This document, prepared by the House Tri-Committee staff, outlines the topline differences between the House and Senate bills that need to be resolved. (It is very much worth a read if you are interested.) In almost every case where the two bills differ, it is because the Senate bill is dramatically worse. Some of the most important issues where the Senate bill is worse than the House bill are:

  1. Weaker employer mandate
  2. Most regulations won’t apply to the large group market
  3. Lower minimum benefit requirements
  4. Large age rating
  5. Multiple state-based exchanges versus one national exchange
  6. Lack of a public option
  7. Later start date
  8. Does not repeal health insurance anti-trust exemption
  9. Smaller Medicaid expansion
  10. Does not increase payments to Medicaid primary care providers

The Senate bill is not a terrible bill only because it lacks a public option. That is just the most important and glaring fault with the bill, but there are dozens of other reasons why it is a bad bill. The bill is so poorly designed, it is almost impossible to imagine how it will not quickly fail. It lacks strong regulatory enforcement mechanisms. Insurance companies will easily subvert the few things in the bill meant to hold them accountable. Finally, the lack of a strong employer mandate, combined with insufficient subsidies and very low minimum benefit requirements, is a recipe for a massive increase in the dramatically underinsured. The Senate bill is not a half-a-loaf, or even a quarter loaf, it is an extremely poorly designed foundation that will make efforts to get actual reform in the future more difficult.