ABC News Medical Editor
Nov. 5, 2008 -- Forty-seven million Americans -- most from working families -- have no health insurance, and 25 million more are considered "underinsured," meaning they have health insurance but not enough to protect them from high medical bills.
Now, with the fear of an economic recession, tens of millions of additional workers are worried about losing their health benefits if they lose or change jobs. The plans proposed by President-elect Barack Obama to address the situation reflect two very different ideas about health care reform.
Currently, 160 million Americans get their health insurance from an employer, and according to surveys from the Commonwealth Fund, a private foundation specializing in health policy research, most people want to keep it that way, for a variety of reasons.
"There are better premiums, there are better benefits … you've got a human resources manager to help you out if you've got a claim denied," Commonwealth Fund president Karen Davis said.
She says Americans will become cost-conscious if they have to pay their own way. And she cautions that the cost of the Obama plan to the federal government could be very high -- "between $60 billion to $120 billion more than the very expensive health care we already have," she said.
Health Care Reform Difficult Territory
There is one thing health policy experts we've spoken with over the course of this campaign agree on: Health care reform will not be a winner-take-all game for Obama.
"There's not going to be a plan that satisfies the right or that satisfies the left. There can only be a plan that represents some kind of a combination approach," said Drew Altman, president and CEO of the nonpartisan Kaiser Family Foundation.
"It will fundamentally depend on the Congress, and on the willingness of a president, to reach out and try to craft a bipartisan solution," said health economist Gail Wilensky, former Medicare head and an adviser to John McCain's campaign.
Davis also emphasizes the bipartisan role the president will have to play to steer government and business to work together on health care solutions that are cost-effective for both the family and federal budgets.
"We spend an enormous amount of money on administrative costs, because we have no leadership, no collaboration between the government sector and the private sector," Davis said.
Here are the major policy points of president-elect Obama's health care plan:
Health Care Under an Obama Administration
Expand Employer-Based Health Insurance Coverage: Under an Obama administration, employers will have to offer coverage to their employees or pay a tax to help cover the uninsured. Some small businesses will be exempt from this requirement. Low-income workers will be eligible for subsidies to purchase employer insurance.
Create a New Public Health Insurance Plan: The plan will be open to the uninsured, and employees who can't get health insurance through an employer. The plan is described as similar to Medicare.
Create a National Health Insurance Exchange: For those who want private insurance, the exchange will act as a watchdog and set up rules and standards for participating insurance plans to ensure affordability and accessibility. Approved plans will have benefits similar to what federal employees and members of Congress get.
Mandate Insurance Coverage for All Children: Children under 18 must be covered through parents' employer-sponsored insurance plans, through Medicaid or SCHIP, through the Public Plan or Exchange plan.
Control Costs With Insurance Industry Regulation and Electronic Medical Records: Plans to reduce a typical family's premium by $2,500 through savings gotten by Health IT investment and regulating the insurance industry by creating rules and standards.
Some critics of the Obama plan say it relies too much on big government, and that it will put a greater tax burden on some American companies.
Obama sees it another way: "Well, I think it should be a right for every American. In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills … there's something fundamentally wrong about that."