President Barack Obama and congressional Democrats are pulling together a final version of a health care overhaul bill and pushing for House votes as early as this coming week. Democrats are awaiting cost assessments from the Congressional Budget Office that will allow them to finish details. Some of the main features as the bill takes shape:
—HOW MANY COVERED: 31 million uninsured Americans.
—INSURANCE MANDATE: Like the bills approved last year by the House and Senate, the proposal would require almost everyone to be insured or pay a fine. There is an exemption for low-income people.
—INSURANCE MARKET REFORMS: Stops unpopular insurance industry practices such as denying coverage to people with pre-existing conditions or charging women more. In response to recent insurance premium rate increases, including increases as high as 39 percent by Anthem Blue Cross in California, the legislation adopts an Obama proposal to give the federal government the authority to block rate hikes, roll back premium prices and force insurance companies to give rebates to consumers.
—MEDICAID: The legislation would expand the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. The federal government would pick up more of the tab, paying 100 percent of the cost for newly eligible individuals through 2017. A special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity has been eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remained.
—TAXES: The legislation would scale back a Senate-passed tax on high-cost insurance plans that was opposed by House Democrats and labor unions. The tax would be delayed from 2013 until 2018 and the thresholds at which it is imposed would be moved up from policies worth $8,500 for individuals and $23,000 for families, to $10,200 for individuals and $27,500 for families. Those changes mean $120 billion in lost revenue over 10 years that would be replaced mostly by applying an increased Medicare payroll tax to investment income as well as wages for individuals making more than $200,000, or married couples above $250,000. The Senate bill had applied the tax only to wage income.
—PRESCRIPTION DRUGS: The proposal would close the "doughnut hole" coverage gap in the Medicare prescription drug benefit that kicks in once seniors have spent $2,830. The Senate bill would have provided a 50 percent discount on the cost of brand-name drugs in the doughnut hole, but Obama would close the gap entirely by 2020. The added cost, which Democrats have not yet disclosed, would be paid for in part by an additional $10 billion in fees on the drug industry.
—EMPLOYER RESPONSIBILITY: The legislation keeps the approach in the Senate bill, which doesn't require businesses to offer coverage but charges fees to companies with more than 50 employees if the government subsidizes employees' coverage. The proposal increases the fees to $2,000 per worker instead of $750, but grants companies an allowance that was not part of the original Senate plan. The proposal includes part-time workers in the calculations, counting two part-time workers as one full-time worker.
—SUBSIDIES: The proposal provides more generous subsidies for purchasing insurance than the Senate bill did. The aid is available for households making up to four times the federal poverty level ($88,200 for a family of four).
—HOW YOU CHOOSE YOUR HEALTH INSURANCE: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges. People working for big companies would not see major changes.
—GOVERNMENT-RUN PLAN: The proposal does not include the government-run insurance plan sought by liberals and approved by the House. It takes the Senate approach, which gives Americans purchasing coverage through new insurance exchanges the option of signing up for national plans overseen by the federal office that manages the government health plan available to members of Congress. Those plans would be private, but one would have to be nonprofit.
—ABORTION: The proposal does not change the abortion provision in the Senate bill, which is opposed by anti-abortion groups that say it allows federal financing of abortion. The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage.
No health plan would be required to offer coverage for the procedure. In plans that do cover abortion, beneficiaries would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother.
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