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This week, Democratic leaders in the House were front and center in the debate on health care reform. On Thursday, House Speaker Nancy Pelosi (D-Calif.) released the chamber’s highly anticipated bill. TV newsers and political pundits took note of the bill’s price tag and the provision for a public health insurance plan option.

MSNBC’s “The Ed Show”

Host Ed Schultz did not seem impressed with the “back-slapping” from Pelosi or the bill, which he described as “watered-down, piece of garbage written on Republican toilet paper.” Schultz called on House Blue Dog Coalition member Earl Pomeroy (D-N.D.) and Rep. George Miller (D-Calif.) to discuss the legislation.

ABC’s “World News”

Senior congressional correspondent Jonathan Karl focused on the House bill’s price tag, which was pegged at just north of $1 trillion. It exceeds President Obama’s pledge to keep the legislation under $900 billion. Karl notes that Republicans and moderates in Congress pounced on the cost, adding that Pelosi still does not have all the votes to pass the measure (Watch).

American Public Media’s “Marketplace”

Marketplace‘s Steve Hehn, in an audio report, examined the similarities and differences between the House bill and the potential Senate bill, particularly the state “opt-out” public plan in the Senate bill, and the proposed tax on families earning more than $1 million annually.

Meanwhile, the spotlight shifted to the moderates in the Senate this week — particularly independent Sen. Joseph Liebermann (Conn.) — who expressed concern and hesitation about supporting the bill that was announced on Tuesday. Sen. Evan Bayh (D-Ind.), a moderate, drew the attention of the TV talking heads when he suggested that he would not back the bill.

CBS News’ “Washington Unplugged”

About 5:50 into the video, Bayh evades a direct question about his support for the bill and tells CBS News’s Bob Scheiffer that he will vote for a “good bill” that he has had the chance to review. Bayh also clarified that his concerns revolve around the cost of the Senate bill and its impact on the federal deficit. He said that he is not as focused as his colleagues are on the inclusion of the public option, but whether the final bill is fiscally responsible (Watch).

MSNBC’s “The Rachel Maddow Show”

Reporting on Lieberman’s announcement, Maddow highlighted Bayh’s remarks to Scheiffer — which Republicans reportedly hailed in Congress. However, Maddow noted that Bayh’s office clarified his position and Bayh himself said that he is not likely to vote against cloture of the bill (Watch).

by Santosh Rao, Staff Writer

Today, learn about the men and women behind the headlines in the health reform debate. First, there’s Oklahoma’s famous “Dr. No,” Sen. Tom Coburn (R), who will do everything he can to kill the multibillion-dollar health reform bill. Or is it more like a trillion? More on that later. Next, hear what colleagues have to say about House Speaker Nancy Pelosi (D-Calif.), and learn what motivates Senate Majority Leader Harry Reid (D-Nev.). Finally, see what White House Chief of Staff Rahm Emanuel and Sen. Charles Schumer (D-N.Y.) really think of each other.

And, in honor of Halloween, here’s a note from the National Retail Federation. Apparently, nurses and politicians have fallen out of favor for his year’s top costumes. NRF CEO Tracy Mullin said the move “could be an indication that Americans would like to shelve the health care reform debate — at least for one night — to have a little bipartisan fun.” Amen to that.

• “1,990 Pages at $2.2 Million a Word“: Jonathan Allen breaks down the dimensions of the new House health reform bill: it’s longer than War and Peace, has five times as many words as the Torah and weighs in at a whopping 19 pounds (Allen, Politico, 10/29).
• “A Senate Naysayer, Spoiling for Health Care Fight“: Sen. Coburn, a physician who seems to genuinely dislike Washington and the chamber in which he serves, has long been known as “Dr. No” for opposing any legislation he considers fiscally unsound. Now, he is bracing for the fight of his career and will use “every annoying tool in his arsenal” to oppose the health bill, which he believes will leave the country in financial ruin (Leibovich, New York Times, 10/30).
• “‘I’m Not Big on Showing Weakness‘”: Politico profiles Pelosi, who colleagues say is one of the most hands-on speakers in recent history and who possesses a rare combination of endurance and persuasiveness. On the other hand, critics point to her smothering style (which has earned her the nickname “Mother”) that emphasizes consensus over debate (Rogers, Politico, 10/30).
• “Opt-Out Divides Schumer and Emanuel“: Politico dissects the relationship between Schumer and Emanuel, who apparently “like each other in a competitive, towel-snapping way.” The story’s best line: “They are like Batman and Robin, but each one thinks the other is Robin” (Thrush, Politico, 10/30).
• “What’s Driving Reid?“: Reid isn’t pushing for a public option just to increase his chances of getting re-elected. Instead, he thinks it’s the best way to get the bill passed. “How do you think a guy who seems to have had any charisma drained from his body, who regularly seems afflicted by some kind of rhetorical Tourette’s syndrome and who often has trouble expressing himself with clarity and cogency has ascended to the apex of congressional power? How? He knows what his colleagues want, and he knows how to put together compromises,” Politico writes (Ralston, Politico, 10/30).
• “Why 60 Is the New 50“: John Dickerson explains why Reid needs 60 votes and not just 50 to pass his health reform bill. Also, because of the infamous John Kerry rule — “I actually did vote for the $87 billion before I voted against it” — it’s unlikely a senator would vote to allow debate on reform legislation but against the bill itself, lest he risk looking like a hypocrite (Dickerson, Slate, 10/29).

