One Down, Two To Go: Senate Votes On Health Care Just after 1 a.m. Monday, the Senate moved one step closer to a vote on the Democrats' health care overhaul. Julie Rovner, health policy correspondents for NPR, stayed up late for the vote. She fills us in about what's in the Senate bill, what's not, and what happens next.
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One Down, Two To Go: Senate Votes On Health Care

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One Down, Two To Go: Senate Votes On Health Care

One Down, Two To Go: Senate Votes On Health Care

One Down, Two To Go: Senate Votes On Health Care

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Just after 1 a.m. Monday, the Senate moved one step closer to a vote on the Democrats' health care overhaul. Julie Rovner, health policy correspondents for NPR, stayed up late for the vote. She fills us in about what's in the Senate bill, what's not, and what happens next.


This is TALK OF THE NATION. I'm Rebecca Roberts, in Washington. Neal Conan is away.

Early this morning, just after 1:00 o'clock Washington time, the Senate moved one step closer to a vote on health care overhaul. Senators voted along party lines, 60 to 40, to end a Republican filibuster. Although a few more procedural votes remain, a final vote on the Senate version of the legislation is scheduled for Christmas Eve. The vote this morning came after a weekend of bitter debate and a huge snowstorm here in Washington.

In just a minute, one of NPR's health policy correspondents, Julie Rovner, will be here. But what questions do you have about the Senate health care bill and what's in it and what's not and what happens next?

Our number here in Washington is 800-989-8255. Our email address is And you can join the conversation on our Web site. Go to and click on TALK OF THE NATION.

Later this hour, don't blame the weatherman. We'll talk about the science of snow prediction and your take on your snowy-day stories. Tell us how the storm upset your holiday plans. You can send us email now:

But first, the Senate health care bill. Joining us here in Studio 3A is NPR's Julie Rovner. She stayed up late last night, and she is kind enough to be here today. It's good to have you with us.

JULIE ROVNER: Nice to be here.

ROBERTS: So watched this unfold over the weekend. Describe the scene for us.

ROVNER: Well, I'll tell you, the more the snow fell, the nastier the debate seemed to get. Saturday morning, of course, Senator Harry Reid, the majority leader, laid down what's called the manager's amendment, and this is the final amendment to the bill, the catch-all, if you will, everything that everybody wanted, to get to those 60 votes. And the Republicans, as they had threatened to do, required that amendment - usually, you know, the reading of amendments is waived. That's a routine thing, they offer the amendment. In this case, the Republicans required it to be read aloud, and that took until a little bit before 4:00 o'clock Saturday afternoon. So while they...

ROBERTS: Because it was 300-plus pages long.

ROVNER: It was 383 pages. So they had to keep shuffling in clerks to share the reading. Of course, you know, the snow was coming down, and the clerks were reading, and off the floor, there were various press conferences. But, of course, the big news Saturday morning is that Senator Ben Nelson of Nebraska, who'd been, at that point, the lone-remaining holdout, had come to agreement to support cloture, to support the bill, to be the 60th vote, to get it done. And, of course, as the Democrats finally got to basically what the, you know, ending all the tension that, you know, there will be 60 votes for this bill, that even infuriated the Republicans even more, who were just absolutely apoplectic, that they say this bill is being rushed through, that they hadn't seen this manager's amendment - which, of course, they hadn't.

No one has seen this manager's amendment, and they're just getting their first look at it and that they're going to vote on it, as they pointed out, and which they did at 1:00 o'clock in the morning, this morning, which is part of why they were requiring it to be read. And it was full of sweetheart deals, which it is because these things genuinely tend to be full of sweetheart deals. That's what they do to cement down those votes - not that the Republicans haven't done these kind of thing in the past.

ROBERTS: Well, give us a sense of what was in it, because you mentioned Senator Nelson of Nebraska, and that has certainly getting some press today about what it to get him to be the 60th vote. But there were some promises in there for a bunch of other senators, as well.

ROVNER: Yes, there were a lot of things. Now, there were a lot of things for other senators that were, you know, more sort of policy issues. Bernie Sanders of Vermont, who was unhappy, one of the many liberals unhappy that the public option was taken out. And at one point, it looked like the public option would be taken out, the government-run plan, and in exchange, there would be a Medicare buy-in. People age 55 to 64 would be able to get on Medicare early, and that was taken out because Joe Lieberman of Connecticut said he wouldn't vote for it unless they took the Medicare buy-in out.

