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What does health care bill mean to you

Given the Senate's difficulty in passing a bill, the final legislation negotiated with the House is likely to tilt toward the Senate version. Here's where things stand and how you might be affected.

What are the biggest disputes?

The biggest battles will come over how the legislation would be paid for, whether to include a government-run insurance plan and how much to spend on subsidies to help lower- and middle-income Americans afford insurance.

More questions and answers on Page 6A.

What about abortion?

Abortion remains perhaps the thorniest issue. The Senate bill would allow insurance plans that operate in newly created exchanges, or marketplaces, to offer abortion coverage, but enrollees would have to write separate checks for it. The House bill has even tighter language: Insurers in the exchanges that accept federal subsidies — which is likely to be most if not all of them — couldn't provide abortion coverage at all.

I don't have health insurance. Would I have to get it, and what happens if I don't?

Under both bills, most Americans would be required to have coverage or to pay a penalty. Some would be exempted from the requirement, called an individual mandate, due to financial hardship or religious reasons. Under the House bill, you'd have to have coverage by 2013 or pay up to 2.5 percent of your income; the penalty couldn't exceed the average cost of a plan sold in the exchanges.

The Senate version would take effect in 2014. The penalty for not having coverage would be $95 in 2014 or 0.5 percent of an individual's income, whichever is higher. The penalty would rise in 2016 to $750, or 2 percent of income, up to the cost of the cheapest plan.

I'm over 65. How would the legislation affect seniors?

The Medicare prescription-drug benefit would be improved substantially under both bills, though only the House bill would eliminate the sizable coverage gap called the "doughnut hole" by 2019. Both bills would enable most seniors to get half-price brand-name drugs when they hit the gap. The final bill to emerge from conference might favor the more generous House approach.

I want health coverage, but can't afford it. How would the legislation affect me?

Both bills would expand Medicaid, the state-federal program for poor people and those with disabilities, to include millions of people, including childless adults, who aren't generally eligible. Under the House bill, individuals with incomes up to 150 percent of the federal poverty level, or $16,245, would be eligible for Medicaid. Under the Senate bill, eligibility would reach 133 percent of poverty, or $14,404 for individuals.

Even if you make too much for Medicaid, you could get help buying private insurance in the new marketplaces, called exchanges. Both bills would provide billions of dollars for subsidies once premiums exceed a certain percentage of annual income. The subsidies end at four times the poverty level, $88,200 for a family of four.

How much is all this going to cost? Will it increase my taxes?

The House-passed bill is estimated to cost $1 trillion over a decade, the Senate bill $871 billion. The final measure probably will be closer to the Senate bill.

Both bills hit up the wealthy, but in different ways. The House would impose a 5.4 percent income tax surtax on individuals who earn more than $500,000 a year and couples that earn more than $1 million. The Senate would increase the Medicare payroll tax rate from 1.45 percent to 2.35 percent for people who earn more than $200,000 a year and families that earn more than $250,000.

To raise money to pay for the legislation, the Senate would impose a 40 percent tax on the portion of most employer-sponsored health coverage that exceeds $8,500 a year for individuals and $23,000 for families.

How would the legislation affect the kind of insurance I can buy? Would it make it easier for me to get coverage, even if I have health problems?

Both bills would make it easier for you to get coverage; insurers would be barred from rejecting applicants based on health status once the exchanges are operating, in 2013 in the House bill and 2014 in the Senate version.

In the meantime, both bills would create a temporary high-risk pool for people who have been rejected for coverage or have pre-existing medical conditions.

Under the bills, the exchanges initially would be open only to individuals who buy their own insurance and to certain small businesses.

I buy my own insurance. How would the legislation affect how much I pay?

Because insurers wouldn't be permitted to charge sick people more, their premiums might initially cost less compared with what they'd pay under current law. Younger, healthier people might pay more. Also, under the House bill, older people could be charged only two times more than younger people; in the Senate, older people could be charged up to three times more.

I understand that the public option isn't in the Senate bill. Is Congress still likely to approve it?

The Senate is unlikely to accept the government-run "public option" health insurance measure in the House bill. Instead, Senate Democrats would create large, privately run, multistate insurance plans and have the federal Office of Personnel Management administer them. Every exchange would offer at least two such plans, one of which must be nonprofit. The final deal is expected to include this Senate provision.

What does health care bill mean to you 12/24/09 [Last modified: Thursday, December 24, 2009 9:59pm]
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