More healthcare votes ahead for Congress

Reporting from Washington — 

The Senate passed its version of the healthcare overhaul on Christmas Eve. Here are some questions about what’s next as the legislation continues to work its way through Congress:

What’s going to happen this month?

The Senate’s healthcare legislation must now be merged with the House version -- and that could be tricky.

Senate and House negotiators could choose to meet in a formal conference committee to work out the differences or instead work out a deal in a looser, give-and-take fashion. Even though the conference committee would ostensibly be a more public forum, the nitty-gritty will be worked out in private no matter what.

One major bone of contention is whether to help pay for the overhaul with a tax on high-end health plans or a surtax on wealthy Americans. Other issues include restrictions on the use of federal subsidy dollars to cover abortions and whether to include a government-run health insurer, known as the “public option.”

When a final version is completed, both chambers must vote again on the measure. Democrats will again need 60 votes in the Senate to force a final vote.

If the healthcare bill does become law this year, will there be some immediate effects?

Assuming that the final bill ends up looking much like the Senate version passed last month, the legislation would do a number of things in the short term.

It would create a national high-risk insurance plan to help those with preexisting conditions who can’t currently find affordable insurance. It would also begin to close the Medicare Part D “doughnut hole” that forces enrollees to assume the full cost of some prescription drugs.

It would allow a child on a family insurance plan to stay on as a dependent until age 26. Medical device-makers, pharmaceutical companies and health insurers would also soon begin paying new fees to help finance the cost of expanding coverage.

But the highest-profile element of the bill, the new insurance exchanges, wouldn’t come into existence until 2013 or 2014.

What is this government plan to help people with long-term care needs? Is this the public option?

No. The public option, which remains in the House version of the legislation, is a government-run health insurer that would compete with private companies.

The long-term care plan is separate, and is in both the Senate and House proposals. It would allow workers to have payroll deductions go into a fund that would pay them a benefit years later if they become disabled.

The benefit could be used to hire in-home help and avoid a nursing home or an assisted-living facility.

Critics worry that the premiums for the insurance plan will be too costly and will discourage participation, forcing the government to ultimately prop up the program.

joliphant@latimes.com