With a health care reform bill already passed by the Houseearlier this month, and with the Senate giving the green light todebate its own very different proposal after Thanksgiving, it lookslike legislation might yet be passed after all. The question is,what will its final form be, and what impact will it have on theinsurance industry and consumers?

In football vernacular, I wish we knew whether it's thesecond, third or fourth quarter of this political Super Bowl! TheSenate's quarterback–Majority Leader Harry Reid–is acting like he'sin the fourth quarter with the ball and two minutes left to score,but we may yet have a long way to go before we finish playing.

Politics is not a spectator sport. We can be players in thisepic game.

I personally have been selling health insurance for over 30years now. The most dreaded message I've had to deliver numeroustimes was: "I'm sorry, but because of your previous health history,this insurance carrier has denied your coverage."

Complete denial was just one option. Insurance carriers wouldalso charge additional premium for preexisting conditions. Theycould also refuse coverage on the preexisting condition for one ortwo years after the inception of the policy.

Affordability has also been a problem. With double-digitincreases in health premiums, over the last 10 years manymiddle-income families simply cannot afford to pay thesepremiums.

Small employers have discontinued their plans or requireemployees to pay more. Even families that may have modest coveragemight not have enough to cover their costs–thus high medical billshave caused many to file bankruptcy.

Don't get me wrong. I am proud to be a part of not only thehealth insurance arena, but the insurance industry in general.Insurance enables our society to build, grow and conserve withimmeasurable confidence and prosperity.

Through research and development, this industry has financedmany innovative projects and technologies that have improved thelives and lifestyles of all Americans.

As far as government intervention is concerned, personally I amfor less government imposition whenever possible. Historically, thegovernment intervenes where it feels we, the people, have failed(or may fail) at consumer protection or human rights.

Maybe we, the insurance community, should be more proactive inresearch and development–especially concerning topics that couldinvite government encroachment, such as health insurance.

A proactive approach would be an effective public relations toolfor the insurance industry. Currently, we are in a reactive mode,mostly on the defensive, trying to kill off the "public option"while facing the possibility of competing with the federalgovernment.

I see the national health care reform debate as an opportunityto advance our society. A healthier America will be the result.More Americans will have access to much needed preventive care andmedicine, which should lessen the dollars spent for more expensivecare in the long run.

Politics aside, I feel health care should be available for allU.S. citizens. We have here in the United States the best medicalfacilities in the world. Let's not deny our U.S. citizensreasonable access to these facilities. Our citizens should also notface "financial ruin" because they need medical attention.

Public option or not, let's not lose sight that any plan mustinclude the following basic features. Care and coverage mustbe:

o Affordable.

o Accessible for all U.S. citizens.

o Available to all, despite preexisting conditions.

o Gender neutral.

o Part of a plan to control escalating health care costs

While there are many differences between the House and Senatebills, both set minimum standards for policies that would beoffered in the new insurance exchanges proposed, where smallbusinesses and individuals without employer-sponsored insurancecould shop for policies.

A government-run health plan–referred to as a public option–isin both the House and Senate bills. The Senate bill would allowstates to opt out from offering the federal health plan. If theSenate bill passes, this will surely shift the health care reformdebate to each individual state.

Both the House and Senate plans will require most people toobtain health insurance. Both plans will penalize those by tax orfee who are non-compliant–with a wide disparity between the two,dollar-wise, right now.

As far as "employer mandates" are concerned, the House versiondoes require employers with payrolls over $500,000 to providehealth insurance for workers or face being fined up to 8 percent ofpayroll.

The Senate bill has no employer mandates, per se, but if anyemployees of firms with 50 or more workers obtain federallysubsidized coverage on the exchange, their employer will be subjectto a fine up to $3,000 per worker to help cover the costs totaxpayers.

The biggest difference between the two bills is in how they arefinanced. Basically, the House bill would impose a 5.4 percentsurtax on individuals earning more than $500,000 a year and couplesmaking more than $1 million. It also raises money by imposing a 2.5percent excise tax on medical devices, by ending some tax breaksfor multinational companies and by closing a biofuels tax loopholefor paper companies.

The Senate bill's financing includes a 40 percent excise tax onhigh-cost health insurance plans. It also raises payroll taxes forMedicare to 1.95 percent from the current 1.45 percent forindividuals earning $200,000 or more, and for couples earning$250,000 or above.

The Senate bill includes special fees on insurers, drugcompanies and medical device makers, and it imposes a 5 percent taxon elective cosmetic surgery.

Now, how do we reconcile these bills?

I am totally confident our bright minds, collectively, can makethis work for the greater good. Let's get it done.

I encourage all of you to contact your local congressionalrepresentative and tell them how you feel. This is not the time tosit back and watch the debate on television. It is time to speakup, and loud, to help shape this historic legislation.

Whatever the final outcome, I am sure we all will endure.

Jerald L. Tillman, LUTCF, is founder of theNational African American Insurance Association (www.NAAIA.org), as well as principal ofthe JL Tillman Insurance Agency in Cincinnati, Ohio. He may bereached at [email protected].