Beyond public option, big decisions loom for healthcare reform bill

The hoopla provoked by Senate Majority Leader Harry Reid’s (D-Nev.) decision to include a public option in healthcare reform has obscured the fact that major issues in the bill remain unsettled.

Reid shifted the debate in the Senate by making major concessions to the liberals in his caucus and putting centrists on notice that a reckoning would come on the Senate floor on an issue that has divided the Democratic Party.

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But Reid’s announcement did not resolve all the challenges facing the Senate’s effort to make President Barack Obama’s signature domestic policy initiative a reality.

Sen. Charles Schumer (N.Y.), the third-ranking Democrat in the upper chamber, said Wednesday that insurance affordability, a controversial excise tax on high-cost insurance plans, whether most employers will be required to offer health benefits, how to raise needed tax dollars and whether to create a federal long-term-care insurance program are the remaining issues.

“I’d say those and the public option are probably the [five] big ones. … And all of those are going to have to be resolved,” Schumer said.

From this point until the Senate floor debate begins sometime next month, the fate of some of those issues rests in the hands of Reid — and the Congressional Budget Office (CBO).

Reid has been mum about how he would answer those questions.

Although the public option has captured most of the attention in recent days, finding the right balance on these other issues will be critical to the success of the healthcare reform bill.

Democratic senators nearly across the board are concerned that the bill could require most individuals to obtain health insurance but do too little to make sure they can afford it. But beefing up insurance subsidies would drive up the cost of the bill, which not only would threaten Obama’s $900 billion spending cap but would unnerve centrist Democrats already worried that the bill does too little to constrain healthcare costs.

Moreover, yielding to objections by labor unions and many Democratic lawmakers to the tax on high-cost insurance would reduce the amount of tax revenue the bill would generate, further limiting the legislation’s reach. A coalition of Democrats has also demanded that a fee on medical device companies be eliminated, or at least scaled back.

Reid is asking the CBO to evaluate different versions of key sections of the bill and will assemble a finished product based on the cost estimates.

“We are sending them modifications on as many pieces as we have ready,” Reid spokesman Jim Manley wrote in an e-mail, noting that the opt-out public option is the version of that proposal being analyzed.

“The leader’s still listening to people and talking, and so I’ll leave that up to him at this point. We’ve had our opportunity to make our say,” said Sen. Chris Dodd (D-Conn.) of the Health, Education, Labor and Pensions (HELP) Committee. “We’ll see how it goes.”

Finance Committee Chairman Max Baucus (D-Mont.) indicated that Reid has already made decisions on some of the remaining big issues but would not disclose which, indicating that too much information circulating about the options could derail the process of getting the bill to the floor.

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“We’re waiting for the package to be scored and, to be honest about it, the less anyone talks about, the more likely CBO can come back privately and tell the leader,” Baucus said.

Schumer endorsed the same tactic, underscoring the benefits to the Democratic leadership of keeping its cards close to the vest until Reid is ready to make an announcement.

“Before he can really make it public, he has to see what CBO says,” he said. “Letting it all out now doesn’t make much sense until we get a CBO score.”