Moderates express concern for Senator Reid's "Public Option"

Moderate Democrats have responded with concern today to Senate Majority Leader Harry Reid's decision to bring to the chamber's floor a health-care bill containing a "public option" government insurance plan. Some have said they still do not know whether they could support a public option on a final vote even if they were supportive of the procedural motion to bring the measure to the floor. But many moderate remain opposed to any form of government-run insurance plan even if it has a state "opt-out" option.

If the Senate bill advanced next month it is still possible the opt-out provision could be cut from bill during Floor debate. Some moderate Democrats are more comfortable with the "trigger" approach that Senator Olympia Snowe (R-ME) has advocated, saying that a variant of a public plan is more likely to win 60 votes. Under Snowe's approach, a public plan would be available only in states where private companies do not offer policies at broadly affordable rates which creates a trigger to incent cost reductions by insurers.

As of today, Washington insiders report that Senator Reid is short of the votes to pass a government-run public option in the Senate bill. Several moderate Democrats including Sens. Ben Nelson (D-NE); Evan Bayh (D-IN); and Blanche Lincoln (D-AR)have so far declined to say if they'll support a motion to begin debate on the bill.

Politics vs Good Health Policy: Senate unable to gain votes to fix Medicare SGR Physician Payment Issue

Despite widespread, bipartisan acknowledgement that the Medicare Physician Reimbursement issue (known as Sustainable Growth Rate or SGR) needs to be fixed, today the Senate failed to assemble the votes necessary to move this issue forward. Feels like politics at play versus taking advantage of the larger health reform debate to address issues that have needed to be fixed for several years.

Due to the flawed SGR issue, physicians will receive a 21% cut in Medicare reimbursement on January 1st and the Senate was attempting to permanently fix this issue separate from health reform since the issue was skewing the debate. The Senate Finance Health Bill does have a one year fix which would (once again) defer this issue which is a huge distraction and frustration since the "cost" to fix the issue grows each time a temporary fix is made.

Today, a vote on the motion to invoke cloture on the motion to correct this issue (S. 1776) failed in the Senate, 47-53. 60 votes were needed to move forward.

Republicans and some Democrats questioned the price of the Medicare measure -- $247 billion over 10 years -- and said proponents haven't offered any new revenue sources or spending cuts to offset the cost. Supporters of the bill say the sharp payment cuts, unless reversed, would encourage doctors to stop seeing Medicare patients.

Since a temporary fix is needed we will likely hear more debate on this issue in the remaining weeks of this year given the looming January 1st massive reimbursement cut.

Senator Kennedy and Impact on Health Reform?

This past week, with the death of Senator Edward Kennedy, Democrats lost not only a champion of healthcare reform, but also someone who was often able to work with Republicans for bipartisan reforms. Some are now focused on passing health reform in his memory while others argue that someone that was key to the potential for bipartisan reforms is now gone. While it may not change the outcome on health reform this fall, he does leave big shoes to fill.

Sen. Chris Dodd (D-CT) vowed to continue the fight for healthcare reform following the death of Senator Kennedy , but he could not say whether he intends to succeed Kennedy as chairman of the Senate health committee. Dodd, who chairs the Senate banking committee but spearheaded the health panel's five-week markup of health reform legislation, said he would take time to weigh his options and confer with Democratic leaders before making a decision.

The chairmanship of the Senate Health, Education, Labor and Pensions (HELP) Committee is one of many holes that Kennedy's death has left in the Senate. Dodd is now the panel's most senior Democrat, and could become its new chairman, if he is willing to give up the chairmanship of the Senate banking committee. If Dodd does not take the HELP position, the next senators in line would be Tom Harkin (IA) and Barbara Mikulski (MD). Harkin, like Dodd, would have to surrender his chairmanship of the Agriculture Committee in order to lead HELP.

HELP along with the Senate Finance Committee are the key committes for the Senate focused on health reform.