Key details of health reform bills

Major similarities

Key similarities between the Senate and House legislation include the following provisions:
  • Establishment of "insurance exchanges." Both bills create insurance exchanges to provide a tightly regulated marketplace for the uninsured to buy coverage. Plans sold on the exchange must provide minimum levels of coverage and a simplified range of options stipulated in the bills.
  • Caps on annual out-of-pocket medical costs. Limits are placed on the amount of money insurers may require policyholders to pay out of pocket for doctor's visits, medical procedures and other types of care.
  • Pre-existing condition protections. Insurers cannot exclude an individual from insurance coverage because of a pre-existing medical condition.
  • Ban on rescission. Insurers are prohibited from engaging in "rescission" -- the practice of retroactively denying a claim based on an error in the covered person's insurance application, except in cases of fraud.
  • Creation of an appeals process. Insurers must establish a process allowing people to challenge denied insurance claims.
  • Individual insurance mandate. Both bills require Americans to purchase at least a bare-bones health insurance policy. People who refuse to do so will incur financial penalties that differ in the House and Senate bills.
  • Subsidies for those who can't afford insurance. Subsidy amounts vary according to income and family size.
  • Penalties for businesses that break rules. Fines and fees would be assessed to large- and medium-sized businesses that don't offer health insurance plans to their employees.
  • Curbs on Medicare spending. Both bills include provisions that curb Medicare spending over the next 10 years.
  • Tax credits. Credits are offered to small businesses that offer health coverage to employees.

Regardless of how you feel about the bill, don't expect to feel the effects right away if it passes. Most of the provisions described above wouldn't take effect until 2014, although the aforementioned 0.9 percent payroll tax would begin in 2013.

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