Healthcare reform: HFMA's budgetary breakdown of both bills

The Healthcare Financial Management Association (HFMA) has issued a monetary breakdown between each piece of the healthcare reform legislation—the version originally proposed by the Senate and the House Reconciliation Act--and while the differences between the bills are modest, the Reconciliation Act price tag is $70 billion more expensive.

President Barack Obama signed the Senate healthcare reform bill into law on Tuesday and the House of Representatives’ Health Care and Education Affordability Reconciliation Act (H.R. 4872) has since been passed by both houses of Congress with minor edits.

The Reconciliation Act increases costs to $940 billion, compared to the initial cost of the Senate's version of reform, which came in at $871 billion. The Reconciliation Act also increased the number of Americans who will now have health insurance coverage by one million—from 31 million to 32 million.

Additionally, rather than the reductions in reimbursement by the Senate that looked to adjust the rates by $103 billion over the next 10 years, the reconciliation bill will reduce reimbursement by $9.9 billion over the next 10 years, according to HFMA.

The House proposed that Medicare and Medicaid disproportionate share hospital (DSH) payments be pushed to 2014, but made reductions in their amounts by $3 billion and $4.1 billion, respectively, compared to the $44 billion reductions proposed by the Senate bill.

The Reconciliation Act makes no significant changes pertaining to delivery system reforms which would save an apparent $13.5 billion in the next 10 years by implementing value-based purchasing and pilot programs to test bundled payments, while decreasing payments for readmissions.

As for tax exemption status, the Senate bill embraced new provider criteria to retain not-for-profit status including: conducting needs assessments, developing and implementing charity care policies, applying collection efforts only after attempting to gain charity care status and avoiding billing patients who qualify for assistance more than the amount billed to insured patients.

The House's reconciliation bill does move to increase the flat fee rate for business to $2,000 for every uncovered full-time employees (FTEs), but allows the first 30 uncovered to be subtracted. The Senate bill would have cost businesses with more than 50 FTEs to pay a flat fee of $750, for employee’s eligible and receiving subsidies.

However, the Reconciliation Act would lower the flat payment for individuals to $695 in 2016, opposed to penalizing individuals without insurance $750 per each uninsured adult in 2016, but would increase income percentages to 2.5 percent.

While there was little change in the sector of independent payment advisory board, the Reconciliation Act would reduce savings by $14.7 billion because of changes for Medicare Advantage plans. In comparison, the Senate bill proposed a savings of $23.4 billion within the next 10 years and set up a commission to oversee Medicare rates.