by Ryan Holeywell, staff writer

The House and Senate this week made the embarrassing mistake of showing up to the health reform Halloween party with the same costume — a dead on version of the cowardly lion from the Wizard of Oz. However, after arguing over who should take the costume off (a tail or two might’ve been pulled), the chambers realized that they weren’t the same costume after all. The House was the lion before going to see the wizard, and the Senate was the lion after he received his courage.

Why? Because the liberal House didn’t have the bravery to go forward with the “robust” public option many liberals wanted, while the more conservative Senate had the courage to add in a public plan despite many thinking such an option was dead. Here’s the deal:

Senate Majority Leader Harry Reid (D-Nev.) on Monday announced that the Senate’s final health reform bill would include a federal public health insurance plan option that would allow states to opt out. The proposed national plan would take effect in 2013, when other major provisions of health reform legislation are implemented. By 2014, states would have to decide if they want to participate in the public plan.

Reid’s announcement marked a major change from his position on the public option from about two weeks ago, when he seemed to distance himself from the plan to avoid losing the support of Senate moderates. The decision also culminates weeks of negotiations involving Reid, top White House officials and key Senate Democratic leaders to merge the chamber’s two competing health reform bills from the Senate’s Finance (S 1796) and Health, Education, Labor and Pensions (S 1679) committees.

Meanwhile, House Democratic leaders on Thursday unveiled the chamber’s final health reform bill (HR 3962), which includes a public health insurance option favored by moderates that would have providers negotiate their reimbursement rates directly with the government. The final version of the bill is more centrist and less costly than versions of reform legislation passed by two House committees earlier this year.

What form a public option would take had been the most contentious issue for House Democrats in recent weeks. Moderate Democrats advocated including a public option in which doctors directly negotiate reimbursement rates with the government. Liberals preferred a more “robust” version of the public option in which reimbursement rates are tied to Medicare rates plus 5%.

Last week, House Speaker Nancy Pelosi (D-Calif.) signaled that she had enough votes to ensure passage of the robust option, which she repeatedly had said would provide her with the most leverage during conference negotiations to meld House and Senate reform bills. But subsequent whip counts showed that the robust plan had fewer than the 218 votes needed to guarantee its passage.

Both chambers might need a little courage to push through reform legislation, though, because of fierce opposition to both a public option and overall reform legislation.

After the release of the House bill, a number of opponents made their displeasure public. In a letter to Pelosi and House Minority Leader John Boehner (R-Ohio), a coalition of major business groups criticized many provisions of the House bill and urged lawmakers to reject the legislation. The letter — signed by the U.S. Chamber of Commerce, the National Association of Manufacturers, the Business Roundtable and other business organizations — stated that the House bill “falls short of the bipartisan goal of controlling costs.”

America’s Health Insurance Plans CEO Karen Ignagni said the legislation’s inclusion of a public option would have dire consequences. “A new government-run plan would bankrupt hospitals, dismantle employer coverage, exacerbate cost-shifting from Medicare and Medicaid, and ultimately increase the federal deficit,” she said. The BlueCross and BlueShield Association released a statement saying that the public option “would jeopardize affordability and access to coverage for the 160 million people who receive their benefits through their employers today.”

Criticism of Reid’s decision to include the opt-out public plan came from a number of sources. Sen. Olympia Snowe (R-Maine) — who voted to approve the Finance Committee bill, making her the only Republican in either chamber of Congress to vote for any health reform bill — said she was “deeply disappointed” with Reid’s decision. Other Senate Republicans said that they plan to band together to reject cloture on the final Senate bill. Senate Minority Whip Jon Kyl (R-Ariz.) said that Reid’s opt-out plan eventually would lead to a government-administered health plan similar to the public option for which many liberal Democrats have long advocated.

Senate leaders are attempting to cobble together 60 votes to overcome a filibuster and move forward with a final reform bill. A senior Democrat said that at least 10 Democratic senators are withholding support for the bill, and Reid has begun meeting with moderate Democrats. Reid has begun offering concessions in the form of broad policies and “provisions affecting home-state industries.” Also, Sen. Joseph Lieberman (I-Conn.), who traditionally caucuses with the Democrats, dropped a bombshell by announcing that he would withhold his support if the Senate’s final health care reform bill includes a government-run public health insurance plan.

