One could be forgiven for being flummoxed over the politics of healthcare. It is Republicans, who until recently advocated privatizing Medicare, who have cried loudest about cuts to the government-run program. Meanwhile, the man dictating some of the harshest terms for the Senate bill is none other than former Democratic vice presidential candidate Sen. Joe Lieberman, a Connecticut independent. Lieberman this month rejected the very same expansion of Medicare coverage to those 55 and older that he had championed just months ago, saying it would be too expensive.
But Lieberman wasn't the only holdout. Nebraska Democratic Sen. Ben Nelson announced that he wouldn't support the Senate's healthcare reform bill unless his concerns about abortion were addressed. Meanwhile, with the necessary 60 votes apparently in hand, the clock is ticking down to the self-imposed Christmas deadline for Senate passage, and leaders announced Tuesday afternoon that the final vote on healthcare legislation is scheduled for 8 a.m. on Christmas Eve.
Yet for all the kerfuffle, Democrats are remarkably close to where they were at the beginning of the debate. Without a public option, an expansion of Medicare, or the legalization of prescription drug reimportation from other countries, the most significant components of the Senate bill are those that received broad support from Democrats before debate began. But there are still major areas of disagreement between the House and Senate versions of reform that will need to be ironed out if the Senate manages to pass something.
The GOP, for its part, is united against any reform effort. "We are going to do everything we can in terms of the rights we have to stop the bill from passing," South Dakota Republican Sen. John Thune promised last week.
Both the House plan and the current Senate draft prevent health insurance companies from dropping customers who get sick and mandate coverage of those with pre-existing conditions, and both include a variety of taxes and incentives designed to expand the ranks of the insured by several million. "At core, there are huge similarities between the two bills, and much of the differences comes down to definitions," says Brookings Institution healthcare policy expert Henry Aaron. "Most of the negotiations are over a fairly narrow spectrum of issues."
Within that spectrum, however, there are substantial differences between the House and Senate bills, particularly on abortion funding, penalties for not buying insurance, and how to pay for reform.
But it is funding for abortion that is generating the most controversy in the last-minute negotiations—and looks to be the most contentious when the House and Senate bills are reconciled. The House bill bans any tax dollars from funding abortions or insurance plans that cover abortions. The Senate has different compromise language designed to win Nelson's support.
While many in the GOP oppose all the current health reform bills and have promised to use every procedural trick in the book to stall the legislation, a few of the central ideas could have won support from at least some Republicans had the debate gone differently, experts say. "Mandating coverage of pre-existing conditions, for instance, and preventing customers from being dropped by insurance companies if they do get sick was always low-hanging fruit that no one seriously disagrees with," says Michael Tanner, a senior fellow at the libertarian Cato Institute. But the land mines for reform aren't buried in common ground.