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The debate shifts <br> Health care reform now heads to courts, regulators and elections

So ends Phase 1 of the great American health care argument. Hot on its tail are Phases 2, 3 and perhaps more. But the fact is, for better or worse, Congress has passed a health care reform bill that President Obama signed, delivering on a key promise of his election campaign and changing the health care landscape.
The new law provides winners and losers and, more than that, unanswered questions about how the law will be implemented and what it will mean for the national economy, already one-sixth consumed by health care. That's because federal regulators and state lawmakers must now decide how health plans will compete, write rules governing their profit and decide which medical benefits must be provided.

In the meantime, before this year is out, the plan will:

*Provide a $250 rebate to Medicare prescription beneficiaries whose initial benefits have been exhausted.

*Provide access to high-risk pools for those who lack insurance because of pre-existing conditions.

*Prohibit insurers from canceling coverage for people who get sick.

*Prohibit insurers from denying coverage to children with pre-existing conditions.

*Ban lifetime caps on health insurance benefits.

*Allow children up to the age of 26 to remain on their parents' health policies.

Insurers, meantime, could also benefit. They are expected to gain up to 32 million new customers because of a mandate that most Americans carry health insurance or pay a fine.
What is murkier at this point is how the plan will affect the economy and the federal budget deficit. The nonpartisan Congressional Budget Office last week found that the reform will cut the deficit over 10 years, but that depends on a number of factors, such as the excise tax on "Cadillac" health care plans producing the amount of revenue forecast. No one really knows how that -- or the inevitable court tests -- will pan out.

As interesting as the law, itself, is the political impact on President Obama and, more immediately, on Democratic and Republican members of Congress, less than eight months before midterm elections. Will voters reject Democrats for pushing this bill through without Republican support, or will they punish Republicans for failing to seek a compromise on an issue of national importance?

Republicans don't seem to be backing away from that approach, if Sen. John McCain's declaration proves accurate: "There will be no cooperation for the rest of the year," the Arizona Republican said during an interview with The Hill. "[The Democrats] have poisoned the well in what they've done and how they've done it."

But Republicans could also be tarred as the fringe party based on actions of the "Tea Party" movement, especially over the past week. That could drive independents back toward Democrats and simply cause them to stay home in November.

More than health care will drive voters this fall. Americans are severely frustrated with Washington, but much of that is because of the federal budget deficit, which the health care bill will affect, and also the economy: jobs. Some theories suggest that the early benefits of the health law could please voters, especially if the economy is on the mend by November. That also could help Democrats.

We remain convinced that the bill didn't do enough to control growth in the costs of health care. Costs weigh heavily on business, which pays the major share of health care premiums. We hope Congress will continue to focus on that because, ready or not, health care reform is here. Whether it is in fact reform or an additional tax on a cash-strapped nation remains to be seen.

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