Each of the two ratified versions of the health care bill currently sitting in Congress was barely passed, by virtually the slimmest margin possible, in a hectic last-minute stampede. Dozens of harsh compromises had to be hammered out to cobble together the fragile framework now standing in each chamber.
The two bills are like delicate Jenga towers, swaying nerve-wrackingly in the breeze, that must now be reassembled by a team of 535 clumsy attention-seekers into a single tower twice as tall. And legislators across the two chambers—and even within them—are not even speaking the same language.
Here are a few of the myriad discrepancies legislators must reconcile to ensure that their monument to Obama’s greatness doesn’t tumble to the ground:
In the House version of the bill, a government-run insurance exchange is created on a national level and includes a public option. In the Senate version, exchanges are created on the state level and do not include a public option. Virtually identical!
The House completely bans the practice 0f charging those with preexisting conditions higher premiums. The Senate allows insurers to offer unlimited discounts for customers who engage in subjectively defined wellness activities: say, exercising, eating healthy, not having contracted lung cancer.
Insurance exchanges are implemented in 2013 in the House bill and 2014 in the Senate bill.
In the House version, employers are forced to provide insurance for their employees and pay a fine if they do not. In the Senate version, employers are not required to provide insurance, but pay a fine for employees who opt for government-run insurance and receive federal subsidies. The House has higher penalties than the Senate.
The House version funds the bill by imposing a surtax on families making over $1 million a year. The Senate version establishes a tax on those with “Cadillac” plans, which includes not only many union members, but millions of families who will unexpectedly find themselves unlucky Cadillac owners over the next 10 years due to the non-inflation-adjusted nature of the provision.
The House version does not tax insurance offered by employers; the Senate version taxes employer insurance above a threshold.
The House version charges older people a maximum of twice the premiums as younger people; the Senate version sets a maximum ratio of three-to-one. The House version offers fewer insurance subsidies for the middle class than does the Senate. The Senate version offers weaker measures to limit out-of-pocket costs than does the House.
The House bill covers 5 million more people than the Senate bill by expanding Medicaid to those earning up to about $2,000 more than in the Senate bill.
To buy Ben Nelson’s vote, the Senate version gives $100 million to Nebraska for indefinite coverage of all new Medicaid enrollees in the state. The Senate bill gives $300 million to Louisiana for Medicare increases (in exchange for Mary Landrieu’s vote); $10 billion to Vermont for new public health centers (for Bernie Sanders’ vote); billions to Nebraska and Michigan to waive nonprofit insurers’ excise taxes (for Ben Nelson and Carl Levin’s votes); millions to Massachusetts and Vermont for Medicaid; and millions to Florida, New York, and Pennsylvania for Medicare Advantage. None of these provisions is in the House bill.
The Senate version includes, per the insistence of construction unions, an important exception to the employer mandate. As an article in the New York Times titled “In Health Bill for Everyone, Provisions for a Few” reports, “Under the Senate bill, businesses with fewer than 50 employees would be exempt from the penalties in every industry but construction.” In the construction industry, the mandate holds for employers with as few as 5 employees. The House includes no such provision.
Restrictions on abortion funding are tight in the House, with no federal funding allowed; and loose in the Senate, with mere separation of federal and private money, and states allowed to make up whatever rules they want regarding abortion funding.
Coverage for illegal immigrants is not disallowed in the House bill; it is explicitly banned in the Senate bill.
It should be sobering for Democrats to realize that if just one Senator or two Representatives decide they can’t tolerate the alternative version of even one of these provisions, that will be enough to topple their whole health care reform edifice.
It’s no wonder, then, that Congressional Democrats now plan to merge the bills behind closed doors, shutting out all Republicans from discussion of the reconciliation process and preventing them from using parliamentary procedures to slow down consideration of the bill and allow the public to digest it. Talking Points Memo cites one Democratic House aide who proudly admits, “This process cuts out the Republicans.” The House will simply take the Senate’s bill, amend it, vote on it, and send it to the Senate; who will then amend the bill, vote on it, and send it to the House; and back and forth until some hideous, lopsided, structurally unsound blueprint garners enough votes in both chambers.
If Democrats had to merge these two bills in a public conference committee—never mind on C-SPAN, as previously promised, and recently offered by the network’s CEO—it would take about five minutes for the cacophony of their health care Tower of Babel clatter to bring it crashing down.