So one of the things that Bernie Sanders had wanted was more money for community health centers. So there's an extra $10 billion for community health centers. Now, that's obviously not just for Vermont. That's for the entire country.

There's also in there - now, there are also Medicaid provisions that do affect individual states. And one of the things that Senator Nelson is being criticized for is that Nebraska is the only state - the way the Medicaid expansion works in this bill is that the federal government will pay 100 percent of the cost of expanding Medicaid, but only for the first three years, and then the states will have to resume paying their portion of it. Nebraska will get its share paid into perpetuity. That was one of the things it took to get Ben Nelson.

Now, there are some other Medicaid changes in the bill. Early on, there was a couple - there's $300 million for Louisiana. That helped to get Mary Landrieu's vote back when they needed the first cloture vote to get the bill to the floor. That's being called the Louisiana Purchase.

There are also some Medicaid changes for Vermont and for Massachusetts, but those were explained that there - actually because Vermont and Massachusetts already cover the people to whom Medicaid would be expanded. So that was considered not so much a special favor for Vermont and Massachusetts, but because every other state will be getting extra money, Vermont and Massachusetts wouldn't because they're already there. So that would just be - that's considered just sort of basic fairness. Every other state's getting something to expand Medicaid. Vermont and Massachusetts should get them, also. So that wasn't necessarily for Sanders. That was more the community health center money.

So there's some things in there to sort of assuage liberals in general who are unhappy that other things got taken out. There's some things about requiring insurance companies to spend more money on actual benefits and less on administration and profits. So there's a lot of things that are not necessarily what you would call sweetheart deals, but things in there to make sure that senators who gave up some things would also get things to make them like the bill better, if you will.

So it's a combination of things. That's why it's 383 pages.

ROBERTS: Yeah, no kidding. So if the Senate Democratic leadership was able to get, by whatever means, to the 60 votes needed - in this case, for cloture - to cut off debate on this amendment, does that mean they have the votes going forward to actually enact the Senate version?

ROVNER: Yes, assuming everybody shows up. And this is something that Senator Mitch McConnell, the minority leader, pointed out on Saturday, you know, when they said, you know, why don't you - they have the 60 votes. Why are you making them go through this? And, of course, the Senate rules say that you have to have these - you have the cloture vote, and then they'll approve this amendment. And then you have to have another vote 30 hours later on the substitute to the bill, and then you'll have 30 hours later, a vote on final passage of the bill. And they say to the Republicans: Look, you're messing up everybody's holiday. They have the 60 votes. Why don't you just let them go?

And, you know, Senator McConnell says they still have to show up and vote. And the Republicans say this is the biggest bill that any of the sitting senators now have ever voted on in their career, and the Republicans really, really oppose it for ideological, as well as political reasons, and they really want to fight this to the end.

And in order - for them to do that, they will now exhaust all of their options until, I believe, it's 7:00 p.m. on Christmas Eve. And they say, darn it, that's what they're going to do.

ROBERTS: Let's take a call from Evie in Boise, Idaho. Welcome to TALK OF THE NATION.

EVIE (Caller): Hi. I want to know what changes Ben Nelson received pertaining to abortions and paying for abortions.

ROVNER: This was fairly complicated, and actually he's - he must have gotten the compromise just right because it's being opposed by both pro-choice and pro-life groups.

One of the things that he's gotten is that states will be able to pass laws if they want to say that they can have no abortions offered by state law in private insurance.

Now, of course, that's the case now. There are five states that do not allow abortions to be offered in insurance, in private insurance policies. And actually, during one the staff briefings, we asked about that. And the staff said yes, that is the case that states always could opt out. But they were making it clear that federal law wouldn't trump state laws. So states can opt out.

The other thing that they did for Ben Nelson was they made it sort of extra clear that yes, there will be, within these exchanges that individuals and small businesses can join, there will be plans that can offer abortion. But if they do, then women who elect those plans will have to write two separate checks, basically, if - one for the regular premium, and one for the part of the premium that will cover abortion, which is going to be sort of administratively complex. And I think that some of the abortion rights groups are worried that perhaps plans won't want to go to the trouble of offering plans with abortion coverage because it will be too much trouble.

ROBERTS: And that's to keep the payment for the abortion services separate from anything that has federal money in it?

