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The House Has Passed Health Care. Now What?

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The House Has Passed Health Care. Now What?

Health Care

The House Has Passed Health Care. Now What?

The House Has Passed Health Care. Now What?

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  • <iframe src="https://www.npr.org/player/embed/120318326/120318313" width="100%" height="290" frameborder="0" scrolling="no" title="NPR embedded audio player">
  • Transcript

Late Saturday night, the House passed a sweeping health care bill by a narrow 220-215 vote. Its sponsors say the trillion dollar package would be the most dramatic expansion of health coverage since Medicare and Medicaid. Neal Conan talks to NPR's Julie Rovner and Ron Elving about what's in the House bill, and the politics of health care in Congress.

NEAL CONAN, host:

This is TALK OF THE NATION. Im Neal Conan in Washington.

Late last Saturday night the House passed a trillion dollar package that its sponsors say would be the most dramatic expansion of health coverage since Medicare and Medicaid. Tens of millions more would be able to get coverage. Insurance companies would no longer be allowed to refuse coverage to people with pre-existing conditions or drop coverage when somebody gets sick. But the bill has its critics, mostly on the right. Republicans say it cost too much, doesnt control costs, and vastly expands the government role in health care. Some critics on the left agree its way too complicated and some object that it goes beyond current law to restrict access to abortion.

If you want to whats in this bill and what isnt, give us a call. 800-989-8255. Email us, talk@npr.org. You can also join the conversation on our Web site. Thats at npr.org. Click on TALK OF THE NATION.

In a few minutes well also talk about the next step and whats likely to happen when health care goes to the Senate. Later in the program, a Veterans Day visit to Arlington National Cemetery and a new history called On Hallowed Ground.

But first, NPR health policy correspondent Julie Rovner joins us here in Studio 3A. Julie, always good to have you on the program.

JULIE ROVNER: Always nice to be here.

CONAN: And one of the most controversial elements of this bill is the so-called public option, but there are about 87 different versions of the public option. Which one ended up in the House version of the bill?

ROVNER: Yes, there are, and boy if you think theres a lot of jargon in health care, theres a set of jargon just for the public option. So the public option that finally ended up in this bill is what we call the less robust version of the public option. This is the public option

CONAN: Sounds like were arguing about coffee blends.

ROVNER: Yeah, pretty much. Yes, this is kind of the not the French roast, if you will, but milder version. This public option would have to pay for itself and the plans would have to negotiate rates with hospitals, doctors and other health care providers rather than pay rates that would be tied to Medicare. That would be the robust version

CONAN: Mm-hmm.

ROVNER: that basically they would pay either Medicare plus five percent or Medicare plus 10 percent. Now, the sponsor of the bill had to do that to win the votes of at least some of these moderate deficit hawk Blue Dog Democrats. Interestingly, those negotiated rates save less money than the Medicare rates would have, but those Blue Dogs tend to come from areas where Medicare rates are kind of low. And so what turned out to happen is that the Blue Dogs were more worried about their health care providers, mostly their hospitals, saying that they were going to be underpaid if that public plan was linked to Medicare. So in the end their deficit hawk worries were trumped by their worries from their own providers and we ended with this negotiated rate public plan rather than the Medicare-linked public plan. So that was the public plan that ended up in the bill.

CONAN: And two of the major goals of this legislation were to include as many people as possible. How many more people would now get health care coverage? Would it include everybody?

ROVNER: It would not quite include everybody. Of course illegal immigrants, which is another big hot button issue, will not be eligible for subsidies under this bill, so they will and they will not be eligible for any of the benefits under this bill. They will - and this did not get changed - they will be eligible to go into this new insurance exchanges and buy coverage with their own money. That was something that a lot of Republicans had wanted to change but in the end that is still in there. According to the Congressional budget office, 36 million more people will be able to get insurance or will be estimated to get insurance at the end of 10 years. Thats about 96 percent of the legal population at the end of that time. So most people, not quite everybody.

CONAN: Another thing that the spiraling cost of health care has been a major motivating factor behind all of this well, for the past 20 years and more. The fact is, does this control the escalation of costs?

ROVNER: Yes and no.

