Meanwhile, on the House side, CQ Politics reports ”Speaker Nancy Pelosi said Thursday she wouldn’t rule out keeping the House in session for part of Christmas week, if that could lead to final action this year on a health care overhaul.” In the Senate, Democratic leaders are waiting for an updated Congressional Budget Office analysis on the latest proposals – a report not expected before next week.

“Asked at a news conference if Congress could complete work on the health package in the next week to 10 days, Pelosi said there is a big difference between those two time frames. If the Senate passes its bill by the end of next week, she said House and Senate conferees could meet over the weekend of Dec. 19-20 to try to resolve differences between the two versions.” She also said that if final votes slip into 2010, Democrats will still act quickly to finish work on the measure. In addition, she ”brushed aside suggestions that the House might accept whatever the Senate passes, rather than go to conference — although she said that about 75 percent of the two bills is the same” (12/10).

Politico: Pelosi told reporters, “‘We would like to see a full conference’ negotiation with the Senate … meaning she wants to appoint House negotiators to hash out a final version with their Senate counterparts before scheduling a vote on the combined package.” These negotiations can sometimes drag on for weeks and months, “but the speaker suggested Thursday that negotiators could wrap up these health care talks over a single weekend if the Senate finishes its bill by the end of next week.” Politico terms this “an an incredibly abbreviated timeline based on the amount of energy both chambers have invested in their versions of the legislation. … But it may suggest the speaker is willing to accept much of what the Senate produces” (O’Connor, 12/10).

The Wall Street Journal: “Pelosi said that she still held out hope that Congress could complete health-care legislation before lawmakers leave town for the Christmas recess.” But that likelihood ”entirely depends on when the Senate can reach agreement on final passage of its version of the bill.” Pelosi also seemed “to endorse part of a Senate alternative to a public health-insurance plan that would allow people between 55 and 64 to buy into the Medicare program” (Boles, 12/10).

Reuters: Pelosi “voiced support for an important provision of a tentative Senate Democratic compromise that scales back a public insurance option that she supports.” Although she wants more details on the specifics of the Senate’s overall accord, she said “one element — expanding Medicare, the federal health program for the elderly — had merit” (Ferraro, 12/10).

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The expanded Medicare program could help cover the 4.3 million uninsured Americans in the 55 to 64 age group who are among the most expensive patients to insure, the Philadelphia Inquirer reports. That could be especially helpful to “people forced into early retirement by the economy and thereby forced out of their medical coverage.” Details of the plan aren’t available yet, and its unclear exactly which people in the age group would be eligible. The new Medicare recipients would have to buy into the program, unlike people over 65, but subsidies may be available (Bergen and Burling, 12/10).

The Wall Street Journal: Under the plan “congressional aides estimate that two million to three million people would participate.” The approach ”could be good news for some in the 55-64 bracket who currently don’t have an easy way to get coverage. Those who must buy coverage on their own often face high premiums or are shut out entirely because of pre-existing conditions.”

But their payments would also likley be more than those paid by people older than 65, who pay $100 a month or more for coverage, depending on their income. “Based on data from the Congressional Budget Office, a report by the seniors’ lobby AARP estimated that an earlier proposal to expand Medicare to a narrower group would cost participants $634 a month. … Another issue is whether participants will have access to the same doctors as they do on private insurance. Some doctors have stopped taking Medicare patients because of the lower payment rates” (Adamy, 12/10).

NPR reports that a previous CBO estimate — done last year– concluded that allowing people age 62-64 to buy into Medicare would cost $7,600 a year including drug coverage, more than the $4,722 for the average cost for purchasing coverage in the non-group market. And a 2002 estimate found that without subsidies ”a Medicare buy-in would only cut a single percentage point from the proportion of uninsured adults ages 55 to 64, leaving 9 percent rather than 10 percent without coverage.” But some think that allowing the non-disabled to buy in to Medicare could be less disruptive to the insurance market — and would cost less than a public option (Hensley, 12/9).

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Reuters: “From 2005 to 2008, Medicare Advantage insurers reported $27 billion in expenses unrelated to care, according to the report released by [the House Energy and Commerce Committee], which looked at 34 such insurers. It also pointed to millions spent on executive compensation and company retreats in Hawaii, Cancun, Mexico and other exotic locales.”

Rep. Henry Waxman, chairman of the committee, said “Medicare Advantage insurers are squandering billions of dollars on overhead costs.” Health care reform efforts seek to trim the spending. “Under the House reform bill, health insurance companies could not spend less than 85 cents of every premium dollar on actual patient … care; if they do, surplus money would be returned to customers through rebates — essentially capping insurer profits. The Senate bill currently under debate also calls for similar rebates, but could require a 90 cent on the dollar threshold under a compromise deal unveiled late on Tuesday” (Heavey, 12/9).

