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What health reform means for you
Thebills are in flux, but it's time to dig in. Here's what the big idea inWashington could mean if you get insurance at work, buy it on your own,or have none at all.
NEW YORK (CNNMoney.com) -- Lawmakers arestill far from consensus on how to fix the health care system. So it'stoo soon to know exactly what reform would mean for individualAmericans.
But a picture has started to emerge from two key billsput out by Democrats in the House and Senate. A third bill is expectedsoon from the Senate Finance Committee.
The first two bills propose:
- a national insurance exchange on which insurers would compete for consumers' business;
- a public health plan that would compete with private insurers on that exchange;
- and subsidies for financially strapped Americans eligible to buy health insurance on the exchange.
Bothbills would also set minimum standards for health insurance policiesand require insurers to guarantee coverage for those with pre-existingconditions.
Considered in broad terms, here's how those bills arelikely to affect three groups of Americans: those who are currentlyinsured through their employer; those who buy insurance on their own;and the 49 million Americans who are expected to go uninsured next year.
Unlikely to see much change:The more than 160 million Americans with employer-sponsored insurancetoday wouldn't see much change, said Congressional Budget OfficeDirector Douglas Elmendorf after doing a preliminary analysis of thetwo bills.
That would accomplish one of lawmakers' goals for health reform -- to preserve the employer-based health insurance system.
Butit doesn't prevent companies from changing workers' plans if theydecide to change the benefits menu or switch policy providers.
Atthe same time, workers with insurance through their employers are notlikely to see lower premiums, Elmendorf told lawmakers last week. Infact, at least initially, their premiums may continue to increase apaceas they have for years.
And if workers don't like the healthoptions provided by their employers, they may not have the option ofbuying insurance on the exchange. That's because the bills include"firewalls" that would prevent them from doing so.
Under theHouse bill, for instance, only workers who today pay more than 11% oftheir income for employment-based coverage would be allowed to purchasea policy on the exchange and would qualify for a subsidy.
In all,the CBO estimates that the House bill might allow about 3 millionworkers with employer-based coverage to qualify to buy subsidizedinsurance on the exchange. The added advantage for them is that theywouldn't have to change insurance policies bought on the exchange ifthey changed jobs.
May have to pay a new tax: The mostcontroversial debate over health reform is how to cover the cost.Roughly half is likely to be paid for with new tax revenue.
TheHouse bill calls for a surtax on high-income earners -- starting at$280,000 for singles and $350,000 for married couples. The surtax wouldrun as high as 5.4% on income over $1 million.
But on Monday,House Speaker Nancy Pelosi let it be known that she may push toincrease those thresholds so the surtax would only affect individualsmaking at least $500,000 and couples making $1 million or more.
"Itnarrows the number of people who would be affected. I think it probablygoes a long way in protecting the small businesses we were concernedabout and it puts more pressure on our House colleagues who are writingthe bill to identify more in savings." Rep. Gerry Connolly, D-Va., toldCNN.
The Senate Finance Committee had been heavily focused ontaxing a portion of the health benefits that workers currently receiveas tax-free income from their employers. But that idea has run intopolitical headwinds.
Whether a benefits tax of some kind ends up in the final package is still anyone's guess. If it does, however, not everyone would have to pay it.
That'sbecause a benefits tax can be set up so that it only targets a certaingroup of people -- for example, those with very expensive healthinsurance plans, or high earners with expensive plans.
It's alsopossible a benefits tax would not be included at all. Another ideareportedly under consideration is a tax on insurers and employers thatoffer expensive or "Cadillac" plans. Of course, if that happens, it ispossible the cost of the tax would be passed along to workers in theform of higher premiums.
Likely to see lower costs:The people most likely to see a decrease in what they pay for healthinsurance are those who currently buy policies on their own, Elmendorfsaid.
Thatgroup could see their costs go down for three reasons: the creation ofan insurance exchange; the additional competition from a public plan;and guarantees that insurers could not refuse coverage to anyone with apre-existing condition, he noted.
If their income qualifies themfor a federal subsidy, consumers who currently buy insurance on theirown could see their costs go down considerably from where they aretoday. Under the House bill a family of three making up to $73,240 thisyear could qualify for some subsidy.
May get help from an employer:The CBO estimates that under the House bill roughly 3 million peoplecould be added to the rolls of those with employer-sponsored insurance.That's because the bill would require companies either provide workerswith coverage or pay into the health insurance exchange to subsidizethe cost of their policies.
May get help from the government:Those who are uninsured may get a subsidy from Uncle Sam if theirincome qualifies. Or they may qualify for Medicaid since both the Houseand Senate bills would expand eligibility for the program -- under theproposals, eligibility would be extended to those with income up to150% of poverty level in the Senate health committee bill and up to133% in the House bill.
Will be required to have insurance:Both bills would mandate that most individuals be insured or pay apenalty. The CBO estimates the House bill would reduce the number ofuninsured by more than 68% within 10 years.
- CNN's Dana Bash and Deirdre Walsh contributed to this report 
