Unfortunately, there's still one big elephant in the reform room: There are no restrictions on increases based on age. Unless something changes drastically in the final version of the bill (and if you don't call your congress critter, it definitely won't), this is a giant shell game in which health insurers will get their profits from one new underwriting emphasis rather than another.

WASHINGTON -- Top Senate Democrats are close to finalizing their health bill and could unveil a measure as soon as early this week that would include stiffer penalties on employers who fail to provide health coverage.

Senate leaders plan to submit the bill to the Congressional Budget Office for a cost estimate as soon as Monday, and make the legislation public as soon as Tuesday, according to a person familiar with the negotiations.

Details of the legislation could change, but its broad outlines are becoming clear. Employers with more than 50 workers wouldn't be required to provide health insurance, but they would face fines of up to $750 per employee if even part of their work force received a government subsidy to buy health insurance, this person said. A bill passed by the Senate Finance Committee had a lower fine of up to $400 per employee.

The bill to be brought to the Senate floor would create a new public health-insurance plan, but would give states the choice of opting out of participating in it, a proposal that Senate Majority Leader Harry Reid of Nevada backed last week.

The bill is expected to expand health coverage to tens of millions of Americans by giving low- and middle-income Americans subsidies to offset the cost of insurance, and expanding the Medicaid federal-state insurance program to cover a broader swath of the poor. Most people would be required to buy insurance or pay a fine, though exceptions would be made for those deemed unable to afford it.

Also expected are new rules on insurers to prevent them from denying coverage to people with pre-existing health conditions and from dropping customers' insurance once they become ill.