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The Fargo Forum reports that Sen. Kent Conrad, D-N.D., is “back in the national spotlight.”

“Earlier this year, Conrad was a member of the ‘Gang of Six’ senators to cultivate health care reform legislation. Now, Conrad is among some Democrats who have voiced reluctance and opposition toward a deal struck by Senate leadership Tuesday, which trades a public health insurance option for an expansion in Medicare coverage to include those between 55 and 64 years old. Conrad in the past has said he won’t support a health care option tied to Medicare rates, claiming it would hurt North Dakotans because the state has one of the lowest Medicare reimbursement rates in the nation” (Daum, 12/9). 

The Newport News, Va.,Daily Press: “Senate Democrats are deep in health-care reform wrangling that could drag on until Christmas, and U.S. Sens. Jim Webb and Mark R. Warner are poised to play vital roles in the debate. But in Washington’s constantly evolving political landscape, neither Virginia Democrat appears ready to vote ‘yes’ on reform yet. Webb pointed out that during a series of recent votes about health care, he sided with Republicans who oppose cuts to Medicare funding” (Payne, 12/9).

CongressDaily: “Senate Majority Leader Reid, dangling the chance of a free weekend, wants to move off healthcare reform early next week and take up a nearly $450 billion FY10 appropriations ‘minibus’ spending package with Republican consent. If Republicans object, as seems likely, Reid said he will keep the Senate in session this weekend for required procedural votes on the spending legislation. Reid’s gambit is part of an increasingly tough effort to approve health care and a series of year-end measures before Christmas” (Friedman, 12/10).

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Based on the Senate’s recent revisions, the short answer is “that those without employer-provided insurance would have more options for buying coverage, but if they are younger than 55, their money would go to a private insurer, no matter what. Rates would be more competitive than what they are offered now, but possibly less so than under a ‘public option.’” (MacGillis, 12/10).

The Associated Press reports on the big picture of new benefits’s costs. ”President Barack Obama’s health care overhaul — now looking like a real possibility — should give uninsured Americans options they’ve never had before. But it won’t be a free ride. As with the Medicare prescription drug benefit that passed when Republicans ran Washington, consumers will face a complicated lineup of health plan choices — and they’ll be costly for some” (Alonso-Zaldivar, 12/10).

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The organizations, including the American Hospital Association, the Federation of American Hospitals and the American Medical Association, said the proposal would hurt their members because Medicare pays providers at a lower rate than private insurers. “Hospital representatives said the idea also would violate a deal they reached with the White House this year to give up $155 billion in Medicare payments over the next decade. The concession helped to lower the cost of a health-care package that promised hospitals a pool of at least 30 million newly insured customers” (Murray and Montgomery, 12/10).

USA Today: “Though the idea gained traction on Capitol Hill — and got a boost from President Obama — the outcry from the medical groups underscored the difficulty lawmakers are facing as they look for compromises that can win broad support for the Senate’s bill, which would cost $848 billion in the first 10 years. ’Bringing more people into a system that doesn’t work very well is not a good answer,’ said Jeffrey Korsmo, executive director of the Mayo Clinic Health Policy Center. ‘The current Medicare program is not sustainable’” (Fritze, 12/10).

The New York Times: “The American Hospital Association issued an action alert on Tuesday urging its members to oppose the plan and to call their senators’ offices. … The Federation of American Hospitals also issued a bulletin … ‘Any Medicare Buy-In would invariably lead to crowd out of the private health insurance market, placing more people into Medicare,’ the group said. ‘It is critical that you contact your Democratic Senators today!’” (Pear and Herszenhorn, 12/9).

The Wall Street Journal: ”The insurance industry’s trade association, America’s Health Insurance Plans, opposed the measure to fix companies’ medical-loss ratios at 90%. Medical-loss ratios are closely watched measures of how many premium dollars companies spend on patient care versus administrative costs and profits.” Insurers say it would be very difficult to reach and could hurt their abilities to “weed out fraud and run other programs designed to cut costs and improve wellness.”

Drug companies as well could see less money for medicines under the Medicare plan than what private insurers give them, the Journal reports (Johnson and Rockoff, 12/10).

Related KHN story: Democrats’ Ideas To Expand Medicare Raise Hackles Of Doctors, Hospitals, Insurers (Appleby, 12/9).

