10 party-line vote.

The bill is expected to be merged with whatever bill emerges from the Senate Finance Committee. Like the House bill, the HELP bill has a health insurance exchange, referred to in the bill as an "Affordable Health Benefit Gateway," which states would be responsible for establishing. It also features a government-run, public health insurance option that would compete with private insurers to drive costs down.

Under the "shared responsibility" section, all individuals would be required to obtain healthcare coverage, although some exceptions could be made for those who cannot afford coverage. Employers with 25 or fewer employers also would be exempt from penalties. The bill's minimum penalty to accomplish the goal of "enhancing participation" is $750 per individual annually.

The bill also has a greater focus on prevention and wellness efforts than the House bill. The bill also calls for:

• Prohibiting insurers from denying applicants coverage based on their health status
• Promoting higher quality of care through health insurance policies that include financial incentives as rewards for providers involved in using, for instance, care coordination, chronic disease management, and medical error reduction
• Coverage of preventive health services
• Extending coverage for dependent adults, with all individual and group coverage policies being required to continue offering dependent coverage for children until the child turns age 26
• No lifetime or annual limits on the dollar value limits of individual or group health insurance policies

The Senate Finance Committee bill. Nobody knows what this bill will include because there is no bill nor is there draft language. There's not even a lofty, official-sounding name like the Liberty and Justice and Healthcare for All Bill of 2009.

There is great debate about whether or not the bill will include the public plan option found in the other bills. Over the last several months, the committee has laid out a series of papers that could be viewed as a possible framework for the eventual bill.

Finance Committee Chairman Max Baucus (D-MT) says the committee will begin the mark up before the Aug. 7 start of the committee's summer recess. The eventual bill may include a mandate for individuals to have health insurance.

To facilitate the requirement, the bill may create a Health Insurance Exchange where people and small businesses can buy coverage with financial assistance available to the poor. The bill is also expected to expand SCHIP and expand at least temporary coverage for Medicare/Medicaid.