A_AT1 Start_NN1 on_II Health_NN1 Care_NN1 Reform_NN1 The_AT Senate_NN1 's_GE passage_NN1 of_IO a_AT1 heath_NN1 care_NN1 reform_NN1 bill_NN1 over_II lockstep_NN1 Republican_NN1 opposition_NN1 required_VVN every_AT1 single_JJ member_NN1 of_IO the_AT Democratic_JJ caucus_NN1 to_TO vote_VVI to_TO override_VVI Republican_NN1 filibusters_NN2 ._. 
It_PPH1 will_VM take_VVI equal_JJ political_JJ will_NN1 to_TO fuse_VVI the_AT Senate_NN1 's_GE bill_NN1 with_IW the_AT more_RGR expansive_JJ reform_NN1 approved_VVN by_II the_AT House_NN1 and_CC enact_VV0 a_AT1 final_JJ version_NN1 ._. 
The_AT House_NN1 bill_NN1 was_VBDZ approved_VVN by_II 220_MC to_II 215_MC ,_, and_CC the_AT Senate_NN1 bill_NN1 passed_VVN with_IW 60_MC votes_NN2 ,_, the_AT minimum_NN1 needed_VVD to_TO defeat_VVI a_AT1 filibuster_NN1 ._. 
The_AT risk_NN1 is_VBZ that_CST anything_PN1 that_CST upsets_VVZ the_AT balance_NN1 of_IO compromises_NN2 in_II either_DD1 chamber_NN1 could_VM doom_NN1 the_AT effort_NN1 ._. 
The_AT Senate_NN1 bill_NN1 seems_VVZ especially_RR fragile_JJ ._. 
Senators_NN2 --_NN1 especially_RR self-styled_JJ moderates_NN2 --_NN1 will_VM have_VHI to_TO forswear_VVI the_AT posturing_NN1 that_CST weakened_VVD and_CC almost_RR derailed_VVD their_APPGE bill_NN1 ._. 
It_PPH1 is_VBZ time_NNT1 to_TO put_VVI the_AT public_JJ interest_NN1 first_MD ,_, because_CS there_EX are_VBR valuable_JJ features_NN2 in_II each_DD1 bill_NN1 that_CST warrant_VV0 inclusion_NN1 in_II the_AT final_JJ product_NN1 ._. 
The_AT House_NN1 bill_NN1 ,_, which_DDQ is_VBZ superior_JJ in_II many_DA2 critical_JJ respects_NN2 ,_, does_VDZ a_AT1 better_JJR job_NN1 of_IO making_VVG health_NN1 insurance_NN1 affordable_JJ ;_; the_AT Senate_NN1 bill_NN1 has_VHZ stronger_JJR provisions_NN2 to_TO restrain_VVI escalating_JJ medical_JJ costs_NN2 ._. 
The_AT basic_JJ framework_NN1 of_IO the_AT bills_NN2 is_VBZ the_AT same_DA ._. 
Both_DB2 would_VM require_VVI everyone_PN1 to_TO obtain_VVI health_NN1 insurance_NN1 --_NN1 and_CC all_DB employers_NN2 to_TO provide_VVI it_PPH1 --_JJ or_CC pay_VV0 a_AT1 penalty_NN1 ._. 
Both_DB2 would_VM set_VVI up_RP insurance_NN1 exchanges_NN2 on_II which_DDQ small_JJ businesses_NN2 and_CC people_NN who_PNQS buy_VV0 their_APPGE own_DA health_NN1 insurance_NN1 could_VM choose_VVI from_II an_AT1 array_NN1 of_IO private_JJ plans_NN2 (_( but_CCB perhaps_RR not_XX a_AT1 public_JJ plan_NN1 ,_, the_AT way_NN1 the_AT winds_NN2 are_VBR blowing_VVG )_) ._. 
Both_DB2 would_VM provide_VVI subsidies_NN2 to_TO help_VVI low-income_JJ people_NN buy_VV0 insurance_NN1 on_II the_AT exchanges_NN2 and_CC expand_VV0 Medicaid_VVN to_TO help_VVI the_AT poorest_JJT ._. 