(Soundbite of laughter)

ROVNER: It does pay for itself - that was one of President Obamas absolute, you know, so he will not sign a bill that does not pay for itself, and according to the Congressional Budget Office, it even lowers the deficit a little bit. I think in the last year it lowers it by $10 billion, which is

CONAN: A billion here, a billion there.

ROVNER: Yes. So youre talking about real money, but not when you spent $2.2 trillion a year on health care, thats not a lot of money. It mostly lowered it mostly pays for itself in traditional ways, reducing payments to health care providers and Medicare. Biggest chunk of that is actually taking back extra money that the Republicans gave to Medicare managed care plans in the 2003 Medicare drug bill. It also pays for - partly pays for this bill with a tax surtax on high earners, millionaires, in terms of couples, people earning more than a million dollars, half a million dollars for individuals.

What it does not do is what they call bending the curve on health care costs, really changing the way health care providers are paid to encourage them to be more efficient, really encouraging consumers - health care consumers to want to consume less health care. There are a lot of demonstration projects in this plan, things like medical homes where people could go, sort of one stop shopping for medical care, accountable health organizations which would, you know, have lots of different kinds of health care providers under one roof to make care more efficient. But again, those are more demonstration project, not the kinds of fundamental changes that a lot of health economists had hoped for in this bill.

CONAN: Lets see if we get some callers questions in. Our guest is, of course, Julie Rovner, NPRs health policy correspondent. 800-989-8255. Email: talk@npr.org. Roger is with us from Tallahassee.

ROGER (Caller): Good afternoon. Thank you for taking my call.

CONAN: Sure.

ROGER: My question is twofold. I currently purchase my own private health insurance. I took early retirement. I purchased insurance for a family of three. Its a very good coverage but its quite expensive. So my question is twofold. Am I now going to be taxed on this health coverage that I pay for? And secondly, is there any chance therell be some downward pressure on this current the rates that I pay? Its my single largest monthly expense for a family of three is health care, and we are extraordinarily healthy.

CONAN: Well, hes got what, I guess, would qualify as one of those Cadillac health insurance plans, but nevertheless its not income, is it, Julie, if hes paying for it himself?

ROVNER: No. The answer well, actually, the short answer to his question is no and yes. The taxing of expensive plans is not in the House bill. They are talking about it in the Senate bill. If you are self-employed, you get you do get a tax deduction right now. That would not change. And in fact if you were self-employed, buying your own insurance, you will be eligible to go into this exchange. And the idea of having this exchange is that there will be less expensive plans, there will be competition, there will be this public plan, if the House bill prevails, that you will be able to choose from presumably you will be able to get less expensive coverage. So this should all be if this plan were to become law, this would all be good

(Soundbite of laughter)

ROVNER: for this caller.

CONAN: Roger

ROGER: Great.

CONAN: congratulations.

(Soundbite of laughter)

ROGER: Great. Thank you. One question. I am currently retired, took early retirement at age 55. I am not working. Do I have to somehow create myself as being self-employed?

ROVNER: Oh, no, no. As long as youre buying individual coverage, your own coverage, youre still able to go into the exchange. The rule is that you not be eligible to get a coverage from an employer - you can go into the exchange.

ROGER: Great. Thank you so much for your time.

CONAN: Thanks for the call, Roger. And lets go next this is Stephanie. Stephanie with us from Granville, Ohio.

STEPHANIE (Caller): Hello. I have a question. I have what I consider to be typical insurance coverage through my husbands employer. Its not a premium plan by any means. Our premiums have been going up, as has our deductible, so each year Im more frustrated at open enrollment time, but it is good insurance. I am wondering, how does this bill affect me? Will it affect me? What will it do to my rates?

CONAN: Julie, I think thats a question a lot of people have.

ROVNER: Yes. And this is where the answer becomes, it depends. It depends how large the employer is. Small employers will be eligible to go into this exchange. It will gradually be open to larger and larger employers as the years go by. There are some insurance changes that do apply to everyone, regardless of the kind of insurance they have and whether they get it from their employer, things like there will be limits on annual and lifetime limits.

