A Health Reform Debate Set to Change Its Tune

Until now, the Senate’s health reform debate has been largely partisan, with Republicans blasting the various reform bills as a step toward socialized medicine, and Democrats, despite some criticism, firing back that the GOP is merely protecting the insurance industry at the expense of patients. Ideologically driven arguments, both. And the committee votes have reflected those predictable divisions. Indeed, the Senate HELP Committee in July passed its reform proposal strictly along party lines, and the Finance Committee didn’t do much better today, as Democrats were able to entice only one GOP supporter in the form of Sen. Olympia Snowe (Maine).

With passage of the Finance bill, though, the tenor of the debate is destined to change. The reason? Because at this point the Republicans move to the sidelines while the various factions within the Democratic Party begin fighting in earnest for their pet provisions — first in back-room discussions, and later on the chamber floor. With 60 seats secured in the upper chamber, the Democrats could pass the bill even without Snowe — if they could just find accord amongst themselves.

There are plenty of areas of disagreement. Most notably, the HELP bill contains a public option, while the Finance proposal goes the co-op route. Liberal Democrats are vowing to push for some form of public plan, but likely opposition from moderate Democrats threatens to sink the entire bill if they succeed. Snowe has floated a trigger plan that could gain traction, and Sen. Maria Cantwell (D-Wash.) has pushed a strategy to allow states to create their own public option to compete with private insurers. But it’s tough to say at this point whether those concepts will satisfy the liberals urging a robust and immediate national insurance option.

Another area of contention: Sen. John Kerry (D-Mass.) wants to adopt a requirement that large employers offer their workers health coverage. Massachusetts has such a system, and it’s worked wonderfully, Kerry says. But that hasn’t satisfied some moderate Democrats who view the employer mandate as a burdensome new tax on businesses. Indeed, the Finance bill excludes the mandate in favor of a provision allowing employers to pay a fee instead of offering insurance.

And another sticking point: Sen. Ron Wyden (D-Ore.) wants to grant workers the option of buying insurance on the exchange even when their employers offer coverage. Under the Wyden plan, workers could receive cash vouchers from their employers in order to shop for their own coverage — a proposal criticized by many Democrats, who fear it would result in an exodus of healthy workers searching for cheaper plans, thereby undermining the employer-sponsored model that’s been the backbone of the nation’s health insurance system for decades.

And another still: Some Democrats want to close the coverage gap in Medicare’s prescription drug benefit by empowering states to negotiate drug prices on behalf of their lowest-income seniors — something the White House promised the pharmaceutical industry it wouldn’t support.

All of this does nothing to mention the enormous funding discrepancies between the Senate bills — which pay much of the tab by taxing high-cost insurance plans — and the legislation moving through the House, which hikes taxes on the wealthy instead.

Reid’s office said Tuesday that the majority leader will begin the official negotiations tomorrow with Finance Chairman Max Baucus (D-Mont.); Sen. Chris Dodd (D-Conn.), who ushered the HELP bill through the committee in the absence of the ailing Sen. Edward Kennedy (D-Mass.); White House Chief of Staff Rahm Emanuel; and Nancy-Ann DeParle, director of the White House office of health reform. Afterward, they’ll send the compromise to the Congressional Budget Office to be scored — a process that could easily push the floor debate a few weeks down the line.

Considering the number of sticking points, they could probably use the time to iron some things out.