Glossary of terms in U.S. healthcare debate

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The debate over U.S. healthcare reform is full of terms familiar to lawmakers and lobbyists but often obscure to the public.

Here is a glossary of words and phrases being bandied about as Congress considers President Barack Obama's top domestic priority: legislation that reins in healthcare costs, expands coverage to millions of uninsured people and bars insurers from denying coverage for pre-existing conditions or dropping coverage for the sick.

* Age rating:

This refers to the ratio of how much insurers can charge older people relative to the amount they charge young people for health insurance. It is particularly important to the AARP, the influential advocacy group for older people. The House of Representatives bill, which is backed by AARP, has a ratio of 2:1, meaning insurers can charge an older person twice what they charge a young person. The Senate bill has a ratio of 3:1, which would allow insurers to charge older people up to three times what they charge younger people. The AARP prefers that all ages be treated the same for premiums.

* Bending the cost curve:

U.S. healthcare spending is rising much faster than the general rate of inflation. Lawmakers have no expectation of actually cutting prices. The best they hope for is slowing the rate of growth and thus bending the cost curve.

* Cadillac health plans:

These are high-cost insurance plans that require little or no out-of-pocket expenses for medical treatment. Many union employees, workers in high-risk professions and corporate executives have them. The Senate bill calls for imposing a tax on such plans, something ardently opposed by unions, which are a key Democratic constituency.

* Cooperatives:

A nonprofit, membership-owned medical insurance plan. Premiums are collected from members to pay for health expenses of the group. Both the Senate and House included provisions and start-up money for health cooperatives. The idea was first offered in the Senate as an alternative to a proposed new government-run health insurance plan that would compete with private insurers. Liberal Democrats say the co-ops would be too weak to compete effectively with private insurers, but the idea attracted support from centrist Democrats.

* Doughnut hole:

A gap in coverage for prescription drugs under the Medicare government health plan for the elderly. The gap changes every year. In 2009, beneficiaries pay 100 percent of drug costs after $2,700 is spent. Coverage begins again after beneficiaries spend a total $4,350 out of pocket. Legislation being considered aims to close that coverage gap.

* Exchanges:

Both the Senate and House bills would create new marketplaces called exchanges where individuals without employer-sponsored health plans and small businesses can shop for health insurance coverage. Insurers offering products in the exchange would have to meet minimum coverage requirements set by the government.

* Public Option:

A new, government-run health insurance plan that would compete with private companies and offer health coverage through the exchanges mentioned above. Liberal Democrats want some version of the public option to be included in the legislation that goes to President Barack Obama for his signature. But some moderate Democrats are wary of broadening the government's healthcare role and the idea is strongly opposed by Republicans and insurance companies who say it would lead to a government-run system.

* Opt-in:

A version of the public option that would allow states to decide whether to participate in the new government program. Moderate Senate Democrats such as Ben Nelson prefer this version. But liberals including Democrat John Rockefeller worry it would produce a weak public option. They argue the insurance industry holds great sway in state legislatures and would block many states from joining the proposed new government plan.

* Opt-out:

A variation of the public option that would allow states to choose to drop out of the proposed new government-run insurance plan. Supporters and critics agree it would be difficult for many states to opt out of the public plan. This provision is in the Senate version of the bill.

* Trigger:

A fall-back position on the public option offered by Senator Olympia Snowe, the only Republican lawmaker so far to offer any support for the Democratic-led healthcare reform effort. A public option would be triggered only if affordable insurance did not become available in the reformed insurance market.

* Single Payer:

This is a system in which the government would collect taxes to provide medical coverage for all its citizens and legal residents. The single-payer system enjoys support among many liberals but it has not entered the current debate because it would likely fuel Republican criticisms about a socialist takeover of the healthcare system and would not pass Congress. 

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