This is a companion piece to "Insurance essential but often unaffordable."

As millions of uninsured Americans remain vulnerable to medical costs, policymakers in Washington debate the future of health insurance in the United States and whether or not those Americans will finally have a shot at the coverage they need.

Two bills generating the most discussion are: the Affordable Health Care for America Act or H.R. 3962 proposed and passed by the House; and the Patient Protection and Affordable Care Act, submitted to the by Senate Majority Leader Harry Reid (D-Nev.)

H.R. 3962 passed the House on Nov. 7, 220-215. The bill estimates it would insure 96 percent of the U.S. population, up from the 83 percent currently covered. According to the Congressional Budget Office, this bill would reduce the deficit by $109 billion by 2019. The bill costs an estimated $1 trillion over 10 years and would be paid mostly by a tax on high-income households and penalties for businesses that don’t insure workers.

The Senate bill entered into a full-house debate with a 60-39 vote Nov. 21. A combination of bills passed by various Senate committees, the newest bill would cover 31 million more Americans while cutting the most money from the budget deficit of any bill — $130 billion over 10 years. The CBO estimates the bill will cost $849 billion over the next 10 years, which will be paid for through a new excise tax on insurance companies with expensive insurance plans and penalties for those who don’t buy health insurance.

Although the bills attack the same flawed health care system, they approach the problems in varying ways. Areas of most concern to students include the age limit of dependents, employer-based health insurance, health insurance costs and pre-existing conditions. Here’s a look at how the bills address these issues.

Dropped at 23

Both bills would extend coverage through age 26.

Eric Foss, Overland Park law student and chairman of the College Republicans, said he disagrees with some in his party on one issue of the health reform debate: length of dependent coverage.

Today, most full-time students are covered as dependents until they reach the ages 19 to 25, depending on the state and their parents’ insurance plan.

However, both the Senate and House will would extend dependent coverage until age 26.

“I certainly think that extending the dependent clause to 26 is a good step in the right direction,” he said. “I’m glad that’s being considered.”

Foss said maintaining the status quo for dependents was a detriment to the U.S. economy because it would prevent students from seeking a post-graduate education and continue to place even more liability on already debt-ridden students.

According to one federal analysis, one out of 10 uninsured young adults in America paid more than $700 out of pocket in medical expenses in 2005. Last year, a quarter of uninsured young adults were contacted by collection agencies.

Bye, bye benefits

House Bill: requires businesses with payrolls greater than $500,000 to provide some form of health benefit to its workers.

Senate Bill: requires businesses with more than 200 employees to purchase health coverage for its workers.

Although most of the insured college students rely on their parents’ health insurance plan provided through their jobs, employer-based insurance is becoming less standard.

The House bill would require all businesses with payrolls greater than $500,000 provide some form of health coverage for employees, whereas the Senate bill would require businesses employing more than 200 workers to provide some form of health coverage for its employees.

Bethany Christiansen, Emporia junior, went without health insurance for an entire year after her father quit his job. He had a job as a private contractor out of Missouri before he quit, she said, but the new company wouldn’t cover her dad or the rest of the family.

Christiansen said her parents spent the year trying to find an affordable plan. Their current plan, she said, leaves her and her two siblings without dental and eye care.

She said she hoped the health care reform would offer a backup plan for people who are in between jobs or whose employer doesn’t offer benefits.

“It doesn’t make any sense that you don’t have a job or health insurance when you’re most vulnerable to being sick or getting injured,” Christiansen said. “That’s how people get bankrupt.”

Affording the unaffordable

Both bills would keep costs competitive with a public option and insurance exchange.

The average health insurance premium in Kansas rose 105 percent from 1999 to 2009 while the average wage increased only 39 percent in that time, according to the Kaiser Family Foundation.

As the number of uninsured continues to climb, it’s taking a heavy toll on America’s budget. One study estimated that the federal health care spending would reach $2.5 trillion by the end of this year and $4.4 trillion by 2018. The estimated 2010 federal budget for the United States is $3.6 trillion.

With the rapidly increasing cost of health care and health insurance, both the Senate and House bills offer two solutions on how to cap the costs and provide more coverage at the same time.

The first is to offer a public insurance option operated and funded by the federal government. Proponents of the bill claim the public option would benefit the customers because it would keep prices down by increasing competition among private insurers.

Opponents, however, say the measure discourages competition.

Foss said the private insurers couldn’t compete with a government option because private companies had to answer to stockholders and operate on a fixed budget.

“The federal budget would not be restricted by that,” he said. “We all know that the federal government spends however much they like and then goes to the federal treasury for more money.”

After receiving backlash from Republican counterparts and the American public, the Democrats in the House have scaled back the public health option by requiring that rates be negotiated with private providers.