Both_DB2 would_VM impose_VVI new_JJ rules_NN2 on_II insurance_NN1 companies_NN2 and_CC force_VV0 them_PPHO2 to_TO accept_VVI all_DB applicants_NN2 without_IW regard_NN1 to_II pre-existing_JJ conditions_NN2 ._. 
Both_DB2 would_VM begin_VVI to_TO move_VVI Medicare_NP1 ,_, and_CC through_II its_APPGE example_NN1 the_AT entire_JJ health_NN1 care_NN1 system_NN1 ,_, away_II21 from_II22 wasteful_JJ fee-for-service_JJ medicine_NN1 toward_II coordinated_JJ delivery_NN1 systems_NN2 that_CST improve_VV0 quality_NN1 and_CC lower_JJR costs_NN2 ._. 
The_AT House_NN1 bill_NN1 would_VM spend_VVI $1.05_NNU trillion_NNO over_II the_AT next_MD decade_NNT1 to_TO expand_VVI coverage_NN1 of_IO the_AT uninsured_JJ ,_, a_RR21 lot_RR22 more_DAR than_CSN the_AT $871_NNU billion_NNO proposed_VVN by_II the_AT Senate_NN1 bill_NN1 ._. 
The_AT Congressional_JJ Budget_NN1 Office_NN1 estimates_VVZ that_CST the_AT House_NN1 bill_NN1 would_VM cover_VVI 96_MC percent_NNU of_IO all_DB citizens_NN2 and_CC legal_JJ residents_NN2 below_II age_NN1 65_MC by_II 2019_MC ,_, while_CS the_AT Senate_NN1 would_VM reach_VVI only_RR 94_MC percent_NNU ._. 
Both_DB2 numbers_NN2 would_VM represent_VVI a_AT1 substantial_JJ improvement_NN1 over_II the_AT current_JJ 83_MC percent_NNU ._. 
Neither_DD1 bill_NN1 would_VM bust_VVI the_AT budget_NN1 ;_; they_PPHS2 would_VM reduce_VVI the_AT deficit_NN1 over_II the_AT next_MD decade_NNT1 by_II comparable_JJ amounts_NN2 in_II31 excess_II32 of_II33 $130_NNU billion_NNO ,_, according_II21 to_II22 the_AT budget_NN1 office_NN1 ._. 
Here_RL are_VBR the_AT major_JJ differences_NN2 :_: FINANCING_VVG The_AT Senate_NN1 bill_NN1 has_VHZ the_AT better_JJR financing_NN1 feature_NN1 to_TO help_VVI subsidize_VVI coverage_NN1 of_IO the_AT uninsured_JJ --_NN1 a_AT1 stiff_JJ excise_NN1 tax_NN1 on_II the_AT most_RGT costly_JJ employer-provided_JJ health_NN1 plans_NN2 ._. 
The_AT tax_NN1 would_VM provide_VVI a_AT1 strong_JJ incentive_NN1 for_IF employers_NN2 and_CC workers_NN2 to_TO shift_VVI to_II lower-priced_JJR plans_NN2 ._. 
Organized_JJ labor_NN1 is_VBZ strongly_RR opposed_VVN to_II the_AT tax_NN1 and_CC the_AT House_NN1 is_VBZ cool_JJ to_II the_AT idea_NN1 ,_, but_CCB it_PPH1 should_VM be_VBI retained_VVN ._. 
Health_NN1 economists_NN2 of_IO all_DB political_JJ stripes_NN2 see_VV0 the_AT tax_NN1 as_II the_AT major_JJ cost-reduction_NN1 element_NN1 ._. 
The_AT main_JJ source_NN1 of_IO money_NN1 in_II the_AT House_NN1 bill_NN1 would_VM be_VBI an_AT1 income_NN1 tax_NN1 surcharge_NN1 on_II the_AT amount_NN1 by_II which_DDQ incomes_NN2 exceed_VV0 $500,000_NNU for_IF individuals_NN2 and_CC $1_NNU million_NNO for_IF couples_NN2 ._. 
