Unless there is a "pin pong" maneuver that circumvents the conference committee entirely, the differences between the House and Senate bills means there are still a long list of fights left on health care reform. These include:
Areas where the Senate compromise is better
Areas where the House bill is better
- 90% versus 85% The Senate bill dictates that 90% of all money received from health insurance premiums must be spent on health care. The House bill only dictates 85%. We need to push for 90%.
- Medicare buy-in. The Senate bill has a partial buy-in to Medicare for Americans aged 55 to 64. The House bill does not. We need to push to keep the Medicare buy-in, and make it as expansive as possible.
- Stupak amendment: The Senate compromise does not contain Stupak-amendment language. The House bill, infamously, does. Again, we need to keep the Senate version on this provision.
There are at least nine major differences between the House bill and the Senate compromise. To get as good a bill as possible, we need to score victories on as many of them as possible.
- Non-triggered public option. The House bill has a non-triggered public option, but the Senate bill has only a triggered co-op. The House bill is almost infinitely better on this front.
- Medicaid at 150% or 133%? The House bill expands Medicaid eligibility to 150%, while the Senate bill only expands it to 133%. This is another public option discrepancy where the House bill is better.
- Subsidies: 574 billion versus 338 billion: Through 2019, the House bill provides $574 billion in subsidies (pdf, page 5) to help people purchase health care, while the Senate bill provides only $338 billion. The final number needs to be closer to the House bill.
- Anti-trust exemption. The House bill repeals the anti-trust exemption for health insurance companies, while the Senate compromise does not (thanks, Ben Nelson). Another advantage to the House bill.
- Rate of eligibility expansion for the exchanges. The House bill expands eligibility for the insurance exchanges faster than the Senate bill. This is also a public option fight, since it will determine who is eligible for the Medicare buy-in, and / or new public option program. And the House bill is better.
- National vs. State exchanges. The House bill has a national exchange, while the Senate bill only has state by state exchanges. Score yet one more for the House bill.
- Taxing high-end insurance plans: The House does not tax high end insurance plans, but the Senate bill does. Personally, I don't think we should be weakening the health care coverage of union members in this bill,
Some people will probably point out that the best way to succeed in these fights is to keep raising hell and call the overall deal unacceptable. They may very well be right, since doing that over the past few months was probably the only reason we won the concessions we did. In defense of my recent writing, I think there is an argument to be made that, in order to stay active, people also need to know their activism is producing tangible results.
In terms of measuring our success on the public option front of these fights, I strongly suggest that we measure how many people will be added to public health insurance plans above current law, rather than just the creation of a new public option. We already have three federal public options: Medicare, Medicaid, and CHIP. Expanding those would be just as good as creating a new, fourth public option.