Senators jostle for position on health reform provisions

CongressDaily reports that the "only public insurance option proposal Senate Majority Leader (Harry) Reid included in his healthcare overhaul bill this week appears simply to be a starting point that will be sliced and diced before reform is said and done." Some of the most vocal advocates are "leaning toward a combination of a trigger and state-based solutions rather than a national, government-run plan." Senate Finance Committee Chairman Sen. Max Baucus is meeting "almost daily" with moderates to hear their concerns so that he can gather the 60 votes needed to pass the bill (Edney, 10/30).

Meanwhile, the "opt-out" public option approach is dividing President Obama's administration officials from some Democratic senators. Politico reports that there's a "divide" between White House chief of staff Rahm Emanuel and Sen. Chuck Schumer. "Schumer, a New York Democratic senator, is pushing a proposal that allows states to opt-in to a public option. Emanuel, who left the House to become President Barack Obama's chief of staff, has backed Maine Republican Sen. Olympia Snowe's plan to 'trigger' the option if insurers misbehave." The fight may be over timelines: Schumer is trying to win the midterm elections for Democrats while Emanuel is focused on helping Obama's bipartisanship credibility by winning even on Republican vote (Thrush, 10/30).

South Dakota's Governor, Mike Rounds, talks to NPR about the opt-out: "The devil will be in the details. We haven't seen a copy of the bill yet. But as we understand it, all of the states, even if they were to opt out, would still be subject to all of the taxes that it's going to take to put together the public plan. In addition to that, we would still be subject to the additional increased cost that would be cost shifted from the public plan to all of the private plans (in the form of higher premiums in private plans)" (Siegel, 10/28).

Issues beyond the public insurance opton continue to be in play as well. Lawmakers are pressuring Reid regarding other provisions, with costs tallying as much as $100 billion, Bloomberg reports. "The Nevada Democrat is under growing pressure to exempt more workers from a proposed tax on high-end insurance plans; cut in half a proposed $40 billion fee on medical-device makers; increase subsidies to help lower-income Americans get coverage, and make it easier for the elderly to buy medication" (Donmoyer, 10/30).

The New York Times profiles Sen. Tom Coburn, R-Okla., "known as Dr. No." "As the health care overhaul heads to the Senate floor, Mr. Coburn is preparing for what he considers a career pinnacle of havoc. Enacting the proposal, he says, would be catastrophic, and so if precedent holds, he will try to hinder it with every annoying tool in his arsenal: filing amendments (he has done that 508 times since joining the Senate, second only to John McCain's 542 in that period), undertaking filibusters and objecting strenuously" (Leibovich, 10/29).

Roll Call reports that the GOP is calling on Reid to make the text of the bill he sent to the Congressional Budget Office available so they can "review it while CBO scores its costs." All 40 Republican senators signed a letter asking Reid for the bill (Stanton, 10/29).