Health Care Reform Proposals

Comparing BoehnerCare with ObamaCare

By Daniel Brockman, 100223
MS-Word Format


R = Republican and D = Democratic
Intention and Caveats
Substantially common provisions in R and D
Some provisions are hard to judge
Provisions found in R not found in D
Provisions found in D not found in R
Sources of information

R = Republican and D = Democratic

For brevity, I refer to the Republican version as "R" and the Democratic version as "D".



When I published the paper "Health Care Reform Proposals: Comparing BoehnerCare with ObamaCare" (100222), the President simultaneously published a revised proposal. According to some opposition comments, the revision isnít significantly different, and I found no new documents at the minority leaderís website . This document compares the Democratic revision with the Republican proposal.


Intention and Caveats

I will try to present here a balanced comparison of Republican and Democratic proposals on health care reform for the United States. This is a profoundly complex topic, and I apologize for any errors that you may find in this comparison.

Let me first acknowledge my own biases. I voted for Obama, partly because I believe guaranteed universal health care is more efficient than optional privately contracted arrangements. I presently think I voted wisely. I donít consider myself a liberal. I donít consider myself a conservative.

The comparison laid out here identifies many more provisions in the D. This isnít bias on my part. D is much more detailed than R.


Substantially common provisions in R and D

1. Both assert they will reduce the cost of health insurance premiums for small businesses and families.

2. "Low-cost" or "affordable" national high-risk pools (R calls these "Universal Access Programs") to protect people with preexisting conditions.

3. Multiple uses of the word "affordable" without defining it. I take this as an intention of both R and D.

4. Medical liability reforms to prevent defensive medicine.

5. Prevents insurers from canceling coverage, except for demonstrable fraud.

6. Provides coverage to people with preexisting conditions.

7. Both assert they donít increase the deficit.

8. Coverage of dependents on parentsí policies through age 25.


Some provisions are hard to judge

I think there is room for agreement among willing negotiators.

1. Medicare. D "protects Medicare for seniors". R "protects seniors Medicare benefits". R says "the Pelosi bill" will cut Medicare benefits for seniors. R says that R will not increase Medicare premiums. D says benefits will improve in quality. D revises prescription drug benefits by phasing to a 25% coinsurance. D says there will be a maximum of $4,080 for out-of-pocket spending for Medicare beneficiaries.

2. Exchange, high-risk pools, and national extents. D proposes an insurance Exchange, apparently spanning state lines that would allow small businesses and uninsured persons to compare policies and choose the least costly. R and D propose national high-risk, low-cost pools. For D, they are interim measures pending establishment of the Exchange.

3. R asserts it lowers health care premiums by "up to 10%" and costs by "nearly $5,000" for "millions". R asserts it "reduces the deficit by $68 billion over the next ten years". D asserts it will reduce the deficit by "$100 billion over the next ten years -- and about $1 trillion over the second decade". These assertions are couched in sufficiently vague terms so that they couldnít be disproven under any circumstances. (Both R and D include vague terms that allow proponents ample political wiggle room.)


Provisions found in R not found in D

1. Mention of reinsurance programs associated with guaranteed access to affordable care for all Americans.

2. Incentive payments to states that reduce premiums and reduce the number of uninsured persons.

3. Asserts it encourages employers to reward employees for adopting healthier lifestyles.

4. New incentives (unspecified) for HSA Health Savings Accounts.

5. R contains many derisory references to Democrats and their proposals. I simply donít find this kind of insult in D.

6. "No Tax Increases. Period."

7. Assertion that R promotes innovation and preventive care.

8. Prohibits use of federal funds to pay for abortion.


Provisions found in D not found in R

1. Requires all persons to either buy insurance or make mandatory payments based on income to offset the cost of care. Waives payments for persons with incomes less than the tax-filing threshold. Compensates for health insurance premium costs with income tax provisions. A family of four with income less than $44,000 will pay no more than 6.3% of income for premiums less tax credit. A family of four with income less than $88,000 will pay no more than 9.5%.

2. Requires businesses of more than 50 employees to either offer health coverage to employees or to make offsetting payments.

3. $40 billion in tax credits to small businesses providing health coverage to employees.

4. Strengthens anti-fraud provisions of current law.

5. Federal financing to states to compensate for expansion of Medicaid.

6. Cost sharing assistance (Iím donít know what that is) for individuals and insurance companies, from 70% for a family of four with annual income of $88,000 to 94% for families with lower incomes.

7. Creates the Health Insurance Rate Authority, a regulator that will provide assistance and oversight to states conducting reasonableness reviews of premium rate changes. Insurers must submit proposed premium increases to state authorities for review, annually.

8. Requires members of Congress to purchase health insurance through the Exchange, thus all persons have access to exactly the same health insurance available to members of Congress.

9. Asserts D lowers the cost of health care for government.

10. Caps annual out-of-pocket expenses per person. No annual or lifetime coverage limit.

11. Preventative care, without deductibles or copays.

12. Funds scholarships and loan programs to expand education and training of doctors, nurses and other health care personnel.

13. Funds community health centers in underserved areas.

14. Prohibits a branded drug manufacturer from paying generic manufacturers not to produce equivalent drugs.

15. Excise tax on insurance premiums that exceed $10,200 per year per individual, adjusted for inflation.

16. Increases Medicare taxes on persons and couples with incomes exceeding $200,000.

17. Tax on branded pharmaceuticals of $33 billion, on health insurers of $67 billion, on medical device manufacturers of $20 billion over 10 years.


Sources of information

For the revised Democratic version, I used at .

For the Republican version, I chose .
For the older Democratic version, I chose .
Both of these claim to be summaries. I read them carefully.

I supplemented the summaries with the following documents, which I read less carefully.
For R, and .
For D, and and .

Also, .



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