A look at 3 health-care bills in the works

In his speech Wednesday, President Obama outlined a set of health-care goals he supports - including a mandate that everyone have health insurance and the addition of a public health-insurance alternative for the uninsured. But there is no single Obama overhaul bill yet.

In varying forms, several of his proposals are included in three measures in the works in Congress: the House tri-committee bill; the Senate HELP (Health, Education, Labor, and Pensions) committee bill; and the Senate Finance Committee bill, still in draft form. Experts caution that these bills could change, and that important details that could determine the cost of premiums have not yet been ironed out.

Jennifer Tolbert, principal policy analyst for Kaiser Family Foundation, has studied the measures and patiently acted as a guide to all three panels. All of the bills, she said, would create exchanges that would allow individuals and small groups to use combined bargaining clout to get better insurance prices.

The bills also would:

Prohibit setting premium rates on the basis of health or gender, though age would be OK. To limit prices, the House bill says an insurer cannot charge a 64-year-old more than twice what it charges an 18-year-old. The Senate bill would allow a 5-1 ratio.

Cap out-of-pocket expenses for covered benefits at about $5,000 per person, $10,000 per family. This would not include the cost of, say, getting surgery at an out-of-network hospital.

Expand Medicaid to include everyone with incomes up to 133 percent of the poverty level. Currently, childless individuals are excluded unless they are disabled.

Subsidize the price of insurance for people making up to three or four times the poverty level, depending on the measure. The poverty level for a family of four is $22,050. The House bill would cap total cost on a sliding scale, topping out at 12 percent of income at 400 percent of the poverty level.

The Senate Finance bill would not require employers to provide coverage. The other bills would for companies of a certain size. Employers would have to pay 60 percent to 72.5 percent of an employee's premium or face penalties.

It's hard to know what insurance will end up costing any of us at the end, Tolbert said. Details of what will be included in the minimum allowable plan won't even be worked out until after a bill passes. That's good, she said, because you don't want Congress to have to decide on coverage every time a new piece of medical technology emerges, but it means it will be a long time before anyone can accurately estimate prices.

"Because we don't know what these plans will look like in terms of benefits, we don't know what a base premium would be."

It's possible, Tolbert said, that the combination of premium and out-of-pocket expenses will still be too high for families with medical problems.