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A quick update on health care

Sun., Aug. 2, 2009

Amid a flurry of activity on health care legislation, the House left Friday for its monthlong summer recess. The Senate will take off Aug. 7.

Here is an update on where the debate stands in Washington:

Q. Has Congress agreed on how to ensure that all Americans will be able get health insurance?

A. The two major bills that have cleared committees in the House and Senate would establish insurance marketplaces, or exchanges, through which individuals and small businesses could compare a variety of plans that meet basic standards to be established by the federal government. Those exchanges would feature private plans as well as a government insurance program, which advocates say would put pressure on commercial insurers to lower costs and improve quality. The federal government would provide subsidies to help low- and moderate-income people afford the insurance.

Q. Does that mean there will be a government plan?

A. Not necessarily. The government plan remains very controversial because some fear it could ultimately drive private insurers out of business. The nonpartisan Congressional Budget Office, which is charged with evaluating the effects of legislation, has estimated that would not happen. But because Republicans and some centrist Democrats object to a government plan, a bipartisan group of lawmakers in the Senate Finance Committee is trying to develop an alternative. That might be a system of health insurance cooperatives owned by consumers.

Q. Will these exchanges really control the cost of health care?

A. Not by themselves. The two major bills include other provisions designed to encourage Americans to be healthier, such as eliminating co-pays for some check-ups and other preventive care. Many believe that will ultimately save money. The House bill also contains several pilot programs in Medicare to encourage hospitals and doctors to be more efficient in how they deliver care.

Q. Would that mean that Congress won’t raise taxes to pay for this health care overhaul?

A. That’s still not clear. The House bill would assess a new surtax on individuals making more than $280,000 and couples making $350,000 a year to raise $544 billion to help offset the cost of the legislation. In the Senate, where there is little support for a new income tax, lawmakers are talking about other proposals, including taxing some health benefits or assessing fees on insurance companies.

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