ROVNER: Yeah, for the abortion coverage, not the abortion services. Remember, we're just talking about abortion being covered as a service. Also, there will be one plan that will not - in each exchange - that will not offer abortion coverage, and this is similar in some ways to the Capps amendment that was originally in the House bill, offered by Lois Capps of California. That was the original compromise that was trying to keep this - the object was to keep this abortion-neutral, was to keep the status quo, was to not allow federal funds to pay for abortion, to keep that part of the premium separate. But that was not good enough for abortion opponents.

It does seem to be good enough for Senator Nelson, but obviously, it's now opposed by both sides of the abortion debate, ironically enough.

ROBERTS: Let's take a call from Diana in Plainsboro, New Jersey. Diana, welcome to TALK OF THE NATION.

DIANA (Caller): Hi. I'm wonder what this bill is going to do to keep insurance costs down for people who are self-employed and have to purchase individual plans.

ROVNER: Well, that's where these exchanges come into being, that there will be insurance exchanges. So there will be some competition. As I mentioned earlier, there will be limits on these what we call medical-loss ratios. That's how much insurance companies have to spend on actual benefits, as opposed to administration and profit. There will be, under the Senate bill, the Office of Personnel Management will oversee some - there will be at least a couple of national plans. So there will be some competition, even in places where there are not a lot of private plans.

There will not, as we've mentioned, be a government-run, specially government-run public plan. But there is in the House bill, and remember these bills have to go to conference now and then come back. So we'll see what they'll be able to work out in conference.

Now, this will be tricky. The House Democrats are not going to want to vote for a bill that doesn't have a public option. The Senate Democrats, as we can see, are not going to vote for a bill that does. So this is not over yet.

ROBERTS: Does either bill have a penalty for an individual who doesn't purchase insurance?

ROVNER: Yes. Both bills have penalties for individuals. There will be a mandate. Unless - there's an affordability threshold. Unless you can prove that you cannot afford it, you will be required to purchase insurance. However, there will be fairly generous subsidies for people all the way up to 400 percent of poverty, and I should have memorized these amounts by now. I know that for a family of four, 400 percent of poverty is $88,000. I forget what it is for an individual.

ROBERTS: We are talking about the health care legislation that took one step close to passing in the Senate just over the weekend, and NPR health policy correspondent Julie Rovner is with us.

You can join us if you have question about what's in it and what happens next, when the Senate bill has to reconcile with the House version. Give us a call: 800-989-8255. Or you can send us email. The address is I'm Rebecca Roberts. This is TALK OF THE NATION from NPR News.

(Soundbite of music)

ROBERTS: This is TALK OF THE NATION. I'm Rebecca Roberts, in Washington. At this point, all signs point to the U.S. Senate passing its version of a health care bill before Christmas, but that vote would only be the beginning of the next step: merging the Senate bill with another version passed in the House before a final vote.

But what we see in this current bill comes from months of negotiation and represents, at least in part, some aspects of what we'll likely see in any final bill.

So what's in it, and what was left out, and where do we go from here? NPR's health policy correspondent Julie Rovner is here to answer your questions. If you want to talk with her, give us a call: 800-989-8255. And our email address is

So were they any surprises, anything glaringly different in the final Senate bill from what people had talked about or glaringly different from the House version?

ROVNER: Well, you know, it's funny. You go back - I think Max Baucus, the chairman of the Finance Committee, said however many months ago: I don't think there's 60 votes in the Senate for a public option. I guess this is the point where he gets to say I told you so.

(Soundbite of laughter)

ROVNER: You know, as much - there's so much criticism. There's been so much attention to this public option, and when you go back - and you really do have to think, it's not that big a deal for how this plan would work.

Within the exchanges - remember, not that many people will be in these exchanges. It's really just for people who are self-employed, people who are uninsured and don't get insurance on the job and people who are in very small businesses.

In the House, there's possibility of the exchanges later being opened up to larger and larger businesses, but in the Senate, there's what they call this firewall. So there's really - you're only talking about 30 million people, perhaps, and the public option was only going to be one option within that.

So, you know, at best, you were talking five, six, seven million people in that public option. So I think for all the attention to the public option, it was only ever going to be a small piece of this.

ROBERTS: So why was it such a lightning rod?

ROVNER: I think it was such a lightning rod because people saw - particularly liberals saw it as, you know, the one chance to keep the insurance companies honest, you know, to go after the health insurance companies, who are seen as really, you know, the big, bad, you know, demons in driving up health insurance costs. And I think even that's not necessarily the case.

In a lot of cases, where it's - where you only have, you know, a single hospital or a single hospital chain, sometimes it's the hospital that's driving up the prices and not necessarily the insurance companies that's driving up the prices. So I think people may be surprised sometimes at what's driving up health care costs. It's not always going to be the insurance companies.

