Health care reform cleared a major hurdle in the Senate November 21, but this long legislative battle might not end until next year.

Businesses might be tired of all the twists and turns the legislation has taken and tempted to just wait for the final verdict before figuring out how they would be affected.

But that would be “a dangerous thing,” said Ken Huber, senior vice president of the employee benefits group for PSA Insurance & Financial Services in Baltimore.

There are important differences between the bill that passed the House and the version that will be debated by the Senate after Thanksgiving. Huber, whose company provides employee-benefits brokerage and consulting services to small and medium-sized businesses, said business owners need to look at these two bills and let members of Congress know what they think.

Huber personally thinks the Senate bill would be better for businesses than the House version because its employer mandate is less onerous. But he is concerned that the Senate bill’s mandate for individuals to obtain insurance coverage is too weak and would lead many to wait until they were sick to get insurance.

“That really could spell increasing costs for everyone,” he said.

Businesses shouldn’t make any changes to their insurance plans yet in anticipation of health care reform, he said, but they do need to look at where they fit on coverage mandates and whether their benefits and contribution levels meet what might be required.

Public Plan Might Have to Go

The Senate bill would reduce the number of uninsured Americans by 31 million by 2019, according to the Congressional Budget Office. It would expand eligibility for Medicaid, require individuals to obtain coverage, penalize businesses with more than 50 employees that don’t offer affordable coverage, and provide tax credits to some individuals and small businesses to help them afford insurance.

The legislation also would prohibit insurers from denying coverage or charging higher premiums to individuals with preexisting conditions and make other reforms in the insurance market. It also would create new state insurance exchanges that aim to help individuals and small businesses get better deals on insurance.

In the bill’s current form, the exchanges would include a government-run plan, but states would have the right to opt out of the public plan. The CBO estimates that 25 million Americans would purchase insurance through the exchanges, and up to 4 million would enroll in the government-run plan, which would be supported by the premiums it charges.

The public option might have to be jettisoned in order for the bill to pass the Senate, however. At least two senators who voted to proceed with debate on the bill November 21 said they will not vote for the legislation if it includes a government-run plan. That could leave Democrats short of the 60 votes they need to get the bill passed, since all 40 Republicans oppose the bill at this point.

Most groups representing small businesses are against the public option, contending it would underpay health care providers and shift costs to private insurance plans. The Main Street Alliance, a coalition of small businesses that support President Barack Obama’s vision of health care reform, strongly favors a public plan, however.

“A public option will give small business new bargaining power, put downward pressure on costs, and help keep the insurance companies honest,” said Main Street Alliance member Maude Verela, owner of Kidutopia in New Orleans, which offers a variety of services to children and their parents.

Small Business Majority also supports the legislation, contending it would reduce health care costs for small firms and their employees.

Bill’s Foes Hope to Change It

Most other business groups disagree, including organizations such as the U.S. Chamber of Commerce and the National Federation of Independent Business that have advocated health care reform in hopes of reducing the cost of insurance. They contend both the House and Senate bills would make insurance more expensive, not less.

NFIB, however, will continue to lobby for changes in the legislation instead of moving to all-out opposition.

“I think it’s in the best interest of our members to remain involved in every step of this bill, no matter what,” said Amanda Austin, NFIB’s Senate lobbyist on health care. “This could be reality.”

“To the extent that changes can be made, we will be involved in them,” Austin said.

NFIB will fight to remove the public option and employer mandates, improve the insurance tax credits for small businesses, and make sure the minimum-benefits level reflects what small businesses are offering today.

“It’s hardly reform if you’re asking small employers to buy up from the coverage they have today,” Austin said.

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Kent Hoover is the Washington bureau chief for bizjournals.