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CNN highlights some other potential sticking points in a consensus version, including abortion, the Medicaid expansion, an individual mandate and financing (12/9). 

Roll Call: “House Democrats, including some prominent liberals, appear to be warming to the reported Senate health care compromise, despite the inclusion of a ‘trigger’” for a public insurance option.” Liberal Rep. Anthony Weiner, D-NY., called the proposed Medicare expansion “‘way better than a public option’ and ‘an unvarnished, complete victory for people like me who have been advocating for a single-payer system.’” Roll Call notes that “Other liberals were actively working against the emerging Senate deal, however” (Dennis, 12/9).

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In addition to Financial Services, the package will include the FY 2010 Commerce-Justice-Science (HR 2847), Labor-HHS-Education (HR 3293), Military Construction-Veterans Affairs (HR 3082), State-Foreign Operations (HR 3081) and Transportation-HUD (HR 3288) appropriations bills. The Defense spending bill (HR 3326) would be a separate measure (Women’s Health Policy Report, 12/9).

The Labor-HHS-Education bill totals $163.5 billion, an increase of $8.5 billion over FY 2009, excluding stimulus dollars, CQ Today reports. The measure would continue restrictions on federal funding for abortion services and ease restrictions on federal funding of needle-exchange programs.

A continuing resolution has been funding the government agencies affected by the appropriations bills since the fiscal year began in October. The CR expires on Dec. 18, so another stopgap bill might be required if the omnibus package is not signed by then.

The budgetary process has been delayed by partisan debate and a legislative calendar dominated by health reform, according to CQ Today (Koss/Clarke, CQ Today, 12/8). That problem may persist, as Senate Majority Whip Richard Durbin (D-Ill.) said Tuesday that the Senate will not take on any more legislation — including the spending bills — until it has finished work on health reform

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NPR: “The amendment, offered by Sens. Ben Nelson (D-NE) and Orrin Hatch (R-UT), would have made the Senate bill’s abortion language nearly identical to that adopted by the House last month. Nelson insisted there was nothing complicated about his plan. ‘Our amendment only ensures that where taxpayer money enters the picture, people are not required to pay for other people’s abortions,’ he said. … But opponents of Nelson’s amendment said it would go much further … ‘What this amendment would do, as I read it, is to prohibit any health insurance plan that accepts a single government subsidy or dollar from providing coverage for any abortion, no matter how necessary that procedure might be for a woman’s health, even if she pays for the coverage herself,’ said Sen. Dianne Feinstein (D-CA)” (Rovner, 12/8).

The Associated Press reports that Reid urged Democrats to reject the amendment in a speech on the Senate floor, though he opposes abortion himself. Reid “recognized the threat Nelson’s amendment posed to the overall bill to expand health coverage to some 30 million uninsured Americans. … ‘This is a health care bill. It’s not an abortion bill,’ Reid said, carefully reading a prepared speech on the Senate floor. ‘We can’t afford to miss the big picture’” (Kellman, 12/8).

Roll Call: “‘It makes it harder to be supportive’ of the health care bill, Nelson said after his amendment was defeated. He added, ‘We’ll have to see if they can make it easier.’” Nelson said that “losing his abortion amendment ‘could’ be the determinative factor” in terms of how he votes for the sweeping health bill (Pierce, 12/9).

The Christian Science Monitor: If Nelson now decides not to vote with the Democratic caucus, “Democrats will have to find a Republican to join them (perhaps one of Maine’s pro-abortion-rights moderates), which is no small task. … But it’s also possible that Nelson could sign on to a compromise over abortion. Earlier on Tuesday, Senate majority leader Harry Reid told reporters that he would work with Nelson on language the Nebraskan would find acceptable”

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CBS News reports that “Americans’ views about the government funding abortions, and about abortion itself, have remained stable for many years.” In a CBS News poll conducted last month, more than half of Americans said “that health care reform should not cover abortions, while just 34 percent thought it should. … In 1994, CBS and the New York Times found 53 percent of Americans thought abortion should not be part of any government health care plan. In CBS News Polls conducted in the late 1970s, about half felt the government should not ‘help a poor woman with her medical bills if she wants an abortion’”

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The current language in the Senate bill would allow federally subsidized insurance plans to cover abortion services but would require plans to segregate federal funds from private money that would pay for the services (Pear/Herszenhorn, New York Times, 12/9). During a floor speech before the vote on Nelson’s amendment, Senate Majority Leader Harry Reid (D-Nev.) said the bill’s current language represents “a fair middle ground” on the issue (Murray/Montgomery, Washington Post, 12/9). Reid, an abortion-rights opponent who voted against Nelson’s amendment, said that the “reason I oppose abortion and the reason I support this historic bill are the same: I respect the sanctity of life” (Hook/Levey, Los Angeles Times, 12/9). He added that the health reform bill is “not an abortion bill” and that the Senate “can’t afford to miss the big picture,” noting that “[n]either this amendment nor any other should overshadow the entire bill or overwhelm the entire process. … I will not support efforts to undermine this historic legislation” (Kellman, AP/NPR, 12/9).

