12/31/09 HC Reform Update by Mark Sanna: What happens when you spend months crafting a big piece of legislation, making the compromises and deals necessary to win passage in Congress? You get something like the 2009 (soon to be 2010) healthcare reform bill, a hulking 2,000-page piece of legislation designed to the appeal to no one – or rather, designed to be just acceptable enough to appeal to just enough politicians to pass.

12/30/09 HC Reform Update by Mark Sanna: Prominent conservatives are calling for Republicans to campaign in 2010 on a pledge to repeal the Democrats' health care legislation. Meanwhile, Democrats have yet to even pass the bill. Before the bill is ready for the President’s signature, a conference committee made up of members of the House and Senate must merge the two health care bills. Then, each chamber will have to pass the new version of the bill.

12/29/09 HC Reform Update by Mark Sanna: At the heart of health care legislation is a paradox. Both the Senate and House bills squeeze a half-trillion dollars from Medicare over the next 10 years to offset the cost of covering the uninsured. At the same time, this money would shore up the Medicare trust fund to cover older Americans in the future. How can Medicare savings mean both more money available to spend now and more money to spend later?

12/28/09 HC Reform Update by Mark Sanna: Many major provisions in the health care legislation would not begin until 2013 under the House bill, and 2014 under the Senate bill. On the flip side, many of the new taxes and fees that will help pay for the legislation would take effect much sooner. For this reason, some Republicans have criticized the bill as akin to legislation on a layaway plan: pay now for benefits later.

12/24/09 HC Reform Update by Mark Sanna: Health care reform legislation is likely to be approved Thursday morning, with the Senate divided on party lines — something that has not happened in modern times on so important a shift in domestic policy or on major legislation of any kind. Many senators said the current vitriol, which continued on the floor on Wednesday with a fight over when to cast the final health care vote, was unlike anything they had seen.

12/23/09 HC Reform Update by Mark Sanna: The Senate voted 60 to 39 early Tuesday on 3 steps leading up to a final vote Thursday morning on sweeping health care legislation. Democrats began celebrating their imminent victory with a raucous news conference. Republicans said that they were still searching the bill for unexpected provisions and that they would not agree to hold the last vote any sooner than Christmas Eve.

12/22/09 HC Reform Update by Mark Sanna: Nancy Pelosi, Harry Reid, and the White House face major challenges in merging the House and Senate health bills. They must find a way forward on abortion even as they confront other big differences between the bills, including how to pay to expand insurance coverage to more than 30 million Americans and whether to include a government-run plan to compete with private insurers.

12/21/09 HC Reform Update by Mark Sanna: After a long day of acid, partisan debate, Senate Democrats held ranks early Monday in a dead-of-night procedural. The vote was 60 to 40, a tally that is expected to be repeated 4 times as further procedural hurdles are cleared in the days ahead, and then once more in a dramatic, if predictable, finale tentatively scheduled for 7 p.m. on Christmas Eve.

12/20/09 HC Reform Update by Mark Sanna: Thirty million people without health insurance stand to gain coverage under a deal announced on Saturday by Senate Democrats. To get the 60 votes needed to pass their bill, Democrats scrapped the idea of a government-run public insurance plan and replaced it with a proposal for nationwide health plans, which would be offered by private insurers under contract with the government.

12/18/09 HC Reform Update by Mark Sanna: The White House and Senate Democratic leaders seem willing to give Senator Ben Nelson, Democrat of Nebraska, just about anything he wants to win his support of major health care legislation. Anything, that is, but the item at the top of Mr. Nelson’s wish-list: air-tight restrictions on insurance coverage for abortions. The bid to win Mr. Nelson’s support has become a race against the clock. The Senate majority leader, Harry Reid of Nevada, has developed plans for a series of votes beginning at 1 a.m. Monday and round-the-clock Senate sessions intended to meet his deadline of completing the health care bill before Christmas.

12/17/09 HC Reform Update by Mark Sanna: Healthcare reform came to a standstill on the 17th day of Senate floor debate on Wednesday with the request by Sen. Tom Coburn (R-OK) to read out Sen. Bernie Sanders’ (I-VT) 767-page amendment supporting a single-payer system on Wednesday. While Sanders later withdrew the amendment, which stopped the reading, the action’s impact on Democrats was palpable.

12/16/09 HC Reform Update by Mark Sanna: The scuttling of the public option from the Senate health care bill has infuriated organized labor and left their leaders in a bind about how to proceed. Top labor officials of several unions are meeting with their executives today, and some plan to on Thursday, to devise their strategies, now that the Senate has dropped the public option, a government-run health insurance plan to compete with private insurers.

