Comprehensive Look at Health Reform

A new Commonwealth Fund report analyzes the similarities, differences, potential impacts, and costs of current bills passed by the five committees of jurisdiction in the United States Congress. The full report is here.

This report provides an overview of key provisions of the two separate comprehensive health reform bills passed by the five committees of jurisdiction in the U.S. Congress: the Finance Committee and the Health, Education, Labor, and Pensions (HELP) Committee of the Senate, and the Ways and Means, Education and Labor, and Energy and Commerce committees of the House of Representatives. While the general frameworks of the bills are very similar—all bills include provisions intended to improve and expand coverage and all would create a comprehensive and coherent strategy for improving health care quality—they differ in a few key respects. Most important, the Senate Finance Committee bill does not include a public plan option or a requirement that employers offer coverage, nor does it reform for more than one year Medicare’s formula for setting physician fees; the House bill includes all of these features.

This year, policymakers in Washington have risen to the challenge posed by the faltering U.S. health care system and placed major reform at the top of the nation’s agenda. The five committees with jurisdiction over health care in the U.S. Senate and House of Representatives have now voted to pass major reform bills. The Senate Health, Education, Labor, and Pensions (HELP) Committee passed its bill in July, and the three key House committees—Ways and Means, Education and Labor, and Energy and Commerce—worked in concert on a bill that each passed by July 31, with amendments. The Senate Finance Committee passed its bill on October 13.



This report provides an overview of the key provisions of the Senate and House bills that are critical to achieving a high performance health system, as well more detailed descriptions of these provisions in Appendices A, B, and C. It also discusses estimates prepared by the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) of the number of people potentially covered under the bills and the projected effect on the federal budget. Forthcoming Commonwealth Fund reports will analyze the coverage, system reform, and financing implications of these proposals in more detail.

According to this report all of the bills include provisions that:

• seek to expand and improve health care coverage by building on the strongest aspects of the United States' mixed public-private system -- employer-sponsored insurance and Medicaid and the Children's Health Insurance Program -- while reorganizing and regulating the individual and small group insurance markets;
• establish requirements for insurers to offer coverage to all Americans who apply and prohibit them from denying coverage or charging more based on people's health;
• create a new health insurance exchange or exchanges;
• set an essential benefit standard for health insurance;
• provide subsidies to help people afford insurance premiums and out-of-pocket costs;
• require all individuals to have health insurance;
• have employers share responsibility for financing coverage;
• improve health care quality and outcomes while controlling costs;
• invest in primary care and provide more funding for prevention and wellness; and
• test innovative provider payment methods.

"The many areas of agreement among the bills currently being considered by Congress reflect broad consensus on what is needed to fix our fragmented and inefficient health care system," said Commonwealth Fund President Karen Davis. "We have a historic opportunity to enact comprehensive national health care reform that ensures that all Americans can get the high quality, affordable health care we need and deserve."

The report also points out that there are differences among the bills in terms of how reform would be financed, and what actions would be taken to control costs and expand coverage, including:

• choice of a public health insurance plan option to be offered through the new insurance exchanges in addition to private plans;
• exemptions from the individual requirement to have health insurance;
• requirements for employers to provide coverage or contribute to a health insurance fund;
• the level of subsidies to purchase health insurance and cost-sharing subsidies; and
• the degree to which revenues to pay for reforms are derived from high income households or from insurers and device manufacturers.

The report will be updated continually as the legislation evolves. An audio companion piece from Commonwealth Fund President Karen Davis, additional breakdowns, comparisons, and an interactive side-by-side chart are available on The Commonwealth Fund's Web site, http://www.commonwealthfund.org/.

The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system.