Blueprints for a health care fix
How the national policy debate will affect your business.
(Fortune Small Business) -- Barack Obama made health-care reform a central promise of his presidential campaign. But the shape any change takes will probably depend as much on Congress as on the new president's plans.
"Unlike in 1993, Congress will own this debate," predicts Len Nichols, director of health policy for the New America Foundation, based in Washington, D.C.
Several existing bills could become the cornerstone of eventual health-care reform. The Healthy Americans Act would eliminate employer-based insurance and require all Americans to purchase private insurance plans through new, state-run regulatory agencies. To subsidize coverage for low- and middle-income earners, a new tax would be levied on businesses, with smaller firms paying lower rates.
Other proposals include the Small Business CHOICE Act and the Small Business Health Options Program Act, each of which would open up insurance pools and provide subsidies to small firms.
The most likely blueprint could be the "Call to Action" issued by Sen. Max Baucus, D-Mont., last fall. The proposal echoes Obama's support for government-sponsored insurance pools to make cheaper plans available to more small businesses and individuals.
Unlike Obama's plan, however, the Baucus blueprint would make participation mandatory. Proponents say mandates are critical to lowering premiums, because they expand the pool and keep healthy individuals in the system. Large insurers recently suggested adopting mandatory coverage as a trade-off for eliminating discrimination based on pre-existing conditions.
Nichols predicts "a two-year conversation" before sweeping health-care reform is ready for consideration, and the recent economic nosedive hasn't changed his opinion.
Small business should remain central to that discussion, says economist Linda Blumberg of the Urban Institute in Washington, D.C.: "There is broad interest in helping small employers and their workers because so many of them are uninsured." 
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