12/15/09 HC Reform Update by Mark Sanna: With the Senate facing a potential deadline next week for voting on its health care legislation, interest groups have unveiled a raft of television commercials — most of them arguing against the bill. A group called the 60 Plus Association, which bills itself as a conservative alternative to AARP, is spending $1.7 million to run commercials for eight days starting Monday.

12/14/09 HC Reform Update by Mark Sanna: In a surprise setback for Democratic leaders, Senator Joe Lieberman, independent of Connecticut, said on Sunday that he would vote against the health care legislation in its current form. But on Sunday, Mr. Lieberman told the Senate majority leader, Harry Reid, to scrap the idea of expanding Medicare and abandon any new government insurance plan or lose his vote.

12/12/09 HC Reform Update by Mark Sanna: Democratic leaders hit a rough patch Friday in their push for sweeping health care legislation, as they tried to fend off criticism of their proposals from a top Medicare official, Republicans and even members of their own party. Slogging through a 12th day of debate on the legislation, the Senate found itself at an impasse over a proposal to allow imports of low-cost prescription drugs from Canada and other countries.

12/10/09 HC Reform Update by Mark Sanna: Tuesday night, Senate Democrats announced a tentative agreement, retreating from the proposed government-run insurance plan or public option, which is opposed by some centrists, and taking shelter in some more familiar programs, including an expansion of Medicare. The agreement calls for creating a new menu of national insurance plans, modeled after those offered federal workers, including members of Congress.

12/9/09 HC Reform Update by Mark Sanna: The Senate has rejected an anti-abortion amendment to a healthcare bill. The Senate majority leader, Harry Reid, said Tuesday night that he and a group of 10 Democratic senators have also reached “a broad agreement” to resolve a dispute over a proposed government-run health insurance plan, which has posed the biggest obstacle to passage of health care legislation. Mr. Reid refused to provide details.

12/8/09 HC Reform Update by Mark Sanna: In return for concessions on their proposal for a new government-run health insurance plan, liberal Democratic senators pushed Monday for expansion of Medicare and Medicaid and more stringent federal regulation of the insurance industry. Liberal and centrist Democrats are trying to work out a deal on the proposal for a public option.

12/7/09 HC Reform Update by Mark Sanna: The upcoming Senate vote on the pro-life Hatch-Nelson amendment to the health care bill has been called into question as an audio recording has surfaced with Wisconsin Senator Herb Kohl vowing to vote against abortion in the health care bill. The vote is expected as early as Monday.

12/5/09 HC Reform Update by Mark Sanna: Senate Democrats on Friday beat back Republican efforts to strip out two major provisions of their health care bill that would make deep cuts in payments to private Medicare Advantage plans and create a new long-term-care insurance program.

12/4/09 HC Reform Update by Mark Sanna: The Senate voted Thursday to require health insurance companies to provide free mammograms and other preventive services to women, and it turned back a Republican challenge to Medicare savings that constitute the single largest source of financing for the bill. With the votes Thursday, the Senate broke a logjam over how to handle the first amendments to the health care bill. But Senate Democrats still face a long road ahead.

12/3/09 HC Reform Update by Mark Sanna: Senate leaders of both parties said they would vote Thursday on four proposals dealing with two issues: how to guarantee additional health benefits for women and how to squeeze nearly half-trillion dollars from Medicare over 10 years without adversely affecting older Americans. Democrats offered one proposal to cover a wide range of screenings and preventive health services for women.

12/2/09 HC Reform Update by Mark Sanna: The Senate health care debate has just begun and already there is evidence that it is going to be a slog. For much of Tuesday, Senate Democrats had predicted that there would be an early evening vote on the first amendment to the big health care legislation — a proposal by Senator Barbara Mikulski, Democrat of Maryland, to require insurers to provide a package of enhanced health benefits to women, with no co-payments.

12/1/09 HC Reform Update by Mark Sanna: The Congressional Budget Office said Monday that the Senate health bill could significantly reduce costs for many people who buy health insurance on their own, and that it would not substantially change premiums for the vast numbers of Americans who receive coverage from large employers.

11/30/09 HC Reform Update by Mark Sanna: Even if lawmakers do not take a day off until Christmas, the Senate majority leader, Harry Reid of Nevada, has just 25 days to meet his own goal of finishing the Senate version of the bill by the holiday. And then he must iron out differences with the House bill, including some major disagreements over how to pay for the legislation that will almost certainly have to be resolved after New Year’s.

