Hopefully, the Senate Democrats would succeed with their largely identical reform measure with some compromise to satisfy moderates among them because they need 60 votes to overcome determined Republican resistance in the 100-member chamber. It is still uncertain whether the Senate floor debate would yield an acceptable version in time for its reconciliation with the House bill for the final legislation to be signed by the President before the end of the year.

President Obama had placed health care reform ahead of his other priorities including climate change and financial sector regulations. A House bill on energy, setting limits to GHG emissions to a limited extent by 2020, is languishing in the Senate. Indeed this has constrained the President in making credible advances in combating global warming in the run-up to the UN Conference on Climate Change in Copenhagen where a new Treaty in place of the Kyoto Protocol expiring in 2012 had been expected to be concluded.

Besides his major concern over rising unemployment (over eight million rendered jobless since the start of the recession in December 2007), the President has been mulling a new strategy to defeat the Taliban and al Qaeda forces in Afghanistan and Pak-Afghan border areas. The big question before him is whether to send another 30,000 troops into Afghanistan to bolster the existing troop strength (67,000 US and 40,000 Nato forces), as called for by the US Commander of the operating forces in Afghanistan.

The rise in US casualties in recent weeks in Afghanistan has cost support for the war at home and to some extent contributed to a lowering of the President's rating, combined with the economic downturn and unabated increase in joblessness. As if the challenges before him are not enough, the upset victories of Republicans in two major gubernatorial elections (New Jersey and Virginia), ending Democrats' hold, has raised new concerns on the political front about a possible Republican revival, in the context of the 2010 mid-term Congressional elections.

President Obama had set great store by health care reform, right from the days of his campaigning for the high office, and made it his top priority for accomplishment before the end of his first year in office. He made frequent trips to the Capitol Hill to persuade reluctant Congressmen to translate his dream into a reality, and just before the House vote, he urged law-makers to rise to the moment and “answer the call of history to vote 'yes' for (reformed) health insurance for America”. He said when he signed the bill, it would be seen in the future as “my finest moment in politics”.

His main argument for the reform is that health insurance costs have been skyrocketing and becoming a crushing burden for both middle-income groups and small businesses as well as the Federal Government. America spends the highest on health care - something of the order of over two trillion dollars or one-sixth of its GDP - and it is the only industrial country which, OECD noted, does not ensure health care coverage to all its citizens and does not have any meaningful edge in quality of care.

With USA running record deficits and debt, set to continue over a long haul, President Obama made it clear from the outset that he would not sign a bill that would add even a dime to the deficit but instead while extending coverage to all uninsured Americans would be fully funded from within. Indeed, the President assumes that the reform as proposed would lower the current growth in Federal expenditure and would help to reduce deficit over the ten year period. The savings within would include slicing 400 billion dollars in Medicare over the projected ten-year period.

The bill which the House had debated since July was passed with a narrow majority 220-215 (with 39 defections and all but one 177 Republicans voting against). Democrats have a total of 258 votes in the 435-member House. Nevertheless, Speaker Nancy Pelosi described vote as “defining social policy achievement” since the Social Security Act of 1931 followed by the Medicare and Medicaid legislation in 1965. Since then, efforts to reform and extend health coverage did not take off beyond committee levels under successive Presidencies.

The present bill would expand coverage for an additional 36 million Americans in the coming years. It requires every individual to obtain insurance and all employers, other than the smallest, should provide coverage to their workers. Failure on their part would make them liable to pay penalty of 8 per cent of their payroll. Individuals would be required to obtain insurance or pay a fine as 2.5 per cent of income.

Financing for the reform would come from a tax on high insurance (golden) policies. Individuals earning more than 50,000 dollars or families with more than one million would pay 5.4 per cent surcharge on top of their existing income tax while small businesses with 25 workers would get tax credits for providing cover to their workers. The Obama Administration also expects sizeable savings in the way the health insurance is operated at present. The Congressional Budget Office sees a possible deficit reduction of over 100 billion dollars over the ten year period from the House bill with a price tag of 1.1 trillion.

For the first time, private insurance industry would have to compete with a national insurance exchange, including a government-run scheme, from which consumers can choose the best option including federal policies. Those who prefer to retain their existing insurance would get more security and stability in terms of the legislation. It would make it affordable with quality to those who are newly covered. The bill also would vastly expand Medicaid insurance plan. More importantly, private insurers can no longer deny coverage on the ground of pre-existing medical conditions and would no longer be able to charge higher premiums on the basis of gender or medical history.

States would be required to extend Medicaid coverage to as many as 15 million additional people. Low- and middle-income individuals who still could not afford coverage could apply for federal subsidies through the proposed insurance marketplace that would negotiate with private insurers to provide comprehensive policies alongside a government-run “public option.” Congressional budget analysts say there would still be some 18 million people without insurance by 2019, about a third of them illegal immigrants.

The Senate version which had passed through committees and due for floor debate would cost 829 billion dollars over 10 years, taking the health care coverage to 94 per cent of Americans eligible. It would also reduce deficit by 81 billion dollars over ten years. But the “public option” included is resisted by several Democrat senators, leave alone Republicans who have been charging the Obama Administration with “Government take-over of health insurance”. Although the bill has left it to states to opt out of public option, it still faces rough weather when it goes to the floor.

The Senate majority leader Harry Reid has ominously indicated that it might not be possible to finish legislation this year, generating concerns whether the President would be able to sign the law this year. Outside, barring the insurance industry, which has lobbied hard against the bill and buttressed by Republicans arrayed against any sweeping changes in the present system, the President is comforted by the widespread support in the country, especially from the drug companies, the American Medical Association, doctors and nurses and other health providers. The debate is on until the Senate votes. (IPA Service)