This_DD1 is_VBZ eminently_RR fair_JJ given_CS21 that_CS22 the_AT wealthy_JJ benefited_VVD enormously_RR from_II the_AT Bush-era_JJ tax_NN1 cuts_NN2 ._. 
The_AT Senate_NN1 rejected_VVN such_DA a_AT1 tax_NN1 ,_, but_CCB should_VM agree_VVI to_TO extract_VVI more_DAR money_NN1 from_II the_AT wealthy_JJ ._. 
MEDICAL_JJ CARE_NN1 REFORMS_VVZ The_AT House_NN1 bill_NN1 relies_VVZ heavily_RR on_II pilot_NN1 projects_NN2 within_II Medicare_NP1 to_TO determine_VVI which_DDQ approaches_VVZ to_II restraining_VVG medical_JJ costs_NN2 might_VM work_VVI best_RRT ,_, but_CCB lacks_VVZ a_AT1 strong_JJ mechanism_NN1 to_TO drive_VVI successful_JJ reforms_NN2 into_II widespread_JJ use_NN1 ._. 
The_AT Senate_NN1 bill_NN1 would_VM empower_VVI an_AT1 independent_JJ board_NN1 to_TO carry_VVI out_RP successful_JJ reforms_NN2 broadly_RR within_II Medicare_NP1 and_CC recommend_VV0 changes_NN2 in_II private_JJ programs_NN2 ._. 
The_AT board_NN1 is_VBZ a_AT1 crucial_JJ cost-control_JJ mechanism_NN1 ._. 
It_PPH1 should_VM be_VBI strengthened_VVN ,_, by_II removing_VVG a_AT1 10-year_JJ exemption_NN1 for_IF hospitals_NN2 and_CC hospices_NN2 ._. 
AFFORDABILITY_NP1 Under_II the_AT more_RGR generous_JJ House_NN1 bill_NN1 ,_, low-income_JJ people_NN would_VM pay_VVI substantially_RR less_RRR and_CC get_VVI better_JJR benefits_NN2 than_CSN under_II the_AT Senate_NN1 bill_NN1 ._. 
The_AT House_NN1 bill_NN1 has_VHZ far_RG better_JJR subsidies_NN2 to_TO help_VVI lower-income_JJ Americans_NN2 with_IW premiums_NN2 and_CC cost-sharing_NN1 ._. 
The_AT Senate_NN1 bill_NN1 offers_VVZ better_JJR subsidies_NN2 for_IF middle-income_JJ people_NN ._. 
House_NN1 staffers_NN2 calculate_VV0 that_CST a_AT1 family_NN1 of_IO four_MC earning_VVG $33,000_NNU a_AT1 year_NNT1 would_VM pay_VVI $1,521_NNU in_II premiums_NN2 under_II the_AT Senate_NN1 bill_NN1 ,_, which_DDQ is_VBZ $530_NNU more_DAR than_CSN under_II the_AT House_NN1 bill_NN1 ._. 
The_AT same_DA family_NN1 would_VM be_VBI exposed_VVN to_II as_CSA much_DA1 as_CSA $4,100_NNU in_II cost-sharing_NN1 under_II the_AT Senate_NN1 bill_NN1 ,_, which_DDQ is_VBZ $3,100_NNU more_DAR than_CSN under_II the_AT House_NN1 bill_NN1 ._. 
Affordability_NN1 is_VBZ probably_RR the_AT most_RGT critical_JJ issue_NN1 in_II winning_VVG popular_JJ support_NN1 ._. 
The_AT Senate_NN1 needs_VVZ to_TO agree_VVI to_II more_DAR subsidies_NN2 ._. 
MEDICAID_VVD The_AT House_NN1 bill_NN1 would_VM expand_VVI Medicaid_JJ coverage_NN1 to_II higher-earning_JJR people_NN than_CSN the_AT Senate_NN1 bill_NN1 does_VDZ ._. 
It_PPH1 would_VM raise_VVI Medicaid_NP1 's_GE low_JJ payments_NN2 to_II doctors_NN2 in_II one_MC1 crucial_JJ respect_NN1 --_NN1 paying_VVG primary-care_JJ doctors_NN2 the_AT same_DA that_CST Medicare_NP1 pays_VVZ ._. 
