Public option. Individual Mandate. Doughnut Hole. Excise tax.
These terms are so complicated, and so abstract, it's no wonder that more than half of Americans, according to a recent poll, say they still don't know what the Democrats' healthcare bill contains.
Here's a cursory look at what's in the legislation that the House of Representatives passed last night—and what didn't make the final cut. See a slide show of the 10 things that are (and aren't) in the healthcare bill.
1. Insurance for millions
Under the legislation, 32 million more people will have health insurance in 2019 than without the bill. That means that about 94 percent of all U.S. citizens will have insurance by the end of the decade. That still falls short of "universal coverage," but it's a significant increase from the 83 percent of American citizens who are covered today.
2. Coverage for people with pre-existing conditions
Right now, insurance companies can deny coverage to people with "pre-existing conditions," like cancer and heart disease, to name just two of many. The healthcare bill would ban this practice.
3. Help buying insurance
Lower-income Americans who can't afford to buy insurance will get help in one of two ways. The bill expands Medicaid, the free government plan for the poor and disabled, to anyone making up to about $15,000 a year. (About 16 million new people are expected to go into Medicaid or the Children's Health Insurance Program because of the bill.) Second, it would provide subsidies to people who aren't poor enough to qualify for Medicaid but still struggle to afford insurance. Individuals making up to about $44,000 would qualify for some kind of subsidy. And for people who don't get insurance from their employers, they'd be able to shop for plans on new insurance exchanges.
4. Help for prescription drugs
Right off the bat, the bill will give seniors a $250 rebate to help pay for prescription drugs. Over the next decade, it also will get rid of the so-called doughnut hole (Medicare, thanks to quirks of past laws, helps cover seniors who spend either less than $2,700 or more than about $6,150 on prescription drugs, but nothing in the middle). To put it simply, seniors will get much more help paying for drugs.
5. Penalties for people who don't buy insurance and companies that don't offer it
The bill has what's called an "individual mandate," which means that most Americans, starting in 2014, must have insurance or face a penalty. The penalty would be $95 or 1 percent of income (whichever is greater) in 2014 and go up to $695 or 2.5 percent of income in 2016. The bill also includes an "employer mandate," which means that most businesses that don't offer insurance to their employees will face a penalty, too. Companies with fewer than 50 workers would be exempt.
6. No "public option"
Much of the debate in the past year was consumed by talk about the "public option," which was pushed by liberal Democrats who wanted the government to provide an alternative to private insurance plans. The House included it in its bill last fall, but the Senate, in order to get to 60 votes, did not. The final bill doesn't have the public option, either.
7. No traditional Medicare cuts
Seniors won't see cuts to their regular Medicare benefits. Those who have Medicare Advantage, however, may see some changes. Medicare Advantage plans, which are paid for by the government but administered by private companies, offer extra benefits like eye care and dental visits. These plans, on average, cost the government about 15 percent more per person than regular Medicare. In an effort to cut spending, the bill gradually cuts the amount the government will give private insurers to offer Medicare Advantage, which may lead to insurers dropping benefits or dropping out altogether.
8. Higher taxes for the wealthy
To help pay its $940 billion price, the bill raises certain taxes on individuals making more than $200,000 a year and couples making over $250,000. For example, the Medicare payroll tax would rise (for these individuals), as would taxes on some investments.
9. Cutting the deficit
Even though Republicans say the bill is too expensive and spends wastefully, the Congressional Budget Office says that it will actually help cut the deficit, by more than $130 billion in its first 10 years and more than a trillion in the second 10 years. That said, the CBO admits that there's considerable uncertainty in its estimates.
10. Making healthcare cheaper
The cost of healthcare for Americans (and the amount the government spends on healthcare) has been rising for more than a while now. The bill has several ideas for "controlling costs," including experiments to pay hospitals and doctors a lump sum for treating a particular patient, rather than paying them for every single test and procedure they provide. There are also programs in the bill to bring medicine into the digital age. Experts say these ideas could be game-changing, but it's too early to tell if they'll actually work.
- See photos from the final week of the healthcare debate.
- See a slide show of the 10 keys to an Obama comeback.
Corrected on 3/23/10: A previous version of this article incorrectly implied that the government-insurance program for the poor is Medicare. Medicaid is the insurance program for the poor.