Both House and Senate bills include employer mandates that would require all but the smallest employers to provide health insurance for employees.  The bills require a minimum employer contribution (60% - 72.5% for employees) towards the cost of insurance. The Senate Finance Committee’s position on this point is still under consideration, although at this time it appears likely that an employer mandate of some sort will be included in a final bill.

Along with mandating employers to provide coverage, both bills include minimum acceptable benefit levels for qualifying plans, including required coverage for hospital services, physician services, medical equipment, maternity, prescription drugs, rehabilitation, and mental health and substance abuse services. Annual and lifetime limits on benefits would be prohibited. The House bill also defines limits on participant costs, including annual out-of-pocket limits of $5,000 individual / $10,000 family and a general requirement that participant cost sharing overall be restricted to 30% or less of the total actuarial value of the insurance policy.

The most controversial component of proposed legislation is the creation of a public plan option that would offer coverage to individuals through a federal government-sponsored insurance plan. The main concern among opponents is that the government can simply set rates and propose requirements that would overly subsidize the public coverage option, pricing private insurers out of the market. The two main points of contention are:

Both the House and Senate expect the final bill to cost approximately $1 trillion over the course of the initial 10-year budgeting period, and are committed to including new sources of funding to fully pay for Healthcare Reform.  Funding is expected to come from several sources, including Medicare and Medicaid (rate changes, reducing insurer subsidies, and system reforms); however, a substantial portion of the $1 trillion cost remains to be funded. The House bill includes an income tax increase on high-earners, and the Senate Finance Committee has yet to disclose a preferred funding mechanism.

The House bill’s provisions would come into effect beginning in 2013. The Senate Health Committee bill’s provisions would begin to phase in as early as 2010 and 2011.