Insurance industry studies contend that premiums would go up because various fees imposed on health insurers and health care providers to pay for covering the uninsured would inevitably get passed on to consumers.

We believe premiums would come down for several reasons. Companies would no longer need to spend as much money on administrative costs, to screen out people with pre-existing conditions (prohibited by all reform bills). If they wanted to participate on the exchanges (and have access to millions of new customers), the companies would also be forced to compete with other private plans, and possibly a public option, encouraging them to lower premiums and accept lower profits.

A hint of what might happen can be seen in an analysis by the Congressional Budget Office. Under a version of the Senate Finance Committee bill, the average single person would pay a $5,000 premium for a “silver plan” sold on the exchanges in 2016 but would pay $6,000 for a plan with less generous coverage if the reform failed.

WILL THERE BE HELP? Right now, only the poorest Americans get help, through the state-federal Medicaid program. The bills in both houses would expand eligibility for Medicaid to cover millions more people, and lower the contributions of the poorest Americans.

For those buying policies on the exchanges, perhaps 30 million people in all, the bills would provide tax-credit subsidies to help low- and middle-income people pay the premiums. People would have to pay specified percentages of their income toward the premium, ranging in the House bill from 1.5 percent for those barely above Medicaid level to 12 percent for those earning four times the poverty level, or $88,000 for a family of four.

That sounds like a substantial hit at the upper end  $10,560 for a family of four before subsidies kick in. But it is comparable to what many workers are currently willing to pay for their group policies.

And just in case the premiums might still look unaffordable to large numbers of people, the Senate Finance Committee’s version has proposed an escape hatch. No one would be required to spend more than 8 percent of their income on health insurance. They would not be insured, but they would not be fined.