What’s Next After the Senate Health Vote?

The Senate on Thursday passed sweeping legislation to change the health care system. Here are some questions about what’s next as the legislation continues to work its way through Congress:

It seems like the health care debate has been dragging on for months. When will this end?

Most likely in February. All signs point to the House and Senate ironing out the differences between their versions of the health care bill in January, with the goal of sending it to the president for his signature sometime around the State of the Union address in early February. But deadlines have not always held.

Sen. Ben Nelson struck a deal with Senate leaders in which his state, Nebraska, won’t have to pay the same cost of expanding Medicaid as other states. Is that illegal?

Some Republicans claim it is. Nelson indeed saved his state about $10 million a year by forcing the federal government to assume the entire cost of expanding Medicaid to 133% above the poverty level.

On the Senate floor last week, GOP senators argued that the exemption violates Congress’ tax and spending powers under Article I of the Constitution, which requires the powers be used for the “general welfare.”

Some legal experts agree. But other experts say that Congress is free to send tax money wherever it wants -- and that Nelson’s move was simply good politics.

I’m 55. Would I qualify for Medicare under the Senate bill?

No. The proposed Medicare “buy-in,” which would have allowed those 55 to 64 to pay a premium to join the program, was jettisoned from the Senate bill at the behest of Sen. Joe Lieberman (I-Conn.) and other senators who expressed concern about its cost. The qualifying age for Medicare will remain 65.

What was the most significant part of the so-called manager’s amendment added to the Senate bill last week?

Probably the provision that would create multi-state private health insurance plans operated by Office of Personnel Management, which oversees plans for federal employees. The hope is that the plans will provide consumers with another insurance option, especially in states where competition is limited, and help keep premium costs from rising.

Another significant provision would limit the amount insurance companies can spend on activities other than paying claims, such as marketing.

A third prevents insurers from capping the amount of medical benefits you can receive under a policy during your lifetime.

I don’t understand the differences between the Senate and House bills on abortion coverage.

The House has more restrictive language: the so-called Stupak amendment, which bars insurers that benefit from federal subsidies from offering policies that cover abortions.

The Senate version requires consumers who receive subsidies to purchase policies through the new insurance exchanges to essentially write two checks -- so that money for abortion coverage is segregated from federal funds.

Expect this to be a point of contention as the House and Senate bills are reconciled.

joliphant@latimes.com