Here’s the 25-page Congressional Budget Office “preliminary estimate” of the Senate bill with the House package of changes. Much, much more here and on Time.com once I’ve had a chance to comb through and absorb all the policy implications. There are no earth-shattering changes. The Senate bill with the reconciliation package would reduce the federal deficit by $138 billion by 2019; the Senate bill itself would reduce the deficit by $118 billion over the same period.
Some people say that comprehensive health care reform is like a balloon – squeeze one part and another part expands. Increase subsidies, which the reconciliation package does, and the cost of the bill goes up. Delay the start of the excise tax, which the bill does, and revenue from the bill goes down. House Democratic leaders worked under severe fiscal constraints in designing their reconciliation package. They had to keep the legislation under $1 trillion over 10 years, make it save more than the Senate bill did, and expand coverage and affordability to satisfy House Democrats. These are not easy rules to follow, especially when the whip count is still volatile and the clock is ticking. But they followed the rules and the package could earn endorsements from some wavering House Democrats today.
Here are a few ways the reconciliation package would alter the Senate bill, based on a plain-language summary of the package leaked to The Hill earlier today:
Relative to the Senate bill, the reconciliation package:
* Increases subsidies to make buying insurance more affordable for middle-income Americans
* Weakens the individual mandate by reducing the penalty people pay if they don’t maintain insurance coverage and phasing the penalty in over time.
* Strengthens employer mandate by increasing penalties that large companies would pay if they didn’t provide coverage or their workers qualified for subsidies
* Closes Medicare Part D prescription drug gap known as the donut hole
* Adds a new tax to unearned income
* Increases payroll taxes for individuals earning $200,000 or more per year
* Increases the massive tax on the drug industry tax, but delays it by 1 year – the industry would have to pay $3.85 billion per year beginning in 2011.
* Increases the massive tax on the health insurance industry tax but delays it by 4 years – the industry would have to pay $11.2 billion per year beginning in 2014.
* Eliminates the much (and deservedly) maligned Cornhusker Kickback.
As I said, more to come. Stay tuned.