Health care bills set for debate

WASHINGTON — Both houses of Congress are poised to start a historic debate on sweeping legislation to overhaul America's health care system, yet despite months of committee deliberations, some major issues remain unsettled.

Early next week, the Senate Finance Committee is expected to take the last step that sets the stage for the full chamber's debate when it votes on its version of a bill. Since the committee has a 13-10 Democratic majority, and Sen. Olympia Snowe, R-Maine, may vote yes, approval is expected.

President Obama hailed the committee, which wrapped up its bill-writing work early Friday morning, as achieving "another milestone," saying in a statement, "We are now closer than ever before to finally passing reform." The committee is delaying its final vote until the nonpartisan Congressional Budget Office estimates its proposals' cost and effects on consumers. The Finance committee staff pegged the cost at nearly $900 billion over 10 years.

The five congressional committees that spent the summer and early fall drafting health care legislation have found agreement, at least among Democrats, that nearly everyone should be required to have basic insurance, get subsidies if their incomes are low and have easy access to "exchanges," or marketplaces, where they can shop for coverage.

Insurers would be barred from denying policies because of someone's health status, and be subject to limits on premiums because of age or family size.

However, the Senate Finance Committee also exposed sharp divisions among Democrats about the extent of government involvement in health insurance and how to pay for any changes, while Republicans are all but universally opposed to the Democrats' terms.

Senate Finance was the only one of five committees, including three in the House of Representatives, that rejected creating a government-run insurance plan, or public option, as an alternative to private health insurance. Finance Committee members also had no interest in the kind of income tax surcharge on the wealthy that House Democratic leaders have endorsed.

All this suggests that Democrats still have some big decisions to make as they craft final legislation, with conclusive floor votes not likely before late November or December.