​The legislative proposal to come will be massive in size and scope, expanding many existing government programs and creating brand-new bureaucracies. Some of the very basic proposals in the Obama plan, which reflect greatly on the Christmas Eve bill passed in the Senate last year, are:

• Require most U.S. citizens and legal residents to have health insurance. State-based American Health Benefit Exchanges would allow individuals to purchase coverage, with premium and cost-sharing credits available to individuals or families with income between 100 and 400 percent of the federal poverty level. Separate exchanges would allow small businesses to purchase coverage.
• Require U.S. citizens and legal residents to have qualifying health coverage. Those without coverage pay a tax penalty of the greater of $695 per year, up to a maximum of three times that amount ($2,085) per family, or 2.5 percent of household income.
• Assess employers with more than 50 employees that do not offer coverage and have at least one full-time employee who receives a premium tax credit a fee of $2,000 per full-time employee, excluding the first 30 employees from the assessment. Employers with more than 50 employees that offer coverage but have at least one full-time employee receiving a premium tax credit will pay the lesser of $3,000 for each employee receiving a premium credit, or $750 for each full-time employee (effective January 1, 2014).
• Restructure payments to Medicare Advantage (MA) plans by creating a set of benchmark payments for MA plans at different percentages of Medicare fee-for-service rates, by area, phased in over an unspecified period, taking into account relative payments to fee-for-service costs in an area.
• Reduce annual market basket updates for inpatient hospital, home health, skilled nursing facility, hospice, and other Medicare providers and adjust for productivity (effective dates vary).