That_DD1 would_VM make_VVI it_PPH1 more_RGR likely_JJ that_CST poor_JJ patients_NN2 could_VM find_VVI a_AT1 doctor_NN1 willing_JJ to_TO serve_VVI them_PPHO2 ._. 
The_AT Senate_NN1 should_VM follow_VVI the_AT House_NN1 lead_NN1 ._. 
EMPLOYER_NN1 MANDATES_NN2 The_AT House_NN1 bill_NN1 imposes_VVZ higher_JJR penalties_NN2 on_II employers_NN2 who_PNQS fail_VV0 to_TO offer_VVI coverage_NN1 ,_, a_AT1 prod_NN1 estimated_VVD to_TO increase_VVI the_AT number_NN1 of_IO covered_JJ workers_NN2 by_II six_MC million_NNO in_II 2019_MC ._. 
The_AT Senate_NN1 bill_NN1 has_VHZ weaker_JJR penalties_NN2 that_CST would_VM allow_VVI more_DAR employers_NN2 to_TO opt_VVI out_RP ,_, reducing_VVG by_II four_MC million_NNO the_AT number_NN1 of_IO workers_NN2 covered_VVD ._. 
Under_II the_AT House_NN1 bill_NN1 ,_, employers_NN2 would_VM have_VHI to_TO pay_VVI most_DAT of_IO the_AT premium_NN1 and_CC meet_VVI minimum_JJ benefit_NN1 levels_NN2 ;_; the_AT Senate_NN1 has_VHZ weaker_JJR requirements_NN2 ._. 
The_AT House_NN1 bill_NN1 is_VBZ superior_JJ ._. 
INDIVIDUAL_JJ MANDATE_NN1 The_AT House_NN1 has_VHZ stronger_JJR penalties_NN2 on_II individuals_NN2 who_PNQS decline_VV0 to_TO buy_VVI insurance_NN1 and_CC would_VM exempt_VVI fewer_DAR individuals_NN2 on_II grounds_NN2 they_PPHS2 could_VM not_XX afford_VVI to_TO buy_VVI coverage_NN1 ._. 
Given_CS21 that_CS22 the_AT reforms_NN2 would_VM work_VVI best_VV0 with_IW the_AT greatest_JJT number_NN1 of_IO people_NN insured_VVD ,_, the_AT House_NN1 provisions_NN2 should_VM prevail_VVI ._. 
EXCHANGES_NN2 Analysts_NN2 disagree_VV0 over_RP whether_CSW it_PPH1 would_VM be_VBI best_JJT to_TO set_VVI up_RP a_AT1 strong_JJ national_JJ exchange_NN1 while_CS allowing_VVG states_NN2 that_CST meet_VV0 national_JJ standards_NN2 to_TO operate_VVI the_AT exchanges_NN2 (_( the_AT House_NN1 bill_NN1 )_) or_CC to_TO let_VVI the_AT states_NN2 set_VVI up_RP exchanges_NN2 with_IW federal_JJ government_NN1 oversight_NN1 (_( the_AT Senate_NN1 bill_NN1 )_) ._. 
A_AT1 national_JJ exchange_NN1 would_VM ensure_VVI greater_JJR uniformity_NN1 and_CC probably_RR impose_VV0 tougher_JJR standards_NN2 ._. 
State_VV0 exchanges_NN2 would_VM know_VVI their_APPGE local_JJ markets_NN2 the_AT best_JJT ._. 
Either_DD1 approach_NN1 could_VM work_VVI ._. 
The_AT more_RGR important_JJ issue_NN1 is_VBZ how_RRQ the_AT exchanges_NN2 would_VM operate_VVI ._. 
EXCHANGE_NN1 RULES_VVZ The_AT House_NN1 bill_NN1 would_VM merge_VVI individual_JJ buyers_NN2 and_CC small_JJ businesses_NN2 into_II a_AT1 large_JJ pool_NN1 that_CST would_VM spread_VVI the_AT risks_NN2 among_II sick_JJ and_CC healthy_JJ patients_NN2 so_BCL21 as_BCL22 to_TO keep_VVI average_JJ premiums_NN2 low_JJ ._. 
