Now that both the Senate and the House have passed health reform bills, what can we expect next? The Senators and Representatives won’t be back to work for a week or two. Meanwhile, staff (who got very little “vacation” over Christmas) of both houses will be talking by phone this week and meeting in person with the Leadership of the House and the Senate next week to work out the differences between the two approaches in “conference committee”. How that conference committee gets constituted and which “house” sets the rules is unbelievably complicated.

Bottom line? Negotiations are proceeding now and will continue into January, with the hope that a final bill can be voted on by the end of January or early February 2010.

( If you are truly into detail, check out this great Daily Kos blog that tells you more than you would ever need to know about how this might work.)

While all this negotiation is going on, you can be sure that every interest group in America will be weighing in. Not just the usual suspects like hospitals, pharma, insurance plans, doctors, nurses, but also AARP, unions, public health advocates, family planning and choice advocates, etc. They have all been at the table all along, but this is their final chance to put in a pitch for their favorite issue. Hospitals will be watching payment changes; seniors will be watching age rating; choice advocates will be worrying about which version of the abortion provision gains prominence. The lines outside Senate and House offices will be long. And what about us, just regular folks? We are left with calls and letters to our representatives, donations to the advocacy group we prefer; emails to friends. But most important is that we all educate ourselves about what is actually in this legislation.

At a party last night, I was talking to some friends who are very literate about health care but knew relatively little about what was in the bills. So for their sake and yours, here are some places you can look to get yourself up to speed.

1. The Kaiser Family Foundation has a great site where you can create your own “side by side” comparison of the two main pieces of legislation - the House leadership bill and the Senate leadership bill.

2. Health Affairs has a blog that offers a variety of different viewpoints on the two bills. Two pieces by Timothy Jost, one on insurance reform provisions and one on delivery system and cost control, are great and readable summaries of what is in these bills.

Jost makes a list of things that were added to the Senate bill via the “manager’s amendment” (which was passed on Christmas Eve) that attempt to address changing the way we pay for and deliver health care. Anyone who tells you that there is nothing good in this bill, needs to read this list and tell us all why these provisions are not worthy of support. Here are just a few new initiatives from that list:

New initiatives in the manager’s amendment

– Medicaid coverage for former foster children under the age of 26 who age out of Medicaid.
–“Balancing payment incentives” to incentivize new program initiatives to encourage the use of Medicaid-funded home and community-based care in states that rely disproportionately on institutional long-term care.
– Extended federal funding for the CHIP program for 2014 and 2015.
– The development of a value-based purchasing program for ambulatory surgical centers.
– A revision to the national quality improvement strategy to mandate quality outcomes measures for doctors and hospitals for 10 acute and chronic diseases in 24 months and 10 primary and preventive care measures within 36 months.
– New provisions for testing payment and delivery system innovation models by the Center for Medicare and Medicaid Innovation.
– A quality reporting program for psychiatric hospitals.
– A pilot study for a pay-for-performance programs for psychiatric, rehabilitation, long-term care, and cancer hospitals and for hospices.
– Development of a physician compare website with information on outcomes, patient safety, patient satisfaction, and continuity of care.
– The creation of a Deputy Assistant for Minority Health in HHS and creation of offices of minority health in the CDC, HRSA, SAMHSA, AHRQ, the FDA, and CMS. This provision is, in my mind, long overdue.
– Creation of a new national center for excellence in depression research and a national center on congenital heart disease.
– Additional funding for training nurse practitioners, rural physicians, and preventive health and public health specialists.
– Six billion dollars in new funding over 5 years for community health centers.

And this is only a partial list.

The main issues of disagreement between the House and the Senate approaches will be the following, so keep your eyes and ears open on these, remembering that the final version is going to look much more like the Senate plan than the House plan, given the need to keep the 60 votes together in the Senate:

1. How to fund reform - the House proposes a tax on the rich; the Senate proposes a tax on rich plans (those that cover everything with little copayments or coinsurance requirements for members). Both bills propose savings in the Medicare program — not by cutting benefits as opponents have charged, but by paying providers differently so that there is more “pay for performance” and less “pay for doing more”.

2. National vs. state “insurance exchanges” – the House proposes a national exchange with state flexibility; the Senate proposes state exchanges.

3. The public option — the House version has a weak public option; the Senate version has no public option but proposes that the Office of Personnel Management (OPM) that manages the benefits of federal employees (including Senate and House reps) - offer and manage at least one nonprofit plan in each state exchange.

4. The abortion provision — the House “Stupak” amendment or the Senate “Ben Nelson” amendment? I wrote this blog for the Huffington Post on the House amendment. The Senate abortion provision is complicated and burdensome but may be what has to be passed at this point. Stupak is not likely to get his way.

5. The amount of subsidies — the House provides more generous subsidies than the Senate, but the cost of the House bill is greater. So the debate will be how to make sure people can afford to buy insurance if they are mandated to do so.

How health reform may affect you? This article in USA Today gives a good breakdown.