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Health Insurance Reform - 2009   Tags: congress, health, health_reform, political_science, public_policy  

Last Updated: Nov 18, 2009 URL: Print Guide RSS UpdatesEmail Alerts

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Understanding the Congressional Health Care Reform Package

Here are some key (and impartial) documents to fill in the context of the health care bills moving through Congress:

  • 2008 US Census Bureau report on income, poverty, and health insurance coverage in the United States.

Ways in Which House Health Care Bill Could Impact You

According to McClatchy Newspapers1, there are 10 major changes that would happen if the House bill passed on November 7, 2009 became law:

1. Establish government-run plan to offer insurance coverage to compete with private sector insurance companies.

2. Set up health insurance "exchanges," or marketplaces, where consumers can easily compare coverage and rates.

3. Require nearly everyone to obtain health insurance coverage starting in 2013.

4. Require health plans to allow young adults to remain on their parents' policies till their 27th birthday.

5. Provide federal financial help for lower and middle income consumers so they can obtain coverage.

6. Bar insurers from denying or limiting coverage because of pre-existing conditions.

7. Bar insurers from imposing lifetime limits on coverage.

8. Expand Medicaid coverage to more people.

9. Impose 5.4% surcharge on adjusted gross incomes of more than $500,000 for individuals and $1 million for joint filers.

10. Impose penalties on people and businesses who fail to comply with the new law.

1. David Lightman. "10 Ways the House Bill Would Change Health Care," McClatchy Newspapers, November 7, 2009 (accessed November 9, 2009).


House Bill Passage, Senate/House Bill Comparisons, and Next Steps

The House bill H.R. 3962, the Affordable Health Care for America Act, was passed on a 220-215 vote on November 7, 2009. The bill passed after a deal was struck that satisfied the reservations of Bart Stupak (a Democrat from the 1st District of Michigan) and 38 other Democrats, largely from the Blue Dog Coalition or from districts that voted for John McCain in 2008. Stupak and many of the other Democrats who were resisting voting for the bill were adamant that public funds be explicitly barred in any health care reform from being used to fund or otherwise support abortion procedures.

Only one Republican, Anh Cao (from the 2nd District of Louisiana), voted in favor of the bill.

The Republican Party released statements after the pro-H.R. 3962 votes of Democrats in districts that are considered "unsafe" (that is, their voters tended to side with McCain in 2008) indicating that the Republican Party would actively work to remove those representatives from office in the next election cycle.

  • A CQ Politics analysis of the Democratic House members who didn't vote the party line on November 7.
  • A chart from the New York Times analyzing the Democrats who voted against the bill, their district compositions, and whether those districts voted for McCain in 2008.
  • A press release from Representative Stupak's office explaining his vote.

According to a November 8 Bloomberg analysis1 of the main Senate and House bills, the biggest differences between the House and Senate versions are the following:

  • Senate bill would allow states to opt out of a public insurance program (the so-called "public option").
  • House bill would require employers to insure their employees or pay penalties, with possible exemptions based on company size or hardship. Senate bill would instead require employers with 50+ full-time employees to pay a fee for every low-income employee who qualifies for a new health care tax credit.
  • House bill would add a surtax on the wealthiest Americans, starting with couples who make more than $1 million per year, and would also raise funds for the health care program from other sources, including a tax on medical device companies that would raise $20 billion over 10 years. Senate bill would tax so-called "Cadillac health insurance plans" (those employer-sponsored plans with the most generous benefits) and impose annual fees starting in 2010 on insurers, medical device companies, pharmaceutical companies, and clinical laboratories.

Senate Majority Leader Harry Reid must find 60 votes for a Senate bill (the main Senate bill under consideration as of November 2009 is S. 1796, America's Healthy Future Act of 2009, sponsored by Max Baucus, D-MT, which passed the Senate Finance Committee on October 13) to avoid a Republican filibuster and a process called reconciliation, in which a more watered-down version of the bill could pass on a majority vote without Republican support. Thus far, fewer than 60 Senators have indicated that they will back the bill in its current state.

1. Kristen Jensen and Nicole Gaouette. "House, Senate Health-Care Legislation: Side-by-Side Comparison,", November 8, 2009 (accessed November 8, 2009).

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