ROBERTS: Let's take a call from Kelly in Augusta, Michigan. Kelly, welcome to TALK OF THE NATION.

KELLY (Caller): Hi. My question is: What is the future of SCHIP within universal health care coverage? And just to piggyback on what she just said, it appears as though we're going to reward the three most - the three industries that have the most to gain, and that's hospitals, insurance companies and pharmaceutical companies.

ROBERTS: And SCHIP, we should just say, is the State Children's Health Insurance Plan, or Policy. I don't know what the P stands for.

(Soundbite of laughter)

ROBERTS: You do, I'm sure.

ROVNER: The State Children's Health Insurance Program. This has been an interesting and sort of under-covered piece of all of this, what happens to SCHIP. Actually, it's been renamed CHIP in the last authorization bill.

There was some talk that CHIP would just be folded into the exchange, and that children would end up being - low income - these are the children who are not poor enough to get on Medicaid, sort of moderate-income children. And there was a lot of worry about children's advocates who'd worked really hard for this program, that they would not get as good benefits in the exchange as they get in CHIP.

And so there was a lot of fighting about that. And Jay Rockefeller, Senator Rockefeller, who'd worked very hard, was very upset about that and wanted the CHIP program to continue. And he actually won that in the Senate bill to allow CHIP to continue. And, in fact, in the manager's amendment, CHIP is extended another two years beyond the authorization that they just, that the president signed last spring.

So it's not - now, that's not in the House bill. So that's another issue for conference, you know, what becomes of CHIP and whether those, whether kids who are on CHIP will continue to have the CHIP benefits, which are richer, in fact, than the benefits that they would be guaranteed in the exchange. So that's an issue for conference, for a House-Senate conference.

As to the rewarding the hospitals and the insurance industry and the pharmaceutical industry, the hospitals and the pharmaceutical industry cut deals, you know, early on to not oppose this bill. I think one of the reasons that it looks like this bill has - well, it certainly has gotten further than any previous major health bill in the past. Whether or not it becomes law is still be seen - is that it has not had the opposition of the hospital industry and the pharmaceutical industry.

The insurance industry, they've gotten off a little bit easier, but they're not so thrilled with a lot of the things in this bill. So it's yet to be seen.

ROBERTS: We have an email from Penketch(ph) who says: I'm a physician, and I've been following the above bill closely. It's great to make insurance pay for preexisting conditions and cover people. I wonder who will pick up the tab of the increased expenses related to covering those with preexisting conditions. Will it be healthy and young people? Or may they just jack up the premiums for those who have pre-existing conditions to such a level that they cannot afford to purchase insurance and hence remain uninsured and then pay the penalty?

ROVNER: Well, this is part of the - the argument is that if everybody is covered, then there will be enough money in the pool to pay for people with preexisting conditions, hence the mandate. That's why the requirement.

One of the issues and one of the things that the insurance companies are very worried about is that the penalties are not high enough to make people buy the insurance, that if the penalties are very low - and, in fact, in the Senate bill, the first-year penalty is something like $75, and that's a problem.

ROBERTS: A lot cheaper than insurance.

ROVNER: Yeah, it's a whole lot cheaper than insurance. So now they did raise the penalties in the manager's amendment for higher-income people. I think it's up to two percent of income. So - or, you know, or the cost of the insurance. So obviously, for rich people, you'd way rather buy the insurance than pay two percent of your income.

So that will make the insurance industry a lot happier, but they're very concerned about requiring people to buy insurance. They're worried about a backlash. But the insurance industry is worried about not getting people into the pool.

That was the deal that the insurance industry cut. They said, look, if everybody gets in, then we can afford to not have to worry about preexisting conditions. But the idea is that everybody needs to be in so that they can spread the risk. If there's enough people in the pool, then the premiums from the healthy people will pay for the sick people.

ROBERTS: Well, that also brings up an email from Danna(ph) in Fort Collins, who says: Does the mandate require individuals to purchase comprehensive health plans, or would catastrophic insurance be enough?

ROVNER: Well, this is another difference between the House and the Senate bill. In the House bill, yes, it's comprehensive coverage. There are different levels of it. I forget. It's - I think it's gold, silver and bronze, or that may be the Senate bill. They have different names for them.

