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Three big differences between House and Senate healthcare bills

Even if the Senate healthcare bill is approved, reconciling it to the House bill will take a concerted effort on three major points: who bears the cost, the public option, and abortion funding.

From left to right, Sens. Charles Schumer and John Kerry talk with Senate Majority Leader Harry Reid following a 60-40 cloture vote, the first step toward passing a health care bill, on Capitol Hill on Monday.

Harry Hamburg/AP

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At heart, the House and Senate versions of healthcare reform legislation are very much the same. Both require virtually all Americans to have health insurance, while offering low- and middle-income people subsidies to make that mandate more affordable. Both would establish new marketplaces, called "exchanges," where individuals who don't get insurance from employers could buy coverage.

Both would cost about $1 trillion over 10 years and pay for themselves via cuts in projected Medicare spending and tax and fee increases. Both would ban insurance firms from denying anyone coverage due to pre-existing health conditions.

But though their frameworks are the same, the two bills are very different in some of the details. So different, in fact, that harmonizing the bills could be a daunting task for a conference committee of House and Senate negotiators.

Here are three of the biggest obstacles to melding the bills together:

Financing. The largest source of new revenue in the House version of healthcare reform legislation is a tax on wealthy Americans. It consists of a 5.4 percent surcharge on families with annual incomes over $1 million and on individuals with incomes over $500,000. It's estimated to bring in $461 billion over the next decade.

In contrast, the largest source of new revenue in the Senate version of the bill is an excise tax on high-cost health insurance plans. The Congressional Budget Office estimates this would raise $149 billion over 10 years. The Senate raises another $238 billion over the decade via a mix of fees on insurers and some health device manufacturers, and other provisions.

Public option. The House version has a public option – a government-run insurance plan that would negotiate payment rates with doctors and hospitals. (Liberals would have preferred that it use the Medicare rates set by the government, which would probably have been lower.)


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