You can no longer say you can only have $5,000 worth of benefits this year or you can only have a million dollars of benefits over your lifetime. That will imply to that will apply to all insurance inside and outside the exchange, things like rescissions, where an insurer can come back and say, you forgot to say that you were treated for acne on your application 20 years ago, therefore, now that you have some kind of cancer thats going to be expensive, were going to cancel your insurance. Those sorts of things will apply to everyones insurance.

So theres certain protections that will apply across the board. There are other insurance changes that will apply only within this insurance exchange. So it will depend on your employer and what kind of coverage you have to know whether you will be eligible for this new insurance in the exchange.

But the hope is, at least, that there will be some downward pressure on all kinds of insurance because, remember, there will be far fewer people who dont have insurance. So what happens now is that the uninsured get paid for by everyone else who has insurance. Its called cost shifting. Those people go to the hospital when theyre sick or hurt, and they end up being paid for by everybody else.

So hopefully when those people have their own insurance and get paid for by their own insurance, everybody else no longer has to pay for them. So everybodys coverage perhaps wont go down, but at least wont go up as fast.

STEPHANIE: May I ask one further question?

CONAN: Sure.

STEPHANIE: So you dont see it as applying to my premiums or my deductibles?

CONAN: Well, your premiums and deductibles are going up every year. And what shes suggesting is that they wont be going up by so much every year. Am I getting that right, Julie?

ROVNER: Youre getting that right, Neal.

STEPHANIE: Well, then may I just make one final comment? That kind of smacks to me like a couple of years ago when we had $4.50 a gallon of gas

CONAN: Mm-hmm.

STEPHANIE: and airlines started charging for baggage because, hey, their fuel costs were so high they had to recoup the cost for baggage. Well, now gas has gone back down, but theyre still charging for baggage because they found a way to make extra money. The idea that the health care industry - which already is out for money - is going to suddenly go, oh, well, now were going to ease up on everyone sounds kind of ludicrous to me.

CONAN: Well

(Soundbite of laughter)

CONAN: Youre not alone in there, Stephanie. Thanks very much for the call.

STEPHANIE: Thank you. I appreciate it.

CONAN: Bye-bye. Appreciate it.

And heres an email we have from Marsha(ph) in Kansas City. My husband and I are covered by a good employer-provided health care plan. However, my husband had a kidney transplant three years ago. It was very successful. Hes in good health, relatively. However, anti-rejection meds and ongoing checkups would be impossible for us to cover without health care.

Yet when we checked into getting coverage on our own several years ago when there was a potential of a workplace move where health insurance was not provided, we were told he was uninsurable outside of a group or employer-paid health care plan. With this new plan, do we have an option outside if one of us is working for a larger employer who provides a good health care plan with the cushion of lots of employees participating?

ROVNER: Yes. And that is exactly the kind of person that this plan and certainly this Senate bill that is aimed at, at banning exclusions based on preexisting conditions exactly like that, that all plans will be barred from saying that the people are uninsurable because they have been sick. Thats the tradeoff. Everyone will be required to have coverage, but in exchange, people who have been sick will be able to get insurance. They wont be charged anymore. They wont be able to be charged higher premiums because of that. And they will be able to go anywhere either within this marketplace or in a small group or somewhere else and be able to get that kind of insurance coverage.

CONAN: Julie Rovner, NPR health policy correspondent is with us here in Studio 3A as were talking about whats actually in the House health care bill that passed late Saturday night by a vote of 220 to 215, numbers were going to remember for a very long time. But nevertheless, just the first of four critical votes that health care would have to pass before it would end up on President Obamas desk.

So, in any case, if you have questions about whats in the bill or what is it, give us a call. 800-989-8255. Email us: talk@npr.org.

Stay with us. Im Neal Conan. Its the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. Im Neal Conan in Washington. Were talking about health care and what is actually in that House bill that passed on Saturday night by a vote of 220 to 215. NPR Health Policy Correspondent Julie Rovner is with us. And joining us here in Studio 3A is Ron Elving, NPRs senior Washington editor. If you would like to join the conversation, give us a call. 800-989-8255. Email us: talk@npr.org.

