Health Care Reform Would Entail Major Changes for Americans

Oct. 22, 2009— -- Democratic senators and White House officials are working behind closed doors to hash out final health care legislation that they hope will pass on the floor.

The main issue is how to resolve the differences between the bill passed by the Senate Finance Committee and the Health, Education, Labor and Pensions Committee in June.

Meanwhile, the Congressional Budget Office (CBO) will review the House bill to assess its costs. Previous legislation was pegged at more than $1 trillion and President Obama has put the threshold at $900 billion for a suitable plan.

Democratic lawmakers insist that health care legislation will pass, that it's just a matter of when and what it will include. White House officials, including Chief of Staff Rahm Emanuel and director of the Office of Health Reform Nancy-Ann DeParle, have been closely involved in negotiations with leaders in the Senate. Even Obama is trying to fire up his own party to get momentum and quick action.

"Sometimes Democrats can be their own worst enemies," the president said during a speech in New York City Tuesday. "Democrats are an opinionated bunch. You know the other side, they just kind of do what they're told. Democrats -- ya'll [are] thinking for yourselves. I like that in you, but it's time for us to make sure that we finish the job here, we are this close and we've got to be unified."

At a separate event that same day, Obama expressed confidence about the negotiations.

"We've got people who are engaging even if they don't want to engage," he said, "because they are realizing it's not a matter of what, it's a matter of when."

Most Americans agree that health care reform is needed, but they differ on what an overhaul should entail and on the elements of the different plans being proposed. Costs are a key concern among both lawmakers and the public. An ABC News/Washington Post poll found that 68 percent of Americans thought reform would increase the federal budget deficit, but from that group, nearly half -- 46 percent -- said it's still worth it.

Whatever the final bill, any overhaul in the nation's health care system likely will impact all Americans, even those who are already covered. Here's a look at some key components being discussed by lawmakers in the Senate and what they mean for Americans:

The idea of a government-run insurance option is one of the main points of contention, not just between the right and the left, but among Democrats themselves.

In the summer, Democratic lawmakers faced rowdy constituents protesting the idea of government involvement in their health decisions, but an ABC News/Washington Poll released this week found that a majority of Americans -- 57 percent -- actually do support a public option. That figured jumped to 76 percent if a public option is limited to those who can't get affordable private insurance. In fact, Americans in the poll, by 51-37 percent, said they'd rather see Democrats pass a plan without Republican support if it included a public option based on affordability, than pass a plan with Republican backing but no such option.

Because the plan proposed by Senate Finance Committee Chairman Max Baucus, D-Mont., includes no such option, and the one by the health committee does, several lawmakers have attempted to propose variations.

Senators are leaning toward a plan proposed by Sen. Chuck Schumer, D-N.Y., in which states would be able to opt out of a government-run insurance option.

Another option on the table is that of a "trigger" public option, a plan pushed by Maine Sen. Olympia Snowe, the only Republican to vote for a Democratic health care bill. Under this plan, a public option would go into effect in those areas where private insurers failed to provide affordable, accessible coverage to Americans.

Baucus said instead of a public option -- which he claims will not garner enough votes on the Senate floor to pass a bill -- member-owned, nonprofit co-operatives would be able to better compete with private insurance providers.