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Five questions that could decide fate of healthcare reform bill

Senate healthcare reform bill needs 60 votes to advance. Here are five questions that could determine whether Democrats will rally around it.

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Seniors vote in disproportionate numbers. Which side will they choose as Medicare's savior? The answer could sway the outcome in key states. (See "Where's Blanche," above.)

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3. What's with those numbers? On Thursday the Congressional Budget Office ruled that the $848 billion bill would in fact save the government $130 billion off the deficit in its first decade. In other words, new taxes, fees, and cost containment would pay for the bill, and then some.

Proponents reacted with relief to CBO's judgment; cost concerns could sink the whole health reform effort. But the CBO forecast was far from definite. A CBO letter to Reid, dated Nov. 18, noted the "imprecision" of the calculation and the great degree of "uncertainty" inherent in healthcare reform finances.

Critics note that the bill does not include the $200 billion needed to avoid a 21 percent cut in Medicare reimbursements to doctors next year.

"If history is any guide ... we can expect a host of accounting gimmicks to hide the bill's true costs," said Michael Tanner, a senior fellow in domestic policy at the Cato Institute, a policy think tank.

4. Who wins the "pocketbook test"? To the progressive healthcare advocacy group Families USA, the key assessment Americans should make about the Senate bill is a "personal pocketbook test."

"Will the legislation result in needed financial relief for families struggling to pay for health coverage and cost?" said Ron Pollack, Families USA executive director.

Mr. Pollack's answer is that the bill does pass such a test, due to its subsidies intended to limit a family of four with income of around $88,000 a year or less to spending no more than about 10 percent of income on health insurance premiums.

But Republicans insist that the answer is not clear cut and that the Reid bill could squeeze middle-class consumers by mandating that they purchase health insurance they can't really afford.

5. When will history get here? The Senate debate on the health bill may be historic, but it is not timely. The health reform effort has blown through numerous deadlines established by both the White House and congressional leaders. While the delays may have been needed to pull together legislative language and support from stakeholders, they also could hurt the bill's chance of final passage.

That's because each day gone means it is one day closer to next year's midterm elections, when many worried Democrats will be up for reelection. That's a big reason Republicans are complaining that the effort has been too hasty, given the stakes.

As for Reid? He believes the finish line is finally in sight. "I'm confident we'll cross it soon," he said Wednesday night.

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See also:

Senate Democrats backing down on tough anti-abortion measure

Senate healthcare reform bill: What's taking so long?

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