And Ron, as were talking about whats in the House version of the bill, nevertheless, were also talking about politics. And it was Sunday morning when Republican Lindsey Graham pointed to that number, 220-215, and says: This bill is dead on arrival in the United States Senate.

RON ELVING: Yes. But it would have been dead on arrival in the United States Senate if the vote had been 250 to correspondingly fewer. There was never any chance that the Senate was going to consider many of the elements that are in this particular bill - for example, the tax increase that Julie was describing a few moments ago. Thats a nonstarter in the Senate, and there are many other elements of this bill, including, of course, most notoriously, the public option.

CONAN: Because one of those 60 votes in the Senate - you need a 60-vote majority to avoid a filibuster. One of the 60 votes the Democrats would be counting on, thats Joe Lieberman of Connecticut, says if theres a public policy - a public option, hes not going to let it get to the floor.

ELVING: Now, of course, and there is a public option apparently going to be in whatever version Harry Reid, the Senate majority leader, brings to the floor. He has made that announcement. He has said hes going to meld the bills that came from the Senate Finance Committee and the Senate Health Committee in such a fashion as to include a public option with a state opt-out provision, so that states that dont want to have that dont have to have that.

But its clear thats not satisfying the people in the Senate who are in the middle between the two parties mainstreams and who are saying they just really dont want a public option. So its awfully hard to see how the House version of a public option, which does not have a state opt-out, would fly in the Senate.

CONAN: And let me ask you one more question before we get back to our callers and emails. And that is we were talking a lot throughout the summer, and now were well into the fall, about the timing of this bill, that if it runs too late, senator President Obama is going to be - start running out of options.

ELVING: You know, another big factor in all this and the consideration of how badly the White House wanted to move health care before August, and then if it wasnt going to be before August, then certainly before November because of the change in the political climate that comes with the off-year elections. And even if you took the rosiest possible view of what was going to happen in New Jersey and Virginia, it was hard to imagine that at least one - probably both of those - were going to go Republican this year. They usually do.

The year after a presidential election, they usually go to the opposite party, and that was going to sap some of the notion of political power out of this administration, in this Democratic majority in the Congress. And thats pretty much what weve seen happen. Fairly or unfairly, whether thats a good perception or not, that is the general perception, and that makes it a little bit harder to ask Democrats to make tough votes.

CONAN: And weve already seen - and lets talk politics here, Julie. the Stupak amendment - this is the amendment that affects abortion, and its were hearing not just the extension of the Hyde Amendment - named for Henry Hyde of Illinois, the longtime pro-life advocate from the state of Illinois - but rather goes beyond that in terms of limiting abortions.

ROVNER: Thats right. Now, there are two pieces to how this abortion amendment works. One of them obviously applies to Federal funding in this new public plan, and those would be federal dollars. And that would be that would extend that would actually permanent for the first time. Now, remember, the Hyde Amendment is an appropriations bill. Thats an annual spending bill, and it says, really, no dollars for any money that comes through the Department of Health and Human Services for abortion.

Thats been, basically, renewed every year since 1976. So, every year that that goes into the bill - this would make it permanent for the first time. But this goes a step further and says that within this exchange, these new marketplaces, no money for that goes to subsidies for private plans could be used for abortion.

So, in essence, what you have is that anybody in these exchanges, choosing from among these plans, if they get subsidized - remember, the subsidies go up to people earning about $88,000. So most of the people in these exchanges will be getting some kind of subsidy. They could not choose a plan that offered abortion as a benefit.

Now, what people in the abortion rights community are saying is that what that end up is that no plan would end up offering abortion, because they could potentially offer plans that offered abortion and all and plans that didnt. But there are other requirements within the bill that say you cant offer discriminatory benefits that would make that illegal.

So, in essence, you would have these exchanges, and there will be no abortion ever available as a benefit. And so you would have people coming in with their own money who werent getting subsidized, and they wouldnt be able to get abortion at all. So youre now saying that people, not just with federal funds, that buying private policies with private funds would not be able to get abortion as a covered benefit.

CONAN: And, Ron, weve already seen some conservative Democrats in the Senate say this looks good to me. Id like to vote for that.

