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The health care debate has so many moving parts that it's hard for anybody to keep them straight. So we decided to put together an overview of where we're at—both good and bad—and what we're all going to need to keep fighting for.

Neither of these bills is close to perfect. But we're entering the home stretch where we risk losing a lot of what's good in these bills and where we have a huge opportunity to strengthen the parts that need work.

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The House of Representatives passed their bill last month. The Senate is aiming to pass its version before Christmas.

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  • cheap lipitor The bills create a one-stop marketplace where people can choose from various insurance plans, including the public option. The details aren't set yet, but initially the Exchange would likely be open to the self-employed, people without insurance at work, and small businesses.1 The key with the Exchange is that it brings "the bargaining power and scale that's generally accessible only to large employers" to individuals—and with that, lower costs and better options.2
  • cheap lipitorThe House bill would expand coverage to 36 million people by 2019. The Senate bill extends coverage to 31 million.3
  • cheap lipitor Insurance companies will have to stop denying coverage to people with "pre-existing conditions." And they won't be allowed to charge women more than men for the same coverage.4


  • cheap lipitorThe bills differ on some details, but in general would place limits on how much people have to pay for health care beyond their premiums. They both cap out-of-pocket costs and ban insurance companies from setting limits on how much health care they'll cover for a person each year.5

Of course, the devil is in the details, and much in these bills still needs work.

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  • cheap lipitor The House bill leaves 18 million without insurance in 2019; the Senate bill, 24 million. Neither comes close to the vision for universal coverage so many of us fought for for years. We'll all need to fight to continue to expand coverage in the bills this year, and in the years to come.6
  • cheap lipitor The public option is a core piece of reform that will create real accountability and competition for private insurance—and that's why it's at the center of such a huge fight. While the House bill creates a national public option, the Senate lets states opt out, denying their residents access to it. Plus, conservatives are working to weaken it even more. We're all going to have to fight hard for the strongest version possible.7
  • cheap lipitor While some pieces of reform go into effect right away, the larger structural changes are not scheduled to go into effect until 2013 (House bill) or 2014 (Senate bill). This includes the Exchange, the public option, and subsidies—the major ways coverage will be expanded.8
  • cheap lipitorBoth bills require virtually all Americans to have insurance. But the caps on how much we're expected to pay are way too high, and the subsidies are way too low. Many progressives are working to fix this, but it's going to be a significant fight.9
  • cheap lipitorcheap lipitor An egregious anti-choice amendment in the bill virtually prohibits anyone purchasing insurance in the Exchange from buying a plan that covers abortion—even if paid for with their own money. We need to make sure the final bill doesn't include this rollback of reproductive rights.10
  • cheap lipitorThe current Senate legislation retains a version of what's called the "free rider" provision, which essentially penalizes employers for hiring lower income workers. This provision needs to be fixed before the bill is finalized.11

cheap lipitor Check out more about the House bill here and the Senate bill here or here, and see what the impact of reform would be in your state here. If you want to read the full bills, for the House, click here or here (PDF), and for the Senate, here or here (PDF).


1.  "A Health Insurance Exchange: The Fine Print," The New York Times, August 20, 2009

"Health Reform at a Glance: The Health Insurance Exchange,"  House Committees on Ways and Means, Energy and Commerce, and Education and Labor, July 14, 2009

2. "Health Insurance Exchanges: The Most Important, Undernoticed Part of Health Reform," The Washington Post, June 16, 2009

3. "H.R. 3962, Affordable Health Care for America Act," Congressional Budget Office, November 20, 2009

"Patient Protection and Affordable Care Act," Congressional Budget Office, November 18, 2009

4. "Top 10 Ways Health Insurance Reform Works for You," The Speaker of the House, October 29, 2009

"How Health Insurance Reform Will Help Your Family," Senate Democratic Policy Committee

"Meeting Women's Health Care Needs," The Speaker of the House

5. "Top 10 Ways Health Insurance Reform Works for You," The Speaker of the House, October 29, 2009

"REPORT: How the Senate Bill Compares to Other Reform Legislation," Think Progress, November 19, 2009

7. "Sen. Reid Announces 'Opt Out' Public Plan," The New York Times, October 26, 2009

"Carper: Conservative Democrats Not Likely To Support Senate Public Option," Talking Points Memo, November 17, 2009

8. "Top 14 Provisions That Take Effect Immediately," The Speaker of the House

"What happens before 2014?" The Washington Post, November 19, 2009

"Senate, House Democratic health bills compared," The Associated Press, November 18, 2009

9. "The Details of The New Merged Senate Bill," Think Progress, November 18, 2009

"REPORT: How the Senate Bill Compares to Other Reform Legislation," Think Progress, November 19, 2009

"Analysis: How the Senate health care bill stacks up with the House health care bill," Think Progress, November 19, 2009

10. "The Ban on Abortion Coverage," The New York Times, November 9, 2009

11. "The noxious 'free rider' provision," The Washington Post, November 25, 2009

"Senate Health Bill Improves Employer Responsibility Provision," Center on Budget and Policy Priorities, November 19, 2009

"The Baucus Bill: The Worst Policy in the Bill, and Possibly in the World," The Washington Post, September 16, 2009


Next meeting "The United States of ALEC" Wednesday, April 3rd

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