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Health Care Reform:

Health Insurance & Affordable Care Act

Broad Disagreements Over Public Option, Cost, and Policies

Health Reform Faces Difficult Senate Tests


The bill squeaked by in the House Saturday in a 220-215 vote.

“For all of my friends in the press who’ve been assaulting me in the hallways asking if we had the votes, the answer, is ‘yes,’” House Majority Leader Steny Hoyer said following passage of the bill Saturday night.

The answer was "yes," but only barely. Thirty-nine Democrats voted against the bill, while just one Republican supported it.

That could forecast a very difficult road for health reform legislation in the Senate.

Most of the difficulty is around the public option plan. Senate Majority Leader Harry Reid has said he intends to include a public option in a bill headed for the floor in the coming weeks. But Sen. Olympia Snowe, R-Maine, the only Republican to back a health overhaul in the Finance Committee, has since pledged to oppose it if it includes any form of public option.

Meanwhile, several moderate Democrats have expressed their displeasure with the public option. Sen. Joe Lieberman, a Connecticut Independent who usually votes with Democrats, last weekend repeated his pledge to oppose any bill that contained the policy. Other, more liberal Democrats have pledged to back a bill only if it does include a strong public option.

The Senate Finance Committee also backed away from the House’s idea of requiring employers to cover their workers. Instead, it embraced a policy requiring most individuals to purchase coverage, with subsidies and tax credits to help lower and moderate income people cover the cost.

The House and Senate also disagree on the overall cost of the package. The House’s bill is estimated to cost $1.2 trillion over 10 years, while the Senate bill is expected to cost around $900 billion. Both bills do not add to the deficit over that time, according to the Congressional Budget Office.

Finally, the senators have backed the idea of taxing high-cost health plans as a way to help discourage excess medical spending and as a way to raise money to pay for the plan. The House approved a surtax on wealthier individuals making more than $500,000 and families making $1 million.

“I’m concerned that they get their 60 votes to pass a bill and start negotiating with us,” Rep. Henry Waxman,D-Calif., said of the Senate on Saturday night following the House vote. “But that’s their job now, and we’ve done ours."

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