美国国会参议院24日清晨投票通过了美国总统奥巴马支持的全面医疗改革法案。

美国国会参议院24日清晨投票通过了美国总统奥巴马支持的全面医疗改革法案。

美国国会参议院以60票赞成，39票反对，通过了为数8,710亿美元的健保改革案。

58名民主党人和2名独立支持，39名共和党人投以反对票，将在月底退休的肯塔基州参议员参议员邦宁没有参加投票。

此前，参议院21日就医改案进行首轮投票，民主党赢得了推动医改案的关键性胜利。参议院多数党

领袖、民主党人哈里·里德当时表示，参议院的决定，帮助我们朝着向所有美国公民提供建立优质、平价的医疗服务迈进了历史性的一步。这项议案将为民众提供多样化的选择，并遏制许多家庭高涨的医疗费用开支。”

奥巴马和民主党高层一直希望参议院能在圣诞节假期之前通过议案。若参议院版医改案最终获得通过，它将与众议院11月通过的医改案经“合并”后，交由众议院、参议院再次投票表决。“合并”的医改案获参众两院通过后，最终交由总统签字生效。

下一步该怎么走?;

众院,参院的不同蓝本;

医疗改革法对你的影响;

医疗改革方案的重大里程碑;

共和党人狗急跳墙???

新方案的大意:

American citizens and legal residents would be required to have health insurance, or pay a fine. For an individual, the fine would be $750 per year or 2 percent of household income, whichever is greater; for a family, the maximum fine would be $2,250 per year or 2 percent of household income. The fines would go into effect gradually, starting in 2014. The House bill is similar, with exemptions for certain low-income people.

Employer obligation. Companies with more than 200 employees would be required to enroll their workers in a health insurance plan, with no ability for employees to opt out. Companies with more than 50 but fewer than 200 workers would not be required to offer insurance, but if they didn't, they'd have to pay a fee of $750 per employee each year (with some variations). Companies with fewer than 50 workers would not have to offer insurance or pay any fees. Those rules would go into effect in 2014. The House bill would place similar requirements on employers, but with a different way of determining which companies are required to offer insurance.

[See 4 countries with better healthcare than ours.]

Government-run health insurance (the "public option"). There is no public option in the Senate bill. The House bill would establish a government-run insurer that would compete with private insurers offering coverage to those not covered by their employers. The public option is one of the biggest differences between the House and Senate bills, and is likely to be one of the biggest battles as healthcare reform hits the home stretch.

Insurance exchanges. This is how people would buy insurance if they don't have an employer that provides it. The structure is complicated, but these exchanges would basically be run by each state in conjunction with the federal government, and states would be allowed to create additional mechanisms for offering insurance to their residents. Traditional insurance companies would be allowed to compete for customers through the exchanges, provided they met a set of requirements set by the federal government. The least expensive plans would offer catastrophic coverage only, and not be available to everyone. There would be several other levels of coverage, priced more for each bump-up in benefits. The exchanges would go into effect in 2014. The House bill includes similar reforms, although there would be an additional health-insurance exchange at the national level. And the public health-insurance plan (not included in the Senate bill) would compete with private plans on each of the exchanges.

Subsidies to help pay for coverage. In general, government subsidies would help cover the cost of insurance for individuals earning as much as 400 percent of the poverty level. (In 2009, the poverty level for an individual in most states was $10,830; for a family of 4, it was $22,050. So an individual earning less than $43,320 or a family of 4 earning less than $88,200 would qualify for some aid.) The House bill has a similar income threshold for subsidies, but a different formula for determining how much the subsidy would be.

[See why more competition won't fix healthcare.]

Medicaid expansion. Eligibility for Medicaid would be expanded to people or families earning 133 percent of the poverty level (with exceptions), effective in 2014. The House bill would broaden Medicaid eligibility to those earning 150 percent of the poverty level, and do so by 2013.

Insurance for high-risk patients. People who can't get traditional coverage on account of a pre-existing medical condition would be eligible for insurance under a new "national high-risk pool," with rates comparable to those for the general population. The pool would go into effect quickly--within 90 days of a bill becoming law. The House bill has a similar provision, with different ceilings for allowed premiums and deductibles.

Lifetime limits. Insurance companies would no longer be allowed to cap the amount of lifetime benefits or cancel coverage, unless the patient defrauded the insurer. Those rules would go into effect in 2010. By 2014, there would be tougher limits prohibiting annual caps on benefits, in addition to lifetime caps. The House bill has similar provisions and would go a step further by severely restricting insurance companies' ability to deny coverage on account of pre-existing conditions.

New taxes. To help pay for increased coverage, a number of long-standing tax credits and deductions would decline, while taxes on some other benefits would increase. One of the most prominent changes would be a tax on "gold-plated" health insurance plans that provide lavish benefits but are expensive; the threshold at which the surtax would kick in would be $8,500 for an individual's annual premium and $23,000 for a family's. There's a lot of fine print, however, and some people with gold-plated plans would probably end up exempted from the tax. The House bill doesn't tax gold-plated plans, but raises funds through an additional 5.4 percent income tax on individuals earning $500,000 or more per year, and families earning $1,000,000 or more. All of these new taxes are controversial, creating more flash points for negotiators.

[See how the government is swallowing the economy.]

Abortion coverage. Federal subsidies cannot be used to fund abortion unless the life of the mother is at risk or there's a case of rape or incest. The House bill has a similar provision, with an additional stipulation that prohibits federal money from being spent on any insurer that provides abortions, even if it's with private funds.

Indoor tanning. Beginning in 2010, there would be an additional 10 percent tax on the cost of indoor tanning services, to help pay for health reform. No kidding. The House bill contains no such provision.

health insurance companies:

Humana® Medicare Plans;

Aetna Health Insurance;

Low Cost Health Insurance;

CIGNA;

Blue Cross Blue Shield Association - Leading the Future of Healthcare;

AARP Health Options;

Blue Cross Blue Shield;

worst insurance companies;

Senate bill could hurt insurers at least initially;