ELVING: Thats right. But youve also seen a number of liberal Democratic senators saying theres no way were going to allow this bill to be used to restrict womens access to choice or access to abortion. The word rights gets thrown around a good bit here, although I think Julie is absolutely right to use the word access. Were now talking about whether or not somebody has a right to an abortion, but were talking about whether or not it can be paid for through these plans.

Lets get some callers questions back: 800-989-8255. Email: talk@npr.org. Norman from Cleveland in Ohio.

NORMAN (Caller): Hi. Im (unintelligible) insurance. Im self Im a self-employed musician. And Im getting - am I allowed to say the plan that I have, its a health maintenance plan, and Im pretty happy with it?

CONAN: All right, sure.

NORMAN: Okay. Well, Ive got Kaiser, although Kaiser isnt available in every place, you know? And portability is the thing that bothers me - and also the price that Im paying, you know, like 580-something a month for a single person with a couple of curses, high-blood pressure and things like that. You know, would I be able to do this public option if I already have insurance? Am I allowed to switch?

CONAN: Julie, would he be allowed to switch?

ROVNER: Absolutely, youll be allowed to switch. The idea of this exchange is that you will have a choice of presumably several plans, not clear entirely how many, but a multiple of plans with the public option. And assuming the House bill were to prevail, a public option would be one of them.

If Kaisers available in your area, probably Kaiser would be one of them, too. And you could choose

NORMAN: (Unintelligible)

ROVNER: from among the plans, there would probably be a national plan that would be available so that if you travel a lot as a musician, you would be able to get, you know, benefits around the country. But thats the idea, is to give you more choice and possibly or probably better prices.

NORMAN: Sure. I dont understand how people who have local Blue Cross and things like that, what happens when they retire and go to Florida, and if they have preexisting stuff? What do they do? I cant

CONAN: If theyre 65, they get Medicare.

NORMAN: Oh, okay.

CONAN: All right. Thanks very much, Norman.

NORMAN: Okay. Okay.

CONAN: Email from Mark in Columbus, Ohio. Is there anything that would keep my employer from just saying go join an exchange and stopping the insurance theyre paying for it now?

ROVNER: Yes, there are. Theres a requirement for in the bill for employers to continue to either pay either continue to provide the insurance, or pay a certain percent of payroll.

CONAN: Yet, Ron, this is one of the major arguments of Republicans. There are so many incentives in this plan, that eventually its going to drive everybody towards the public option, and this is effectively a government takeover.

ELVING: Yes. The keyword there is effective. Is it true that if this mechanism exist, that mechanism will, quote, takeover, unquote? And takeover is a wonderful phrase to use if youre trying to kill something, because in our politics, we are generally quite leery of anything that involves the government taking over. So, it has been a feature - a theme of the Republican opposition throughout the year to portray the bill as a total takeover.

Now, of course, if youre Dennis Kucinich, one of the other people who voted against the bill in the House

CONAN: Liberal a liberal Democrat from Cleveland.

ELVING: Thats right, who ran for president in 2008 as a liberal. And he says, you know, the problem with this bill is that there isnt enough government in it. That it leaves too much of the for-profit insurance industry standing, and what we really should have is a simple single-payer system such as in Canada. And that has many fans in the United States. That has many fans in the United States. But thats not what this bill is, yet thats what the Republicans are arguing against.

CONAN: Lets get another caller. Julie, Im sorry.

ROVNER: I should point out that, you know, that people need to be careful. Employers can end up putting their employees into the exchange. That wont necessarily put their employees into the public plan.

CONAN: Public option.

ROVNER: Right. The public option will only be one option within the exchange. There will be many more private plans available than there will be a public plan.

CONAN: Well, speaking of Cleveland, we have another caller from there, Charlene.

CHARLENE (Caller): Oh, good afternoon. Thanks for the conversation. Im on Medicare. Thats my only form of insurance. And I guess Im Ive been hearing different things about how Medicare is going to be impacted. One, theyre going, you know, cut back on a lot of funding, you know, thats now in there, they consider to be wasteful. So can you speak to anything in this bill that would impact or change the Medicare?

CONAN: Julie?

ROVNER: Yes, obviously, you know, this is where politics and policy intersect. The Democrats who put this bill together know that in the 2010 mid-term elections, seniors vote in disproportionate numbers. So they have been very careful

CONAN: Even more disproportionate.

