Congress Now Negotiating Health Reform in Closed-Door Sessions

Approaching their first full week of trying to merge all the committee-approved versions of the health reform bill, the House and Senate are heading toward likely disagreements over key provisions.

The House, according to promises from Speaker of the House Nancy Pelosi, will deliver a merged bill that will include the government-run insurer that is popular with much of the strong Democratic majority there. And the Senate's tightrope walk to find and retain 60 yes votes for a bill is more likely to see a compromise -- possibly a reflection of the Senate Finance Committee's bill that had nonprofit cooperatives instead of the so-called "public option."

The House promises to experience a much easier process. The bill -- expected to be up for a floor vote in November -- will contain the public option, even though it's been called a deal breaker in the Senate debate. It's still unclear what exact format that public option would follow.

The merged legislation in the Senate faces a more precarious future, now being hashed out behind closed doors by the Senate leadership. A bill must win 60 votes to bypass the potential for a Republican filibuster. The bill passed by the Finance Committee -- introduced and championed by the committee's chairman, Sen. Max Baucus, D-Mont. -- is the only one of the two that attracted a Republican supporter: Sen. Olympia Snowe, R-Maine.

Subsequently, Sen. Susan Collins, the other Republican senator from Maine, also suggested she might be convinced to vote for reforms. "The legislation passed by the Senate Finance Committee represents a substantial improvement over the costly and flawed alternative approved by the Senate health committee as well as the House bills," she said in a statement. But, she added, it falls short of the goal of reining in costs and it "could lead to onerous financial penalties for small businesses that are already struggling to provide affordable health insurance." She said she is "hopeful that many improvements can be made to produce a bill that can achieve bipartisan support."

But even if it achieves bipartisan support, it may lose Sen. Joe Lieberman, the independent from Connecticut. Though he caucuses with Senate Democrats, he straddles the party divide on a number of issues. In this case, he has argued that widespread reform isn't appropriate during this current recession.

Still, the more bipartisan-friendly bill from the Senate isn't a popular option for health insurers. If the Finance Committee bill takes the overall lead, that's a concern for America's Health Insurance Plans. President and Chief Executive Officer Karen Ignagni said, after the bill passed the committee, she was "concerned about its workability and cost." She explained at an Oct. 15 Senate hearing that her organization commissioned a report to study the legislation's potential effects on premiums because, "we had detected alarming trends." The group released the PricewaterhouseCoopers study on the eve of the committee vote. In Ignagni's testimony, she explained its basic finding about the weakened individual mandate under that bill: "Costs are going to go up for individuals and working families if we don't have everybody participate."

After releasing its cost analysis, which was greeted with accusations that health insurers were trying to kill reform, AHIP sent a letter to Senate leaders explaining the report wasn't intended to derail the legislation. "We wanted outside verification of the trends we were seeing in our own analyses, not to stop health reform, but to highlight that key changes were necessary," it said.