President Obama's attempt to reform the US healthcare system is one of the most ambitious and complicated legislative efforts Washington has seen in decades. At the same time, the national debate over the effort has become so loud and confusing that ordinary voters may have trouble figuring out what's really going on.
With members of Congress on break, now may be a good time to try to sort out fact from assumption. So for all those who don't have time to read the thousands of pages of proposed legislation, or listen to hours of C-Span debate, here is a quick summary of the legislative basics:
Health insurance: You'd have to have it. Perhaps the centerpiece of both House and Senate efforts is a requirement that individuals obtain health insurance, or pay a penalty to the government. The analogy is inexact, but health insurance might become more like auto insurance: something you are supposed to have to participate in national society.
For those who have coverage now, this would be no big deal. But for some segments of the population, it could force a radical change in behavior. So all you twenty-somethings who have long figured you don't need health insurance, take note: That approach might be out the window.
But the Feds might help you pay for it. Health insurance is expensive, so if the government is going to require that you buy it, Washington should subsidize those who cannot afford it. That is the thinking behind the subsidy portion of the effort.
Both House and Senate efforts contain subsidy provisions. The House bill would help support housholds earning up to 400 percent of the poverty level, or about $88,000. That cap may end up being lower in the Senate version of the legislation, to help pare the bill's cost.
Your employer might have to help out. Employers would also have to kick in and help their workers get health coverage –under the House plan and one of the two draft Senate bills. They would have to foot the bill for 60 to 65 percent of the cost of family health premiums.
Small businesses probably would be exempt from this provision, though the definition of "small" remains up in the air. The House, for example, excuses employers with a payroll smaller than $500,000 from this mandate.
Uncle Sam might get into the insurance business. Or not. One of the biggest disputes surrouding health reform is whether there needs to be a public health-insurance plan, to provide competition to private insurers and cover people in areas that have few health-insurance options.
Of course, Washington is already in the health coverage business, in a big way. Between Medicare and Medicaid, the US government accounts for some 25 percent of all health spending in the country. And Medicaid, the program that covers low-income and disabled Americans, would get larger under both House and Senate reform bills.
The House, for instance, would enlarge Medicaid to cover households that earn less than 133 percent of the federal poverty level.
The House would also set up a government-run plan that anyone could buy into, if they want – the so-called "public option." But this is controversial with many Republicans, who see it as the leading edge of greater government control in healthcare. Thus the Senate is considering a consumer-run insurance cooperative as an option.
So that's it – the bare-bones guide to health reform's structure. These changes raise as many questions as they answer, of course. Would current insurance stay the same? Would Medicare be affected? Would Washington ration heathcare? All important subjects – and possible topics for further stories.