ROVNER: Yes, even more disproportionate numbers. So they have been very careful not to hurt people who get Medicare. So, yes, they are taking money out of Medicare, but they are giving benefits to lots of people on Medicare. They are for, one thing, closing the doughnut hole. This is where people who have the Medicare drug benefit stop getting benefits after they spend certain amount money for - and then have to pay all of their own drug expenses for several thousand dollars. There are new preventive benefits in it for Medicare beneficiaries.

The only people who could end up losing some benefits are the people who are getting extra benefits now because theyre in these Medicare Managed Care programs. And those - some of those plans are going to be losing some of those extra money - some of the extra money that they get. And that extra money is shared with the beneficiaries in the form of extra benefits. So if they lose that extra money, some of those beneficiaries could lose some of those extra benefits. But beyond that, no beneficiaries are going to lose benefits that they have now. And, in fact, within this bill, there are new benefits for Medicare beneficiaries.

CHARLENE: Very good, thank you.

CONAN: Thanks for the call, Charlotte(ph).

CHARLENE: Mm-hmm.

CONAN: Heres an email from Steven: I am in my mid-30s, self-employed. I cannot afford health care. If this bill passes the Senate, will be there - will there be any provision for me to receive free health care or deeply discounted health care, and will I be required to purchase health care in the future, no matter what the cost or receive some sort of penalty?

ROVNER: Answer to the last question is, no. There will be hardship exemptions for people who truly cannot afford it. There will be a sliding scale of subsidies for people, depending on what they earn. If you earn less than a 150 percent of poverty, for the first time, everyone will be eligible for a

CONAN: Whats poverty just - right now?

ROVNER: I think its ooh.

CONAN: For a single person?

ROVNER: I think it for single person, its about $9,000, I believe.

CONAN: Okay.

ROVNER: Im just Im

(Soundbite of laughter)

CONAN: So, 150 percent would be $14,000 a year.

ROVNER: Yeah, that sounds about right.

CONAN: Still a very small amount.

ROVNER: Yes. Its still very small. But the subsidies go all the way up, as I said, to 400 percent of poverty for family four, which is $88,000. So the subsidies go way up the scale. There are a - so under 150 percent of poverty, you get you are eligible for Medicaid. No matter - it used to be, Medicaid has always been what we call a categorical program. You have to fit into a category, either a single mother with a - or pregnant with a child or a child, or - age, blind or disabled. From now, on all you have to be is poor and you will get Medicaid under 150 percent of poverty.

Over that, you will get subsidies. If - there will be a certain amount of - a big threshold if you absolute if you can prove that you still cant afford the coverage thats available, you can get a hardship waiver. Other than that, you will be then required to buy a plan. And if dont, then there will be a penalty, up to two-and-half percent of your modified adjusted gross income.

CONAN: And imposed by the IRS, I presume.

ROVNER: Imposed by the IRS.

CONAN: And is there - if you this specter has been raised, that if somehow you avoid the if you dont buy coverage, you could end up at jail.

ROVNER: You could end up at jail to the same extent you can end up in jail if you dont your taxes now. I mean, if you are convicted of you know tax fraud

CONAN: Or evasion, yeah.

ROVNER: or tax evasion, you could end up in jail. But the IRS in general, people who evade their taxes usually are dealt on a civil matter.

CONAN: End up in high dudgeon, not Leavenworth.

ROVNER: Yes, yes. You end up in high dudgeon, not Leavenworth.

CONAN: Were talking about whats in the House version of the health care bill and about its prospects in the United States Senate with Julie Rovner and Ron Elving. Youre listening TALK OF THE NATION from NPR News.

And lets see if we can go next to Norm, Norm with us from Titusville in Florida.

NORM (Caller): Yeah, how are you doing?

CONAN: Very well, thanks.

NORM: Good, good. I wanted to ask that your guest - does this bill or any parts of this bill include dental care? And if not, why isnt dental care included as overall health care and covered the same way that you would cover any other medical procedure?

CONAN: Julie has beautiful teeth. But Julie, go ahead, please.

