Seven issues to watch as the Senate begins amending the healthcare bill

Senators will be asked to cast their votes on numerous amendments as they begin a debate to reshape the country’s healthcare system.

Some amendments will be designed to improve the bill, some to satisfy a special interest or pet peeve. Still others will be presented as poison pills.

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Here are seven issues likely to arise during the amendment process.

Public option: An issue that unites Republicans and divides Democrats on ideological grounds inevitably was bound to haunt the Senate Democratic leadership. The notion of creating a government-run health insurance plan to compete with private companies is seen as vital by liberal Democrats but centrists range from skeptical to deeply antagonistic, even though states could opt out.
The best hope for a positive outcome for the Democrats could rest on the chances that liberal Sen. Chuck SchumerCharles SchumerThe Trail 2016: Unity at last This week: Congress eyes the exits in dash to recess Former Gillibrand aide wins NY House primary MORE (D-N.Y.) along with centrist public option supporter Sen. Tom CarperTom CarperCentrist Dems wary of public option push Retailers are shirking consumer data security responsibilities GMO labeling bill advances in the Senate over Dem objections MORE (D-Del.) can forge yet another compromise version of the program to satisfy centrists such as Sens. Ben Nelson (D-Neb.) and Joe Lieberman (I-Conn.), who have threatened to filibuster the bill over the public option. Sen. Olympia Snowe (R-Maine) is waiting in the wings with her “trigger” compromise.

Abortion: It wouldn’t be American politics if the forces on both sides of the abortion issue weren’t at loggerheads. The healthcare bill already includes language that is supposed to keep federal dollars away from abortion funding but the Catholic bishops, and Nelson, don’t think it goes far enough. Democratic Sens. Bob CaseyBob CaseyLiberal group: Kaine could be 'disastrous' VP pick New Guccifer 2.0 dump highlights ‘wobbly Dems’ on Iran deal Senate Dems push Obama for more Iran transparency MORE Jr. (Pa.) and Kent Conrad (N.D.) each voted in committee to beef up the abortion restrictions so their actions on the floor will be key. Sen. Orrin HatchOrrin HatchBacteria found ahead of Olympics underscores need for congressional action for new antibiotics Burr pledges to retire after one more Senate term Leaders appoint allies, adversaries to Puerto Rico growth task force MORE (R-Utah) authored the failed committee amendments and is sure to raise objections to the bill on abortion.

Health insurance excise tax:
The proposed tax on high-cost health insurance plans, a key to raising revenue and reducing long-term healthcare costs according to the Congressional Budget Office, may enjoy support in the White House but many Democrats and labor unions remain staunchly opposed to what they view as a middle-class tax hike. Already scaled down several times – the original idea was to tax the value of all workplace health benefits – Sen. Debbie StabenowDebbie StabenowDems to GOP: Admit Trump is 'unfit' to be president Senate Dems push Obama for more Iran transparency GMO labeling bill good for both environment and the poor MORE (D-Mich.) and others will look to shrink it further, if not eliminate it, but will need to raise additional taxes to make up the difference.

Prescription drugs: The pharmaceutical industry struck a grand bargain this summer with the White House and Senate Finance Committee Chairman Max BaucusMax BaucusGlover Park Group now lobbying for Lyft Wyden unveils business tax proposal College endowments under scrutiny MORE (D-Mont.) to limit its financial exposure from healthcare reform to $85 billion and to support the Democrats’ efforts. That deal has held uneasily since and Democrats are eyeing the chance to take a bite out of a long-time nemesis. Like in the House, Democrats are eager to require larger rebates from pharmaceutical firms who sell drugs to state Medicaid programs and use the additional money to sweeten the Medicare prescription drug benefit. A handful of Republicans such as Sens. John McCainJohn McCainGuess which Cuban-American 2016 candidate best set themselves up for 2020? Fox News bests major networks in convention ratings Meghan McCain: ‘I no longer recognize my party’ MORE (Ariz.) and David VitterDavid VitterDavid Duke will bank on racial tensions in Louisiana Senate bid Former KKK leader David Duke running for Senate Six senators call on housing regulator to let Congress finish housing finance reform MORE (La.) would likely join, or even start, any effort to permit the import of medicines from abroad.

Affordability: Because almost everyone would be required to obtain health coverage, providing fair and adequate subsidies to low- and middle-income people has presented a challenge for lawmakers trying to keep the bill on budget. Liberal Democrats get more attention when they talk about the public option but they have complained about the subsidy levels almost as much, while Snowe has also been adamant that the bill does too little to ensure insurance is less expensive. Sen. Mary LandrieuMary Landrieu oil is changing the world and Washington Ex-Sen. Kay Hagan joins lobby firm Republican announces bid for Vitter’s seat MORE (D-La.), a key swing vote, wants more help for small businesses and the self-employed. Trouble is, every dollar of assistance paid out has to come from somewhere.

Insurance exchanges: The concept of creating an online marketplace where consumers can comparison-shop for healthcare hasn’t been very controversial. But what types of plans people could buy and who will be allowed to buy them has been a point of contention. Democrats will be looking to provide access to the most generous but most affordable plans they can. Meanwhile, Sen. Ron WydenRon WydenDems push for US, EU cooperation on China's market status Senate Dems push Obama for more Iran transparency Watchdog faults Energy Department over whistleblower retaliation MORE (D-Ore.), under an agreement with Reid and Baucus, will offer an amendment to let more people beyond individuals and small-business employees buy insurance on the exchanges. The exchanges wouldn’t launch until 2014, either, so Landrieu and others want to move that date closer.

Medicare cuts: Republicans have railed about the hundreds of billions of dollars in cuts to Medicare contained in the bill though Democrats insist they are seeking to make the program more efficient and are not cutting anyone’s benefits. Because these cuts are essential to financing the rest of the bill, however, they’re here to stay – though some could be scaled back. The deep cuts to private Medicare Advantage plans, for instance, could be mitigated to assuage senators from states with large senior populations. Medical interests from physicians to home healthcare providers will also be seeking concessions.