Key Proposals and here is a refresher on the main proposals before Congress !
Expanding Medicaid
Most uninsured Americans are in working families, and most have low incomes, so many of the uninsured stand to benefit from proposals to expand Medicaid, the federal-state program for the poor. The idea is to allow people with incomes above the poverty level into Medicaid. In some proposals, this would include people who make up to 150 percent of the federal poverty level ($16,245 for an individual; $33,075 for a family of four). One proposal is to allow these people to keep Medicaid for five years, then require them to sign up for coverage through one of the new private insurance exchanges. Expanding Medicaid could reach 20 million more people in a program that already exists throughout the nation. That's more than 40 percent of the uninsured.
One problem: State Medicaid programs are all over the map when it comes to the benefits they provide. And in a bad economy, states are in no position to pay their share of a larger program.
Expanding Medicare
Allowing people ages 55 to 64 to buy into Medicare would give a new alternative to these 24 million "pre-Medicare" people, 5 million of whom are uninsured. Medicare, established in 1965, is familiar to many people, and popular. It would be relatively easy to open it to younger beneficiaries. The cost, however, may keep people at bay. Many couldn't afford to buy Medicare at full cost — that is, without the subsidy currently provided to those older than 65. Health care providers complain that Medicare payment rates are too low, so expanding the program jeopardizes their bottom line.
Insurance Exchanges
A way of bringing buyers and sellers together, providing one-stop shopping among an array of competing health plans. To be listed on the exchange, all plans would have to meet minimum coverage standards, provide a minimum package of benefits and explain themselves in clear language. Exchanges could solve one of the biggest problems in the current health insurance marketplace: It's hard to comparison-shop. They also might allow employers to offer a wider range of choices, instead of negotiating with insurers one at a time as they do now.
But exchanges only work in areas that have enough plans to choose from, and many areas have only two health plans available. Some say exchanges have no record of reducing premiums.
Mandating Insurance
The government would require you to purchase insurance — with subsidies for those who can't afford it — or pay a tax penalty. Some propose a mandate on most employers to offer coverage, too. Requiring everyone to purchase insurance is key to making a universal system work in the U.S. Here's why: When the uninsured fall sick and can't pay their bills, it costs everyone money. Hospitals and doctors recoup their losses by charging insurance companies more. Insurers, in turn, pass that cost on to their clients, through higher premiums. In essence, people with health insurance are helping to cover the costs of the 46 million people who are uninsured.
A fundamental question: Should the government tell individuals or companies how to spend their money? A mandate on employers also could limit wage increases and discourage hiring. Minimum-wage workers could lose their jobs if employers have to cut costs to satisfy the mandate.
New Coverage Standards
At a minimum, many say a new health care law should reduce the most glaring inequities and stabilize coverage for people who don't have access to workplace-based insurance. Requirements would include banning insurers from refusing coverage based on pre-existing conditions. Also there would be strict limits on how much premiums could vary based on age, place of residence and other individual characteristics. These new requirements may appear simple, but they won't work without some others — such as a mandate that virtually everyone buy coverage. Otherwise, they could drive up premiums as older or sicker individuals buy coverage while younger, healthier people don't.
Public Plan
A government-run health plan similar to Medicare but without age restrictions. Care would be provided by existing hospitals, doctors and others. Another model is the plans that public employees have in many states.
Proponents say a public plan would set the pace for private insurers, forcing them to be more efficient. Opponents fear that a public plan would have an unfair advantage and draw people out of private health plans, making them financially unviable. That would pave the way for a government takeover of all health insurance. Possible compromise: Nonprofit health "cooperatives" owned by members, launched with federal startup funds.
Subsidizing Coverage
Under the leading proposals, the government would come to the rescue if you can't afford insurance that meets your needs. Details vary, but in general you'd get varying degrees of subsidy if your income is up to five times the poverty level ($54,150 for an individual; $110,250 for a family of four). Small employers would also get a subsidy to encourage them to cover workers. Again, cost is a factor. Critics balk at the $723 billion to $1 trillion price tag for subsidies over 10 years. Government subsidies might also prompt employers of lower-income workers to drop coverage — or not to start offering it.
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