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David Usborne: Reasons to be cheerful but the hard slog isn't over quite yet


Over pancakes and maple syrup, supporters of an overhaul of the entirely un-universal American healthcare system will be able to celebrate this morning. A bill will have passed in both chambers on Capitol Hill, and probably the hardest phase of this long slog will be over. Yet, there is still one more hurdle to leap. Let the conference begin.

This is the part where the bill likely to emerge this morning from the Senate must be melded with the altogether more comprehensive version passed by the House of Representatives last month. There are lots of differences between the bills, some small, others not.

The little stuff includes the age at which offspring no longer benefit from their parents' coverage and must their own plans. The Senate says 26 years, the House says 27. That's easy. But wider gaps exist on issues such as abortion, the public option and how the bill will be paid.

Liberals in the House want to restore the public option, which would compete with private insurance companies to sell coverage. The Senate won't bend on this. Instead so-called state exchanges will be created (though not for three years) to help buyers shop for plans. Nearly every American will be obliged to buy some kind of insurance. The poorer will get significant financial help to so. On paying for it, a formula will be arrived at that imposes new taxes on the rich and on the most expensive healthcare insurance plans on the market, sometimes known as Cadillac Plans.

But prepare for a nasty fight over abortion and how best to make sure terminations are not paid for with federal dollars. It will be an unpleasant distraction, but we won't be far into 2010 before healthcare reform is at last achieved.