Oct 27 The debate over U.S. healthcare reform
is full of terms familiar to lawmakers and lobbyists but often
obscure to the public.
Here is a glossary of words and phrases being bandied about
as Congress takes up President Barack Obama's top domestic
priority: a bill that reins in healthcare costs, expands
coverage to millions of uninsured people and bars insurers from
denying coverage for pre-existing conditions or dropping
coverage for the sick.
* Bending the cost curve:
U.S. healthcare spending is rising much faster than the
general rate of inflation. Lawmakers have no expectation of
actually cutting prices. The best they hope for is slowing the
rate of growth and thus "bending the cost curve."
* Cadillac health plans:
These are high-cost insurance plans that require little or
no out-of-pocket expenses for medical treatment. Many union
employees, workers in high-risk professions and corporate
executives have them. The Senate bill calls for imposing a tax
on such plans, something ardently opposed by unions, which are
a key Democratic constituency.
A nonprofit, membership-owned medical insurance plan.
Premiums are collected from members to pay for health expenses
of the group. The Senate Finance Committee included provisions
and start-up money for health cooperatives in its health reform
bill. The idea was offered as an alternative to a proposed new
government-run health insurance plan that would compete with
private insurers. Liberal Democrats say the co-ops would be too
weak to compete with private insurers, but the idea has
attracted support from centrist Democrats.
* Doughnut hole:
A gap in coverage for prescription drugs under the Medicare
government health plan for the elderly. The gap changes every
year. In 2009, beneficiaries pay 100 percent of drug costs
after $2,700 is spent. Coverage begins again after
beneficiaries spend a total $4,350 out of pocket. Legislation
being considered aims to close that coverage gap.
Legislation being considered would create state-based
marketplaces called exchanges where individuals without
employer-sponsored health plans and small businesses can shop
for insurance coverage. Insurers offering products in the
exchange would have to meet minimum coverage requirements set
by the government.
* Public Option:
A new, government-run health insurance plan that would
compete with private companies and offer health coverage
through the exchanges mentioned above. Liberal Democrats want
some version of the public option to be included in the bill.
Some moderate Democrats are wary of broadening the government
healthcare role and the idea is strongly opposed by Republicans
and insurance companies who say it would lead to a
A version of the public option that would allow states to
decide whether to participate in the new government program.
Moderate Senate Democrats like Ben Nelson prefer this version.
But liberals, like Democrat John Rockefeller, worry it would
yield a weak public option. They argue the insurance industry
holds great sway in state legislatures and would block many
states from joining the proposed new government plan.
A variation of the public option that would allow states to
choose to drop out of the proposed new government-run insurance
plan. Supporters and critics agree that it would be difficult
for many states to opt-out of the public plan.
A fall-back position on the public option offered by
Senator Olympia Snowe, the only Republican so far to offer
support for the Democratic-led healthcare reform effort. A
public option would be "triggered" only if affordable insurance
did not become available in the reformed insurance market.
* Single Payer:
This is a system in which the government would collect
taxes to provide medical coverage for all its citizens and
legal residents. The single-payer system enjoys support among
many liberals, but it has not entered the current debate
because it would likely fuel Republican criticisms about a
"socialist" takeover of the healthcare system and would not
(For full coverage of U.S. healthcare reform, click
(Reporting by Donna Smith in Washington; Editing by Xavier