Lo and behold: the Senate has finally unveiled its health care reform legislation, and will officially announce the plan at a press conference this afternoon. Numbers and opinions are swirling around every media outlet in the country today and it can be mind-boggling to figure out what this means for you — the consumer. Here is my attempt to break down the Senate bill and highlight the provisions that may actually help to reform our system and those that are withered down to simply words on paper at this point.

The Patient Protection and Affordable Care Act released by the Senate late last night is estimated to cost $849 billion over ten years, but with carefully placed taxes like those on high-income earners and on insurance policies that have high costs (also known as “Cadillac plans”), as well as generating savings from Medicare and Medicaid, the bill proposes to pay for these costs and will end up reducing the government’s deficit by $127 billion over the first decade. Most provisions in the bill will take effect by 2014 — what happens before then? Find out here.

The Good:

• 31 million of the uninsured will now gain health insurance.
• New health insurance exchanges will be created to choose from a range of insurance plans.
• There will be a public plan offered in the exchanges.
• Insurers can no longer deny coverage based on pre-existing conditions, health status or gender.
• Those making up to 133% of the Federal Poverty Level (FPL) can get coverage through Medicaid(expected to insure 15 million more people).
• Young adults will be able stay on their parents’ insurance plans until age 26.
• People making between 133% and 400% of the FPL will be able to receive assistance from the government to purchase insurance.
• The assistance is important because buying health insurance will now be a requirement for most everyone (except for those with very low-income).
• Employers with under 50 employees can buy insurance in the exchange as well (including self-employed people) and receive tax benefits for doing so.
• There will be caps on out-of-pocket expenses, like co-pays for doctor visits and deductibles.
• Preventive care will now be covered by insurance plans.
• Investments to bring more people into the health care workforce will be made through loan repayment programs and scholarships.

The Bad, The Ugly

• 24 million people will still remain uninsured, one-third of them are unauthorized immigrants.
• Unauthorized immigrants will be banned from purchasing insurance through the exchanges, even if they can pay the full costs themselves (in the House bill they would be allowed to buy in the exchange but without federal assistance).
• The health insurance exchanges will be on a state-by-state basis which is weaker than the national exchange offered in the House bill (think bigger pool of competition).
• The public plan is not much more than words on paper at this point. It will have higher premiums than the private plans (due to the fact that it will be negotiating its own rates to providers instead of using set rates tied to Medicare) and states can refuse to offer the public plan to its residents if they want to.
• Only 3-4 million people are expected to use the public plan, which defeats the purpose of it being effective with a large pool of consumers.
• Young adults up to age 30, as well as anyone who may not be able to afford insurance (if their premiums exceed 8% of income), will be eligible for a Catastrophic plan, which means millions of people could get sucked into a plan with almost no comprehensive coverage and really high costs.
• While 25 million people are expected to purchase coverage through the new exchanges, our health insurance system is still largely based on employer-provided insurance plans. Yet under this bill, employers will not be required to offer coverage to their employees.
• But if an employer with 50 or more workers does not offer coverage they will be fined $750 for every worker that requires federal assistance to purchase insurance in the exchange.  This is called the “free rider” provision and leaves the window wide open for companies to discriminate against hiring low-income workers and will encourage them to hire illegal immigrants.
• There will be $50 million put towards abstinence-only sex education (way to throw money at ineffective solutions).

The Big Compromise

• Abortion: The issue of whether a legal medical procedure should be covered by insurance or not shouldn’t even be a question, but this is America –the land of pro-choice vs. anti-choice– so it is. That said, the Senate bill has slightly less restrictive provisions for coverage of abortion than the House bill does with its Stupak-Pitts amendment.
• Under the Senate bill, insurance plans can choose whether to cover abortions or not, but in each state there has to be at least one plan that covers it and one that doesn’t.
• Unlike in the House bill, people receiving federal assistance to buy insurance can buy a plan that covers abortion, but the insurer can only use the money contributed by the consumer to pay for abortion services, putting the federal funds toward other services only. (This whole separation of funds for a certain medical procedure just irks me.  To paraphrase Kierra Johnson of Choice USA, “I can’t separate my uterus from the rest of my body, right?”. It’s like going to the doctor and saying ‘you can go ahead and bill me separately for the part of the check up where you assessed the health of my uterus’.)
• Finally, the public plan could provide abortion coverage but would have to segregate federal dollars, just like the private plans.

That’s it in a long nutshell; the Senate bill that will now be debated and amended over the month of December, and then merged with the House bill to produce what will hopefully be a still recognizabe piece of legislation aimed at reforming our health insurance system.  Click here for a helpful side-by-side comparison of the Senate and House bills.