As Congress gets closer to a final health care bill, many Americans want to know: What's in it for me?
The answer is: It depends.
On your age and household income. Whether you own a business and whether it's big or small. Whether you're insured now and who provides that insurance. In the end, it will depend on how House and Senate negotiators will merge the proposals, and how their vision gets translated into regulations.
Five Americans shared their stories with The Associated Press. Here's an educated guess on how the health care package taking shape in Congress might affect them.
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Name: Holly Brown
Home: Round Lake, Ill.
Age: 28
Employment: Student, working part time, receiving unemployment benefits.
Household income: about $15,000.
Coverage: Insured, but struggling to afford it.
Brown was laid off last year from a job she'd held for four years. She's stayed insured because of the government COBRA program, which allows workers to remain on a health plan for 18 months after they leave their jobs, if they pay the premiums.
Brown works part time and studies medical imaging at College of Lake County. She has a chronic lung condition and was in the emergency room in November with flu and pneumonia. She's paid about $1,000 in medical bills this year that her insurance didn't cover.
She doesn't know how she'll pay her $500 premium this month because a government subsidy that helped her afford the premium has expired.
"It's scary to think about what's going to happen if I can't make the payment by the end of the month," Brown said.
The health care overhaul taking shape in Congress would require her to buy health insurance or pay a penalty. She could pick a plan offered through new state-based insurance exchanges and she would qualify for a subsidy to help pay her premiums because she makes less than 400 percent of the poverty level ($43,320 for an individual in 2009). But all those benefits wouldn't kick in until 2013 in the House bill (2014 in the Senate legislation). Because of her medical problem, she may be able to qualify for coverage during the transition period by going through high-risk insurance pools called for in the legislation.
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Name: Glenn Nishimura

Home: Little Rock, Ark.

Age: 60

Employment: Consultant to nonprofit groups.

Household income: $55,000, including wife's earnings.

Coverage: Uninsured since COBRA expired in May.

Nishimura left a full-time job with benefits in October 2007 thinking he'd be able to find another good position.

Then the recession hit.

He's now a self-employed consultant. Since May, he's been without health insurance. For 18 months, he bought insurance through the COBRA program. When that ran out, he tried to find other coverage. He's been turned down by five insurance companies because he has high blood pressure and high blood sugar levels, even though he's otherwise healthy, has never been hospitalized and controls his conditions through diet and exercise.

"I could get H1N1 or get into an accident and I would be potentially bankrupt," Nishimura said. "It's an untenable situation."

The Medicare buy-in proposal considered in the Senate could have helped Nishimura get insurance, as would portions of both the House and Senate bills that would ban denials for pre-existing conditions. But opposition from moderates and a few liberals is forcing Senate Democratic leaders to scrap the idea of a buy-in to get a bill completed.

Nishimura said he e-mailed President Barack Obama suggesting that lowering the Medicare eligibility age to 55 or 60 would create jobs. "I know a lot of people who would like to retire early, but can't because of health care," he said.

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Name: David W. Brown

Home: Philadelphia

Age: 47

Employment: Owner of BrownPartners, an advertising and marketing agency. Seven employees. $336,000 in annual wages paid.

Household income: $150,000, including wife's earnings.

Coverage: Provides health, dental and vision coverage to employees.

An ad agency owner, Brown has been able to offer health insurance to his seven employees, but has had to cut benefits because of rising costs. Like other business owners, Brown is trying to figure out what will emerge from Congress and how it will affect him.

"We haven't been able to be as generous as we have in the past," Brown said of the insurance plan he offers his workers. "The good thing is, not a lot of folks are leaving because somebody else has a better plan."

Health care overhaul might help Brown and his wife with coverage for their daughters, now age 17 and 20. The proposals would allow young adults to stay on their parents' insurance plans as dependents into their mid-20s.

Brown would be able to shop for insurance for his workers through a health insurance exchange. Neither of the bills would require him to provide coverage. Both bills provide tax credits to help small companies with average wages of less than $40,000 provide health insurance. But pay levels in Brown's agency are above that cutoff.

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Name: Robert Hansen

Home: Seattle homeless shelter

Age: 58

Employment: vendor, Real Change street newspaper.

Household income: $12,000, including tips.

Coverage: Uninsured.

Hansen used to work selling beer and peanuts at Seattle's now-demolished Kingdome. "Age caught up to me, running up and down the stairs, the physical labor," said the 58-year-old Seattle native.

