27 October 2009

After all the press and arguments you have heard about health care reform, you may be wondering how we got here, what’s exactly in the bills, and what’s going to happen next. Explore Health Careers wants to demystify the process for you and provide some insight into what may happen in the weeks ahead.

What Usually Happens with Legislation

Health care reform has taken an interesting road to this point. The normal legislative process starts with introducing a bill in each chamber of Congress (the House of Representatives and the Senate). The bill is then referred to the committee(s) of jurisdiction, which considers the legislation  and votes on it. Each chamber, the House and the Senate, then votes on its own respective bill. If the bills pass in each chamber, the differences in the bills must be reconciled in a “conference” committee.

The members of Congress who reconcile the bills are called “conferees. Once the two bills are reconciled into one, that version is voted on in each chamber. If both chambers vote in favor of the bill, it then moves to the President for action. The President can sign it into law, veto it, or do nothing. If the President does nothing, then after ten days that bill becomes law. If Congress adjourns within that ten day period, however, the bill does not become law; this is referred to as a “pocket veto.”  We expect President Obama will sign a health care reform bill passed by Congress.  

Health Care Reform Process Moving Forward

Health care reform legislation has taken an almost-normal route in the House of Representatives. Before the House version of the bill, H.R. 3200, was introduced, the three committees of jurisdiction (Ways and Means, Energy and Commerce, and Education and Labor) worked together with the Leaders of the House to have a structural agreement of the bill. As such, the bill is called the “House Tri-Committee” bill. It then went through the committee process, where each committee made amendments, adding and deleting provisions. The changes that the committees made to the Tri-Committee bill are currently in discussion. 

In the Senate, the two committees of jurisdiction each introduced its own legislation. The Senate Health, Education, Labor and Pensions (HELP) Committee’s version of the health care reform bill, called The Affordable Health Choices Act, was considered and voted on favorably on July 15.  The Senate Finance Committee’s version of the bill, called America’s Healthy Future Act, was considered and voted on favorably on October 13. These two bills must now be reconciled into one before it will be brought before the Senate for consideration and a vote.

What’s in this Bill?

All versions of the bills include provisions that:

• Require individuals to have health coverage.
• Provide tax credits to those who can’t afford health insurance.
• Outline basic benefits, including mandatory oral health benefits for children.
• Implement health insurance reform, including prohibition on pre-existing condition exclusions.
• Create a program where individuals and small business owners can purchase insurance. (Called the “health insurance exchange” in the Senate Finance bill and the House Tri-Committee bill and the “American Health Benefits Gateways” in the Senate HELP bill.)
• Require employers to offer coverage or pay a penalty. (Senate Finance Committee exempts businesses with 50 or fewer employees, Senate HELP exempts employers with 25 or fewer employees, and the House Tri-Committee bill includes an employer hardship exemption.)
• Expand the Medicaid program. (Senate Finance and House Tri-Committee bill raises eligibility to 133% of the federal poverty level (FPL), Senate HELP bill raises eligibility to 150% of FPL.)
• Provide tax credits to employers to incentivize the offering of health care benefits.
• Workforce provisions.
• Prevention and wellness provisions.
• Long term care provisions.

Next Steps

It is expected that the House of Representatives will bring H.R. 3200 to the floor for debate the week of November 3.  Congressional Democrats hope to have a final bill on the President’s desk by Thanksgiving.

The Senate is currently negotiating the differences between the two bills. Senate leaders hope to have a final bill soon.

Leaders in both the House and Senate hope to have a final bill ready for the President to sign into law by the end of the year.

This article was written by Deb Darcy, Director of Congressional Affairs in the Center for Public Policy and Advocacy at the American Dental Education Association.