PSA: Daily Kos just published an excellent summary of the current health care bills.

Individual Mandate: Beginning in 2014, U.S. citizens and legal residents will be required to maintain "minimal essential coverage," or face a penalty of $750 per person, to a maximum of $2,250 per family. The penalties will be phased in over the period from 2014-16, reaching those maximums in 2016, and then will be annually to the cost of living. There will be exceptions for financial hardship, religious objections, for American Indians and people who have been uninsured for less than three months. Additionally, exceptions will be granted if the lowest cost health plan available to them exceeds 8% of income, or for those with an income below the poverty level ($10,830 for an individual and $22,050 for a family of four in 2009). There are not criminal prosecutions for not having insurance.

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Premium Tax Credits: If you are going to mandate coverage, there has to be assistance to people who can't afford it. This is where it gets expensive for the government. Subsidies will be available to people with an income of up to 400 percent of the federal poverty level ($88,200 for a family of four in 2009) to purchase insurance within the exchange. The premium credits (subsidies) will be tied to the second lowest-cost silver plan (the one at 70% actuarial level) in the area. How much of the premium you pay out of pocket will be set on a sliding scale, so that the premium contributions are limited to 2.8% of income for those at 100% of poverty to 9.8% of income for those between 300-400% of poverty. For those with incomes between 100 and 133% of poverty level, the premium contribution is limited to 2% of income. (At 133% of poverty, individuals will get their coverage through Medicaid.)

Employer Mandates: Employers with 50-199 employees aren't required to provide coverage, but the legislation does set up a schedule of fees for employers required for their employees who receive subsidies or credits. Employers with fewer than 50 employees have no requirements, and are not subject to fees; employers with more than 200 employees are required to cover their employees.

Expansion of Public Programs--Medicare and Medicaid: Again, this doesn't include the Medicare buy-in proposal currently being scored by CBO. The Medicaid expansion is very significant, and in terms of really expanding coverage and getting people access might be the most critical part of the effort. The program would be expended to cover all poor Americans whose household income is below 133% of the federal poverty level (FPL) as of 2014. Any state that wanted to expand coverage sooner could do so as early as January 1, 2011. The states could limit coverage under this expansion to "benchmark" coverage, a basic package of the essential benefits available through the exchange. However, eligibility would be determined based on modified gross income without expenses factored in, so the eligibility ceiling isn't as high as it would be if the eligibility were determined as it is now for Medicaid--more income will be counted.

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Insurance Reforms: Some of the insurance reforms are designed to take effect 6 months after passage, others are phased in. Insurance companies would not be allowed to stop paying for coverage after a certain lifetime limit, but the annual limit loophole, just as problematic for people with serious and chronic illnesses, still exists, as does the exclusion of out-of-pocket expenses in that limit. Insurance companies would not be allowed to charge co-pays for preventative services, such as checkups, immunizations, or recommended mammograms. Young adults under 27 would be able to stay on their parents' plan. Beginning in 2014, insurance companies would be barred from discriminating against applicants based on pre-existing conditions, health status, or gender. Before 2014, uninsured Americans with a pre-existing condition would have access to an immediate insurance program, which would help them maintain affordable coverage.

Risk adjustment mechanisms aren't as strong as they could be, however, and opportunities for cherry-picking enrollees still exist. Insurers will be able to tailor plans to attract young and healthy enrollees, displacing more of the cost burden--and driving up premiums--on certain plans. This was one of the reasons that the CBO estimated the public option could have higher premiums than other offerings in the exchange--it would have the sickest people dumped in it. It's important to remember, though, the public option was still estimated to save $25 billion over ten years.

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Financing: The bill is financed through a combination of savings from Medicare and Medicaid and new taxes and fees. The largest and most controversial source of new revenue will come from an excise tax on high-cost insurance, which CBO estimates will raise $149 billion over ten years. Unfortunately, as Jon Walker describes, that tax is also likely to "result in most people getting worse health insurance from their employer, insurance that covers less." There are other fees on certain manufacturers and insurers, an increase in hospital insurance contributions for high-income taxpayers, additional taxes on cosmetic surgery (not things like breast reconstruction, but vanity surgery), and a .5% Medicare payroll tax hike on single people earning more than $200,000 and married couples earning more than $250,000.

The CBO puts the price tag of the bill at $849 billion over ten years, and says it would reduce projected federal budget deficits in that time fram by $130 billion. It would cover 31 million people, leaving 23 million uninsured. The House bill, by comparison, comes in at just over $1 trillion, would reduce deficits by about $139 billion, and would cover 36 million. The stronger public option and more generous Medicaid expansion are key elements making the difference there.