Five Health Bills Encounter 535 Congressional Opinions

Five bills. Five different approaches to remaking the U.S. health care system.

Congressional leaders are working to find common ground between the many reform bills that have passed committees and now must be merged into legislation that can face overall votes of the 535 members of the House and Senate. There are three bills in the House of Representatives, though their differences are relatively minor. And there are two in the Senate, where the real distances in the debate will have to be bridged.

In the end, if reform is to become law, the House and Senate will each have to produce a merged bill for passage, and those two bills would have to be combined into one final bill that can be approved in both chambers and sent to the Oval Office for a signature. If that happens in this session, the 111th Congress will have produced one of history's major laws, expanding insurance coverage to tens of millions of Americans and adding a massive influx of members to health plans.

These are the versions of the bill they are working on, in order of passage through the five committees that hatched them:

Senate's Health, Education, Labor and Pensions Committee:

The original health bill -- proposed by Sen. Edward Kennedy, D-Mass., before his death -- became the first to pass a committee, meeting a relatively speedy debate and easy Democrats-only passage. It championed the government-run insurer known as the "public option," which the insurance industry has argued would stifle private insurers because of unfair advantages. Like all the other bills in both the Senate and House, it requires individuals get health insurance, establishes public exchanges for the purchase of plans and bans pre-existing condition considerations (or any other discrimination) from use in approval of coverage. The bill -- estimated cost at more than $1 trillion in its first decade -- requires employers to cover workers and pay for much of the expense, and it helps poorer uninsured people buy policies.

House's Ways and Means Committee:

The first House committee to pass the America's Affordable Health Choices Act, it was estimated by the Congressional Budget Office to cost about $1 trillion over 10 years. Employers would have to cover their workers or pay a penalty. The committee -- which handles taxation business in the House -- decided to pay for much of the nationwide expansion of insurance coverage in its bill through a surtax on the wealthy, a gradually increasing percentage based on income. Employers with a payroll above $250,000 would be required to pay for much of their employee's insurance coverage -- or face penalties. And the individuals' out-of-pocket expenses would be limited.

House's Education and Labor Committee:

Hours after Ways and Means gave its bill an OK, the Education and Labor Committee followed suit with a very similar bill. The committee amended the bill to extend COBRA coverage to laid-off workers.

House's Energy and Commerce Committee:

The stiffest opposition in the House didn't come from Republicans, but from fiscally conservative Democrats known as "Blue Dogs." They opposed certain expenses in the bills passed in the other House Committees, so they held it up for a lengthy debate. In the end, one significant change they made was to insist that the public option's medical service reimbursement rates not be tied to Medicare levels but be negotiated with the insurance industry. The bill also said that businesses with payrolls below $500,000 wouldn't have to provide health insurance to employees. All of the House bills ended up passing without any Republican supporters.

Senate's Finance Committee:

The most fiercely contested version of all five reform bills, it was -- for months -- debated by the bipartisan group of senators known as the "Gang of Six." Then Chairman Max Baucus, D-Mont., introduced a bill based on those discussions. Instead of the public option, it allowed for nonprofit insurance cooperatives. It wouldn't tax people directly, but instead partially pays for itself with taxes on higher-cost health policies and fees on sectors of the health industry, including insurers. It doesn't require that employers insure their workers, though it does charge them a fee for the workers that seek insurance through the exchanges. The CBO estimated it would cost $829 billion over its first decade, but its funding provisions would actually benefit the deficit over that time. (President Barack Obama has said he will only sign a health reform package that is fully paid for by cost cuts and revenue generation.) When it passed the committee, it earned a Republican vote from Sen. Olympia Snowe, R-Maine.

The eventual merged House version of the reform bill is expected to include some form of public option. Many Democrats in that chamber have threatened to vote against the legislation if it doesn't. But on the Senate side, a public option isn't expected to be able to get the 60 votes needed to avoid the possibility of a Republican filibuster. So, in that chamber, the compromise version from the Finance Committee is expected to be dominant during its merger with the Health, Education, Labor and Pensions bill. In the end, a combined Senate-House conference committee would have to build a unified bill.