For the first time in what has been a politically charged process, a Republican broke ranks and voted in favor of the legislation. Maine Republican Senator Olympia Snowe voted with 13 Democrats in supporting the bill, but cautioned that her vote on the bill once it reaches the full Senate will be subject to the final language that emerges once competing Senate and House bills are reconciled.

Key components and data points related to the bill approved by the Finance Committee include:

	Individual Mandate – Most Americans will be required to have health insurance or be subject to a penalty that can ultimately include imprisonment. Annual fines for failing to procure coverage could be as high as $750 per individual. Income based government subsidies will be available to make coverage more affordable. The level of penalties and subsidies are certain to be hotly debated as the legislative process unfolds. Opponents to healthcare reform have argued that the US Constitution doesn’t empower the Federal government to mandate that citizens buy any good or service, and for this reason it's possible that the provision could face a Supreme Court challenge if enacted.
	Limited Employer Play or Pay – Employers will not be required to provide health insurance coverage, however employers with 50 or more employees will be required to reimburse the government for healthcare subsidies provided to employees.
	Limits on Copays, Deductibles and Pre-Existing Conditions – Among other provisions, insurers (and presumably employer sponsored health plans) will be restricted or prohibited in their ability to levy pre-existing condition limitations. In addition, the legislation imposes limits on copays, deductibles and out-of-pocket maximums, provisions that are likely to increase premiums for some employer health plans and call into question the viability of consumer directed health plans that commonly feature high deductibles and out-of-pocket maximums.
	Taxes on High Value Plans – To help fund the cost of the bill, employer health plan benefits provided in excess of defined limits will be subject to a 40% premium tax. These limits, which would become effective in 2013, may ultimately vary by state and/or employer risk factors but initial estimates are that healthcare benefits in excess of $8,000 for an individual and $21,000 for a family would be taxable at the 40% rate. The high value tax will be strongly opposed by union groups who will argue in favor of increased taxes on high wage earners.
	No Public Option – The bill does not include what has become a controversial public option to compete against private insurers. The bill does enable and include funding for the creation of state based non-profit purchasing cooperatives that would allow individuals and small businesses another coverage option.
	No Tort Reform – The bill does not include specific steps to reform the tort system as it pertains to healthcare. Rather, the Senate would encourage states to “develop and test alternatives to the current civil litigation system as a way of improving patient safety, reducing medical errors, encouraging the efficient resolution of disputes, increasing the availability of prompt and fair resolution of disputes, and improving access to liability insurance, while preserving an individual's right to seek redress in court.”
	Medicaid Expansion – State run Medicaid eligibility would be standardized at 133% of the poverty level. It isn’t clear to what degree Federal funds would be allocated to reimburse states for the cost of expanding Medicaid coverage.
	Insurance Industry Feedback – The day before the Finance Committee vote, the insurance industry’s main lobbying group, America’s Health Insurance Plans, released a study claiming that the proposed legislation will lead to an 11% increase in private and employer based premiums. The study, which was authored by Price Waterhouse Coopers, projects the price increase because it believes the penalties for opting out of coverage are too weak and as a result the newly insured population will not include enough healthy people to offset the cost of the unhealthy.

What’s Next?

House and Senate leaders will work to reconcile competing provisions amongst various bills. This is likely to take at least 60 days and among the most controversial topics to be debated will be:

1.    Public Option vs. Purchasing Cooperatives
2.    Tax on High Value Plans vs. Tax on High Income Earners
3.    Individual Mandate vs. Employer Mandate
4.    Limits on benefit provisions including deductibles, coinsurance and out-of-pocket maximums
5.    Amendments specifically prohibiting government funding of abortion
6.    Amendments specifically prohibiting coverage for undocumented workers

There is no certainty that legislation will ultimately be passed through Congress and enacted. While a bill is likely to make it out of the House of Representatives, it does not appear that Democrats have the 60 votes required to break a potential filibuster in the Senate. Senate opposition comes not just from Republican ranks, but from moderate Democrats who are concerned about the overall price tag of the bill and its impact on the economy.