Here's where we are:
The House of Representatives passed their bill last month. The Senate is aiming to pass its version before Christmas.
Overall, both pieces of legislation would do four major things:
- Create a "Health Insurance Exchange." The bills create a one-stop marketplace where people can choose from various insurance plans, including the public option. The details aren't set yet, but initially the Exchange would likely be open to the self-employed, people without insurance at work, and small businesses. The key with the Exchange is that it brings "the bargaining power and scale that's generally accessible only to large employers" to individuals—and with that, lower costs and better options.
- Provide insurance to over 30 million more people. The House bill would expand coverage to 36 million people by 2019. The Senate bill extends coverage to 31 million.
- Outlaw discrimination based on pre-existing conditions and gender. Insurance companies will have to stop denying coverage to people with "pre-existing conditions." And they won't be allowed to charge women more than men for the same coverage.
- Eliminate coverage limits and price-gouging. The bills differ on some details, but in general would place limits on how much people have to pay for health care beyond their premiums. They both cap out-of-pocket costs and ban insurance companies from setting limits on how much health care they'll cover for a person each year.
Here's what still needs to be fixed:
- Both bills leave millions uninsured. The House bill leaves 18 million without insurance in 2019; the Senate bill, 24 million.
- The Senate public option is weak, and conservatives are pushing to make it weaker. The public option is a core piece of reform that will create real accountability and competition for private insurance—and that's why it's at the center of such a huge fight.
- Many reforms don't start quickly enough. While some pieces of reform go into effect right away, the larger structural changes are not scheduled to go into effect until 2013 (House bill) or 2014 (Senate bill). This includes the Exchange, the public option, and subsidies—the major ways coverage will be expanded.
- Required insurance could still be too expensive for many. Both bills require virtually all Americans to have insurance. But the caps on how much we're expected to pay are way too high, and the subsidies are way too low.
- Reproductive rights are severely restricted in the House bill. An egregious anti-choice amendment in the bill virtually prohibits anyone purchasing insurance in the Exchange from buying a plan that covers abortion—even if paid for with their own money. We need to make sure the final bill doesn't include this rollback of reproductive rights.
- The Senate bill could discriminate against lower income workers. The current Senate legislation retains a version of what's called the "free rider" provision, which essentially penalizes employers for hiring lower income workers.