A look at key issues in the nation's health care debate:

THE ISSUE: How much more can insurers charge people based on age, sex and pre-existing conditions, and would that change if the health system is overhauled?

THE POLITICS: Charging women, the elderly and people who already have health problems higher rates for health insurance is based on the idea that those groups use more services and therefore cost more. President Barack Obama and congressional Democrats want to curb the practice, a position that could enhance their standing with important Democratic constituencies. First Lady Michelle Obama criticized insurers who consider domestic violence a pre-existing condition. The senior citizen lobby, AARP, and women's groups are pushing to end what they consider discriminatory ratings. Insurance companies say a change could raise premiums for others and might discourage younger people from buying insurance. House Democrats want to limit age rating to a 2-to-1 ratio, meaning an elderly person could be charged twice what a 20-year-old must pay. The bill championed in the Senate by Sen. Max Baucus, D-Mont., would set the ratio at 4 to 1, still too low to please insurers but not low enough to satisfy AARP.

WHAT IT MEANS: Most states allow insurers to charge higher premiums for the elderly, women and people with pre-existing conditions. They may charge six or seven times as much for a 60-year-old as for a 20-year-old, for instance, even if the younger person has health problems and the older person does not. Bills being considered in Congress would end premium differentials based on gender and health status, and curtail discrepancies based on age, for policies sold to individuals and small companies. But the proposals differ on whether insurers should still be able to consider age, gender and pre-existing health status when setting premium rates for companies with a large workforce.

_ Rita Beamish