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Three Areas of Debate When Reform Bill Reaches Senate Floor

Janice Simmons, for HealthLeaders Media, October 14, 2009

One point that became clear with the Senate Finance Committee's vote Tuesday on the healthcare reform legislation was that this was just a short stop along a long path—and far more needs to be done as a reform proposal moves toward the Senate Floor.

President Obama, when congratulating the panel for its 14-9 vote to approve the bill, said "a critical milestone" was reached "in the effort to reform our healthcare system." However, he added that the "bill is not perfect."

"We have a lot of difficult work ahead of us. There are still significant details and disagreements to be worked out over the next several weeks as the five separate bills from the Senate and the House are merged into one proposal," he said.

House Majority Leader Harry Reid (D-NV) similarly noted in a statement that the bill's passage represented another "critical step toward bringing real change to our broken health insurance system." Reid will be involved in reconciling the Senate Finance bill with the Health, Education, Labor and Pensions (STEP) Committee bill.

While all but one Republican on the Senate panel voted against the bill, they all expressed desires to see healthcare reform legislation passed—and can be expected to contribute to the debate when it extends to the Senate floor, possibly as early as the end of this month.

When meeting with reporters after the vote, Finance Committee ranking minority member Charles Grassley (R-IA) said, "I'm not going to stand still and say that a vote against this bill is a vote against the status quo. There are so many things that we can do, and when we go to the floor, we will be there telling people how we can change the status quo.

So here is what is likely to emerge in the full Senate debate:

Public insurance option. Even if a public option is including in a reconciled bill (the STEP bill has a public option), debate will likely ensue. For instance, Sen. Jay Rockefeller (D-WV) plans to reintroduce an amendment that calls for a public plan that would pay providers based on Medicare rates for two years and would be administered by an office within the Department of Health and Human Services.

Sen. Charles Schumer (D-NY) has an amendment that would have "no legislative advantage"—specifically, provider rates would be established competitively and no "federal infusion of federal dollars" if a plan did not make it the first time around.

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