Despite President Obama's promises to broadcast important legislative negotiations on C-Span, this final phase of health care reform has been pretty opaque. In lieu of streaming video, the public is left to imagine the compromises and trade-offs being hashed out.
Luckily, they're not that hard to imagine. The bill is not going through a formal conference committee, as most bills do, with input from representatives of each party and each chamber. It's instead going through a "ping-pong" process in which members of the House and Senate send the legislation back and forth, tweaking as they go (or something).
It's fair to assume that on most issues, the Senate version of the bill will prevail. For all the grandstanding on the left—Sen. Bernie Sanders of Vermont and some liberals in the House have said that they won't vote for a bill that doesn't include a public option—at this point, after all the painful compromises that have already been made, no one is going to torpedo a historic health care bill.
When it comes to health care negotiations, provisions fall into two categories: Those that Sen. Ben Nelson, D-Neb., demanded in exchange for his 60th vote, and those that he didn't. If Nelson asked for it, it's going to stay. If he didn't, then there's some flexibility. Same goes for the provisions added to secure the votes of Sens. Mary Landrieu, D-La., Joe Lieberman, D-Conn., and Blanche Lincoln, D-Ark. The Nelson abortion compromise is therefore likely to stay—especially since the Senate version is, in some ways, more palatable to Democrats than the Stupak amendment in the House. (For example, it allows state exchanges to offer plans that cover abortion.) The public option and its surrogates, like Medicare expansion or a national nonprofit plan, are gone.
But that still leaves a lot of wiggle room. Here are a few big issues that still need to be resolved in the final version of the bill. (For more details, check out this great comparison sheet posted by Politico or this one from the Kaiser Family Foundation.)
The exchanges. The House bill would create a national exchange, whereas the Senate bill would create a series of state-based exchanges. There's no real midway between these two options. Either it's national or it's state-based. Chances are, the Senate version wins out, since "national exchange" is the kind of phrase that makes moderate senators like Nelson skittish. Yet the Senate could loosen up the regulations that would allow states to create multiple exchanges or bond together to form regional exchanges.
The mandates. Unless the Earth shifts on its axis and the individual mandate suddenly becomes unconstitutional, as some believe, health care reform will include an individual mandate. The question is: What's the penalty for not buying health insurance? The House bill would charge a 2.5 percent tax on all income above the filing threshold (about $9,000 for individuals or $19,000 for couples), capped at the amount of the average premium. The Senate version would simply impose a flat penalty, which would reach up to $750 per person by 2016. (It could also impose a 2 percent tax, if the flat rate is too low.) The House version is thus a little more progressive, since Americans with lower incomes would pay lower fees.