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Updated: Kennedy, Committee Introduce Draft Of Bill

The Senate Help, Education, Labor, and Pensions (HELP) Committee just released its proposed health care legislation for markup next week. That's right--it's the actual bill. Not conceptual language. Not leaked drafts. This is actual legislative language that the committee is making public.

The committee will have a hearing on Thursday and begin formal markup next Tuesday. Sometime between now and then we'll get the final language. But this document is closer to final than anything we've seen yet. You can read it online here, in all of its PDF glory.

I've given it only a cursory read, enough to grasp the basics. I'll be back later, maybe tomorrow, with a fuller take--informed, hopefully, by reactions from some of the experts and lobbyists reading through the 600-page document now.

For now, though, here's what I can tell you, subject to revisions as I learn more facts*: 

Insurance would be available to everybody, regardless of pre-existing conditions; insurers would have to charge everybody the same rate, with only a few exceptions. (One of them would be age, but the variation could only be two-to-one, rather than the seven-to-one ration contemplated in the Senate Finance Guidelines.) 

Everybody would have to get insurance, except for hardship cases. Not clear what the penalty would be.

On two of the most contentious points--employer responsibility and the public plan--there's a blank.  Well, not a blank, just a phrase: "Policy under discussion." So stay tuned there. 

Other elements of the bill have more specificty. And here we start to get really wonky.

There are subsidies available to people making up to 500 percent of the poverty line, plus an across-the-board increase in Medicaid eligibility up to 150 percent of the poverty line.  

The regulated marketplaces through which indivdiuals and some small businesses can get coverage--what Massachusetts calls "exchanges"--would be called "American Health Benefits Gateways." States would set up the gateways, on their own or in conjunction with other states. (States could also set up more than one exchange, if that was their choice.)

Note that this risk equalization would happen only through the Gateway. Large employer plans would not be part of this subsidy scheme. So we still wouldn't have one giant risk pool; if the people going into the exchange ended up being sicker than average, it could drive up rates there. (At least so it seems; I haven't run it by my economist friends yet.)

That's not ideal, but perhaps necessary politically, in order to appease large employers that would flinch at becoming part of a national risk pool. I'm pretty sure we're getting the same from Finance and from the House.

The bill has lots of material on delivery reform and the impact on reducing the cost of care. I'm less comfortable making quick reads on that material--I'm just not as fluent on the details--so I'll leave that for later, too.

One final note: This is a Democratic bill. No Republicans have signed on, although perhaps that has something to do with the blanks still to be filled in...  

Update: I originally reported that this was the final bill. But further revisions are possible before markup. Maybe even likely. Folks I've consulted tonight are using words like "fluid" and "lots of moving parts." Like I said, stay tuned!

--Jonathan Cohn