The House of Representatives has returned from its winter break to start the second session of the 111th Congress, and the Senate returns to business next week. At the top of the Congressional agenda is reconciling the differences between the separate health reform bills approved by the House and Senate late last year. While the overarching goals of the two bills are the same – to expand access to high-quality, affordable health care and reduce health care costs – there are numerous differences in the approaches the two chambers take. To highlight just a few issues facing lawmakers, agreement must be reached on, among many other things: whether to include a public health insurance option; whether health insurance exchanges should be state-based or federally administered; the extent to which health insurance premiums should be subsidized; whether expensive health insurance plans should be taxed; how to address coverage of abortion services; whether to repeal the anti-trust exemption for insurers; whether to include an independent Medicare Payment Advisory Board to recommend Medicare savings; how to avert the 21% cut in Medicare physician fee schedule payments that goes into effect March 1, 2010; the extent of Medicare provider payment reductions and Medicare Advantage cuts, along with how such cuts should be structured; how to achieve broader Medicare delivery reforms; and which health care sectors should be subject to industry fees. Rather than convene a formal conference committee, key lawmakers and staff are meeting to reach agreement on the myriad of issues. The tentative plan once final agreement is reached is for the House to consider an amended version of the Senate-approved bill. Assuming House passage, the bill would then be voted on by the Senate; if the Senate then approves the bill without amendment, it would go to the President for signature. Lawmakers hope that this process can be accomplished in the next few weeks, ideally before the President’s (still unscheduled) State of the Union Address, although there are numerous policy and political hurdles that stand in the way of final enactment.