Item    House   Senate 
Cost    $1.1 trillion over 10 years     $849 billion over 10 years     
Exchanges -     A federal exchange will be established; initially for individuals and small groups.  States will be given the option of opting out of the federal exchange to operate a state exchange, but they must comply with the federal exchange rules.   Requires that state-based exchanges begin in 2013.  The exchanges will be limited to individuals and small groups, until 2017.  At that time, large groups will be given the opportunity to participate in the exchanges.      
Market Reforms -       Starting with 2013, Insurance companies would no longer be able deny coverage for preexisting conditions or set lifetime limits on the amount of care they will cover.  Increased premiums will not be allowed for pre-existing conditions or gender; higher premiums will only be allowed based on age.        Beginning in 2014, the Senate requires guarantee issue and renewability of all policies, prohibits rating based on either health status or gender and only allows rating factors of age, tobacco use, family status and location.  At enactment (when the legislation is signed) children up to age 26 can stay on parents insurance and lifetime limits on coverage will be eliminated.       
Individual insurance mandates  –        House requires that all Americans carry health insurance or face fines, with exemptions for those with religious objections or financial hardship. This would certainly affect the California Health Insurance market-both individual and small group.  This will be enforced through a 2.5% income tax penalty.  Subsidies would be provided to help some people pay insurance costs. A new health insurance exchange would be established to offer individual and small business policies. Children would be carried on their parents’ policies until they are 26 years old.       All individuals must obtain insurance through either their employer, private insurance, on the exchange or through the government plan.  There are exemptions for hardship.  Those who refuse to obtain insurance would pay a fine of $95 in 2014 rising to $750.      
Benefits Package –      A committee would recommend a so-called essential benefits package.  This package would include preventative services.  This package would be the basic benefit package offered in the exchange.        This bill sets four levels of coverage.  The low-end level would pay an estimated 60% of health care costs per year.  The most general would cover an estimated 90% of costs.  
Paying for Reform –     A new 5.4 percent income tax on those with high incomes, more than $500,000 for individuals or $1 million for couples. The tax is on the amount earned above the threshold. Also includes a new 2.5 percent tax on medical device makers.

        Reform will be paid with fees on insurance companies, pharmaceutical companies and medical device manufacturers.  In addition, there will be a Medicare payroll tax increase to 1.95 percent on income over $200,000 a year for individuals, $250,000 for couples.  A new 5% tax on elective cosmetic surgery will be implemented as well as additional cuts to Medicare and Medicaid.  An excise tax on insurance companies for “Cadillac” plans, fees on employers whose workers receive government subsidies to help them pay premiums and fines on people who fail to purchase coverage.   
Employer Mandate –      Employers with a payroll of less than $500,00 are exempt; others are required to provide coverage or pay a penalty of 8% (phased in for employers with payrolls of between $500,000 and $850,000.)      This Bill requires groups of 50+ to provide “qualified” coverage or pay a $750 fine for non-covered employees. 
Subsidies       Affordability credits would be offered to individuals with incomes of less than $43,320 or $88,200 for a family of four. Tax credits of up to 50 percent of insurance costs would be offered to small businesses.       Same as House  
Medicare and Medicare Advantage – 
        Reduces funding for both Medicare and Medicare Advantage. Begins to close the “doughnut hole,” the gap in prescription drug coverage for seniors.       Payment reforms would reduce Medicare Advantage funding by an estimated $120 billion over ten years, beginning in 2011. Special Needs Plans would be extended through 2013 and Cost Plans would be extended through 2012.      
Government Run Plan -   A government-run plan would be one of the options offered on the Exchange to compete with private insurance.    States could opt out of a government-run plan, which would be one of the options on the Exchange.  The HHS would determine the payment rates for medical providers with a cap at the average rate of private plans.  If this option does not survive debate, it may be replaced with the “trigger” option.  States will be allowed to offer their own public programs for people between 133% and 200% of FPL. 
Abortion
        No federal subsidies would be used to buy policies with abortion coverage, but private funding could be used to buy abortion coverage through a rider. No public or private funds could be used to buy abortion coverage in the public plan.    Every state must offer one insurance plan with abortion coverage and one without. No federal subsidies would be used to buy policies with abortion coverage, but abortion coverage could be offered in the public plan if public and private funding are segregated.   
Illegal immigrants
        No federal subsidies could be provided to help illegal immigrants buy insurance, but those here illegally could use their own money to buy policies on the new health insurance exchange.       No federal subsidies could be provided to help illegal immigrants buy insurance, and those here illegally would not be allowed to use their own money to buy policies on the health insurance exchange.