“It’s a fact of life,” said Dennis Moore, representative of the 3rd District of Kansas. “If we negotiate rates with some of the providers, I think that’s going to be the incentive they need to adjust their rates when necessary.”

Foss was more skeptical.

“Any time the government says that they’re going to negotiate prices with private companies, it usually means that the federal government is going to mandate what price the private companies have to offer their product or services at,” he said.

Instead, Foss said most Republican Party members wanted to break the political barriers preventing a truly free market for health insurance and let the capitalist system lower the price on its own.

Deviating from one of the more prominent committee bills in the Senate, the latest Senate bill includes a provision for the public option. However, states would be allowed to opt out of participating.

Both the House and Senate bills also propose the idea of a public health insurance exchange. Health insurers can join this exchange if they meet a certain criteria, such as not rejecting people with pre-existing conditions.

George Dungan, Lincoln, Neb., senior and vice president of the Young Democrats, described the exchange as a “one-stop shop for health insurance.”

“Rather than shop around and talk to different brokers from various companies and try to figure out how much it’s going to cost you, you’re going to be able to go to this exchange, find one broker and figure out the best price for you,” he said.

Both bills require almost every American to purchase health insurance or face penalties or the jail time associated with tax evasion. The penalty for refusing to purchase health insurance under the House bill would cost 2.5 percent of the person’s total income. The Senate bill would require a maximum, annual fine of $750 per person without health insurance.

Only dependents, citizens living outside the U.S. and a few other groups are excluded from this mandate in the House bill.

Moore said the bill was designed to provide more Americans with health insurance to lower the costs incurred from uninsured visits to the emergency room.

Dungan said the mandated health care coverage couldn’t come without a public option or subsidies to help people pay for health insurance.

“Mandated health care is necessary to get everybody covered,” he said. “But if you mandate health care without giving them an affordable option, you’re screwing them over, and that’s not what we’re trying to do here.”

The Congressional Budget Office estimated that the House bill would bring in $167 billion in penalties over the next decade from people without coverage, assuming people would rather pay fines than pay for health coverage.

Both bills have a provision allowing people to keep their current insurance policies if they wish.

As a volunteer at JayDoc and a fourth year medical student at University of Kansas Medical Center, Beth Schepker said she had seen all walks of life struggling to pay health bills.

She said she thought the closest thing to fixing the system would be a public option with a universal mandate for health care.

“It makes me really angry at the health system,” Schepker said. “I wish that just for a second we could take a step back and look at the larger issue and that’s that we have people suffering in this country when they don’t necessarily have to be.”

Her colleague at JayDoc, Chris Cassidy, second-year medical student, said the best solution would come from throwing out health insurance altogether.

“The first thing we need to do is stop feeding the beast, and the beast is health insurance,” he said. “With the public option, the underlying problem is still there. We’re still paying for way too many things and not getting anything out of them.”

Up a creek without an inhaler

House: limit pre-existing condition clauses to one month, eventually prohibits them by 2013.

Senate: prohibits bias toward pre-existing conditions in 2010.

People with pre-existing conditions like diabetes, asthma and high blood pressure face an up-hill battle anytime they apply for coverage.

Nick Tallmon, Lawrence senior, was diagnosed with Type 1 Diabetes in May 2008. He had health insurance when he was diagnosed, and while that provides him with coverage, it also makes him susceptible to increased premiums with no way out. That’s because few health insurance agencies are willing to incur the costs of those with pre-existing conditions.

“Unless they change the laws, there’s absolutely no way I could get health care anywhere else because diabetes is considered a high-risk pre-existing condition,” he said.

Both bills prohibit bias against pre-existing conditions, although the House bill would take until 2013 to completely eliminate bias, whereas the Senate bill would eliminate pre-existing condition clauses immediately.

What’s to come

The bills working their way through the Senate and the House have a ways yet to go before a final bill reaches President Barack Obama’s desk, which some expect to be well into next year.

This anticipation leaves people like Willbanks and those at JayDoc at the mercy of the system.

“It doesn’t make sense that the people who could easily pay their expenses out of pocket are the ones that don’t have to,” Willbanks said. “And those of us who can’t pay our expenses out of pocket are the ones who just barely don’t qualify for Medicaid.”

While the United States faces a stalemate in the Senate over health reform, it remains the only industrialized nation without universal health coverage.

Renowned journalist and international health care expert, T.R. Reid, said the problems with American health coverage stemmed from the country’s failure to make a moral commitment to provide coverage to every citizen.

Gina Burrows, Salt Lake City senior and president of the Young Democrats, agreed with Reid.

“Health care shouldn’t be a question,” she said. “It shouldn’t be a debate. It shouldn’t be something we have to work for in an ideal world. I’m glad we’re fighting for change. I’m just flabbergasted that it’s having to happen.”