August 19, 2009 / 8:51 PM / in 9 years

FACTBOX: How do U.S. healthcare proposals compare?

(Reuters) - When Congress returns from recess on September 8, lawmakers will continue work on an overhaul of the $2.5 trillion U.S. healthcare system. There are three different plans in the works, all containing changes that would be phased in over a number of years.

In the House of Representatives, three committees have each approved changes to one House bill. The changes will be melded by House leaders into final legislation before a floor vote expected in September or October.

In the Senate, the Health, Education, Labor and Pensions Committee has approved its version and the Senate Finance Committee is working on a separate healthcare overhaul bill.

The following is a comparison of major points in the various proposals.


All bills bar discrimination based on gender or pre-existing medical conditions, guarantee coverage and seal in benefits with no annual or lifetime caps.

The Senate Health Committee and Finance Committee versions would allow variable premiums, while the House bill would eliminate co-pays for preventive care.


The Senate Health Committee bill would require individuals to obtain coverage, with government help if necessary, or pay a penalty of up to $750 per year. Employers with more than 25 employees would have to pay 60 percent of coverage for workers or pay $750 per year penalty.

The House bill also has both individual and employer requirements, while the Senate Finance Committee bill is likely to include a mandate for individuals to obtain coverage but not for employers to help pay for it.


The Senate Health Committee bill would establish insurance “gateways” or exchanges to help private insurers and a new government-run insurance option to sell policies to those who do not have coverage elsewhere.

People who already have insurance would be permitted to keep their current plans and health insurers could sell policies outside the gateway system.

The Senate Finance Committee bill is expected to provide for non-profit co-operatives rather than a government-run insurance plan, along with state insurance exchanges for small businesses and individuals without employer-sponsored insurance.

The House version would set up a public insurance option similar to the Senate Health Committee bill, while also allowing insurance co-operatives.


The Senate Health Committee and House bills would both provide subsidies to help people obtain insurance, along with some form of premium credit or tax subsidy for small businesses to help them pay for employee policies.

The Senate Finance Committee’s proposal is expected to provide refundable tax credits for individuals and small businesses.


Millions more people would become eligible for state Medicaid health plans for the poor. The Senate Health Committee bill would expand the program to cover those with incomes up to 150 percent of the poverty level, slightly more than House bills would allow. The Senate Finance Committee is still wrestling with how much it would expand the program.

All bills seek to improve quality of healthcare in the Medicare program for the elderly and design payments to encourage quality, not quantity of services.

The House bills requires government to negotiate prices with drug companies and eliminates the drug coverage gap over 15 years.

Compiled by Jackie Frank and Donna Smith in Washington, editing by Eric Beech and Phil Stewart

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