Creating an exchange where consumers can shop for health insurance and expanding the Medicaid program are two of the most exciting aspects of the bills in Congress to reform the U.S. health care system, said Cornell health economist William White in a public lecture Nov. 30 in Mann Library.

White, director of the Sloan Program in Health Administration and professor of policy analysis and management, and Kosali Simon, an associate professor of policy analysis and management, both in the College of Human Ecology, compared and contrasted intricacies of the two bills in the U.S. House of Representatives and the U.S. Senate. While there are differences between the two bills, they share key elements, they said.

Both bills propose to expand health coverage using a combination of incentives and penalties, Simon explained. "Some aspects of the bills are working at the level of the consumers and firms, using both carrots and sticks to expand health coverage," she said.

Positive incentives include providing low-income families with a subsidy to buy health insurance and expanding the Medicaid health insurance program. Those who don't qualify for Medicaid and don't buy health insurance would face fines. Businesses that don't provide health insurance also could face fines, Simon said, while some small businesses would receive subsidies to help provide health insurance.

The bills also would change the rules of the insurance market in which individuals and small groups purchase coverage, Simon said. The changes aim to make health insurance cost less than it currently does for people with pre-existing medical conditions, by having the healthiest individuals pay the same price as all others. The proposed legislation also creates a health insurance exchange to make it easier for individuals and small firms to shop for health insurance.

Both bills also create innovative reimbursement schemes for health providers and improve information sharing with new technologies, Simon said.

While each of the proposals tackle the same broad issues, the details vary between them. For example, the House bill includes larger fines for people without health coverage and for firms that do not offer health insurance, while permitting more low-income families to enroll in Medicaid, relative to the Senate bill.

Overall, it's too early to tell what the final reforms will look like, White and Simon said. If a bill passes the Senate, it will have to be merged with the House bill and then passed again by both chambers before heading to the president's desk for final approval.

"We're likely to see many changes before this is all over," White said.

The lecture was co-sponsored by Mann Library and the College of Human Ecology.

Sheri Hall is assistant director of communications in the College of Human Ecology.