So, as it stands today, Senate leaders are attempting to cobble together 60 votes to overcome a filibuster and move forward with a final reform bill. Meanwhile, in the House, lawmakers are waiting to see more reaction after the Congressional Budget Office released a preliminary score of the chamber’s bill. The fate of a public option — in either chamber — is still up in the air. One thing’s for sure, though: it’s going to take a heck of a lot more than Dorothy clicking her heels together to pass a final reform bill, public option or not.

Tell us what you think: Will a final reform bill include a public option? If so, which version will it be?

With Halloween only a couple of hours away, some bloggers are trying to scare the public over Democrats’ plans to reform the U.S. health care system. With the House unveiling its health reform legislation yesterday and the Senate earlier this week announcing it would include a public option in its plan, some conservative bloggers say there is plenty to be shaking in your boots about.

Conn Carroll on the Heritage Foundation’s “The Foundry” writes that the “scariest thing” about the House bill “is the solid foundation it lays for a complete government takeover of the health care sector of our economy.” According to Carroll, the plan is to “force all Americans to buy health insurance, regulate the private plans till they are too expensive, and then slowly expand the power and size of the public option as Americans are left with no choice but to turn to government-run health care.” Carroll claims, “Not only will health care quality and choice suffer as more and more Americans are forced onto a government plan that reimburses providers at low, government-set rates, but the price tag is guaranteed to skyrocket.”

Michael Tanner on “Cato @ Liberty” writes that provisions in the House bill allowing the government to negotiate reimbursement rates with providers is “the health care equivalent of negotiating with Tony Soprano.” According to Tanner, “regardless of how much lipstick they put on this pig, it still is a government takeover of the health care system that would all but eliminate private insurance and force millions of Americans into a government-run system. Apparently the House leadership has decided that if at first you can’t get the votes by being honest about your true intentions, lie, lie, again.”

David Williams, co-founder of MedPharma Partners, on the “Health Business Blog” writes that the “[r]evival of the so-called public option in health reform legislation has big business in a big tizzy.” Williams goes through the concerns expressed by the Business Roundtable, attempting to debunk each fear with arguments as to how a public plan can actually lower administrative costs, reimbursement rates and utilization of medical care. “I still can’t figure out why big business is so against the public option,” he writes, adding, “I personally don’t think it’s going to be such a big deal one way or the other.”

by Julia Moss, staff writer

The House’s health care legislation (HR 3962) will cost $1.055 trillion between 2010 and 2019 and reduce the federal deficit by $104 billion, according to preliminary analyses from the Congressional Budget Office, Roll Call reports. However, CBO specified that only the bill’s gross cost exceeds $1 trillion; its net cost, after subtracting revenue from taxes and fees, is $894 billion, a number House Democrats emphasized when they released the bill on Thursday (Dennis, Roll Call, 10/29).

Previously, lawmakers stating the cost of health reform legislation have referenced the gross cost, Politico‘s “Live Pulse” reports. For example, the Senate Finance Committee’s overhaul bill (S 1796) was widely reported to cost $829 billion — its gross cost — not $518 billion — its net cost. Still, House Speaker Nancy Pelosi (D-Calif.) at the House bill’s unveiling said that the legislation meets President Obama’s cost limit of $900 billion for health reform (Frates, “Live Pulse,” Politico, 10/29).

The House bill includes a public option with physician reimbursement rates negotiated between the government and doctors, an expansion of Medicaid, new taxes on medical device makers, mandates for U.S. residents to purchase insurance and the creation of a new insurance exchange (American Health Line, 10/29).

The preliminary CBO analysis included the following cost and coverage estimates:

• Coverage: CBO found that the bill would reduce the number of non-elderly U.S. residents who are uninsured by 36 million in 2019. The bill would still leave 18 million U.S. residents without insurance coverage, roughly six million of whom would be undocumented immigrants.
• Medicaid expansion: The federal government would pay for 91% of the Medicaid expansion included in the bill, leaving states with a net increase of $34 billion over the bill’s 10-year window. The legislation’s total cost largely “reflects $425 billion in net federal outlays for Medicaid” and CHIP. CHIP would be phased out by 2019 as the new insurance exchanges take effect. CBO estimates that 30 million people would gain coverage through the exchanges. In addition, Medicaid would raise payment rates to some primary care physicians under the bill, at a 10-year cost of $57 billion.
• Medicare: Medicare spending would rise at an average annual rate of about 6% under the bill, below the about 8% it has grown annually over the previous two decades, according to the analysis. Payment changes for both Medicare and Medicaid would reduce spending by $426 billion over the decade.
• Public option: CBO estimates that just six million U.S. residents would enroll in the public option. According to the analysis, the proposed public plan would “attract a broad network of providers” but would have higher premiums than private insurance options (Reichard, CQ HealthBeat, 10/29).

– Zach Swiss

Note: This is an abridged version of the story that appeared in American Health Line this morning. For complete access to the full version, plus all of AHL’s other stories and content, subscribe to AHL.