House memo outlines outstanding issues for health reform

The three House committees that authored healthcare reform legislation have prepared a memo detailing the major discrepancies that must be resolved to present a final bill to President Barack Obama.

The memo, penned by the staff of the House Energy and Commerce, Ways and Means and Education and Labor committees and distributed to lawmakers, is a roadmap of sorts for House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) to follow as they embark on the final leg of their journey, during which they will have to reconcile some significant differences between the measures that narrowly passed each chamber.

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Though the document opens by highlighting "substantial similarities that will greatly facilitate the final step of developing an agreement on a bill for the President’s signature," and though the fundamental structure of the bills share many features, Pelosi must persuade her caucus's liberal members to accept the more centrist approach adopted by the Senate while Reid must keep together the fragile coalition of 58 Democrats and two independents that approved a bill last month.

Among the tricky issues left to be resolved are how generous and widely available to make subsidies for health insurance while keeping the bill below $900 billion in new spending; whether to tax high-cost insurance plans or wealthy earners to finance the bill; how strongly to establish a requirement that employers offer health benefits; how to establish restrictions against federal dollars from funding abortions without restraining subsidy recipients from accessing those services; and how to reconcile the fact that the House bill would establish a government-run public option health insurance program that the Senate rejected based on objections for a coalition of centrists.

Pelosi, Majority Leader Steny Hoyer (D-Md.), Energy and Commerce Committee Chairman Henry Waxman (D-Calif.), Ways and Means Committee Chairman Charlie Rangel (D-N.Y.) and Education and Labor Committee Chairman George Miller (D-Calif.) are set to huddle Tuesday afternoon to discuss how to proceed.

Tuesday evening, Pelosi and Hoyer will visit with President Barack Obama and Vice President Joe Biden at the White House for another meeting that Reid and Senate Majority Whip Dick Durbin (D-Ill.) will join by telephone. On Thursday, Pelosi has scheduled a meeting of her entire caucus, though many members are likely to participate via conference call.