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Top four differences of Senate and House healthcare reforms bills

The House and Senate will have a difficult time reconciling their healthcare reform bills on several key issues, including abortion funding and a public option, among others.

By Staff writer / November 24, 2009

Democrats gear up: Senators Durbin, Franken, Schumer, Begich, Harkin, and Reid (l. to r.) spoke at a news conference Nov. 18 on healthcare legislation.

Alex Brandon/AP

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Congress is closing in on a historic overhaul of the US healthcare system, decades in the making, that would extend coverage to millions of Americans, curb insurance company abuses, and potentially rein in health costs.

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President Truman, a Democrat, tried to establish a system to cover most Americans. So did President Nixon, a Republican, and President Clinton, a Democrat. All failed under fire from outside groups and weakened by rifts within the Congress.

This time, Democrats, convinced that success on this bill is vital to the Obama presidency, are going it alone. A party-line vote on such a sweeping bill is a high-risk strategy for Democrats. It exposes rifts in their ranks, and the deals that make a Senate bill possible could unravel what worked in the House.

Even with an 81-seat majority, House Democrats passed their reform plan with just two votes to spare. It's even tougher in the Senate, where Democrats plus the two independents that caucus with them have a 60 to 40 majority. On paper, that's the 60 votes they need to overcome a filibuster, but with no GOP support, they can't lose a single vote. On Nov. 21, the majority won a key procedural vote to bring the bill to the floor by the narrowest of margins, 60-39.

Debate on the Senate bill is expected to begin Nov. 30. If the Senate passes its bill, here are potential flash points between the House and Senate:

A Public Option

In a move that looked unlikely only a month ago, Senate majority leader Harry Reid included a public option in his 2,074-page plan, despite threats of a filibuster. Senate Finance Committee Chairman Max Baucus (D) of Montana has said that 60 votes did not exist in the Senate for a public option.

To woo moderates, the Reid plan includes an opt-out for states. The House bill does not. Moreover, the Senate plan could be further amended on the floor, if needed, to bring wavering centrist Democrats on board.

Several moderate Democrats have already said that the public option in its current form is a nonstarter. Sen. Joseph Lieberman (I) of Connecticut, another vote the majority must count on, says that a public option is unacceptable to him - in any form. Vermont Sen. Bernard Sanders, the other independent who caucuses with Democrats, says that he won't vote for a bill that weakens the public option. Likewise, Speaker Nancy Pelosi and liberals in the House Democratic caucus see a robust public option as an essential element of any healthcare reform. Without it, they say, there will not be enough competition to drive costs down. Members of the House progressive caucus have threatened to vote down any bill that does not include a strong public option.

Raising Taxes/Cutting Costs

Both the House and Senate plans count on billions in savings by cutting waste in Medicare and taxing healthcare providers. But the search for additional revenues is opening Democratic rifts.