While it is happening in private consultations, Democratic Party leaders of the House and Senate are supposedly making progress on resolving many of the differences between the bills passed in each house of Congress. The biggest issues and likely outcomes are:

−Public option (in the House bill): likely to be removed, in order to secure passage in the Senate. But the trade-off is stronger insurance regulations, such as eliminating the anti-trust exemptions for insurance companies (in the House bill but not the Senate one).

− A national insurance exchange (House bill) instead of, or in addition to, state-based ones (Senate bill). A national exchange would enable tighter and more uniform regulation of the insurance industry.

− The 40% excise tax on high cost insurance plans provided by employers: since proponents claim it will bring in a lot of tax revenue and control costs by pushing people into plans with higher cost-sharing, the provision may stay in, but with a higher plan cost threshold (e.g., $25-28,000 annual cost for family coverage, vs. the initially passed $23,000).

− Tax increase on high incomes (House bill) and Medicare payroll tax increase on higher incomes (Senate bill): both may be adopted but with a reduced increase or higher threshold, if the excise tax is preserved.

− Low income subsidies to help pay for coverage and limits on plan out-of-pocket expenses: they are leaning towards the House bill, which provides higher subsidies and tighter limits on the out-of-pocket cost. But the consequence of course is higher costs, requiring higher taxes to cover them.

− A higher eligibility threshold for Medicaid (the House bill’s 150% of poverty level, vs. the Senate’s 133%) and a higher share of federal funding of the increase in order to reduce the states’ burdens - also bring a higher cost.

− An independent Medicare Advisory Council to change how we pay providers for care under Medicare, and indirectly all health plans (in the Senate bill).

− The effective date for many of the provisions, such as the exchanges (2013 in the House bill, vs. 2014 in the Senate bill).

The outcome of other controversies, such as restrictions on abortions, are not yet clear. But it is very unfortunate and historically myopic that such a huge effort to improve the financial security and health of Americans has to bend through so many contortions set up by a few representatives and senators in order to win passage.

The theme in most of these changes is the need to increase the 10-year cost of the bill by about $50-100 billion, threatening to miss President Obama’s target of keeping it under $900 billion over 10 years (before using taxes and other controls to produce a net savings and reduction in the federal deficit). It seems like a big problem. But keep in perspective that the projected 10-year costs of the current health care system is $35.3 trillion (according to a projection by the Centers for Medicare and Medicaid Services. Adding another $50-100 billion over 10 years is an increase of 0.14% -0.28% in total national health care spending and 0.33-0.67% in federal health care spending. According to the American Gaming Association (gambling industry) we spent $94 billion in just 2007 alone (likely over $100 billion a year now). Think we can afford better health care, like the rest of the industrialized world?

You can read more about the attempts to resolve the House and Senate bill differences in these articles:

Washington Post (click here)

Politico (click here)