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Reaching for the Finish Line

Top Congressional leaders have just ended eight hours of negotiations in the White House Cabinet Room with President Obama and members of his Administration in order to reach agreement on a final health care bill. The attendees included Representatives Pelosi, Rangel, Steny Hoyer (Md.), James Clyburn (S.C.), George Miller (Calif.), and Henry Waxman (Calif.) in addition to Senators Chris Dodd, Harry Reid (Nev.), Dick Durbin (Ill.), Max Baucus (Mont.) and Tom Harkin (Iowa). Union leaders were also in attendance.

The President continued his newfound ‘executive influence’ today by calling for a National Health Insurance Exchange, and this is now the central fighting point for the House. In addition to the compromises reached earlier this week with a combination scaled-back Excise tax (also supported by Obama)/Medicare payroll tax expansion, it appears that the House is now willing to remove their employer ‘pay-or-play’ requirement in favor of the less-robust Senate version. The Senate employer shared responsibility provision protects many employees from unaffordable insurance, but there may be some market distortion issues that you can read about here and here.

Provisions still on the table:

-133% FPL Medicaid expansion (more likely) vs. 150% Medicaid expansion
-Degree of income-related insurance subsidies (which may now be lowered to the Senate’s level as revenue will be lost as a result of the employer requirement agreement unless new revenue sources are created)
-Fate of insurer anti-trust exemption
-Fate of Medicare Independent Payment Advisory Board
-Extent of Medicare Advantage payment reductions