Whether health care reform legislation should include a public option–an option opposed by the insurance industry–remains a critical stumbling block as the debate on the legislation moves to the Senate floor in the near future.
The focus has shifted to the Senate after the House narrowly passed its version of the legislation, one including a public option, near midnight on Nov. 7 after months of debate.
The Senate bill was scheduled to be unveiled late last week by Sen. Harry Reid, D-Nev., Senate majority leader.
Reid has spent several weeks behind closed doors melding two different bills into one piece of legislation that he has said will include a public option.
Beth Mantz Steindecker, a healthcare analyst at Washington Analysis, predicts that the Senate will need a minimum of two weeks for debate. With the Thanksgiving recess (November 23-27), that means the earliest passage in the Senate would occur is the week of December 7. That would give conferees a mere two weeks to pass the bill before the winter recess.
"Given that we don't know when Reid will drop his bill, and Republicans are promising to slow down the floor debate with amendments, a more likely scenario is that the Senate passes a bill by the end of the year, and the final bill is enacted next year before the State of the Union, which usually occurs in late January," she said.
The House version includes the creation of a government-run insurance plan aimed at promoting competition with private insurers. Under the House bill, reimbursement rates for doctors and hospitals will be negotiated.
However, congressional staffers and healthcare analysts don't believe Reid has the 60 votes needed to initiate debate on a bill containing a public option, even one that would allow an opt-out on a state-by-state basis.
Many believe that after a show vote rejecting a bill containing a public option, Reid will unveil a Plan B without a public option–or one with a public option as a backup–that will launch what is expected to be two weeks of debate on the bill.
According to officials at the National Association of Health Underwriters, if there is one issue that is a show stopper for the insurance industry, it is the public option.
"It is the political impasse through which Sen. Reid is seeking to thread the needle," said John Greene, NAHU vice president of congressional affairs.
"For NAHU, no version of public option; opt-out, opt-in, trigger will be workable in practice," he said. "Simply changing the shade of lipstick on the pig doesn't change the fact it is still a pig."
A second critical issue is affordability of premiums. "Agents want an affordable marketplace but the proposed taxes and the rating bands would have a deeply negative effect on the premiums," Greene said.
He also said that "bending the cost curve is important for the long run and agents are sensitive to it."
NAHU strongly supports employer wellness programs and disease management tools among other things, to change employee behavior and control costs, Greene said.
Besides the public option, there are four other so-called "flash points" the Senate must deal with as the tortuous path to reform continues.
One is cost. One reason Sen. Reid kept delaying the unveiling of his bill is weighing its provisions against cost as determined by the Congressional Budget Office. The House bill would cost about $1.2 trillion over 10 years; Reid is adjusting provisions for the Senate bill to keep it under $900 billion.
Paying for the bill through various taxes is another flash point. The House bill would assess a 5.4% income surcharge on individuals with an adjusted gross income of more than $500,000 a year and on couples with more than $1 million.
The Senate bill, as proposed by the Senate Finance Committee, would charge an excise tax on so-called "Cadillac plans" and also charge new annual fees to various industry sectors: $6.7 billion from insurance companies, $4 billion from manufacturers of medical devices, and $2.3 billion from drug makers.
A third flash point is the proposed individual mandate, the so-called "coverage" issue.
