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Columbia Missourian

Where your legislators stand on the health care debate

By Michael Sewall
November 6, 2009 | 12:01 a.m. CST

COLUMBIA — House Speaker Nancy Pelosi is urging a vote on her health care bill Saturday in the hopes of forcing to a conclusion a debate that's been raging for most of the year.

After a summer of heated town hall meetings on health care reform, Missouri senators and representatives have spent the fall debating and working on various bills in the Capitol. Bills in the House and Senate have been torn apart and reassembled.

Here's a breakdown of some of the key issues and where Missouri senators and representatives stand on pieces of health care reform.

What's on the table: Originally, White House officials said they wanted a single-payer system, but they drew heavy backlash and abandoned that plan. Since then, a public option has been heavily debated and is included in the House version of the bill, which envisions a government-run option providing different levels of benefits. The House bill would also create a health exchange marketplace to compete with private insurance companies, as well as approve loans to help states start up health cooperatives. The Senate Finance Committee's bill does not include a public option. Instead, it creates private, nonprofit insurance cooperatives that would be run by consumers at the state level. The government would provide $6 billion to the states by 2012 to help create the co-ops.

How people might be affected: The House bill would provide tax credits to people with a family income below 400 percent of the federal poverty line. The Senate Finance bill would, starting in 2013, make tax credits available on a sliding-scale basis for people and families who make between 134 and 400 percent of the federal poverty line. All of the bills on the table include an individual mandate, but the penalties and exemptions differ. The House version would impose a larger fine (2.5 percent of adjusted gross income) and exempt fewer people (those who cannot afford it or those who have religious objections). The Senate Finance bill would exempt Native Americans, people with religious objections, people who cannot afford insurance and people who pay more than 8 percent of their income for the lowest-priced available plan. The committee's bill would phase in an excise tax on people who do not purchase health insurance: $200 in 2014; $400 in 2015; $600 in 2016; and $750 from 2017 forward.

How businesses might be affected:  According to a study by the Commonwealth Fund, only 25 percent of small-business employees had health insurance through their employer in 2007. Both the House and Senate bills would give tax credits to employers with no more than 25 full-time employees with an average annual income of $40,000. The tax credits could motivate employers to contribute to their workers' health insurance, but some people have proposed mandating employer contributions or having them pay a fine. The House bill would require employers to pay 72.5 percent of their employees' premiums or make a contribution to a fund that would help expand health coverage among the uninsured. If the coverage an employer offers is unaffordable for low-wage workers, they could choose subsidized coverage in a health exchange and the employer would make a contribution to the exchange. The Senate bill doesn't specifically require employers to provide coverage, but those with 50 or more employees would have to reimburse the government for subsidies provided. Employers with more than 200 workers would have to enroll them in a work-provided health plan, but an opt-out clause is included.

 How it will be funded: The Congressional Budget Office estimates that the Senate Finance bill would cost $829 billion and estimates the House bill would cost as much as $1.055 trillion. The legislation proposes two primary sources of funding: raising revenue through new taxes and fees and decreasing "wasteful" spending in Medicare and medical malpractice lawsuits. The House bill would create an income surtax for the wealthiest 1.2 percent of households and cut about $400 billion from Medicare over 10 years. The Senate Finance version would be funded by $13 billion in new fees and taxes on insurance companies that charge more than $8,000 for individual plans and $21,000 for family plans. The bill would also aim to cut spending on Medicare by linking payments to the hospitals' quality of performance. Another proposal to reduce spending is through tort reform, also known as medical malpractice reform. The idea is to cut back on legal claims injured people can make against medical providers as a way to reduce malpractice insurance premiums. Although some say this could help bring down health care costs, the Congressional Budget Office has estimated it would reduce national health care expenditures by only 0.2 percent.