KHN Morning Briefing

Summaries of health policy coverage from major news organizations

Public Option, Affordability Issues Central To Health Bill Negotiations

Dow Jones Newswires/The Wall Street Journal reports that House Democrats who favor a government-run public insurance plan on Tuesday signaled "they are willing to agree to a final health overhaul bill without a government-run health insurance option if other parts of the bill would fulfill the same goals." The comments came from House Speaker Nancy Pelosi, who said that there are other ways of holding insurance companies accountable. "Rep. Chris Van Hollen (D., Md.), one of Pelosi's top lieutenants, said House leaders will expect concessions from Senate Democrats, including possibly a repeal of the antitrust exemption for insurance companies, if the public option is absent" (Vaughan, 1/5).

The New York Times: "House Democratic leaders said Tuesday that they would insist on changes to the Senate health care legislation to make coverage more affordable for middle-class Americans and to tighten control over the insurance industry. But it remains unclear how much leverage the House will have in negotiations given that Senate Democrats cannot spare a single vote without jeopardizing the bill's chances." According to the article, efforts could begin as early as today to start "clearing away some of the easier differences between the bills, with Congressional leaders to meet face-to-face next week." Meanwhile, Republicans renewed their criticism of the health reform legislation and, "[a]lthough Congress routinely reconciles major legislation without formal conference proceedings, Republicans seized on a request by C-Span ... to broadcast the closed-door talks between House and Senate Democrats as evidence that Democrats were being less than transparent" (Herszenhorn, 1/5).

The Associated Press reports that the cost of premiums for Americans is also central to negotiations among lawmakers. "In exchange for losing the federal 'government option,' House Democrats are pressing the Senate to make premiums more affordable for Americans. The outcome of the talks could mean savings of hundreds of dollars for families buying coverage through new insurance supermarkets created by the legislation. … Major subsidies under the bills won't start flowing to consumers until 2013 at the earliest. Even with federal aid many families would still face substantial costs." The House version would provide $602 billion in subsidies from 2013-2019, while the Senate would provide $436 billion from 2014-2019. The House version of the reform bill would cover 5 million more people than the Senate version would. Although premiums would be higher for a family of four in the Senate bill, there would be greater assistance for households who make between three and four times the federal poverty level in the Senate bill. In the House bill, subsidies would be greatest for those making up to 300 percent of the federal poverty level (Alonoso-Zaldivar, 1/6).

Slate reports on six provisions in the health bills that need to be resolved before negotiations can end. They include the insurance exchanges, mandates on individuals to carry insurance, a Medicaid expansion and subsidies, the Children's Health Insurance Program, closing or narrowing the Medicare prescription drug "doughnut hole," and financing the bill (Beam, 1/5).

The Hill: "Other issues - such as differences in language prohibiting federal dollars from paying for abortion coverage, and tax provisions designed to raise revenue to pay for the bill - will still need to win consensus in one or the other chamber. And where Pelosi signaled an acceptance of the Senate's approach to the mechanism for providing coverage to millions of Americans, she signaled just as strongly that she much prefers the House's tax structure, which increases income taxes on the wealthiest Americans in lieu of levying taxes on high-cost insurance plans, as the Senate's bill does" (Allen, 1/5).

Politico's blog Live Pulse: House Republican Whip Eric Cantor has highlighted 37 Democrats who might vote against a final health bill. "In a memo dated Jan. 6, the Virginia Republican includes Democrats who would vote against the compromise if the House abortion restrictions are watered down, Democrats whose state are feeling a budget pinch and Democrats who represent a high proportion of Medicare Advantage enrollees. Cantor is trying to build the case against passage as it looks more and more likely that Democrats will eventually find the votes to pass a health care bill after party leaders resolve differences between the two bills" (O'Connor, 1/5).

Roll Call: Sen. Blanche Lincoln, D-Ark., is criticizing a deal made by fellow Democrat Sen. Ben Nelson, of Nebraska, to secure additional Medicaid funding for his state in the reform bill and is saying the provision should be dropped, "According to, Lincoln criticized Nelson for 'horse trading,' which she said has no place in policy-heavy legislation such as the $871 billion health care package approved by the Senate on Christmas Eve." Sen. Mary Landrieu, D-La., also received additional Medicaid funding for her state and other senators secured specific provisions to help their home states (Drucker, 1/5).

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