Where does health care debate go from here?

Last week, the Senate Finance Committee voted 14-9 to approve its health care reform bill - the fifth legislative committee to pass reform legislation. Here's a rundown of where things stand - and what to expect in coming weeks.

1. Why was last Tuesday's Senate Finance Committee vote seen as such a big deal?

The Senate Finance Committee was the graveyard of health care reform in 1994 and proved the toughest panel to conquer this year because of its high concentration of moderate Democrats.

It was the last of the five congressional committees engaged in health care reform to complete its work, but it also has the most sweeping jurisdiction. After months of negotiations and substantial Republican input, the committee produced the least costly and most comprehensive of the pending reform bills, and the legislation is expected to serve as the foundation for a final bill.

It also is the only version of reform to have gained some GOP support, with the committee vote of Sen. Olympia Snowe, a Republican from Maine. Chairman Max Baucus, a Democrat from Montana, will remain a key negotiator for the duration.

2 Where does the debate go from here?

House and Senate leaders are attempting to turn a patchwork of committee efforts into full-fledged bills. In the Senate, Majority Leader Harry Reid, a Democrat from Nevada, is working with a small team in his office to meld the Finance Committee bill with the more narrow legislation approved by the Senate health committee.

In the House, Speaker Nancy Pelosi, a Democrat from California, is leading the effort to combine the work of three House committees. Once the mergers are complete, the nonpartisan Congressional Budget Office will determine how much each bill costs, and they will move separately to the House and Senate floors, likely in early November.

Assuming both measures are approved, the House and Senate will form a conference committee to combine the two bills for one final vote in their respective chambers. Then it's on to the White House for President Obama's signature. Democrats are confident of enacting health care reform this year - although many of the provisions won't take effect until 2014.

3. What are the prospects for a government-run insurance option - and who would be eligible?

The public option is one of the most serious areas of disagreement among Democrats. Liberals view it as an essential safeguard against skyrocketing premiums and a pathway to a single-payer system, a kind of national Medicare for all. Moderates recognize the potential cost benefits but are reluctant to add to the substantial federal responsibility of providing health coverage to senior citizens, veterans and the poor.

The House bill is likely to include a strong public option, but the issue remains unresolved in the Senate as Democrats search for less controversial alternatives.

One idea on the table would give states the leeway to devise their own insurance packages, including a public plan, as they see fit. Another would "trigger" the creation of a public option if private insurers fail to deliver affordable plans.

Whichever version, if any, Congress decides to adopt, the public option won't be available to everyone. It would compete for the business of uninsured people who do not qualify for Medicaid or don't have access to affordable coverage through their employers.

4. What are the main things the three bills have in common?

In the broadest sense, the House bill and the two Senate packages are remarkably in sync.

They agree that individuals should be required to buy insurance and that all but the smallest employers ought to contribute to the cost of coverage.

They would provide for a historic Medicaid expansion that would benefit all low-income people, not just select groups, while extracting significant cost savings from Medicare. (next page »)