The White House and congressional Democrats are pushing to reform the nation's healthcare system by the end of 2009. According to the U.S. Census Bureau, 46.3 million of Americans live without health insurance. The goal is to provide options for them as well as strengthening the system so fewer people are denied coverage for important procedures. But there are many details to be worked out.
There are several congressional committees with jurisdiction over healthcare, so there are several different plans being considered. Each plan has different requirements for individuals to get coverage, business to require coverage and for insurance companies to not deny benefits for "pre-existing conditions." The plans also have different outlines on how the government will pay for the program, which could cost between $615 billion and $1.6 trillion over the next 10 years.
The Public Option
The most controversial idea is for a "public option," which would essentially create a federal government-run healthcare plan. Democrats believe a non-profit competitor would force other healthcare providers to lower costs and improve the level of service. But opponents believe employers will simply drop coverage and force employees to choose the government program instead.
An alternative to the public option is a healthcare exchange, which would allow individuals and small business to shop for the best plan, the way larger companies do. The plan would create a virtual marketplace, with the government ensuring that insurance companies could not deny candidates with pre-existing conditions or fluctuate costs.
Another option is a "trigger," which would create a government plan only if private insurers did not improve services and lower costs. That would push insurance companies to move quickly, for fear of facing competition from the government option.
The Democrats' plans also would require individuals to get health insurance. People who did not purchase healthcare plans would face penalties, similar to mandates for car insurance. There would be waivers, however, for the poor. A bill that has passed several committees in the House of Representatives would tax people 2.5% of their income if they did not have health insurance.
Businesses would also face penalties if they did not offer insurance to employees, although small businesses (those with less than 50 employees) would be exempt from this provision as well.
Republicans oppose mandates for individuals and businesses. They have suggested tax credits for small businesses that offer insurance instead. Obama also opposed mandated insurance when he ran for president in 2008, but now supports the proposal.
Democrats have suggested one way to pay for the healthcare reforms is through taxes on so-called "Cadillac plans," the most expensive health insurance plans available. The Senate Finance Committee has offered a tax on insurance companies for 40% of premiums for insurance plans that cost more than $8,000 for an individual or $21,000 for a family.
Other ways to pay for the bill include fees for insurance companies, drugmakers and medical device manufacturers. Republicans oppose new taxes to pay for the reforms. Democrats have also left open the option of increasing taxes on the wealthy.
Both parties believe a large portion of the reform can be paid for by reducing waste from the Medicare and Medicaid system. But the Congressional Budget Office has raised doubts about how much money will be saved.
A Heated Debate
Since the debate began in Spring 2009, the conversation has gotten nasty at times. One Republican congressman was rebuked for yelling "You lie!" during President Obama's speech to Congress in early September.
Some Republicans have said the plans would lead to "death panels," where people will judge someone's level of productivity in society before determining whether to pay for certain procedures. Others have suggested the elderly would be forced to receive counseling on how to end their lives sooner. Independent groups, like PolitFact, have found no language in the bills that would mandate these provisions.
Rep. Joe Wilson (R-S.C.) lashed out after President Obama said that no illegal immigrants would receive government health insurance under his plan. But PolitiFact found that illegal immigrants would not be eligible for tax credits and other provisions to buy health insurance at a reduced cost.
Headed for the Floor
Several different bills have been approved by committees in the Senate and House of Representatives. The bills will be merged into separate legislation in the House and Senate, which will be debated on the floors of both chambers. Democratic leaders in both the House and the Senate have set a goal of completing healthcare reform by the end of 2009.