Republicans and Democrats unveiled details of their respective healthcare reform proposals last week and, although the plans are more similar than last year's, consensus is far from assured.
"There are still many issues, like subsidies for low-income people and malpractice reform, where (lawmakers) are a long way from a meeting of the minds," said Frederick Graefe, a healthcare lobbyist with Baker & Hostetler in Washington.
And any action on the bills may be a long time coming.
Sen. Robert Bennett (R-Utah), who heads the Senate Republican healthcare task force, said he did not expect congressional proposals to begin moving until this summer at the earliest.
"Right now, healthcare is not very bright on anybody's radar screen, if it shows up at all," Bennett said.
Last week, Rep. William Thomas (R-Calif.), chairman of the House Ways and Means health subcommittee, introduced a bill that includes many of the insurance reforms found in most of last year's proposals (See chart).
Included are provisions that would allow workers to continue their coverage after they change jobs and bar insurance companies from denying coverage because of pre-existing medical conditions. Insurers also would be required to offer coverage to anyone applying during open enrollment periods.
The Thomas bill would create "health plan purchasing cooperatives" that would pool the buying power of individuals and small companies. Supporters of purchasing cooperatives say they would increase the bargaining clout of members, helping to hold down cost increases.
Another House bill, scheduled to be introduced this week by Rep. Harris Fawell (R-Ill.), builds on the current Employee Retirement Income Security Act, which regulates the health plans of self-insured businesses.
The Fawell plan seeks to establish purchasing cooperatives and to allow self-insured firms to form voluntary alliances. It would limit states' ability to regulate managed-care plans and health networks, and includes many of the same insurance reforms as the Thomas plan.
In the Senate, Bennett's plan, which has yet to be formally introduced, would require individuals to buy catastrophic insurance, but would allow them to pay out-of-pocket for inexpensive and routine procedures. Instead of buying health insurance for their employees, companies would give workers a tax-free lump sum to spend on healthcare; employees could pocket any unused portion.
Such a proposal, called a medical savings account, is included with some variations in the Thomas and Fawell plans.
Senate Democrats of all stripes-from single-payer advocate Paul Wellstone (D-Minn.) to John Breaux (D-La.), who supported a market-oriented "mainstream" plan last year-are united behind an incremental bill sponsored by Minority Leader Thomas Daschle (D-S.D.).
The Daschle plan is far less drastic than even the most modest Democratic plan introduced last year. Like the Thomas and Fawell plans, the Daschle bill includes insurance reforms. However, it also includes approximately $50 billion in subsidies for low-income women, children and temporarily displaced workers.