Health care reform update: Look for an overhaul that gives Congress flexibility

Anti-trust exemption removed for insurance industry. House: Doubtful. Senate: Doubtful. CC: Doubtful. It's high unlikely that the conference committee would approve both a health care reform bill and an end to the insurance industry's anti-trust exemption. Each is an epochal, enormous shift in policy, and historically the American system has only been able to handle one 'big change' issue in a generation (or longer).

Public Option. House: Probable. Senate: Doubtful. CC: Doubtful. The conference committee may approve a 'trigger option' -- in which a public option would take effect if a state does not meet targeted, universal coverage mandates by specific years. Also possible: a 'flex public option,' which gives states the right to opt-in/opt-out of a public option plan.

Insurance requirement for all citizens. House: Probable. Senate: Probable. CC: Probable.

Subsidies for insurance premiums for poor/lower income citizens. House: Probable. Senate: Probable. CC: Probable. Sliding scale subsidies up to 400% of poverty level, roughly $88,000 in annual income for a family of four.

Elimination of pre-existing condition restriction. House: Probable. Senate: Probable. CC: Probable.

Tax credit for small employers. House: Probable. Senate: Probable. CC: Probable.

Penalty for employers who do not offer health insurance: House: Yes, for companies with more than 25 full-time employees -- they would have to pay into a health care fund. Senate: Yes, but penalties start at 50 employees. CC: Penalties likely to start at 50 employees.

Medicaid shift. House and Senate will likely increase Medicaid eligibility to 133% of poverty level. CC: Probable.

Health insurance exchange. House: Probable. Senate: Probable. CC: Probable. States may be allowed to operate their own exchanges to increase health insurance competition, as a substitute for a national exchange, provided they comply with federal law and mandates.

Minimum benefits package requirement. House: Probable. Senate: Possible. CC: Probable.

Fees on insurance companies, drug companies, medical equipment manufacturers. House: Probable. Senate: Probable. CC: Probable.

Income tax increase on high-income individuals making more than $280,000 per year; couples, $350,000 per year. House: Probable. Senate: Possible. CC: Possible.

Penalty on individuals who do not obtain coverage. House: Probable. Senate: Probable. CC: Probable.

Fiscal Analysis: The American people are split on the public option, but as noted it appears some type of public option will likely emerge from the conference committee, however it most likely will be a 'flex' plan: those states who want in, can join; those states who don't, won't have to, as long as they continue to meet federal requirements for universal coverage for citizens in that state by specified dates. Otherwise, the content of the health care reform bill will reflect large changes, but with program alternatives for Congress, in the event a program doesn't work as intended. For example, if the health care exchanges don't increase competition at the state level, the bill may allow Congress to expand Medicaid to cover even more poor Americans, or broaden Medicare coverage to include more middle-aged residents (ages 55-62) who can't obtain affordable coverage. In sum, look for Congress to give itself and federal/state policy makers several alternatives: in an industry as large and complex as health care, there are going to be some ideas that just don't work as intended.

Finally, the health care reform process has been long, but investors should keep in mind that this is, arguably, the nation's biggest policy shift since the passage of Medicare in 1965: about $2-2.3 trillion in commercial activity is at stake. To be sure, in the United States, the goal of public policy is an outcome: some concept of good for society. But know also that in the United States, livelihoods are influenced by the shape of public policy.

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Financial Editor Joseph Lazzaro is writing a book on the U.S. presidency and the U.S. economy.