As Congress moves closer to a health care reform bill -- one that would affect the lives of almost all Americans and businesses -- key questions come to the fore:
1. Will there be a bill this year? Probably. There are still huge differences to resolve, such as whether to offer a public option and how to cover the projected cost of about $900 billion over 10 years. But Democrats are determined to pass a bill, and President Barack Obama will twist as many arms as he has to.
2. What happens next? The painful process of melding five very different bills approved by five separate House and Senate committees into a single measure. Senate Majority Leader Harry Reid, D-Nev., is leading the Senate discussions, trying to appease both the liberal and conservative wings of his party. He needs virtually every vote in his caucus to overcome Republican efforts to filibuster. In the House, Speaker Nancy Pelosi, D-Calif., is readying a bill for floor action.
3. What about Republicans? The final result wouldn't be bipartisan. One or two Republicans might vote for the legislation -- which includes some ideas offered by Republicans -- but by and large, it would be a Democratic bill.
4. What are the key elements? They include a mandate requiring individuals to buy coverage or pay a penalty, an expansion of Medicaid, subsidies to help people who make too much money to qualify for Medicaid but not enough to buy insurance, and rules requiring insurers to sell to all applicants, regardless of pre-existing conditions. Also expected in a final bill are new exchanges, or marketplaces, intended to make it easier for buyers to shop for coverage, thus fostering competition. That would mean 25 million uninsured people in 10 years, down from a projected 60 million.
5. Would it cost more for employers that offer coverage now? It's not designed to. If fewer people were uninsured, premiums would decline for others because the cost of treating the uninsured wouldn't be as burdensome. And employers would greatly benefit if the overhaul reined in long-term costs. Reform also might help pay for retiree coverage.
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6. What about small companies? Companies with fewer than 25 workers would get tax credits if they offered plans, and they could use the exchanges to get more-competitive rates. The exchanges would force insurers to compete with each other. They would add options for individuals and companies, many of which now have only limited and expensive choices.
7. Would companies face penalties for not offering coverage? There would be no mandate requiring coverage, but employers that didn't offer it would face some costs. They would have to reimburse Uncle Sam for any subsidies provided to the company's workers when those employees bought their own health coverage.
8. Will there be a public option? The odds are improving, but there is still a lot of opposition. If the provision survives, it will be limited in scope and availability. Most likely is a low-cost, bare-bones government option to compete with similar private insurance plans, but it would be available only to those who didn't have coverage through their employers. And individual states would probably be allowed to opt out.
9. Would the health care bill raise the deficit? In theory, no, but we're skeptical. Congress won't pass a bill unless it's officially certified as revenue-neutral by the Congressional Budget Office. But the CBO can make only an educated guess based on a slew of assumptions. There's no guarantee.
10. How would the enhanced coverage be paid for? Through tax increases and Medicare cuts.
11. What kinds of taxes? We don't know yet. The House wants a 5.4% surcharge on singles making more than $500,000 a year and on couples earning more than $1 million. The Senate prefers fees on the health care industry and a tax on high-priced health plans. Critics say fees would backfire, leading to higher medical costs and higher premiums, basically undercutting the bill's goals.
Because of the opposition to these ideas, some lawmakers are going back to the drawing board to come up with new ones.
In other ways, though, Medicare benefits would be expanded. For example, seniors would see enhanced prescription benefits and free access to many prevention services.
13. When would it take effect? It would likely be phased in beginning in 2013.
14. What are the political implications for Obama? Huge. That's why the president is expected to play a much greater role in the health care endgame. Failure to pass a bill this year could cripple his influence on Capitol Hill, making it even harder for him to achieve other goals, such as climate-change legislation.
15. What about the congressional elections next year? Health care will be a critical issue -- second only to jobs -- in the 2010 elections. Any reform bill that passes will not have taken effect yet, but everyone will have strong opinions about it. Republican candidates will attack Democrats for favoring big-government takeovers and for adding to the deficit. Democrats can claim they finally took comprehensive action on health care after several decades of trying unsuccessfully to reform the system.Published Oct. 28, 2009
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