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A Congressional Budget Office analysis of the insurance exchanges included in the Senate’s health reform bill found that premiums in an exchange would be higher than under current law but that federal subsidies would offset the higher costs, CQ Today reports. Insurers participating in the exchange would be forced to offer more coverage than they currently provide, which would contribute to the higher premiums, according to the report.

The bill’s proposals would be fully implemented by 2016. The analysis found that by that time people who purchase insurance via the exchange would pay premiums between 10% and 13% higher on average than under current law. However, roughly 57% of exchange participants would receive federal subsidies in the form of tax credits, which would cause those people to pay 56% to 59% less than they currently pay for insurance. The average cost of premiums on the exchange would be $5,800 for an individual and $15,200 for families.

Coverage for businesses with fewer than 50 employees that participate in the “small group” market would cost between 1% more and 2% less than it does currently, CBO found. However, subsidies for small businesses would allow employers to pay between 8% and 11% less than they do now to cover employees. The effect on larger businesses would be negligible, according to the report (Armstrong, CQ Today, 11/30).

by Zach Swiss, staff writer

It’s all systems go in the Senate with the start of the debate on the chamber’s health reform bill today. In an effort to help us understand the bill and its proceedings, Kaiser Health News and The Hill provide primers with a similar theme.

• “Seven Things You Didn’t Know Were In the Senate Health Bill“: The bill “is chock full of interesting but little publicized provisions” that would affect “people from the cradle to old age,” according to KHN. Some would prefer to call it a congressional tradition of including “pet interests.” For example, the bill would try to provide nursing mothers a reprieve with breast pumps or make the transition into adulthood for teens a little easier (Carey et al., Kaiser Health News, 11/30).
• “Seven Issues To Watch as the Senate Begins Amending the Health Care Bill“: Senators will begin offering amendments to the bill, of which some may be designed to improve the bill. However, some of them may seek to “satisfy a special interest or pet peeve,” but others might be presented as “poison pills” to restrict progress on the measure, according to The Hill (Young, The Hill, 11/29).

Many would argue the Senate’s reform bill is far from perfect, so the debate in the coming weeks could be long and sometimes contentious. Two publications examine potential roadblocks in the form of Medicare Advantage and health insurance premiums.

• “Medicare Advantage Trims Could Affect Millions of Seniors“: Some experts would consider MA “a case of a good idea gone financially wild” because the government now spends nearly 15% more to provide health insurance coverage to MA plan beneficiaries. House and Senate Democrats insist that the proposed cuts in pending reform legislation — estimated at between $120 billion and $150 billion over 10 years, which would be used to help pay for the overhaul — are meant to improve the program. However, Republicans say the cuts would reduce health benefits for seniors in the program (Garber, U.S. News & World Report, 11/25).
• “Health Reform’s Impact on Premiums: Winners, Losers and, for Many, a Question Mark“: One of the many questions that Democrats will attempt to answer will be the effect of their proposed legislation on health insurance premiums for individuals and small-business owners. Republicans maintain the rates will rise as a result of proposed new taxes on insurance companies, while Democrats insist the rates will drop because of new health insurance regulations and billions of dollars in new subsidies for policyholders to purchase coverage. “Who’s right? Perhaps both,” according to KHN, which is why there appears to be a “heated debate over the long-term outlook” (Appleby, Kaiser Health News, 11/25).

by Santosh Rao, staff writer

Today the Senate is starting debate on its long-awaited health reform bill. Harry Reid is going to need a lot of luck as he attempts to cull the 60 votes necessary for cloture. The debate is expected to last several weeks — though there is still hope that something will get passed by Christmas. In anticipation of the momentous debate about to get under way, bloggers are doing what they do best — predicting the future and speculating how the debate will go.

Today the Senate is starting debate on its long-awaited health reform bill. Harry Reid is going to need a lot of luck as he attempts to cull the 60 votes necessary for cloture. The debate is expected to last several weeks — though there is still hope that something will get passed by Christmas. In anticipation of the momentous debate about to get under way, bloggers are doing what they do best — predicting the future and speculating how the debate will go.

Jonathan Cohn of The New Republic‘s “The Treatment” writes that “the next few weeks will be full of drama,” adding that by the time debate is over the “legislation might end up a lot worse than it is now.” He warns that “along the way to implementation” of a fully reformed health care system, “a lot of bad things can happen,” including to “the lawmakers who championed it.” Cohn writes that the “key for the next few weeks, as the Senate debate moves forward, is figuring out how to minimize that danger,” which “should create plenty of drama.”

