The Play-by-Play on Health Care

Sept. 18, 2009— -- It's been nearly two weeks since lawmakers returned from recess, and more than a week since President Obama delivered his speech to the joint session of Congress, but partisanship remains strong in the heated health care debate. At the same time, Americans are divided over the president's handling of the issue, but most agree that there is need for overhaul.

Here's a rundown on what's really happening in Washington and where things stand on health care legislation.

The Latest in Washington:

The push for health care overhaul continues in full force in Washington.

Senate Finance Committee Chairman Max Baucus, D-Mont., met with Democratic senators yesterday to make the case for his bill, which he unveiled Wednesday to a barrage of criticism, not just from Republicans but members of his own party.

On the other side of the Hill, members of a House committee this week heard both from private health insurance companies and Americans who are fighting their insurance firms.

'Gang of Four'

Meanwhile, the "Gang of Six" bipartisan group has led to a "Gang of Four," which includes two Democrats, one Republican and one Independent, Sen. Joe Lieberman, I-Conn.

Hailing Baucus' plan, the bipartisan group said in a statement it wants to exploit similarities rather than differences among lawmakers.

"Despite the differences that have emerged in this health care debate, there is much that we all agree on, including insurance market reforms that bar insurance companies from discriminating against people based on their health status or denying coverage due to pre-existing conditions," the statement said. "Each of us has an obligation to put aside partisan views and to consider how health care reform addresses the needs and challenges faced by individual citizens and our economy as a whole."

Off Capitol Hill, the president continued to try and drum up support for health care reform. On Thursday, he spoke at the University of Maryland about the importance of affordable, accessible health care.

"Health care's about more than the details of a policy. It's about what kind of country you want to be," Obama said.

"I'm going to seek common ground in the weeks ahead," the president said, referring to his Republican critics. "If you come to me with a set of serious proposals, I will be there to listen. My door is always open. But know this: I will not waste time with those who've made the calculation that it's better to kill health reform than to improve our health care system."

The White House also continued to tout "Obama Care" -- the plan outlined by the president last week -- as one that would save costs in the long term and provide more Americans with insurance.

First lady Michelle Obama has also taken to rallying Americans on the issue. Today, Mrs. Obama will deliver remarks at an event featuring stories about women and families affected by the current health care system.

Bills Galore

The list of proposals being discussed in Congress is virtually never-ending. The differences are not just between Republicans and Democrats. Even party members are divided on what they want to see in the final health care legislation. Two different versions of a health care bill are circulating in the Senate and members of the House have their own ideas about what reform should entail. Here's a breakdown of some of the proposals under discussion:

Senate Finance Committee Bill:

Baucus' bill, proposed after weeks of closed-door negotiations with both party members, is the latest to add fuel to the already fiery debate on health care. Despite bipartisan negotiations, committee members have yet to jump on board to Baucus' proposal, and more changes are likely to be made before they do sign.

The bill is expected to cost $856 billion over the next 10 years. It is the bill that comes closest to what Obama called for in his address to Congress last week, and was put together after weeks of closed-door meetings with a group of Republican and Democratic senators in the finance committee.

Under the plan, all Americans would be required to hold health insurance and would pay a penalty if they do not -- up to $950 for individuals and $3,800 for families.

It would also impose a 35 percent excise tax on premiums for plans costing more than $8,000 for individuals and $21,000 for families.

The plan encourages health care cooperatives, which are member-owned, non-profit companies that compete with private insurance providers.

It also bars insurance companies from denying coverage based on pre-existing conditions, and charging people with more serious health problems higher payments, although there is flexibility to that rule.

Baucus is also suggesting a Web-based insurance exchange system, by which Americans would be able to compare and purchase their plans on the Internet.

The bill would expand Medicaid benefits, allowing more people to become eligible. Baucus' plan would make all parents, children, pregnant women and childless adults at or below 133 percent of the federal poverty level eligible for Medicaid. It also includes provisions to help those with household incomes of less than $66,000 to buy insurance.

Illegal immigrants and abortions -- two points of contention for some Republicans -- would not be covered under the bill.

Senate HELP Bill:

The Senate Health, Education, Labor and Pensions Committee's bill, passed on July 15 on a 13-10 party-line vote, boasts a price tag of $615 billion over 10 years.

Like the Baucus bill, it requires everyone to carry health insurance, and individuals will face a hefty fine if they don't comply. Employers who don't provide coverage to their workers will pay a penalty of $750 a year for each full-time worker. Companies with 25 or fewer workers are exempted.

