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FAQ: Making Sense of Health Care Reform

What You Need to Know About Proposed Legislation to Reform the Health Care System

By Andy Miller
WebMD Health News

Reviewed by Brunilda Nazario, MD

Congressional committees are working hard on President Barack Obama's top domestic goal: passing health care reform. It's the most significant effort to enact health reform in many years.

Here's a rundown of some of the issues being discussed and what they may mean to you:

Health Care Reform: Questions, Answers

Health care reform is clouded in controversy and confusion. Get some clear answers here.

Some people have advocated a 'single-payer' system. Why has it not gained more support?

Single payer is a health system run entirely by the government. It would replace the private insurance market, creating a Medicare-like structure that would cover all Americans. The government, the single insurer, would pay hospitals and doctors for their services. The idea has not gained traction, despite passionate advocacy, because of widespread opposition to government-controlled health care and to dismantling the current system. "It's not politically feasible,'' says Donald Taylor, a Duke University health policy professor.

Would reform require individuals to buy health insurance?

It's very likely. People from low to middle incomes would receive subsidies to afford it. Medicaid, a government program for the poor and disabled, could be expanded to cover more lower-income people. The goal: drastically reduce the number of uninsured Americans, currently at 45 million. Meanwhile, people who get insurance through their employer would likely retain that coverage.

Would reform require employers, including small businesses, to cover their workers?

Despite opposition from the business community, a plan that requires businesses to provide insurance benefits for their employees likely will be included. That could mean that companies with more than 25 employees (or possibly 50) would have to provide insurance for their workers or pay a penalty. Smaller businesses would be exempted. The House bill unveiled Tuesday would exempt firms with a payroll of less than $250,000 a year. Wal-Mart's recent endorsement of such an employer mandate ''made a huge difference on this issue,'' increasing chances of this provision passing, says Karen Davis, president of the Commonwealth Fund.

What is the most controversial aspect of the Democrats' reform overhaul?

Democrats are pushing for a public plan, run by the government, to compete with private health insurers. President Obama says it would ''keep insurance companies honest.'' Individuals and small businesses could shop for an affordable plan in an insurance ''exchange'' or marketplace, which would offer different choices. But Republicans feel a public plan eventually would drive health insurers out of business and leave a health system run entirely by the government. This could be the issue that blows up a potential agreement, says Paul Ginsburg, president of the Center for Studying Health System Change.

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