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.

Washington's struggle over healthcare reform – President Obama's top domestic priority – now is within days of a historic turning point.

Senate majority leader Harry Reid says he plans to bring his newly unveiled, 10-year $848 billion healthcare overhaul bill to the Senate floor as early as Saturday. Senator Reid will need all of the chamber's 58 Democrats, plus its two independents, to stand with him on key votes if the legislation is to proceed.

Such cohesiveness is not foreordained. Here are five questions, the answers to which will go a long way toward determining Reid's ability to succeed:

1. Where's Blanche? Some moderate Democratic senators have yet to commit to voting in favor of letting debate on the bill to begin. In particular, Mary Landrieu of Louisiana, Ben Nelson of Nebraska, and Blanche Lincoln of Arkansas, have expressed varying degrees of skepticism about the costs and possible government intrusiveness related to healthcare reform.

If Senator Lincoln and her fellow moderates abandon the majority leader, the health effort is toast. Reid must bring them into line if he is to have a chance of convincing the notoriously independent Independent Joe Lieberman of backing the bill, as well.

2. Who's the defender of Medicare? Senate Republicans have been wooing the nation's seniors in recent weeks by presenting themselves as the true protectors of Medicare, the popular government-run health program for those over age 65.

The Reid bill is partly paid for by slashing Medicare, said Senate minority leader Mitch McConnell (R) of Kentucky in a speech on the Senate floor on Thursday.

Over 10 years, the bill would reduce Medicare spending by almost half a trillion dollars, said Senator McConnell.

"Hospitals, Medicare Advantage, nursing homes, home health, hospice – all of those will be slashed in this $465 billion cut to Medicare," he said.

Yet AARP, the giant seniors' lobby group, supports the bill and on Thursday issued a strong statement urging its passage.

The bill creates a new annual wellness benefit, provides free preventive care benefits, and sweetens the Medicare prescription-drug program, noted AARP.

"The legislation announced today makes progress toward achieving meaningful relief for millions of older Americans who still face challenges accessing affordable, quality health care services," said AARP executive vice president Nancy LeaMond.

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.)

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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