Committee for a Responsible Federal Budget

Senate Introduces New Health Care Bill


Yesterday Majority Leader Harry Reid introduced the Patient Protection and Affordable Care Act. The bill reduces the deficit by $130 billion over ten years, and spends $848 billion in coverage expansion.

We have broken down the costs and savings of the bill, compared to other versions, below.

The bill spends a bit more than the Senate Finance Committee bill last month, but significantly less than the planned costs of the Senate HELP Committee bill. On tax policy, the new bill reduces the excise tax on high cost plans, relative to the Finance bill, so that it raises around $50 billion less than it did in the Finance Committee version. This revenue loss is replaced with an increase on the Medicare payroll tax for high earners.

See our updated chart comparing the HELP Committee bill, the Senate Finance Committee bill, and the Patient Protection and Affordable Care Act below. Click here for our comparison of the new Senate bill with the most recent House bill.

ProvisionsHELP CommitteeFinance CommitteeSenate Leadership
Individual Penalties$36 $4$8
Employer Payments$52 $23$28
Mandate Provisions$88
Exchange Subsidies ($723) ($461) ($447)
Medicaid Expansion X / ($500)* ($345) ($374)
Small Business Credits ($56) ($23) ($27)
Coverage Expansion ($779) / ($1279)* ($829)($848)
Physician Payment Updates n/a ($11) ($11)
Medicare Prescription Drug Coverage n/a ($21) ($23)
Measures to Slow Health Care Cost Growth ($24) ($14) ($17)
Other Spending Changes ($26) ($42)
Other Spending ($24)
 ($72) ($93)
Prescription Drug Cost Reductions X $28 $51
Medicare Advantage Cuts X $114 $119
Reductions in Provider Payment Updates X $163 $160
Medicare Premium Increase X $33 $36
Medicare Payment Commission X $22 $23
Measures to Slow Overall Health Care Cost Growth X $29 $26
Measures to Reduce Federal Health Care Spending X $135 $129
Spending Offsets X $524 $544
Excise Tax on High Cost Insurance X $201 $149
Tax Gap and Loopholes Closing X $17 $17
Limits to Health Care Tax Benefits X $42 $43
Fees on Health Care Companies and Taxes on Certain Heath Procedures X $121
Medicare Payroll Tax Increase for High Earners X n/a $54
Tax Increases X $382 $370
Interactions and Other Spending and Taxes
 $46 $49 $48
Budgetary Impact Subtotal ($669) / ($1169)* $81 $57
CLASS Act+  $58
 n/a $72
Total Budgetary Impact($611) / ($1111)* $81 $130
Tenth Year Budgetary Impact
Deficit Reduction in Second Decadeunknown 0.25% to 0.5% of GDP0.25% of GDP
Reduction in Uninsured21 million / 38 million*29 million
31 million
Numbers in billions, with positive numbers representing a reduction in the deficit
Sources: Congressional Budget Office, Joint Committee on Taxation, and Authors' Calculations
X = Not included within bill due to jurisdictional issues
*The HELP Committee bill includes no Medicaid expansion, due to jurisdictional issues. However, they have expressed their intent to do so, and CBO has provided a very rough estimate as to how much that would cost.
+The CLASS Act makes available government-sponsored long-term care insurance. Because this insurance would have a "vesting period," the provision appears to raise considerable amounts of revenue over the next decade. However, these revenues must ultimately be used to cover the program's costs, and therefore do nt belong in the bill as an offset.