Page last updated at 12:21 GMT, Thursday, 24 December 2009

US healthcare bills: House v Senate

Reform of the US healthcare system is a priority issue for President Barack Obama but lawmakers in Congress found it difficult to agree on a bill to implement reform.

The House of Representatives passed its bill on 7 November, while the Senate passed its version on 24 December.

The substantial differences between the two bills must now be squared or "reconciled" into an agreed version before President Obama can sign the legislation into law.


Date passed

7 November 24 December


$1,052bn over 10 years $871bn over 10 years

Reduce deficit

By $138bn between 2010-2019 By $132bn between 2010-2019

Public option - gov't scheme to compete with private insurers

Yes No

Insurance exchange - to compare policies and prices

National insurance exchange No national insurance exchange, states can form regional exchanges

Expand insurance - to increase number of Americans insured

36 million gain coverage (leaving 18 million uninsured) 31 million gain coverage (leaving 23 million uninsured)

Individual mandate - Must people have insurance?

Yes (2.5% tax penalty if don't obtain health care) Yes, $95 per person penalty in 2014, rising to 2% of households income in 2016+


Health care plans could choose whether to cover abortion. But public plan would not provide abortion coverage Limits on use of public money for abortion services

Firms required to provide coverage?

For companies with annual payroll of $500,000+
No explicit requirement but tax credits for offering a scheme

Taxes , spending cuts - how system will be paid for

5.4% surtax on people earning $500,000+ annually; 2.5% tax on medical devices
cut $404 out of projected growth of Medicare and other federal programmes
0.9% increase on Medicare payroll tax for people earning over $200,000
10% on indoor tanning beds; taxes on medical devices
cut $483bn out of Medicare and other federal programmes

Medicaid & Medicare

Covers everyone with incomes less than 150% of the poverty level (ie $33,075 for a family of four) Covers everyone with incomes less than 133% of poverty level (ie $29,327 for a family of four)

Guaranteeing access to health insurance

Premiums for older people cannot be more than twice those for younger people. Companies stripped of anti-trust exemption that has protected firms from federal investigations.
Price-fixing outlawed.
Premiums for older people cannot be more than three times those for younger people. Insurers competing in new exchanges must justify increases.

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