The_AT Senate_NN1 bill_NN1 would_VM fragment_VVI the_AT risk_NN1 pools_NN2 to_II the_AT point_NN1 that_CST they_PPHS2 might_VM not_XX function_VVI well_RR ._. 
PRESCRIPTION_NN1 DRUGS_NN2 The_AT House_NN1 bill_NN1 would_VM close_VVI the_AT notorious_JJ doughnut_NN1 hole_NN1 ,_, a_AT1 coverage_NN1 gap_NN1 that_CST leaves_VVZ many_DA2 Medicare_NP1 patients_NN2 paying_VVG the_AT full_JJ cost_NN1 of_IO their_APPGE medicines_NN2 ;_; extract_VV0 bigger_JJR discounts_NN2 from_II the_AT manufacturers_NN2 ;_; and_CC allow_VV0 the_AT government_NN1 to_TO negotiate_VVI drug_NN1 prices_NN2 for_IF Medicare_NP1 beneficiaries_NN2 ._. 
The_AT Senate_NN1 should_VM yield_VVI to_II the_AT House_NN1 on_II the_AT drug_NN1 makers_NN2 ,_, who_PNQS will_VM be_VBI making_VVG enormous_JJ profits_NN2 from_II tens_MC2 of_IO millions_NNO2 of_IO new_JJ customers_NN2 and_CC ought_VMK to_TO contribute_VVI more_RRR to_TO reform_VVI ._. 
PUBLIC_RR PLAN_VV0 The_AT House_NN1 bill_NN1 includes_VVZ a_AT1 relatively_RR weak_JJ public_JJ plan_NN1 that_CST might_VM end_VVI up_RP charging_VVG higher_JJR premiums_NN2 than_CSN competing_JJ private_JJ plans_NN2 because_CS it_PPH1 would_VM attract_VVI the_AT sickest_JJT customers_NN2 ._. 
Even_RR that_DD1 modest_JJ plan_NN1 has_VHZ no_AT chance_NN1 in_II the_AT Senate_NN1 ._. 
If_CS it_PPH1 has_VHZ to_TO be_VBI dropped_VVN in_II the_AT interest_NN1 of_IO passing_VVG a_AT1 bill_NN1 ,_, that_DD1 is_VBZ a_AT1 price_NN1 worth_II paying_VVG ._. 
ABORTION_NN1 This_DD1 is_VBZ a_AT1 choice_NN1 of_IO two_MC evils_NN2 ._. 
The_AT House_NN1 bill_NN1 would_VM prohibit_VVI any_DD private_JJ insurance_NN1 plan_NN1 that_CST accepts_VVZ a_AT1 single_JJ subsidized_JJ enrollee_NN1 from_II covering_VVG abortion_NN1 ._. 
That_DD1 could_VM effectively_RR ban_VVI abortion_NN1 coverage_NN1 within_II the_AT exchanges_NN2 ._. 
The_AT Senate_NN1 bill_NN1 would_VM set_VVI up_RP an_AT1 extremely_RR cumbersome_JJ procedure_NN1 in_II which_DDQ everyone_PN1 buying_VVG an_AT1 insurance_NN1 plan_NN1 that_CST covers_VVZ abortions_NN2 on_II the_AT exchanges_NN2 (_( even_RR men_NN2 and_CC post-menopausal_JJ women_NN2 )_) would_VM have_VHI to_TO send_VVI two_MC monthly_JJ checks_NN2 to_II the_AT insurance_NN1 company_NN1 ,_, one_PN1 covering_VVG most_DAT of_IO the_AT premium_NN1 and_CC a_AT1 second_MD tiny_JJ amount_NN1 covering_VVG the_AT estimated_JJ cost_NN1 of_IO abortion_NN1 services_NN2 that_CST might_VM be_VBI provided_VVN to_II some_DD enrollees_NN2 ._. 
