Top four differences of Senate and House healthcare reforms bills

The House bill adds a surcharge for high-income taxpayers. The Senate bill does several things: It adds a Medicare payroll tax on the wealthiest Americans, it taxes high-end, so-called "Cadillac" insurance plans, and it empowers an independent board to propose cuts to Medicare if savings targets are not met. The cuts take effect unless Congress finds comparable cuts elsewhere.

Critics see the independent board provision as punting hard choices. "But it's better than nothing, and that's what the House bill has - nothing," says Maya McGuineas, president of the Committee for a Responsible Federal Budget.

The bigger rift within the Democratic caucus is likely to be about the Senate tax on high-end insurance plans. Unions oppose this plan because it would have an impact on hard-won contracts. "We will work hard to eliminate this provision," said Richard Trumka, president of the AFL-CIO.

Individual Mandates

Individuals are required to purchase insurance policies for themselves and their families in both House and Senate versions of the bill, but the bills differ on enforcement. Penalties in the House version of the bill include a fine of up to 2.5 percent of a person's adjusted gross income and as many as five years in jail. Exceptions would be given to those who cannot afford coverage, religious objectors, illegal immigrants, and those not covered for less than three months.

But Senate Democrats stripped criminal penalties out of their bill. Instead, individuals who fail to purchase insurance face a $95 fine beginning in 2014, which increases to $750 by 2016. Senators were motivated by the prospect of GOP ads blasting Democrats for jailing parents who didn't meet the mandate.

Enforcement is a key issue. Without strong enforcement, insurers say, many people will pay the fine and opt out, depriving insurers of money they need to cover people with preexisting conditions.

Abortion

The House bill includes an amendment by Rep. Bart Stupak (D) of Michigan that toughens restrictions on funding for abortion services. The compromise proposed by Senator Reid bans federal funding for abortions and requires the secretary of Health and Human Services to verify that taxpayer dollars aren't directed to pay for an abortion. But, unlike the Stupak amendment, the Senate plan does not bar insurance plans that cover abortion services from the new health insurance exchanges. The National Right to Life Committee calls the compromise "contrived."

But it may offer a middle ground. "The abortion language is not the language I would like or that Bart Stupak would write, but I do think this is a sensible position that we could accept," said Sen. Barbara Mikulski (D) of Maryland.
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See also:

Senate healthcare reform vote: ‘Now, the real debate can begin’

Illegal immigrants becoming a flashpoint in healthcare reform

Three gimmicks that make Senate healthcare bill look better

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