11/28/09 HC Reform Update by Mark Sanna: The fate of healthcare reform in the seems to be resting with these four women: Arkansas Democratic Sen. Blanche Lincoln, Louisiana Democratic Sen. Mary Landrieu, Maine Republican Sen. Susan Collins, and Maine Republican Sen. Olympia Snowe. This new bipartisan gang of four could be key to removing the heavily partisan debate dogging the legislation.

11/26/09 HC Reform Update by Mark Sanna: Two of President Obama’s senior health care advisers said Wednesday that a proposed tax on high-cost insurance plans and a new commission to control Medicare spending were among “four pillars” essential to major health care legislation. Their remarks firmly aligned the White House with the Senate on two major disagreements facing Democratic Congressional leaders trying to pass a bill.

11/25/09 HC Reform Update by Mark Sanna: Democrats are absolutely committed to finishing health reform by the State of the Union address, Sen. Sherrod Brown (D-Ohio) said Monday night. Brown said that Democrats would work overtime to finish a healthcare bill in the Senate by the end of the year and would work to finish the bill before the late-January speech by President Barack Obama.

11/24/09 HC Reform Update by Mark Sanna: Abortion coverage is way down on the list of concerns of those who oppose Democratic-led healthcare reform, a new Pew survey finds. A majority of Americans—55%—oppose abortion coverage as a "guaranteed medical benefit" in a government-run health insurance plan, according to the poll.

11/23/09 HC Reform Update by Mark Sanna: Anxious that Saturday’s party-line Senate vote to open debate on a health care overhaul gives them little maneuvering room, Obama administration officials and their Congressional allies are stepping up overtures to select Senate Republicans in hopes of winning their ultimate support.

11/21/09 HC Reform Update by Mark Sanna: Sen. Bill Nelson (D-Neb.), one of the last public holdouts in last night’s vote, insisted Chairman Reid omit from the Senate bill any change in the insurance industry's protection from federal antitrust law. Before entering politics, Nelson spent his career as an insurance executive, insurance company lawyer and Nebraska’s state insurance regulator.

11/21/09 HC Reform Update by Mark Sanna: Senate Health Care Vote – Senate health care vote results are in. The Senate has voted (by a vote of 60 vote yea to 39 nay) to allow the healthcare reform bill to come to the floor for debate. Majority Leader Harry Reid (D-Nev.) secured the vital 60th vote by persuading Sen. Blanche Lincoln (D-Ark.) with some funds for her state.

11/21/09 HC Reform Update by Mark Sanna: The clock is ticking up to the Senate’s vote scheduled for 8 p.m. Saturday on whether to proceed to debate on the health-care bill. If Reid wins the Saturday vote, the full Senate is set to start debate the bill and take up amendments after the Thanksgiving break, in the week of Nov. 30. If he doesn’t win the vote, it’s back to the drawing board.

11/21/09 HC Reform Update by Mark Sanna: In a show of unity, Senate Democrats sealed a 60-vote majority needed to advance health care legislation Saturday ahead of an evening showdown with Republicans eager to doom the bill and inflict a punishing defeat on President Barack Obama.

11/20/09 HC Reform Update by Mark Sanna The Senate version of sweeping health legislation would cover 5 million fewer people than a companion bill passed by the House, but it would cost less, in part because Senate Democratic leaders felt they had to win support from fiscally conservative members of their party. The Senate is expected to vote Saturday on whether to take up the legislation.

11/18/09 HC Reform Update by Mark Sanna: Three Democrats could block the health bill in the Senate. Senator Ben Nelson, Nebraska, Mary L. Landrieu of Louisiana and Blanche Lincoln of Arkansas are proving tough sells, raising the prospect that one or perhaps all three of them could scuttle the bill before the fight over it even begins on the Senate floor.

11/17/09 HC Reform Update by Mark Sanna: While Congress searches for ways to slow the growth of health care spending, a new study suggests that its efforts may be overwhelmed by the surging prevalence of obesity.

The report, to be issued Tuesday, projects that if current trends continue 103 million American adults will be considered obese by 2018. That would be 43 percent of adults, compared to 31 percent in 2008, according to the research by Kenneth E. Thorpe of Emory University, an authority on the cost of treating chronic disease.

Mr. Thorpe concluded that the prevalence of obesity is growing faster than that of any other public health condition in the country’s history. Health care costs related to obesity — which is associated with conditions like hypertension and diabetes — would total $344 billion in 2018, or more than one in five dollars spent on health care, if the trends continue. If the obesity rate were held to its current level, the country would save nearly $200 billion a year by 2018, according to the study.

Mr. Thorpe said in an interview that the health care bills in Congress limit their attack on obesity to a few community-centered pilot programs with insufficient funding. Congress has steered clear of measures that might have a more direct impact, like taxing sugary sodas and fat-laden snacks.