Scott Hensley of NPR’s “Shots” says that the Senate reform bill will be “the subject of all kinds of amendments to spice it up,” but that Reid wants Democrats to “restrain themselves” and offer only their “single best idea” as an amendment in order to keep the process moving forward. “Good luck with that,” Hensley writes.

The Republican strategy during the debate is “clear-cut,” according to Steve Benen of Washington Monthly‘s “Political Animal.” Benen writes that Republicans intend to “delay as long as possible, obstruct as much as possible, and bring up as many embarrassing amendments as possible.” According to Benen, they are also “strategizing about having amendments read word for word.”

Drama, spice and clear-cut obstructionism. Sounds like the Senate is in for a heck of a few weeks.

by Julia Moss, staff writer

The Senate on Monday will begin debate on its health reform bill, with opening statements from Majority Leader Harry Reid (D-Nev.) and Minority Leader Mitch McConnell (R-Ky.) at 2 p.m., the Wall Street Journal reports (Bendavid, Wall Street Journal, 11/29). According to Politico, the initial debate is expected to begin at 3 p.m. with a member from each party introducing one amendment to the bill (Budoff Brown, Politico, 11/29). The debate is set to start “in earnest” on Tuesday as Democrats and Republicans begin offering alternating amendments, the Journal reports (Wall Street Journal, 11/29).

Although all 60 members of the Democratic caucus voted for the procedural motion to begin the debate, CQ Weekly reports that it does not appear that those 60 votes will be there to end the debate for the test and final votes on the bill. As a result, it will be up to Reid and President Obama to devise a way “to break the gridlock” (Wayne/Armstrong, CQ Weekly, 11/30).

Some Democrats have indicated that they will withhold their support for the final bill if it includes a government-run health insurance plan, while others have said that they will refrain from supporting the bill if the abortion coverage language is not strengthened. The AP/Chicago Tribune reports that while “no compromise seems possible” on the abortion issue, there is the possibility for a deal on the public plan (Alonso-Zaldivar, AP/Chicago Tribune, 11/30).

Reid’s Private Game Plan

A large portion of Reid’s work on the legislation will come in the privacy of his office, as he attempts to develop a compromise on the public option that would garner the 60 votes necessary for reform passage, Politico reports. During the private meetings, Reid will seek to reach a compromise with at least four moderate members of his caucus — Sens. Mary Landrieu (D-La.), Joseph Lieberman (I-Conn.), Blanche Lincoln (Ark.) and Ben Nelson (Neb.). Lincoln and Lieberman are fully opposed to the public plan while Nelson has indicated that he is open to a public plan with an “opt-in” clause. Landrieu has shown a preference for a “trigger” that would enact a public plan in states where insurers fail to provide adequate and affordable coverage.

In addition, Reid is expected to reach out to Sen. Olympia Snowe (R-Maine), a longtime advocate for the trigger who could be encouraged to vote with the Democrats if a deal with the four moderate Democrats is reached. Meanwhile, a new alternative to the public plan that is under development could attract the support of moderates, according to Politico (Politico, 11/29). Earlier this month, Reid said that Landrieu had been working with Sens. Tom Carper (D-Del.) and Charles Schumer (D-N.Y.) to devise the alternative plan and noted that he is open to considering it (American Health Line, 11/23).

Reid’s Public Game Plan

Reid also has several other “tactical objectives” for the debate in the Senate, Politico reports. Reid is seeking to give Republicans adequate time to offer their concerns and revisions to the bill, while also making sure that they do not slow down the progress on the measure. Republicans reportedly have devised several strategies to delay further votes on the bill, such as introducing large and numerous amendments and demanding that they be read word for word. Reid also will attempt to ensure that certain contentious amendments are not passed by introducing more acceptable alternatives, and discouraging vulnerable members from casting votes that could threaten their seats in future elections, according to Politico.

Democrats, Republicans Devise Separate Team Approaches

Politico reports that Reid and other Senate Democratic leaders also have assigned certain members of their caucus to lead the messaging and amendment teams in several areas — the middle class; health insurance reform; children, senior citizens and Medicare; fiscal responsibility; business and small business; and “the truth squad.” Meanwhile, Republicans also plan to take a similar approach to highlight the more than $400 billion in proposed Medicare cuts, the more than $100 billion in new taxes on health industry players and the impact on health insurance premiums, according to Politico (Politico, 11/29).

– Santosh Rao

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.