Hansen has been homeless since 1994. A top-selling vendor of a weekly newspaper called Real Change, he makes about $1,000 a month. He eats his evening meal and finds a bed at a Catholic Community Services shelter.

The tingling in his feet and the occasional purplish color of his hands worry him. It's been so long since he's had a thorough physical exam that he's not sure if his symptoms could mean a serious health problem such as diabetes. He's uninsured and finds care in community clinics and emergency rooms.

Hansen and most other poor adults without young children don't qualify for Medicaid, the state-federal program that helps low-income families with health care. The proposals in Congress would expand Medicaid coverage to people such as Hansen.

In the leading Senate proposal, people with incomes up to 133 percent of the federal poverty level ($14,404 for an individual in 2009) could enroll in Medicaid. The House bill makes the cutoff 150 percent of the poverty level ($16,245 for an individual in 2009).

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Name: Carol McKenna

Home: Pembroke Pines, Fla.

Age: 68

Employment: Retired payroll coordinator

Household income: About $39,000 from Social Security and some earnings by husband as mattress salesman.

Coverage: Medicare Advantage policy administered by AvMed Health Plans.

If McKenna believes the claims of the insurance industry and many Republicans, she and her husband are among the most at risk to be hurt by Congress' health proposals. If Democrats are telling the truth, they will be among those with the most to gain.

The 68-year-old retiree refrains from any worry, or any premature celebration. She simply believes, "It'll work out."

McKenna and her husband, Morty, who turns 78 on Sunday, are in private Medicare Advantage plans, which many Democrats have called wasteful and which have been made a prime target for major cuts. But Morty McKenna also falls in the coverage gap in Medicare's prescription drug program — the "doughnut hole" — that the health bills have promised to close. More than 3 million Medicare beneficiaries a year hit this gap and start paying the full cost of their drugs until they qualify for catastrophic coverage.

She said the government must "get rid of the abuses" and that pharmaceutical companies "need to step up and be accountable." For now, though, she's just waiting to see what actually happens.

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Associated Press writers Matt Sedensky in Miami, Jesse Washington in Philadelphia and Ricardo Alonso-Zaldivar in Washington contributed to this report.

MONDAY, Dec. 7 (HealthDay News) -- Better screening, healthier living
and new treatments have all continued to help cut the annual number of
cancer cases and deaths in the United States, a new report says.

The findings showed that new cancer cases and deaths from cancer have
declined significantly for both men and women and for most racial/ethnic
populations.

These decreases were largely due to decreased incidence and death from
lung, prostate and colon cancer among men and a drop in two of the three
leading cancers in women (breast and colon cancers). New diagnoses for all
types of cancer in the United States declined almost 1 percent per year
from 1999 to 2006 and cancer deaths dropped 1.6 percent per year from 2001
to 2006.

The report, which appears in the Dec. 7 online edition of
Cancer, was compiled from data by the American Cancer Society, the
U.S. Centers for Disease Control and Prevention, the U.S. National Cancer
Institute and the North American Association of Central Cancer
Registries.

"For me, when I see the downturn in some cancers it says we can
actually address the cancer burden through a variety of efforts," said
report author Brenda K. Edwards, associate director of the Surveillance
Research Program at the U.S. National Cancer Institute.

But the battle against cancer continues, she stressed. "We see the
downturn in mortality, but we still have almost 1.5 million people with
new cancer diagnoses in 2009. So, we still have a large number of people
affected. For some of them, we have relatively effective treatments and
for others not so."

Edwards noted that for the cancers that have seen the biggest
decreases, such as breast and colon cancer, effective screening methods
probably explain the downward trend, although there are still too few
people who take advantage of them.

Cancer rates are still higher for men than for women, but men had the
biggest declines in new cases and death, the report showed.

This year's report focused on trends in colorectal cancer. Colorectal
cancer, the third most-diagnosed cancer in both men and women, is also the
second-leading cause of cancer deaths in the United States. Overall, colon
cancer rates are declining, but the decline is mostly among those over 65.
Increasing numbers of cases in men and women under 50 is worrisome, the
report noted.

Among both men and women, there were major declines in colorectal
cancer cases from 1985 to 1995, minor increases from 1995 to 1998, and
significant declines from 1998 to 2006. Since 1984, death rates also
dropped, with accelerated rates of decline since 2002 for men and since
2001 for women.

In fact, from 1975 to 2000, cases of colorectal cancer fell 22 percent;
50 percent of which was most likely due to changes in lifestyle, and 50
percent to more people being screened.

