The next step in health care reform is for the House of Representatives and the United States Senate to negotiate a final version.  The biggest hurdle is how the legislation will be financially paid; whether to include the government run insurance plan and how much to spend in subsidies to help middle and lower income Americans afford insurance.  Inclusion or exclusion of abortion costs is also a difficult issue.  If you have a pre-existing medical condition under both the House and Senate plans, it will be easy for you to obtain insurance.  Insurers would be barred from rejecting applicants based on health status starting no earlier than 2013.  In the meantime, a temporary high risk pool for people with pre-existing medical conditions will be created.  Both bills say that insurers cannot set lifetime coverage limits.  Those who want to keep their existing policies, however, generally would be able to do so.