It's not official yet, but it's getting awfully close. With the Senate finally passing an $871 billion reform bill, there's just one major step left before the most sweeping health care legislation in at least 45 years becomes law.
Senate negotiators will next meet with their counterparts in the House -- which passed its own $894 billion bill in November -- to work out the differences and try to forge one bill that Congress can present to President Barack Obama.
The last hurdle is a high one, though. Like most of the deliberations so far, the House-Senate negotiations will probably be rancorous and tense, with familiar standoffs over the cost of reform, new fees and taxes, the virtues of a public option, abortion coverage and pet projects rolled into the bill even though they have nothing to do with health care.
Obama had hoped to have a signed bill to tout during the annual State of the Union speech, which typically occurs in late January or early February. But the two chambers might still be dickering when Obama takes to the podium. Still, momentum is building toward a historic set of new rules that will profoundly change health care, for better or worse.
One reason the final negotiations will be so daunting is that both bills contain hundreds of provisions that would impose new rules on insurers, health care providers, employers and patients while also setting up numerous pilot programs to experiment with ways to provide better, cheaper care.
Here are a few provisions of the Senate bill that would affect consumers the most, with a summary of how the House bill compares:
The House bill is similar, with exemptions for certain low-income people.
2. Employer obligation: Companies with more than 200 employees would be required to enroll their workers in a health insurance plan, with no way for employees to opt out. Companies with more than 50 but fewer than 200 workers would not be required to offer insurance, but if they didn't, they'd have to pay a fee of $750 per employee each year, with some variations. Companies with fewer than 50 workers would not have to offer insurance or pay any fees.
The House bill would place similar requirements on employers, although with a different way of determining which companies are required to offer insurance.
3. Government-run health insurance, or the so-called public option: There is no public option in the Senate bill.
The House bill would establish a government-run insurer that would compete with private insurers, offering coverage to people not covered by their employers. The public option is one of the biggest differences between the House and Senate bills, and it is likely to be one of the biggest battles as health care reform hits the home stretch.
4. Insurance exchanges: This is how people would buy insurance if they didn't have an employer providing it. The structure is complicated, but basically these exchanges would be run by each state in conjunction with the federal government, and states would be allowed to create additional mechanisms for offering insurance to their residents.
Traditional insurance companies would be allowed to compete for customers through the exchanges, provided they met requirements set by the federal government. The least expensive plans would offer catastrophic coverage only and would not be available to everyone. There would be several other levels of coverage, priced more for each bump-up in benefits. The exchanges would go into effect in 2014.
The House bill includes similar reforms, although there would be an additional health insurance exchange at the national level. And the public health insurance plan (not included in the Senate bill) would compete with private plans on each of the exchanges.