By Arun Kumar
Washington, Dec 24 (IANS) The passage of a $871 billion healthcare reform package by the US senate Thursday is only half the battle won in President Barack Obama’s quest for a key domestic goal that has eluded several presidents before him.

The other half of the battle will be fought in a conference committee to reconcile several major differences between the Senate bill and the $1 trillion version passed by the House of Representatives last month.

If a combined House-Senate healthcare bill clears Congress and is signed by Obama, it would be the biggest expansion of federal healthcare guarantees since the enactment of Medicare and Medicaid over four decades ago.

House and Senate Democrats are still divided over how to pay for their plans. They are also split on, among other things, language relating to abortion coverage and whether to include a government-run public health insurance option.

The House bill includes a public option; the more conservative Senate measure would instead create non-profit private plans overseen by the federal government.

But the House and Senate bills agree on a broad range of changes that could impact every American’s coverage.

Among other things, they have agreed to subsidise insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.

They have also agreed to create health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage.

Both the House plan and the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.

Insurers also would be barred from charging higher premiums based on a person’s gender or medical history. However, both bills allow insurance companies to charge higher premiums for older customers.

Medicaid would be significantly expanded under both proposals. The House bill would extend coverage to individuals earning up to 150 percent of the poverty line, or roughly $33,000 for a family of four; the Senate plan ensures coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.

(Arun Kumar can be contacted at arun.kumar@ians.in)