(Soundbite of laughter)

ROVNER: Thank you very much, and they are mine. That comes up a lot. Actually, dental and vision care, I believe, are included in the high option plan. Theres a sort of a low, medium and high option plan in the basic benefits package. They are not in the lower option plan. There - Ive gotten, boy, tons and tons

NORM: Are there limits set on it?

ROVNER: I dont know if there are dollar limits set on that. Or I dont it think it goes to that level of detail, just that they will include - that the high option plan will include dental and vision care. I know that there is lots of concern about the - particularly, you know, the relationship of oral health to the rest of health care, and that it really ought to be in there. You know, traditionally, it - dental health has been sort of an add-on to the rest of health care coverage, and an awful lot of people think that thats a mistake. But it is expensive, and traditionally it hasnt been. And I know that thats still a source of some debate.

NORM: Or with a heart transplant, or with a liver transplant is expensive, by the way.

CONAN: Yeah. Yeah.

ROVNER: Im not arguing it. Im just telling you what the bill says

CONAN: Telling you what to do.

ROVNER: I didnt write the bill.

CONAN: She would have writers cramp, let me tell you that. By the way, we just got some numbers - the poverty guideline is 22,000 for a family of four and 10,800 for one person. So thats

ROVNER: Thank you.

CONAN: what it is at the moment. We just have a couple of minutes left. What is your best guess, Ron Elving, as this goes to the Senate? Theyre going to be trying to meld the two versions, very different versions that came out from the Health Committee and from the Finance Committee. Were supposed see something, what, this week?

ELVING: Possibly. There could be something tomorrow or Friday. Of course, today is a holiday. But we dont really necessarily expect to see it tomorrow or Friday. I think its more likely that well see a bill in the Senate next week. They had promised to put out there for a reading, that is to say a literal reading, a chance for people to actually hear whats in the bill, read whats in the bill.

We dont know exactly how long it will to be, but its not going to be much shorter, I dont think, than the Houses 2,000-page job. So, its going to be a daunting prospect to read it, to read it aloud, to read it to oneself. Its going to be an opportunity for people to read it. So, at least that particular criticism cant be leveled against it. And then theyre going to start debate.

CONAN: And then theyre going to start debate, and we dont know where thats going to go. But its likely that as you suggest, this is going to be a very different bill than what the House has come up with.

ELVING: Thats right. Although, we shouldnt overemphasize the differences. I think we want to make it clear that what went through in the House is going to be substantially changed, but we dont want to make it sound as though these are completely apples and oranges. Theyre not. They have a great number of provisions in common and many things that can be easily compromised.

CONAN: And Julie, we keep hearing that from a lot of people who say we all agree on about 85 percent of this.

ROVNER: Thats right. Well, the Republicans like to say that they agree on 85 percent of it, and I think thats not true. But I think the Democrats in the House and the Democrats in the Senate do agree on about 85 percent of this. Its really just the public option is a big source of disagreement. How you pay for it is a big source of disagreement. But, you know, the idea of having these exchanges, taking care of preexisting conditions - having this individual mandate, thats a big, big deal. Those kinds of threshold things, those are things that are the structure of these programs are basically the same.

CONAN: And if you had to be a betting person, would you say that the odds that President Obama will find a bill on his desk at the end of the day, did those odds improve on Saturday night when the House passed its version?

ROVNER: Oh, yeah. I mean, that was - this is the first time ever that a House of Congress has passed a major health overhaul bill, you know, and theyve been trying for a hundred years. So, even though it didnt pass by very much, it passed. Thats a big deal.

CONAN: All right. Well have to see its prospects in the Senate. And when we see that bill - and Ron Elving, well insist that you read every single word of it. And youll come back and talk about whats in that version of the bill. And then well start talking about our favorite word: reconciliation.

Ron Elving, NPRs political editor, here excuse me, senior Washington editor here in Studio 3A. With us also, Julie Rovner, NPRs health policy correspondent. We thank them both for their time today and their tireless work over the past few days on this.

Coming up next: remembering the service of Americas veterans in a new book about the history of Arlington National Cemetery. Stay with us. Im Neal Conan. Its the TALK OF THE NATION from NPR News.

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