President Barack Obama wants the U.S. Congress to send him a sweeping overhaul of the $2.5 trillion U.S. healthcare system by October to help put the struggling U.S. economy on a solid path of growth.
Below are some questions and answers about the state of play for the legislation in the Senate and the House of Representatives, where Democratic leaders, who control the agenda, believe they are on track to meet Obama's goal.
WHAT IS THE STATE OF PLAY IN THE SENATE?
* Senate Finance Committee Chairman Max Baucus is pushing for strong bipartisan support to help ensure final passage of legislation that can maintain public backing as changes are implemented throughout the healthcare system.
* The Senate Health, Education, Labor and Pensions Committee also drafted legislation that it unveiled on Tuesday. Senator Christopher Dodd has taken a lead role in managing the bill in that committee in the absence of the chairman, Edward Kennedy, who is battling brain cancer. Dodd and Kennedy have both expressed a desire for a bipartisan bill.
* There is broad agreement on the need to promote prevention and to reward hospitals and doctors for providing better quality of care instead of the quantity of services. Those changes would be driven through the Medicare program for the elderly.
* There is also broad agreement for maintaining employer-provided healthcare. For those without employer-provided insurance, the proposed legislation would set up an insurance exchange -- a clearinghouse -- in which individuals and small businesses could shop for medical plans and compare benefits and prices.
* A major sticking point is whether a new government-run insurance plan should compete with private insurers in the exchange. Republicans say they cannot support legislation that includes a new public plan, arguing it would drive private insurers out of business and lead to a government-run healthcare system. Many Democrats insist on a new public plan, arguing it can be set up to compete fairly with private insurers and that it is the only way to keep premiums low.
* Obama also wants a public plan option and both Baucus and Dodd say their bills will include one. The issue is how to design it to keep enough Republicans on board to give the Democratic majority bipartisan political cover. Senators are considering a potential compromise that would create non-profit cooperatives, owned and operated by their members, to compete with private insurers to provide healthcare to individuals and small businesses.
WHAT IS THE STATE OF PLAY IN THE HOUSE?
* Three House committees are working on legislation -- the tax-writing Ways and Means Committee, the Committee on Energy and Commerce, and the Committee on Education and Labor. They hope to unveil legislation in the next few weeks and hold committee votes after lawmakers return from the weeklong July 4 holiday break.
* If lawmakers stay on schedule, the bills will be melded together into one piece of legislation that would go to the House floor before the August recess.
* The House bill is unlikely to win backing from Republicans and is expected to include a public plan option that is more to the liking of liberal Democrats. But a sizable group of conservative Democrats -- the so-called Blue Dogs -- are cool to the idea and have thrown their weight behind a trigger that would put a public plan into effect should the private sector fail to meet price and competition targets.
WHAT ABOUT THE SPECIAL INTERESTS?
* Groups representing insurers, doctors, consumer groups and businesses have refrained from broad attacks against reform. Most agree the current system of rapidly rising costs and millions of uninsured cannot be sustained.
* The American Medical Association, which historically has opposed a broader government role in the healthcare system, has issued a statement saying it opposes expansion of Medicare to cover the uninsured or a government plan that offers the same payment structure as Medicare. However, the doctors' group said in the statement released on Thursday that it was open to considering a public plan or a potential compromise.
* Some nursing organizations support an expanded government role in providing healthcare for all. The American Nurses Association backs a so-called single-payer system where the government would finance medical coverage, but that is unlikely to win broad acceptance.
* Lawmakers are balancing the demands of the various interest groups in hopes of keeping the players on board, but that could change in the next few weeks as the committees unveil actual legislation and hold public drafting sessions. Ultimately, congressional leaders will have to decide which special interests can be sacrificed and still get a bill passed.
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