LAURIE MCGINLEY: Good day. I am Laurie McGinley with Kaiser Health News. And this is Health on the Hill, a discussion of health care policy and politics. With me this morning is Mary Agnes Carey, senior correspondent for Kaiser Health News.

Well, Mary Agnes, the Senate Finance Committee finally, after many months, got started on marking up its health care Bill last week, but they have a long, long way to go. Can you tell us what should we expect this week in terms of amendments and battles between the Democrats and the Republicans?

MARY AGNES CAREY: I think you will have Democrats who favor a public option, which is not in the Bill. They are going to offer an amendment to put that in the Bill. They feel that is the best way to give affordable coverage options to everyone in the United States. Of course Republicans will fight that as a government takeover of health care, so that will be a very, very big discussion this week.

LAURIE MCGINLEY: Do they have any chance of prevailing on that?

MARY AGNES CAREY: I do not think that they will prevail, but they certainly want to have this discussion begin and remember, even if amendments don’t succeed at the Committee level, or if they do succeed at the Committee level, this discussion continues and changes will continue to be made before the Bill comes to the Senate floor and when it gets on the Senate floor. So that is something I think important to watch as the Committee debate continues.

You may have some Democrats that also push for greater affordability, provisions in the Bill. They may think that right now it still doesn’t offer enough assistance to people who can’t afford coverage to help them afford coverage, and you may also see further pushing, a pushback rather, on this tax, on the high cost health insurance plans. There are a lot of Democrats that represent Unions where their health care plans may be pretty expensive and they may fall into this tax so they will push to get that changed.

LAURIE MCGINLEY: Let’s talk a little bit about the Republicans and starting with Olympia Snowe. When the public plan debate comes up in the Committee, what is she likely to do?

MARY AGNES CAREY: Well, I think that she may offer her trigger proposal, and again this trigger would say that the public plan would not be activated unless affordable health insurance coverage wasn’t available to 95 percent of people in an individual state. So she may offer her amendment then and the Committee will discuss it and they may vote on it, or she may not offer her amendment then. I don’t know yet what she is going to do, but I think that her trigger idea, which has gotten a lot of attention, and of course Max Baucus who heads the Finance Committee and President Obama, they are both very interested in getting her vote.

LAURIE MCGINLEY: And does she have a good chance of prevailing on that issue?

MARY AGNES CAREY: I think there are many Democrats on the Committee that want the public plan option, so I think it is unclear whether they will support the trigger. I think there are a lot of Republicans who may not like the trigger, so we will have to see how it plays out.

LAURIE MCGINLEY: Tell us a little bit about the Republicans and the main arguments that they made last week. They talked a lot about Medicare. Was there anything to their argument that this Bill is actually going to cut Medicare and cause problems for seniors?

MARY AGNES CAREY: Well, there are many health care analysts that say the reductions – I think it is about $400 billion over the next decade that the Bill would make in Medicare – could easily be absorbed in the current system and not cause problems.

Republicans argue that is not true. And, for example, if you reduce what Medicare pays, Medicare Advantage – these are the private health insurers in the Medicare Program – if you cut those payments, they will cut services, and beneficiaries will be hurt. That is their main argument, that you are paying for this Bill on the back of the Medicare beneficiaries and that the Bill is just too expensive. They talked a lot about that last week. I expect those discussions to continue again this week.

LAURIE MCGINLEY: Tell us a little bit about the flexible spending account provision. That is also generating a lot of publicity and a lot of interest.

MARY AGNES CAREY: Right and again this is money that people can put away on a tax free basis, but you have to use it for health care expenditures. And I think the original Bill had it $2,000, Senator Baucus raised that threshold to $2,500. Republicans will push to have more money into those accounts. They feel that the more you put consumers in control of the health care spending, the more wise, the more cautious they will be with their money, and that consumers should be able to have this sort of tax break and control for making decisions about their health care spending.

LAURIE MCGINLEY: What is the likelihood that the Committee will be finished this week?

MARY AGNES CAREY: Well, they certainly want to do that, and they want to do that because you have to start looking at the calendar. It is not just passing the Finance Bill. The Finance Bill has to be combined with the package the Senate Health, Education, Labor and Pensions, or the HELP Committee, passed. That process I would think would take at least a week and then we are getting up close to the Columbus Day recess. It will probably be just Columbus Day. I don’t think either the House or the Senate will break for that period of time, but if you want to get that Bill on the floor by the middle of October, Finance would have to wrap up I would think by this week or pretty doggone close to it, so we will have to wait and see what happens, but I think that is why they would hope to get it done this week.

LAURIE MCGINLEY: Once they get to the task of combining the two Senate Bills, how difficult is that? How different are the Bills?

MARY AGNES CAREY: Well, the HELP Committee would, in essence, the provisions the HELP Committee would probably pull the Senate Finance Package to the left. For example, the HELP Committee already has the public option. It has a much stronger employer mandate than the Finance package does. It has more generous subsidies than the current Finance package does. Those are three key elements that members of the HELP Committee will certainly be advocating for, for inclusion in the package, and could change the way the package looks once it goes to the Senate floor.

LAURIE MCGINLEY: Tell us, what is going on over in the House while all these battles are happening in the Senate Finance Committee?

MARY AGNES CAREY: That is right, there is so much going on. In the House, you had three different Bills that were passed by three Committees before they left for the August recess. They continue to have meetings at the leadership level with the Committee chairs and Committee members on how to combine those Bills. They have got a package now, it has been sent to the Congressional Budget Office, also known as the CBO, which is the scorekeeper for Congress. They want to get a complete score that would tell members of the House how much this Bill costs before they put it on the floor, so that is where things stand there.

LAURIE MCGINLEY: Well, Mary Agnes, thank you very much. And thank you for watching. This has been Health on the Hill, and I am Laurie McGinley with Kaiser Health News.