Although in the Senate bill, there is something called the Young Invincibles plan. There is a more-catastrophic plan for younger people, but that's a big concern about will that bleed off some of those premiums that are needed to pay for older, sicker people.

There's also an issue of what we call age rating, you know, how much more - there are differences in prices between younger people and older people. They are more dramatic in the Senate bill. Older people can be charged more in the Senate bill than they can in the House bill. That's going to be another issue that they're going to have to work out in this House-Senate conference.

ROBERTS: Let's take a call from Steve in Flagstaff, Arizona. Steve, welcome to TALK OF THE NATION. Hey, Steve. You're on the air.

STEVE (Caller): Yes, I had a couple questions. One was: How much would the subsidies actually be for low-income people? And another one, I was reading the bill, and they were talking about a gateway, and I wasn't exactly sure what the gateway is.

ROVNER: The gateway is basically the Senate version of the exchange. So they - that's just what they're calling it.

ROBERTS: And give us a quick-and-dirty about what the exchanges will be and how they'll work.

ROVNER: The exchange is just where you were go if you were self-employed or in a small business to get your insurance. So that would just be - it may be online. It may be - you know, some people refer to it as the farmers market. It will be basically how you will go. And there will be, you know, a place where you can compare plans and see what's available to you and how much it will cost.

And forgive me, I didn't bring my cheat sheet with me for exactly how much the subsidies will be, but they're going to be on a sliding scale, depending on how much you earn, although it - you know, once you get to 400 percent of poverty, they'll be considerably smaller than - if you're up to 133 percent of poverty, you'll be eligible for Medicaid. Between 133 percent of poverty and 400 percent of poverty, you'll be eligible for a subsidy, and those will be, you know, refundable subsidies. You won't have to wait until, you know, the end of the year to collect them in your taxes. You'll get them as you go to help you pay for those premiums.

ROBERTS: Steve, did that answer your question?

STEVE: Yeah, thank you.

ROBERTS: Thank you. Let's take a call from Bob in Sandusky, Ohio. Bob, welcome to TALK OF THE NATION.

BOB (Caller): Hi, thank you. I've got two questions. The first has to do with the constitutionality of some of these provisions. I'm wondering if a lot of the last-minute inclusions really were done for political reasons, with the understanding that they might not bear the weight of a constitutional challenge by other states, specifically things like the Louisiana Purchase as you've described it other state-specific provisions that other states may want to challenge later as being unfairly treated.

And then the second question I have has to do with the industry itself and the antitrust protection that it has, if once it is passed, if there's any kind of a political weight behind the idea of creating more competition and opening it up to entrepreneurs to kind of level the playing field.

ROVNER: I'm not sure about the second question. You know, on the antitrust exemption, there is talk of - and in the House bill, they would eliminate that antitrust exemption. But that antitrust exemption, if you go back and actually read it, it's fairly limited. It's really just to allow smaller companies to share claims data. So there are a lot of experts who say that eliminating that antitrust exemption wouldn't have that much of an impact.

As to the constitutionality of some of these states' specific changes in Medicaid, Congress has done this lots and lots of times before. I was surprised over the weekend to see Republicans suggesting that this would be unconstitutional. You know, I can find dozens and dozens of bills that give special deals for Medicaid to individual states done by Democrats and Republicans. So, I mean, I don't think anybody has ever sued over it before, so I supposed it would be an interesting case to see. But it's certainly not unprecedented.

ROBERTS: Bob, does that answer your question?

BOB: OK. It sure does. Thank you.

ROBERTS: Thank you. We are talking about the health care bill that passed the Senate last night with Julie Rovner, health policy correspondent here at NPR, and what is in the bill and what is not in the bill. And the big next question: how the reconciliation is likely to happen. First of all, what's the timing on marrying the Senate and House versions?

ROVNER: Oh, I imagine the minute the Senate bill is passed - in fact, I would think that there's staff already starting to put together the paperwork necessary to try and put these two bills together.

You know, I think now that they have the 60 votes and they pretty much know what the Senate bill is going to look like, that they're probably already at work trying to figure out what it is there - you know, there'll be list of doing over - over the break, you know, the members will get something of a holiday break. The staff will not. The staff will be hard at work trying to do what they call clearing the underbrush, things that can be put together by staff, and, you know, the decisions then that will have to be made by members and sort of the easy decisions, and then setting out the hard decisions.

I mean, this kind of a conference would normally take several months, and they're obviously going to try and do it in a matter of weeks. So there are those who - you know, the goal, I think, is to have something by the president's State of the Union address. I don't know whether they'll make that, but certainly, you know, February would be kind of the latest for this.

