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Figure 1: Updated Comparison of Health Care Reform Legislation

HELP Finance President’s


Provision House
Committee Committee Reserve Fund
Mandate Provisions $168 $88 $27 X
Individual Mandate Penalties $33 $36 $4 X
Employer Play-or-Pay Provision $135 $52 $23 X
Coverage Expansion -$1,055 -$779/-$1,279* -$829 X
Insurance Subsidies -$605 -$723 -$461 X
Medicaid Expansion -$425 X / -$500* -$345 X
Small Business Tax Credit -$25 -$56 -$23 X
Other Spending -$226 -$24 -$72 X
Physician Payment Updates n/a X -$11 X
Medicare Prescription Drug Coverage n/a+ X -$21 X
Reinsurance for Seniors -$10 X n/a X
Measures to Slow Health Cost Growth -$29 -$10 -$14 X
Other Spending -$185 -$14 -$26 X
Spending Offsets $569 X $524 $645
Prescription Drug Cost Reductions $83+ X $28 $105
Medicare Advantage Cuts $170 X $114 $176
Provider Payment Updates $173 X $185 $110
Medicare Premium Increase n/a X $33 $8
Medicare Payment Commission n/a X $22 $2#
Measures to Slow Health Cost Growth $37 X $29 $47
Measures to Reduce Federal Health Care
$106 X $113 $197
Spending
Tax Increases $560 X $382 $296
Surtax on High Earners $461 X n/a n/a
Limits to Itemized Deductions n/a X n/a $269
Excise Tax on High Cost Insurance n/a X n/a n/a
Limits to Corporate Tax Benefits $56 X $202 $27
Limits to Health Care Tax Benefits $23 X $17 n/a
Fees on Health Care Companies $20 X $42 n/a
Interaction and Other Effects $15 $46 $49 -$33
Budgetary Impact Subtotal $31 -$669/-$1,169* $81 $908
Long-Term Care Insurance^ $73 $58 n/a n/a
Total Budgetary Impact $104 -$611/-$1,111* $81 $908
Notes: Estimates in billions.
Sources: CBO, JCT, OMB, and US Budget Watch calculations.
X = Not addressed in the proposal, but expected in the final bill.
*Assumes the addition of the Medicaid expansion as per CBO’s rough estimate; ^Generates upfront
+
savings due to “vesting period,” but ultimately spends down revenue on benefits; Costs of expanding
#
prescription drug coverage incorporated into savings estimate for reducing payments; Actual savings
from establishing a commission to propose or enact payment changes are highly uncertain.