Deal or No Deal?


After an several days of negotiations between moderate and liberal Democrats, reports are coming in that the Senate has struck a deal on health care reform. But the strength and specifics of the deal are still highly uncertain.

Details are still somewhat sketchy, but the outline seems to be that the liberals will agree to let their beloved public option go in exchange for an expansion of Medicare that lets those as young as 55 buy in, the creation of a new national health plan put in place by the Office of Personnel Management and run by regional non-profits that would be set up by health insurers (got that?), and strict new insurance regulations that would require health insurers to spend at least 90 percent of all premium dollars collected on medical care for customers. Senate aides told TPM that the deal would trigger the creation a public plan should OPM fail to get insurance companies to create the non-profit plans.

Still, it's not clear how firm or final the deal is: According to the Washington Post, "the deal represents only an agreement among the 10 negotiators to send the new package to congressional budget analysts, not an agreement to support its elements." Presumably, this means that legislators are leaving room change their minds, especially if the CBO returns a politically problematic score.

It's also not clear whether this deal actually secures the necessary 60 votes for passage. There's still significant question about whether it will bring Lieberman—who has up until now expressed the strongest opposition to the public option—into the fold. In a press release this morning, he reiterated his opposition to any sort of public plan, even triggered, so his vote still is far from a lock.

But after the failure of Ben Nelson's abortion-funding amendment, which would have restricted federal dollars from being used to purchase insurance plans that cover abortion, Nelson is far from a sure vote. And Olympia Snowe, the favorite Republican to provide a yes should Democrats fail to bring all 60 of their caucus members on board, has already expressed skepticism about the deal.

And, of course, there are plenty of stakeholders who are unhappy with the terms being floated for the current deal, and may campaign against it. In particular, according to NPR, hospitals, doctors, and insurers are resisting the proposed Medicare expansion. In other words, a deal may be taking shape, but it's far from done.