“If we’re interested in bending the cost curve we’ve got to go back to the source of what’s driving spending,” he said. “And if you go back 5 or 10 years it’s not technology at all. It’s the explosion of chronic disease.”

The study is the first to project obesity levels for individual states, according to Mr. Thorpe. He found that by 2018, Colorado would be the only state where less than 30 percent of adults would be obese. In six states — Kentucky, Maryland, Mississippi, Ohio, Oklahoma and South Dakota — more than 50 percent of adults would be obese.

The research was conducted for the United Health Foundation, the American Public Health Association and the Partnership for Prevention.

11/16/09 HC Reform Update by Mark Sanna: Even as drug makers promise to support health care overhaul by shaving $8 b a year off the nation’s drug costs after the legislation takes effect, the industry has been raising its prices at the fastest rate in years. According to analysts, the industry has raised the wholesale prices of brand-name prescription drugs by about 9% in the last year.

11/15/09 HC Reform Update by Mark Sanna: Some House Democrats have vowed that if the final bill contains an anti-abortion measure, they will oppose it. More than 40 members have attached their names to a letter to Speaker Nancy Pelosi, warning that they would not vote for a final bill if it restricts women’s right to choose any further than current law.

11/14/09 HC Reform Update by Mark Sanna: President Barack Obama probably never intended to do it, but his push for healthcare reform has reopened debate on one of America's most polarizing issues – abortion. "This is a healthcare bill, not an abortion bill," Obama told ABC News. But that aspect of the healthcare overhaul is dividing his Democratic party and may threaten the entire effort.

11/13/09 HC Reform Update by Mark Sanna: The Senate majority leader, Harry Reid, is considering a proposal to increase the Medicare payroll tax on high-income workers to help offset the costs of providing health insurance to millions of Americans, Senate aides said Thursday. The proposal is part of a legislative package that Mr. Reid has put together in secrecy and submitted to the Congressional Budget Office for analysis.

11/11/09 HC Reform Update by Mark Sanna: The Senate majority leader, Harry Reid of Nevada, said Tuesday that he expected to bring major health care legislation to the floor next week and to complete work on the bill before Christmas. But other Democratic leaders said it was unlikely that a bill could reach President Obama’s desk by year’s end. The House approved its version of the health care legislation late Saturday by a vote of 220 to 215. In a first procedural step toward Senate debate, Mr. Reid on Tuesday night moved to put the House bill on the Senator calendar, from which he could call it up any time after Tuesday.

11/10/09 HC Reform Update by Mark Sanna: As health care legislation moves toward a crucial airing in the Senate, the White House is facing a growing revolt from some Democrats and analysts who say the bills Congress is considering do not fulfill President Obama’s promise to slow the runaway rise in health care spending.

11/9/09 HC Reform Update by Mark Sanna: The White House, growing concerned that the Congressional timetable for passing a health care overhaul could slip into next year, is stepping up pressure on the Senate for quick action. In the Senate the bill is stalled while budget analysts assess its overall costs. Unlike the House bill, which pays to extend coverage by taxing individuals who earn more than $500,000 a year and couples who earn more than $1 million, the Senate bill imposes a 40 % excise tax on so-called Cadillac plans that cost more than $8,000 a year for an individual or $21,000 for a family. And unlike the House bill, which includes a national public plan, the Senate measure would allow states to opt out.

11/8/09 HC Reform Update by Mark Sanna: After a daylong clash with Republicans over what has been a Democratic goal for decades, lawmakers voted 220 to 215 to approve a plan that would cost $1.1 trillion over 10 years. Democrats were forced to make major concessions on insurance coverage for abortions to attract the final votes to secure passage. Democrats say the House measure paid for through new fees and taxes, along with cuts in Medicare would extend coverage to 36 million people now without insurance while creating a government health insurance program. It would end insurance company practices like not covering pre-existing conditions or dropping people when they become ill.

11/7/09 HC Reform Update by Mark Sanna: House Democrats put the finishing touches on their health care legislation on Friday, but failed to bridge an internal divide over the issue of insurance coverage for abortions, as party leaders and the White House pushed to lock in votes on the eve of a historic floor debate. Democratic leaders said they were confident that they would have the 218 votes needed to pass the bill. A planned visit to the Capitol by President Obama was postponed until Saturday so that a face-to-face appeal would have greater impact on wavering lawmakers just before the vote

11/6/09 HC Reform Update by Mark Sanna: President Obama made a surprise appearance at the daily White House press briefing on Thursday afternoon to announce that the AARP and the AMA have endorsed the current health care plan being considered in Congress. “We are closer to passing this reform than ever before,” Mr. Obama said, adding that he was “extraordinarily pleased and grateful.”

