House Energy and Commerce Committee chairman Henry Waxman, House Education and Labor Committee chair George Miller and House Ways and Means Committee chairman Charles Rangel
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• Government subsidies to help people buy insurance. Both the House and Senate approaches would require people who don't get coverage from their employers to go out and buy it on their own. And both anticipate that the government would give lower-income people subsidies to help them afford that coverage. The House plan proposes providing those subsidies on a sliding scale to people who earn up to 400% of the poverty level — in other words, $43,320 for an individual and $88,200 for a family. That is about the level that the Senate Finance Committee is expected to come up with as well, but is significantly less generous than the early draft by the HELP Committee, which would provide subsidies to those earning up to 500% of the poverty level. (Read "The Republicans Weigh In with a Health-Care Plan.")
The House leaders note that the typical cost of coverage for a family living at 400% of the poverty level is 14% of their income — an amount that health-care experts do not consider to be onerous. Though not spelled out at this point, the bill will include "hardship" exemptions. More importantly, it would also feature a big expansion of Medicaid, the federal-state program that provides health care to the poor, though lawmakers are still awaiting figures from the Congressional Budget Office that would indicate how much bigger they could make the existing program.
Also included in the House bill, as expected, is a requirement that employers provide health benefits to their workers, although the precise shape of that mandate is unclear. The smallest, low-wage firms would be exempted from that requirement, and the three House chairmen anticipate providing a new small-business tax credit to help others. It also includes a "pay or play" provision: those businesses that do not provide benefits would be forced to pay some percentage of their payroll — 5% or 6% is being talked about — into a fund for the uninsured. And it would prohibit insurers from discriminating against people who have preexisting conditions, or because of gender or occupation. Private insurers would be allowed to vary the premiums they charge — within limits — according to the age of the person being insured.
The biggest question unaddressed in the House outline is how they would actually pay for health-care reform. Specifically, there is no mention of an idea being kicked around in the Senate Finance Committee to impose new taxes on at least some of the employer-provided health benefits that workers now get tax-free. House sources say they are facing strong resistance from rank-and-file Democrats against that idea, and Rangel has previously expressed his opposition to such a funding measure.
The House, like the Senate, has set an ambitious timetable for itself to get the bill passed. Waxman, for instance, expects to hold hearings on the plan later this month and begin drafting his bill shortly after the July 4 recess. Any differences among the versions produced by the three committees would be worked out by the House Rules Committee — which, in practice, means that Speaker Nancy Pelosi will have a strong say in the shape of the final product. House leaders hope to have a bill on the floor by the final week of July.