In addition, deaths from colorectal cancer fell 26 percent during the
same time; 9 percent of the drop came from lifestyle changes, 14 percent
came from screening and 3 percent came from improved treatment, according
to the report.

Going forward, if there were no changes in lifestyle, screening or
treatment, there would be a 17 percent drop in colorectal cancer deaths
from 2000 to 2020. However, if current trends remain the same, there will
be a 36 percent drop in colorectal cancer deaths.

But, if more Americans adopted more healthy lifestyles, such as
quitting smoking, and were screened for colon cancer and had access to
optimal treatment (such as more effective chemotherapy), deaths from colon
cancer could be reduced by 50 percent by 2020, the report predicted.

Other highlights from the report were that among men, cases of
prostate, lung, oral cavity, stomach, brain, colon and rectum cancers have
declined, but cases of kidney/renal, liver and esophageal cancer, along
with leukemia, myeloma and melanoma, are increasing.

Among women, cases of breast, colorectal, uterine, ovarian, cervical
and oral cavity cancers decreased, but cases of lung, thyroid, pancreatic,
bladder and kidney cancers, along with non-Hodgkin lymphoma, melanoma and
leukemia are on the rise.

Where cancers have increased, Edwards noted that in most cases there
are no effective screening tests to catch the cancer early. In addition,
for many of these cancers, the causes aren't known and there aren't
effective treatments, she said.

Cancer death rates remain highest among blacks and lowest among
Asian/Pacific Islanders. Although death rates by race/ethnicity were
similar for most cancers, deaths from pancreatic cancer, the fourth most
common cause of cancer death in the United States, increased in white men
and women but dropped among black men and women.

Among men, except for Asian/Pacific Islanders, the three leading causes
of cancer death were lung, prostate and colorectal cancer. Among
Asian/Pacific Islanders, lung, liver and colorectal cancers were the top
three causes of cancer death.

For women, except Hispanic women, the three leading causes of cancer
death were lung, breast and colorectal cancer. For Hispanic women, breast
cancer was the leading cause of cancer deaths, the study authors noted.

These differences in death rates may be due to differences in risk
behaviors, socioeconomic status and access to and use of screening and
treatment, according to the report.

While these trends are expected to continue, they could be accelerated
if more people would make the lifestyle changes needed to reduce their
risk of cancer. These include not smoking, maintaining a healthy weight,
eating a healthful diet and exercising.

In addition, lives could be saved if more people were screened for
cancers such as breast and colon cancer, and if there was more access to
newer treatments, the report said.

Dr. David L. Katz, director of the Prevention Research Center at Yale
University School of Medicine, said that "there is enormous detail in this
comprehensive report, but the take-away message is as clear as it is
compelling: the incidence and death toll from cancer are both steadily, if
gradually, declining."

That is not a new message, Katz noted.

"The gratifying conclusion is that we are effectively fighting cancer
at every level: preventing it outright by modifying cancer risk factors;
finding it early through effective screening; and treating it ever more
effectively. The benefits of screening suggested here are timely in light
of recent debate about the net benefits of mammography," he said. "The
overall news here is clearly good, and is something of a rebuke for those
who fear modern science rather than embracing the benefits it so often
confers."

More information

For more information on cancer, visit the
American Cancer Society.