11/5/09 HC Reform Update by Mark Sanna: House Democratic leaders struggled Wednesday to strike a deal that would restrict the use of federal money to pay for abortions under health care legislation. The haggling over abortion was part of a frenetic effort by House Democratic leaders to lock in the 218 votes needed to pass the legislation, and it highlighted the political land mines on the path to a vote tentatively set for Saturday.

11/4/09 HC Reform Update by Mark Sanna: House Republicans have come up with an answer to Speaker Nancy Pelosi, drafting an alternative health care bill that would reward states for reducing the number of uninsured, limit damages in medical malpractice lawsuits and allow small businesses to band together and buy insurance exempt from most state regulation.

11/3/09 HC Reform Update by Mark Sanna: As the House moved toward climactic votes on legislation to remake the health care system, the Congressional Budget Office said Monday that middle-income families might be required to pay 15 - 18 % of their income on insurance premiums and co-payments under the proposal. House Republicans were drafting an alternative, which they said would be much less costly.

11/2/09 HC Reform Update by Mark Sanna: After months of plodding work by five Congressional committees and weeks of back-room bargaining by Democratic leaders, President Obama’s arms-length strategy on health care appears to be paying dividends, with the House and the Senate poised to take up legislation to insure nearly all Americans. Debate in the House is expected to begin this week, and the Senate will soon take up its version.

11/1/09 HC Reform Update by Mark Sanna: Of all the elements of a health care bill that the Senate and House will have to reconcile, one of the thorniest is the issue of the so-called employer mandate. To what degree will Congress require employers to provide health insurance for their employees? The three operative bills in Congress — one unveiled in the House on Thursday, and two in the Senate that are being merged into one — take different approaches.

10/31/09 HC Reform Update by Mark Sanna: The House health care bill is more costly than the $894 billion reported by House speaker, Nancy Pelosi. The official cost analysis by the Congressional Budget Office suggests that the number that should have reported was $1.055 trillion, which is the gross cost of bill before taking account of certain new revenues, including penalties by individuals and employers who fail to meet new insurance requirements in the bill.

10/29/09 HC Reform Update by Mark Sanna: Speaker Nancy Pelosi’s fallback public option is to have the secretary of health and human services negotiate rates with health care providers as private insurers do. The Congressional Budget Office considers this so weak that it might attract only 6 million of an estimated 30 million people buying insurance on the exchanges in 2019. Its premiums might exceed the average private plan, in part because the sickest people might migrate to the public plan.

10/29/09 HC Reform Update by Mark Sanna: Under pressure from moderate-to-conservative members of the House Democratic caucus, Speaker Nancy Pelosi has decided to propose a government-run insurance plan that would negotiate rates with doctors and hospitals, rather than using prices set by the government, aides said Wednesday.

10/28/09 HC Reform Update by Mark Sanna: Faced with opposition Tuesday from Senators Olympia Snowe, R-Maine, and Joe Lieberman, an independent, over inclusion of a government-run insurance program in the Senate health care bill, Democratic Leader Harry Reid, D-Nev., intensified negotiations with a handful of Democrats whose support is crucial to passing the legislation.

10/26709 HC Reform Update by Mark Sanna: Senate majority leader, Harry Reid’s public option proposal comes with an escape hatch: A state could refuse to participate in the public insurance plan by adopting a law to opt out. The announcement is a turning point in the debate over how much of a role government should play in an overhauled health care system, and it set the stage for a test of Democratic party unity.

10/26/09 HC Reform Update by Mark Sanna: The contentious debate over health care took a new twist Monday as Senate Majority Leader Harry Reid announced his decision to craft legislation including a public insurance option allowing states to opt out. Reid's decision is a major victory for the more liberal wing of the Democratic Party.

10/26/09 HC Reform Update by Mark Sanna: On Page 251 of the Senate Finance Committee’s 1,502-page health care bill is a remarkable provision that would require all hospitals in the US to establish a list of “standard charges for items and services.” What is remarkable is not that hospitals will have to publish their prices, but that researchers think it will do little good and might only highlight the inability of Congress to lower costs.

10/25/09 HC Reform Update by Mark Sanna: As Congress nears votes on legislation that would overhaul the health care system, insurance brokers and benefits consultants say their small business clients are seeing premiums go up an average of about 15 percent for the coming year — double the rate of last year’s increases. That would mean an annual premium that was $4,500 per employee in 2008 and $4,800 this year would rise to $5,500 in 2010.

