Five flash points as healthcare reform moves to the Senate

In the Senate, passage of healthcare reform legislation will be even harder than in the House. Here are five issues that could delay or, perhaps, torpedo healthcare reform.

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3. “Payfors.” That’s Capitol Hill jargon for how legislators plan to fund the project. Mr. Obama has insisted that healthcare reform not add one dime to the deficit, and the two houses differ dramatically in how they would get there. The House bill would assess a 5.4 percent income surcharge on individuals with an adjusted gross income of more than $500,000 a year and on couples with more than $1 million.

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This proposal is a deal-breaker in the Senate. Instead, the Senate Finance Committee bill would charge an excise tax on the high-end “Cadillac plans” and also charge new annual fees to various industry sectors: $6.7 billion from insurance companies, $4 billion from manufacturers of medical devices, and $2.3 billion from drugmakers.

4. Coverage. Both houses would require most people to carry health insurance, and both would provide subsidies to those who cannot afford it. Americans who still decline to purchase insurance would pay a penalty – though the penalty laid out in the Senate Finance Committee bill is much weaker than it is in the House bill. The insurance industry is concerned that some people will decline to buy insurance until they get sick, and insurers will be barred from turning them down.

5. Abortion. In an 11th-hour deal, House Speaker Nancy Pelosi allowed a vote on an amendment that restricts coverage of abortion in that chamber’s version of reform. The amendment passed by a wide margin. This paved the way for passage of the bill, as many conservative Democrats had threatened to vote no over the issue. Now the battle goes to the Senate, and at least two anti-abortion Democrats – Nelson of Nebraska and Bob Casey of Pennsylvania – are pushing for the same language. If this provision reaches the final version of both houses’ reform, it will be difficult to get it removed. Abortion-rights members in both houses are furious. But would enough of this mostly pro-Obama camp walk away over abortion rights to kill the whole reform? They’re hoping the legislative path doesn’t reach this point.

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