Reid was joined by 50 Democrats, two independent and two Republicans — Maine Sens. Susan Collins and Olympia Snowe — in voting against the amendment. Seven Democrats — Nelson, Evan Bayh (Ind.), Robert Casey (Pa.), Kent Conrad (N.D.), Byron Dorgan (N.D.), Ted Kaufman (Del.) and Mark Pryor (Ark.) — voted for the amendment along with 38 Republicans.

Sen. Dianne Feinstein (D-Calif.) said, “A majority saw it was not right to say that a woman could not pay for abortion or abortion coverage herself if her insurance company received any federal dollars,” adding that the vote “is the first thing we’ve won in years.”

More Abortion Battles Lie Ahead

Tuesday’s vote “complicates the outlook” for the bill’s final passage, as Reid and other Democratic leaders continue to work toward the 60 votes needed to pass the final bill out of the Senate, the Times reports (New York Times, 12/9). Although the seven Democrats who voted for the Nelson amendment are not expected to vote against the final Senate bill over the issue, Reid needs the support of the entire 60-member Democratic caucus — including Nelson — if he hopes to pass the bill, The Hill reports (Young, The Hill, 12/8).

Nelson had threatened to withdraw his support for health reform legislation if his abortion language was not included in the final bill. However, he said that he is unsure of how he will vote after Tuesday’s rejection of his amendment. “Until everything is settled and you’ve got a clear view of what changes might be made and what may be there, it’s hard to say,” he said, adding, “I don’t want to be stubborn or closed-minded (but) I have trouble imagining what (another compromise) would be” (Pierce, Roll Call, 12/9).

According to CQ Today, Democratic leaders have two options in the wake of Nelson’s amendment: finding at least one Republican to offset the possible loss of Nelson’s vote or find a compromise on the abortion language that will not risk any other Democratic votes (Ethridge, CQ Today, 12/8).

Top Democratic staffers in a Dec. 4 meeting discussed setting up a process to allow the House to pass the Senate bill without a conference, according to several party aides, CongressDaily reports. The maneuver could avoid Senate filibusters and possibly deliver a bill to President Obama by the end of the year. According to CongressDaily, Democratic leaders are concerned that conservative Democrats who support the House’s Stupak language on abortion coverage could vote against a final bill that is closer to the Senate’s language, while abortion-rights advocates could vote against a bill that includes the more restrictive language. Rep. Diana DeGette (D-Colo.), who supports abortion rights, has said that 41 members of Congress are willing to oppose a final bill that includes the House language (Hunt, CongressDaily, 12/8).

Agreement Reached on Public Option

Reid also announced on Tuesday night that a groups of 10 Democratic senators had reached “a broad agreement” to table the proposed public option in the bill, which has “posed the biggest obstacle” to passing the bill in the Senate, the Times reports. The agreement would expand Medicare by allowing people ages 55 through 64 to “buy in” to the program, while giving the government power to offer a new insurance plan if the private plans do not meet certain goals, the Times reports (New York Times, 12/9).

NPR, ‘Countdown’ Examine Reform Debate

MSNBC’s “Countdown” on Tuesday included a discussion with Washington Post columnist Eugene Robinson about the impact of health reform on women (Olbermann, “Countdown,” MSNBC, 12/8). NPR’s “Morning Edition” on Wednesday also reported on the Senate votes (Rovner, “Morning Edition,” NPR, 12/9).

Stupak ‘Hopeful’ Amendment Will Be in Final Bill, New York Times Opinion Piece Says

In a New York Times opinion piece, Stupak writes that he is “hopeful that the spirit of our legislation will make it into the final bill.” Stupak claims that his amendment, which was added to the House bill in November, “maintains current law, which says that there should be no federal financing for abortion.” Women receiving federal subsidies to purchase insurance would not be allowed to purchase policies that cover abortion services, but the amendment “does not prevent private plans from offering abortion services, and it does not prohibit women from purchasing abortion coverage with their own money,” he argues (Stupak, New York Times, 12/9).

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