10/24/09 HC Reform Update by Mark Sanna: Supporters of the public option want it in the bill at the outset, meaning opponents would need 60 votes to pass an amendment stripping it out. Opponents want to leave the government plan out of the bill, so that supporters would need 60 votes to pass an amendment to add it in. The margins are so tight, that neither side seems to be able to muster 60 votes. And that leaves the crucial decision in the hands of the majority leader, Harry Reid.

10/23/09 HC Reform Update by Mark Sanna: In pushing to include a government-run health insurance plan in the health care bill, the Senate majority leader, Harry Reid, is taking a calculated gamble that the 60 members of his caucus could support the plan if it included a way for states to opt out. Mr. Reid met with President Obama at the White House Thursday to inform him of his inclination to add the public option to the bill.

10/21/09 HC Reform Update by Mark Sanna: In the face of solid Republican opposition, Senate Democrats on Tuesday backed down from their effort to increase Medicare payments to doctors without offsetting any of the cost over the next 10 years. It was the first skirmish in a larger partisan battle over President Obama’s effort to remake the health care system in a fiscally responsible way.

10/20/09 HC Reform Update by Mark Sanna: Senate Democrats and White House officials met on Monday evening to discuss how to merge the two versions of the Senate’s health care legislation, and Democratic aides said they were aiming to have a combined bill “mostly baked” by the end of this week. Once the bills are melded, the Congressional Budget Office will be asked to develop a revised cost analysis, which will take several days.

10/19/09 HC Reform Update by Mark Sanna: As she pulls together a health care bill, Speaker Nancy Pelosi has been exceedingly direct, lawmakers say, asking them explicitly Across the Rotunda, Senator Harry Reed, the majority leader, is trying a different tack, acting like what one participant in closed-door sessions described as a coach, urging key chairmen not to get bogged down in pride of authorship and to keep their eyes on the legislative ball.

10/18/09 HC Reform Update by Mark Sanna: President Barack Obama lashed out on Saturday against the "deceptive and dishonest" efforts of health insurance companies, who he said are trying to kill health care reform, no matter the cost to the country. Sharpening his attack on insurers, Obama also signaled support for a congressional review of the insurance industry's long-standing exemption from federal anti-trust laws. Some Democrats want the privilege repealed.

10/17/09 HC Reform Update by Mark Sanna: The Obama administration on Friday backed away from an order that had prohibited insurance companies from warning Medicare recipients about the possible loss of benefits under pending legislation to overhaul the health care system. Medicare officials set off a political storm when they tried to stop such communications last month. Under new guidelines, insurance companies can communicate with Medicare beneficiaries on pending legislation, provided they do not use federal money to do so. In addition, insurers must get permission from beneficiaries before sending them information about legislation or asking them to join grass-roots advocacy efforts.

10/16/09 HC Reform Update by Mark Sanna: Deep fissures among Senate Democrats became evident on Thursday as lawmakers moved closer to a floor debate on legislation to remake the health care system. The divisions involved two issues: whether the government should sell health insurance, in competition with private insurers, and whether Congress should offset any of the cost of legislation to increase Medicare payments to doctors.

10/15/09 HC Reform Update by Mark Sanna: Lobbyists for the American Medical Association and other physician groups met with Senate Democratic leaders on Wednesday to discuss a long-term fix to the health care crisis. Under current law, doctors face cuts of 21.5 percent in January and about 5.5 percent in each of the next four years.

10/14/09 HC Reform Update by Mark Sanna: After months of relentless courting and suspense, Senator Olympia Snowe, Republican of Maine, cast her vote with Democrats on Tuesday as the Senate Finance Committee approved legislation to remake the health care system and provide coverage to millions of the uninsured. With Ms. Snowe’s support, the committee backed the $829 billion measure on a vote of 14 to 9, with all the other Republicans opposed.

10/13/09 HC Reform Update by Mark Sanna: A proposed tax on high-cost, or “Cadillac,” health insurance plans has touched off a fierce clash between the Senate and the House as they wrestle over how to pay for legislation that would provide health benefits to millions of uninsured Americans. Whether it remains in the bill is emerging as a test of the commitment by President Obama and his party to slowing the steep rise of medical expenses.

10/12/09 HC Reform Update from Mark Sanna: The latest battle between the Obama administration and the health insurance industry escalated quickly on Monday, as the White House and Congressional Democrats fired back at an industry report prepared by Price Waterhouse Coopers suggesting that health premiums would rise sharply as a result of the proposed heath care legislation.