A few years ago, an adviser went to Sheik Mohammed bin Rashid al-Maktoum with a plan for a tall office building. "Only 90 stories?" the ruler of Dubai asked. The aide was sent back to the drawing board, with instructions to design the highest structure not just in Dubai, not just in the Middle East, but in the world. When the Burj Dubai has its grand opening in January, it will be an 818-meter monument to the visionary autocrat who dreamed the Dubai dream - and, as it turns out, a conspicuous symbol of the hyper-ambition that now threatens the emirate with financial ruin. (See the top 10 bankruptcies.)
Sheik Mo, as he's dubbed by the media, was tweeting in London last week when officials back home stunned financial markets by announcing a request for a six-month repayment standstill on part of the sheikdom's $80 billion debt. The immediate issue is Dubai's inability to come through on a $3.52 billion tranche due in mid-December. Yet, with some 400 property projects already reportedly frozen in Dubai, the news raised the specter of a gigantic default that would sink exposed creditors around the world. "Inspired by Islamic artifacts," read the sheik's post on Twitter during a visit to the British Museum as share prices from Tokyo to New York City were about to plunge in response to Dubai's announcement. (See a story about Dubai's debacle and the global financial crisis.)
While the Anglophile sheik kept a stiff upper lip, Dubai's inability to pay its debts is a heavy blow to an ego that easily dwarfs Dubai's gleaming new 160-story skyscraper. In the wake of the 2008 global financial meltdown, Sheik Mohammed repeatedly waved off predictions of Dubai's demise, staunchly defended his economic development model and dismissed Western media criticism as a bigoted slur on an Arab success story. "I can safely say that we have succeeded in containing the risks of the global financial crisis in record time," he said last April. Indeed, even as the property bubble was bursting and throwing thousands out of work in his realm a year ago, Dubai played host to probably the biggest party ever thrown in the Middle East: a $20 million red-carpet extravaganza, with fireworks visible from outer space, to celebrate the opening of the $1.5 billion Atlantis hotel and resort. (See a story about whether Dubai's problems will spread.)
Jealous rivals and cynical pundits will revel in Sheik Mohammed's fall from grace, but none can deny Dubai's remarkable accomplishments - or ignore the fact that only an ambitious dreamer could have made them happen. In the 1980s, when Dubai's neighbors were either hibernating behind a curtain of oil wealth or dabbling, sometimes disastrously, in Middle East politics, Sheik Mohammed began transforming oil-poor Dubai from an Arab backwater into a global city. Within a decade Dubai had a world-class air carrier in Emirates Airlines and a glamorous, iconic "seven-star" hotel, the Burj al-Arab, as high as the Eiffel Tower. Within another decade, Dubai had become truly a global hub - the largest international financial center between Singapore and Europe, a regional headquarters for global brands from investment banking to bespoke tailoring, and a destination for more than 6 million tourists a year.
"In the beginning," Sheik Mohammed once told an Arab journalist, "they said that Dubai was crazy." Certainly few Arab leaders have demonstrated such a relentless drive to succeed. He imagined Dubai as a great city from Islam's rich heritage, a Baghdad or a Cordoba. His immense appetite for work is matched by a passion for play. He is a world-class thoroughbred racer and breeder and, at 62, he remains a celebrated equestrian who engages in arduous endurance races across hundreds of miles of terrain. Doubtless it takes a politician of supreme self-confidence not only to write Arabic poetry but to post it in volumes on his website. In an interview with a Kuwaiti newspaper in 2003, the sheik explained what linked all his endeavors: "I love success. I despise failure."
It would thus be crazy to write off Sheik Mohammed, or Dubai, for that matter. The sheik is a hereditary leader whose ruling tribal lines date back to 1833. Although he only formally became Dubai's ruler in 2006 upon the death of a brother, he has been the driving force behind the emirate for three decades. Of equal importance, his ambition and competence have made him a leading figure - presently serving as Vice President, Prime Minister and Defense Minister - in the United Arab Emirates, the country created by a confederation of seven Arab sheikdoms in 1971. No leader in the U.A.E., or perhaps in the Arab world at large, can rival Sheik Mohammed's global connections in politics and business.
For a lifeline out of the crisis, Sheik Mohammed will certainly look again to Abu Dhabi, whose vast oil deposits make it by far the richest U.A.E. entity. It stepped up with $10 billion in support immediately after the global crash in 2008 and can be expected to do so once more; Abu Dhabi's ruling al-Nahyan family, as cautious as the al-Maktoums are daring, knows that it, too, will be dragged back by the demise of Dubai. A glance at the $600 billion–plus balance sheet of Abu Dhabi's sovereign wealth fund puts Dubai's debt crisis in a softer light. And, as far as Dubai's leaders are concerned, the problem is largely limited to egregious overborrowing by one company in one sector: Nakheel, the Dubai World subsidiary behind huge property projects like the Palm and the World, built on injected sand off the Gulf coast. "It will take a bit of time, but Dubai will come back," a Dubai insider told TIME. "It will come back stronger, because the crisis will help create a more sustainable model for the future."
That remains to be seen, but the world cannot afford the failure of Sheik Mohammed. Whatever Dubai's excesses, this metropolis on the desert edge - not Cairo, Beirut, Tehran or Tel Aviv - has become the Middle East's crossroads of cooperation. In a region where conflicts still rage, Dubai has become a place where Arabs and others have learned to go to build a future together. In a 2007 speech to international business leaders, Sheik Mohammed chastised Arabs who preferred "to sit around waiting, praising our glorious past and blaming others for our failures and our problems." Instead, he said, "We have to arm ourselves with courage and work quickly and seriously, to tackle the reasons that put our region behind the rest of the world." Sheik Mohammed is a dreamer whose ego proved too large to contain. But his big dream remains the Middle East's hope.
See 25 people to blame for the financial crisis.
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