WASHINGTON - Health-care overhaul now looks like it really will happen, with a compromise coming together in the Senate to give uninsured Americans options they've never had before. But it won't be a free ride.
Have your checkbooks and credit cards ready. There's a price for health-care security - particularly for solid middle-class households, who wouldn't get much help with premiums.
President Obama hailed the Senate agreement yesterday, building expectations that the yearlong fight over revamping health care had finally come down to the bill now emerging.
That measure, like the Medicare prescription-drug benefit that passed when Republicans ran Washington, would offer consumers a dizzying lineup of health-plan choices - with different costs and benefits.
"People who need to buy coverage as individuals and small employers are going to have a lot more in the way of attractive health-insurance options, and they won't have to worry about whether their medical condition precludes them from being covered," said policy expert Paul Ginsburg, who heads the nonpartisan Center for Studying Health System Change.
The downside: "Sticker shock is going to come to some."
Get ready for a whole new set of trade-offs.
For example, people in their 50s and early 60s, when health problems tend to surface, are likely to pay less than they would now. Those in their 20s and 30s, who get the best deals today, will face higher premiums, though for better coverage.
The tentative deal by Democratic senators would give millions of Americans the option of signing up for private plans sponsored by the federal employee health system, which covers some 8 million, including members of Congress. The compromise, which also offers people age 55 to 64 the option of buying into Medicare, appears to have given Democrats a way around the deal-breaker issue of a new government plan to compete with private carriers. Senators continued to debate for a 10th day, with Democrats pushing to pass the bill by Christmas.
The 2,074-page Senate bill will grow even longer as amendments are considered, but the basic outlines of the legislation most likely to pass are becoming clearer.
The overhaul will be phased in slowly, over the next three to four years. But eventually all Americans will be required to carry coverage or face a tax penalty, except in cases of financial hardship. Insurers won't be able to deny coverage to people with health problems, or charge them more or cut them off.
Most of the uninsured will be covered, but not all. As many as 24 million people would remain uninsured in 2019, many of them otherwise eligible Americans who still can't afford the premiums. Lawmakers propose to spend nearly $1 trillion over 10 years to provide coverage, most of the money going to help lower-income people. But a middle-class family of four making $66,000 would still have to pay about 10 percent of its income in premiums, not counting co-payments and deductibles.
No dramatic changes are in store for most people who get coverage through their jobs - about 60 percent of those under age 65. The Congressional Budget Office says the bill wouldn't have a major effect on premiums under employer plans, now about $13,000 a year. Parents would be able to keep dependent children on their coverage longer, age 27 in the House bill.