Although there is no clear consensus between the House and Senate on how to provide insurance coverage for Millions of uninsured Americans, the final bill will have some mechanism for covering the uninsured. This is likely where consensus will be most difficult to achieve and in the end, could prove to be what kills healthcare reform. If a compromise is reached, it is expected that by 2019, approximately 92 – 96% of all Americans will have some type of insurance coverage. This compares to the estimated 83% of Americans who would have insurance if we did nothing to change the current system. Of the estimated 54 Million people who would be uninsured in 2019 if we do nothing, 32 – 34 Million would have some type of insurance coverage. This would mean that in 2019, approximately 20 – 24 Million people would still be without health insurance.
The House healthcare reform proposal, the Affordable Health Care for America Act, has a very robust “public option”. The Senate, by comparison, did not include a public option in its version of healthcare reform, the Patient Protection and Affordable Care Act. Instead, the Senate relies upon a system of vouchers or subsidies individuals could use to purchase health insurance (offering minimum benefit packages) through newly established healthcare exchanges. The House bill also calls for the establishment of state-based “Exchanges” but these Exchanges would offer a new public program to compete with commercial insurance products available through the Exchange. The government negotiated products contemplated in the Senate proposal would be overseen by the federal Office of Personnel Management, the same agency that oversees the Federal Employee Health Benefits program.
Both the House and the Senate include provisions in their respective bills expanding Medicaid eligibility. The House bill would extend Medicaid coverage to include any individual with an income below 150% of the federal poverty level. The Senate proposal also expands Medicaid to all low-income individuals but tops out at 133% of poverty. As with a number of other provisions, this Medicaid expansion will likely not go into effect until 2014. Both the House and Senate included language authorizing the federal government to pay the cost of covering these newly eligible individuals. However, how long the federal government will cover these costs and how much of the cost the federal government will cover will have to be negotiated between the House and Senate.
