Lawmakers wrestle with health reform details - publicly and behind closed doors

Reporters examine which provisions - such as the public option or cost control provisions - may be included as House and Senate negotiators try to meld various Democratic health reform bills.

The Associated Press:  reports that Democratic "intraparty disputes may prove the most grueling test of all as Congress tries to write a bill that fulfills President Barack Obama's goal of extending coverage to millions of Americans and reining in rising medical costs. The disagreements extend well beyond whether or not to allow the government to sell insurance in competition with the private market, though fissures over the so-called public plan — preferred in the House, less so in the Senate — have drawn the most attention. Some of the toughest fights loom over what requirements employers should have to shoulder to see that their workers are covered, and perhaps stickiest of all, how to make coverage affordable and pay for extending it to millions of uninsured. … Any showdown between the House and Senate is a ways off, and will happen only if both succeed in passing their own health bills. Democratic leaders in both houses are working to finalize their legislation — a process that is itself fraught with difficulties — in time to hold floor debates within the next several weeks. (Werner, 10/18)

The Washington Post sheds light on critical behind-the-scenes negotiations: "Senate Majority Leader Harry M. Reid (D-Nev.) sits at the head of a wooden table at his office as he and Sens. Christopher J. Dodd (D-Conn.) and Max Baucus (D-Mont.) work to merge two competing versions of health-care legislation into one bill. The three men will be joined by top aides as well as by members of President Obama's health-care team, led by White House Chief of Staff Rahm Emanuel. The sessions started on Wednesday and could be completed this week. The group will make such key decisions as whether to include a government-run insurance plan designed to compete with private insurance companies. The bill passed in July by the Senate Health, Education, Labor and Pensions Committee, which Dodd led while Sen. Edward M. Kennedy (D-Mass.) was ailing, included such a provision, but the legislation passed last week by Baucus's Finance Committee did not."

Although much of the writing of legislation happens in closed-door meetings, congressional Republicans have sharply criticized the ongoing process. 'This bill is being written in the dark of night,' said House Minority Leader John A. Boehner (R-Ohio), adding that 'the president ought to keep his promise to the American people and open this process up'" (Bacon Jr., 10/18).

Meanwhile, other senators are weighing in on the shape of the final bill:

The New York Times: "Senator Tom Harkin, the chairman of the Senate health committee, predicted on Friday that Congress would pass sweeping health care legislation before Christmas. And he said it would include a new government insurance plan — the so-called public option — which would compete with private insurers. 'The vast majority of the Senate Democratic caucus is for the public option we have in our bill,'' which was approved by the health committee in July, Mr. Harkin said. … Mr. Harkin, an Iowa Democrat, said Congress would probably have to 'go outside the health care system'' to raise revenue to finance coverage of the uninsured. "That's what the House has done,'' Mr. Harkin said" (Seelye, 10/16).

Bloomberg: Democrats shouldn't tailor a health-care overhaul to the wishes of Republican Senator Olympia Snowe and need to push for legislation that includes a government-run insurance program, Senator Jay Rockefeller said. "We can't sort of hedge and say 'what's Olympia going to do,'" Rockefeller, a West Virginia Democrat, said in an interview on Bloomberg Television's 'Political Capital with Al Hunt,' airing this weekend. 'We've got to decide what we want.' …Senate Majority Leader Harry Reid, a Nevada Democrat, is trying to craft a final measure that satisfies conflicting demands within his party, such as whether to include a government-run plan. 'If we calculate so finely and so exquisitely, we're going to lose our leadership and our momentum," said Rockefeller, 72. 'And right now yes, we did get her vote. As she said yes for this one, it doesn't mean for the next round of votes'" (Dodge, 10/17).

San Francisco Chronicle: "Obscured by the war in Congress over a government-run health insurance option are several behind-the-scenes battles that could do more to transform the U.S. health care system. Sen. Ron Wyden, D-Ore., wants to open up to everyone the health care 'exchanges' that most bills limit to small businesses or individuals without employer-based plans. ... Rep. Ron Kind, D-Wis., wants to get rid of the Medicare fee-for-service model that pays doctors and hospitals by volume of services rather than care aimed to keep patients healthy. ... These and similar efforts at the fringes of the debate take aim at the most vexing part of the $2.6 trillion U.S. health system: soaring costs, which are bankrupting individuals, businesses and government, devouring wages and swelling the ranks of the uninsured. ... No bills in Congress make cost control a central feature" (Lochhead, 10/18).