10/10/09 HC Reform Update by Mark Sanna: As the drama over health care legislation builds, the uncertain intentions of Ms. Snowe, Maine’s senior senator, have made her one of the foremost Scrum Queens on Capitol Hill. A vote by the Senate Finance Committee next Tuesday on its version of the health overhaul has set off a particularly intensive round of “What Will Olympia Do?”

10/9/09 HC Reform Update by Mark Sanna: Democrats are looking at the possibility of a windfall profits tax on insurance companies as part of healthcare reform, House of Representatives Speaker Nancy Pelosi said on Thursday. She added that insurance companies would get some 50 million new consumers, many subsidized by taxpayers, under reforms Democrats are planning and "we think they can put more on the table."

10/8/09 HC Reform Update by Mark Sanna and Breakthrough Coaching: According to the new Congressional Budget Office analysis, the Senate Finance Committee’s health care legislation would cost $829 billion to provide insurance coverage to millions of Americans. But over 10 years, it would also reduce federal deficits by $81 billion. Besides providing insurance coverage, the other main goal of the legislation is to slow the steep rise in federal spending on health care, particularly on Medicare, which covers Americans over age 65 and the disabled. The analysis by the nonpartisan budget office shows that the savings generated by slowing Medicare growth, combined with revenues from new taxes, would more than cover the cost of providing health benefits to roughly 29 million people.

10/7/09 HC Reform Update by Mark Sanna: A group of centrist Democratic senators, who could determine the fate of the major health care legislation, sent a letter Tuesday to the majority leader, Harry Reid, Democrat of Nevada, urging that the public be given at least 72 hours to review the legislation before debate begins on the Senate floor. White House officials and the committee chairman expect the Democrats to support the bill, if only to advance it to the next stage of the legislative process, the Senate floor, for what is likely to be a raucous, riveting and unpredictable debate.

10/6/09 HC Reform Update by Mark Sanna: As Democrats prepare to take up health care legislation on the floor of the Senate and the House, they are facing tough choices about two competing priorities. They want people to pay affordable prices for health insurance policies, but they want those policies to offer comprehensive health benefits. These goals collide in the bills moving through Congress.

10/3/09 HC Reform Update: It wasn’t pretty at times, but at 2:15 a.m. Friday, the Senate Finance Committee finished debating amendments to its sweeping health care legislation. The bill will now be delivered to the Congressional Budget Office for a crucial cost estimate. A final vote on the measure is expected next week.

9/30/09 HC Reform Update: The Senate poses the main hurdle to President Obama’s effort to overhaul the health care system. But passing so far-reaching a bill in the House is not going to be easy either. Few Democrats doubt that ultimately the House will approve its version of a program to expand insurance coverage and restrain long-term health care spending, given the party’s sizable majority.

9/30/09 HC Reform Update: After an intense debate that captured the essence of the national struggle over health care, a pivotal Senate committee on Tuesday rejected two Democratic proposals to create a government insurance plan to compete with private insurers. The votes, in the Senate Finance Committee, underscored divisions among Democrats and were a setback for President Obama.

9/29/09 HC Reform Update: When the Senate Finance Committee resumes debate today, a proposal for a government-run insurance plan — the public option — will take center stage. Supporters say a public option would drive down the cost of private insurance. But the insurance industry opposes it. Sens. Rockefeller and Schumer intend to press the issue in separate amendments before the committee.

9/28/09 HC Reform Update: Democrats proposing an overhaul of the American health care system have gotten themselves locked in a box around the question of affordability. The affordability question vexing Democrats is whether those with moderate income will be able to afford health insurance, even with the subsidies the legislation would provide and all sorts of new rules aimed at controlling costs.

9/26/09 HC Reform Update: The proposed federal mandate for every individual to have health insurance has stirred a legal debate over whether Congress has the constitutional authority to impose such a requirement. Conservatives and libertarians have been advancing the theory lately that the individual mandate, in which the government would compel everyone to buy insurance or pay a penalty, is unconstitutional.

9/25/09 HC Reform Update: This week, Democrats on the Senate Finance Committee largely stood up to Republicans’ attacks on a proposal to overhaul the health care system. But behind the scenes, their united front has given way to intraparty tensions. This will become more evident next week when the Finance Committee tries to finish its work and liberals press to change a bill that is too conservative for their liking.

9/25/09 HC Reform Update: The Senate Finance Committee says the panel will not get to the matter of a public option debate today. Democratic Sens. Jay Rockefeller and Chuck Schumer yesterday said they were planning to introduce amendments on the so-called public option, and they would take place today. But committee sources say there is not time. The committee will work a shortened day today and not be in session Monday due to the Jewish holiday.