ROBERTS: How far apart are the two versions?

ROVNER: Well, it's not so much they're of that far apart. It's that there is no margin for error in either house. Remember, the House bill just barely passed and the Senate bill will pass with no margin of error. That's going to be the difficulty, is that there's just no room to maneuver from either bill.

ROBERTS: You're listening to TALK OF THE NATION from NPR News.

Let's take a call from Todd in Las Vegas. Todd, welcome to TALK OF THE NATION.

TODD (Caller): Thank you for taking my call. I had a quick question. My wife and I are both union members, and we have a very good insurance plan. And we both pay roughly the same amount of our total wage package to these plans. And my concern is if I'm taxed on that plan, do I fall under that Cadillac plan that they've been talking about taxing? And if so, does that count as income against my gross pay, and so on?

ROVNER: No. That's not how the - that's not really how the Cadillac plan tax -Cadillac plan, yes, tax works. Although they also - they change - that was another thing that they changed in the manager's amendment. They tried to adjust that so that it only applied to for-profit plans instead of non-profit plans. And then it would depend on who - how your - really, who your carrier is.

But also the way it would work is that the tax would actually be leveled against the insurer, and it would - it's to deter the plan from being so generous. So it wouldn't come back to you in income. It would really come back to you - it's to try and deter your employer from offering such generous coverage.

ROBERTS: Although presumably, if the insurer was paying, they would pass that cost on to the insuree.

ROVNER: That's right. Yeah. But you would probably end up with lesser coverage. You wouldn't end up having to pay the tax.

ROBERTS: Among the differences between the House and Senate version, you mentioned the president's state of the union as a potential deadline. Well, of course, last year, when the president was addressing a joint session, that was not quite a State of the Union, there was this outburst when he mentioned coverage for illegal immigrants, saying that they would not be covered under this bill, and you lie. Where does that issue stand, and is that likely to be a contentious part of this debate?

ROVNER: That is likely to be a contentious part of the debate, and the House, of course - illegal immigrants, sort of by default - it doesn't say that definitely, but illegal immigrants are not barred from purchasing coverage in the exchange...

ROBERTS: With their own money.

ROVNER: ...with their own money. That's right. They don't get any help. There are no benefits for undocumented immigrants in the bill. But there is no bar on their purchasing coverage in the exchange. In the Senate, there is one. So that's an issue that's going to need to be worked out. Now, the Hispanic Caucus in the House is very firm on keeping that in, and so that's going to be an issue that's going to be subject to, I think, some serious negotiation. So, yeah. There are things like that. There's going to be difficulties. You know, any - remember, any one senator walks away, you don't have a bill in the Senate.

(Soundbite of laughter)

ROBERTS: We have an email from David in Boulder, Colorado who says: Why won't many of these changes take effect until 2013 or 2014? Doesn't that mean thousands of Americans will suffer or even die before the changes take effect?

ROVNER: Yes. Unfortunately, you know, it takes a long time to get something this big up and running. Now, they have done a lot of work to get a lot of these changes, many of these changes into effect sooner than that. There are small business tax credits that take effect sooner. There is a ban on preexisting condition for children that takes effect sooner. There are annual and lifetime limit restrictions that take effect sooner. There's a closing of the Medicare prescription drug donut hole that takes effect sooner. But the big things - the exchanges, the ban on preexisting conditions for everyone else, the mandate - the heart of this bill does not take effect in the House till 2013, in the Senate till 2014. And that's really because it takes awhile to get something this big organized, up and running.

You've got to negotiate, you know, a different - you've got to negotiate contracts. You've got people who have contracts that are ongoing. You've got to change the way plans are structured. I mean, it really is a big operation. You've got to write regulations, federal regulations. And they've got to have time to be, you know, drafted and commented upon and made final. So it's, you know, it's almost 2010, it's not that far away.

ROBERTS: Julie Rovner. She's the health policy correspondent here at NPR, joining us here in Studio 3A. Thank you so much, Julie.

ROVNER: You're welcome.

ROBERTS: Go home and get some sleep.

(Soundbite of laughter)

ROBERTS: Up next, don't blame the weatherman. We'll talk about the science of snow prediction. And tell us, whether you're here in D.C., or in Denver: How does the weekend snowstorm changed your holiday plans? 800-989-8255. Or email I'm Rebecca Roberts. Stay with us. It's TALK OF THE NATION from NPR News.

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