This committee's bill does include a "public option," a government-run insurance program that would compete with private insurers. The idea was proposed by the late Sen. Ted Kennedy, who said his vision was to see all Americans receive affordable and accessible health care.

The plan prevents insurance companies from denying coverage based on pre-existing conditions, and also prevents them from placing annual or lifetime limits on coverage.

The plan would also create a voluntary insurance program, under which the government would provide some cash to help disabled people stay in their own homes instead of transferring to nursing homes. It also includes subsidies and financial assistance for low income families to help them purchase health insurance.

House Democratic Bill:

The key feature of the House Democrats' bill is the option for a government-run insurance plan. Many Democratic lawmakers say they will not sign any bill unless that provision is included in some form.

The key criticism of the plan is that it would cost more than $1 trillion over 10 years, according to estimates by the nonpartisan Congressional Budget Office.

The bill would impose new taxes on individuals making more than $280,000 a year, and couples making more than $350,000. It would raise revenues by making cuts in Medicare and Medicaid, and hiking taxes for businesses.

Like the Senate plans, it mandates health coverage. Individuals would pay a penalty of 2.5 percent of income if they are not covered, and employers would pay a penalty of 8 percent of payroll.

It also presents the option of a health insurance exchange by which individuals and small businesses can choose their plan.

House Republican Plan:

The House GOP leadership has not provided a cost estimate of its plan, except to say it would cost less than the Democratic plan.

The plan's goals are, House Republican leaders say, to make quality health care affordable and accessible; prevent Americans from being forced into a new government-run health care plan; let Americans who like their coverage keep it; ensure that medical decisions are made by patients and their doctors rather than by the government; and improve Americans' lives through effective prevention, wellness and disease management programs.

Unlike the Democrats' bill, it does not require individuals to have health insurance and does not offer an insurance exchange mechanism.

Republicans insist that medical malpractice reform should also be a part of any health care legislation that passes Congress, although they did not specify that in their proposals.

Best-Case Scenario for Democrats:

House Democrats, including Speaker Nancy Pelosi, D-Calif., have expressed optimism that there are enough votes to pass a health care overhaul bill. But the question is whether there will be enough votes in the Senate to garner support. In Kennedy's absence, Democrats will need the support of moderate Republicans to pass legislation, but it remains unclear whether there will be ample votes.

Democratic senators are adamant to move ahead with a health care bill.

"We'll either do a health care bill on a bipartisan basis or -- I hope we don't have to do this -- but if we can't get the 60 votes we need, then we'll have no alternative but to do reconciliation. I strongly favor a bipartisan approach," Senate Majority Leader Harry Reid, D-Nev., told reporters Tuesday.

In a news conference Wednesday, Baucus expressed confidence that the final bill will have bipartisan support.

"No Republican has offered his or her support at this moment, but I think by the time we get to final passage, in this committee, you'll find Republican support," he told reporters.

What Happens in September:

Next week, the finance committee will debate and vote on Baucus' bill, before it is presented on the Senate floor.

Sticking Points:

Public Option: Republicans have still not warmed up to the idea of a government-run insurance plan that would compete with private insurance companies. The president continues to push for a public option, but has not issued an ultimatum that he will not pass a bill that doesn't include one. Instead, White House officials say they are open to alternatives. But some Democrats say they won't sign a bill without some form of a public option.

"A public option will be in the bill that passes the House of Representatives," Pelosi told reporters Thursday.

An alternative presented by some, including GOP Sen. Olympia Snowe, is a "trigger" mechanism, by which a public option would come into play if private insurance companies fail to provide affordable coverage to Americans.

Tort Reform: Republicans want to see measures implemented that would give doctors some protection against medical malpractice lawsuits, and cut their costs.

Cost: Obama has said he will not sign a bill that adds to the deficit, but Republicans are not convinced. Instead, GOP leaders are lashing out at Democrats' proposed cost cuts in Medicare and Medicaid.

"Even if they were able to make it deficit-neutral -- which the American people don't believe is possible and most of us are skeptical about -- you're looking at a minimum of $400 billion of cuts in Medicare, not to make Medicare more sustainable, not to make it solvent somewhere in the future, but to transfer those funds to those who are currently uninsured," said Senate Minority Leader Mitch McConnell, R-Ky.

ABC News' Jonathan Karl and Z. Byron Wolf contributed to this report.