9/25/09 HC Reform Update President Obama scored a big victory on Thursday as the Senate Finance Committee rejected a proposal to require pharmaceutical companies to give bigger discounts to Medicare on drugs dispensed to older Americans with low incomes. The victory came at the expense of senators in Mr. Obama’s own party who had championed the proposal.

9/24/09 HC Reform Update: Senate Democrats swatted down Republican attempts to make fundamental changes in their health care legislation on Wednesday as the Finance Committee voted on a wide range of amendments that highlighted the deep partisan divide over the bill. Much of the debate focused on the question of whether the bill would help or hurt older Americans in the Medicare program.

9/23/09 HC Reform Update: The Group of Six is over, done. What’s left is the Group of One: Senator Olympia J. Snowe, Republican of Maine. Ms. Snowe is the only member of her party on the finance panel willing to support the proposed health care legislation. Her Republican colleagues will vote against it, and so the focus on Wednesday will turn to policy fights among Democrats themselves.

9/22/09 HC Reform Update: The chairman of the Senate Finance Committee, Max Baucus, said Monday that he would modify his health care bill to provide more assistance to moderate-income Americans to help them buy insurance. Mr. Baucus also said he would make changes to reduce the impact of a proposed tax on high-end health insurance policies.

9/21/09 HC Update: A tax proposed by Senator Baucus on insurance policies for the well-heeled to help raise money for the nation’s health care overhaul has prompted anxiety among the middle class. The supposedly Cadillac policies include ones that cover many of the nation’s firefighters and coal miners, older employees at small businesses — a whole gamut that runs from union shops to Main Street entrepreneurs.

9/20/09 HC Reform Update: President Obama, appearing in interviews on five television networks, said the health care fight had been more difficult than he anticipated and conceded that he has struggled “breaking through.” He said he remained confident he would sign a health care bill into law and welcomed Republicans to the effort, but added, “I don’t count on them.”

9/19/09 HC Reform Update: President Obama will appear on five Sunday talk shows — an unprecedented step for a president — to promote his health care plan. The television networks broadcast brief parts of their interviews on Friday evening, all of which focused on a question the White House has sought to avoid all week: Has race played a role in the debate?

9/18/09 HC Reform Update: Senators of both parties said Thursday that they would seek significant changes in a Democratic proposal to tax generous high-cost health insurance policies. The tax, proposed as a way to help finance coverage of the uninsured, would be levied on insurance companies. But the senators said they worried that it would be passed on to individual policyholders, families and employers who buy insurance for their workers.

9/17/09 HC Reform Update: The chairman of the Senate Finance Committee on Wednesday unveiled his long-awaited plan to remake the nation’s health care system and insure millions of Americans. But he did not win support from a single Republican despite tailoring his proposal to be less costly and to extend the reach of government less than other health bills moving through Congress.

9/15/09 HC Reform Update: Two of the three Republicans in a small group trying to forge a bipartisan compromise on health care have requested numerous major changes in a proposal drafted by the chairman of the Senate Finance Committee, Max Baucus, reducing the chances that he can win their support.

9/14/09 HC Update: Sen. Max Baucus, who is leading the effort to develop bipartisan health care legislation, plans this week to unveil his “mark” — the proposal to be taken up by the Senate Finance Committee. Reaction to his plan could finally reveal whether the “bipartisan six” subgroup that Mr. Baucus has been working with for months will stick together or whether Democrats will head off largely on their own.

9/12/09 HC Reform Update: The top lobbyists for every major sector of the health care industry including AMA and big pharma publicly insist they are squarely behind the Obama administration’s health care reform. But as the debate gets down to the details, each industry group is also working quietly to scuttle or reshape some element of the administration’s proposals that might hurt profits.

9/11/09 HC Reform Update: President Obama’s speech on health care failed to bridge the gulf with Republicans, but Democrats said Thursday that the president had largely succeeded in unifying his party by making a cogent, persuasive pitch to the American public, and by casting his plan to overhaul the health care system as a political and moral imperative.

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Health Care Reform Update: 9/8/09 The centerpiece of President’s domestic agenda — remaking the health care system will be on center stage as he addresses the Congress and nation in a televised address tonight. Despite tensions between Democrats, they agree on most proposals: to require all Americans to have insurance; provide government subsidies for those who cannot afford it and regulate private insurance. At question is the pubic plan.

9/8/09 More details about the Bacus plan emerged Monday. It includes lower-cost catastrophic illness insurance for those 25 and younger; expanding basic Medicaid coverage; forming state-run, nonprofit, member-owned insurance coops. It will be paid for in part by fees of $6 billion/yr on insurance companies, $4 billion/yr. on manufacturers of medical devices and $750 million/yr. on clinical labs.