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Published July 07, 2009 12:02 am -

A look at health care plans in Congress


The Associated Press

A look at health care legislation taking shape in the Democratic-controlled House and Senate as President Barack Obama pushes to overhaul the system, cover nearly 50 million uninsured Americans and reduce costs. Many of the details are still being negotiated and any final health care bill would have to meld proposals from the House and Senate.

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HOUSE DEMOCRATS

WHO’S COVERED: Around 95 percent of Americans would be covered. Illegal immigrants would not receive coverage.

COST: Unknown.

HOW’S IT PAID FOR: Cuts to Medicare and Medicaid; $600 billion in unspecified new taxes, likely including new levies on upper-income Americans.

REQUIREMENTS FOR INDIVIDUALS: Individuals required to have insurance, enforced through tax penalty with hardship waivers.

REQUIREMENTS FOR EMPLOYERS: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Certain small businesses are exempt.

SUBSIDIES: Individuals and families with annual income up to 400 percent of poverty level ($88,000 for a family of four) would get subsidies to help them buy coverage.

BENEFIT PACKAGE: A committee would recommend an “essential benefits package” that includes hospitalization, doctor visits, prescription drugs and other services. Out-of-pocket costs limited to $5,000 a year for individuals, $10,000 for families. Health insurance companies can offer several tiers of coverage, but all plans must include the core benefits. Insurers wouldn’t be able to deny coverage based on pre-existing conditions.

GOVERNMENT-RUN PLAN: Plan with payment rates initially modeled on Medicare to compete with private insurers.

HOW YOU CHOOSE YOUR HEALTH INSURANCE: Through a new National Health Insurance Exchange open to individuals and, initially, small employers; it would be expanded to large employers over time.

CHANGES TO MEDICAID: The federal-state insurance program for the poor would be expanded to cover all individuals with incomes up to 133 percent of the federal poverty level ($14,404). Currently Medicaid eligibility varies by state, but childless adults are ineligible no matter how poor, and in some states parents with incomes well under the poverty line still aren’t covered.

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SENATE HEALTH, EDUCATION, LABOR AND PENSIONS COMMITTEE



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