WASHINGTON — President Barack Obama and House Speaker Nancy Pelosi said Wednesday that they expect to have a health care package before Congress by the end of July.
Their aim is to make medical coverage cheaper and more widely available, while reining in costs throughout the $2.5 trillion health care system.
The Senate could act even sooner. The insurance and pharmaceutical industries, which helped kill a similar effort championed by the Clinton administration 15 years ago, appear to be on board.
Based on discussions with White House aides, congressional sources and health policy experts, here are some of the basic questions about the effort:
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Q: How much will it cost?
A: The current guess is somewhere around $1.2 trillion over 10 years.
Q: Where will Washington find the money?
A: A number of ways are under discussion. It could be a combination of tax increases — possibly on alcohol, soft drinks and tobacco — and spending cuts in programs like Medicare, where overcharges run into the billions of dollars.
A possible revenue target could be the tax-free status of employer-provided health plans. It's unlikely Congress would eliminate it, but lawmakers could cap the benefit or make other changes. Tax-free flexible spending accounts could be affected as well.
Cost savings could come from changes such as bill bundling, so that a patient gets a single bill for care instead of several — from the doctor, the hospital and other parties involved in treatment.
"We need to keep all of the options on the table," said Democratic Sen. Max Baucus of Montana, chairman of the Senate Finance Committee and a key player in the debate.
Q: Will the effort ensure that everyone has coverage?
A: About 46 million people are without insurance, but possibly another 25 million are underinsured. That includes a third of all people who work for small businesses. They can't pay what's left of their medical bills after their own insurance kicks in. Universal coverage appears to have worked in Massachusetts, where only a small percentage of people remain uncovered after universal coverage passed in 2006.
Among the ideas are several alternatives for a public health insurance option that offers basic services, including primary, preventive, emergency, medical, surgical and maternity care.
Q. Won't a government-run option undercut the private insurance companies?
A. This is one of the thorniest issues in the debate. A public plan was a campaign promise of President Barack Obama. Most Democrats on Capitol Hill want to ensure that low-income people have an affordable insurance option. Some moderate Democrats are leery, however, as well as many Republicans and the insurance industry. They worry it could drive companies out of business. How the debate plays out could determine the outcome of the legislation, or at least whether it becomes a bipartisan effort.
Q: Will doctors, insurance companies or the government make health care decisions?
A: Supporters insist that doctors would. Opponents worry, however, that it could lead to more government control over private health care choices. Their concerns are grounded in a debate over the use of government-backed research into which kinds of treatments work and which don't, known as comparative effectiveness.
Health and Human Services Secretary Kathleen Sebelius recently told a House committee that comparative effectiveness can improve care.
"We want to highlight what we know works," she said.
Q: How will Medicare's looming financial problems affect health care?
It will likely be part of the solution.
"We can't solve Medicare in isolation from the broader problems of the health care system," Obama said earlier this year.
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