I'm going to attempt to describe a list of issues that we may be able to improve in conference. While there is a lot of press about how the House may "fold" given the Senate filibuster threats, I believe most of this press is centered around the hot-button issues, while there are a large amount of issues remaining that can possibly lead to a stronger bill.
- Implementation Date - The House bill has an earlier implementation date than the Senate bill. The distant implementation date has always been mostly about budget tricks, but now that there is an air of inevitability behind the bill, we may be able to move up the implementation date even if it makes the bill appear to cost more over the first ten years - especially since the long-term outlook will continue to have a projection of decreasing the deficit.
- National/State Exchange - The House bill has a national exchange, while the Senate bill has state-based exchanges. This is part of the reason that the Senate has a further off implementation date. Dianne Archer has more on this here.
- Excise Tax versus progressive tax - Senate leaders argue strongly that the Excise Tax (also known as the Cadillac Tax) is one of the strongest health care cost controls they have. The House, in turn, uses a progressive income tax. The problem is that unions don't like the excise tax, and the house version of the bill is just as deficit neutral as the senate version in the short term. But, the excise tax makes the senate version better for the deficit in the long term. The Senate also has a progressive Medicare payroll tax, but the House is unlikely to have a problem with this.
- Employer mandate - The House bill has an employer mandate which may be superior to the Senate's, which apparently contains "perverse incentives", as described here.
- Medicare Advantage - As also described in this post, the Senate version of overhauling MA may be preferable to the House's, due to competitive bidding.
- Medicaid Expansion - This is pretty straightforward. The House expands Medicaid up to 150% of the poverty line, while the Senate expands it up to 133%. This is the difference between 14 million and 15 million new recipients.
- Basic Plan Coverage - The House's "basic plan" covers 70%, while the Senate's covers 60%. Individual plans currently cover 55%-60%.
- Amount of Subsidies - The House may be able to argue for higher subsidies in return for giving up other priorities.
- Public Option - This one is obvious - the House will probably make a lot of noise about this to get other concessions above, before giving up on it.
- Abortion - Ironically, the House probably could have passed this without Stupak's amendment had they given the moderates a few other of the concessions above back when they were passing this. Given that, maybe there's an outside chance of weakening the abortion amendment further. And, I'm not sure on this, but I think Nelson's abortion amendment in the Senate would be made irrelevant if they switch the exchanges to national instead of state-based.
Upon the conclusion of making this list, I also found this summary of differences over at the NY Times. Check there for additional details on immigration, long-term care, etc.
You may also be able to find several details using this tool here. It is highly detailed.
Overall, I think there is significant opportunity to improve the innards of this bill without risking the support of the Senators that are focused on hot-button issues.
Please check Elise's diary for a greater examination of the cost controls currently in the bill, with more suggestions of what to do next.
