RENEE MONTAGNE, host:
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And sitting in for Steve Inskeep, I'm Linda Wertheimer.
The Senate took another step toward approving a massive health care bill. This morning, a majority of senators approved an amendment making final changes to the bill. As the Senate lurches toward their final vote on health care overhaul, some people are daring to look ahead to the last step in the painstaking process, marrying the House and Senate bills.
Like everything else about this bill, putting the two measures together will not be easy. NPR's Julie Rovner reports.
JULIE ROVNER: On the surface, the House and Senate health overhaul bills have a lot in common. They both require everyone to have health insurance and provide generous subsidies to help people buy it. They both create new insurance exchanges where individuals and small businesses would go to buy insurance, and they both put new requirements on health insurers, like banning them from discriminating against people who have pre-existing medical conditions. But the bills differ in some profound ways too, particularly in how they would be financed.
Mr. ALEC VASHON(ph) (Health Policy Consultant): The biggest challenge is getting the money sorted out.
ROVNER: Alec Vashon is a health policy consultant and former Republican Senate health staffer. Both bills rely for about half their funding from reductions to the Medicare program, but for the other half, Vashon notes, that the House bill relies largely on raising money from wealthy individuals.
Mr. VASHON: The surcharge on singles making over a half million dollars, couples making over a million bucks.
ROVNER: While in the Senate bill, on the other hand�
Mr. VASHON: They have industry tax increases that don't appear in the House bill.
ROVNER: Like taxes on drug makers, medical devices and health insurance companies, as well as a separate and controversial tax on generous health insurance plans known as the Cadillac health plan tax. But Vashon says he thinks Democrats are more than motivated to work things out, and because the Congressional Budget Office says the Senate bill would actually reduce the deficit, negotiators have some financial wiggle room.
Mr. VASHON: There's nothing that's not a matter of negotiations. So maybe they can dial back on the Cadillac tax. It'll grow more slowly. Again, they're going to do that across the board and all the savers, all the new revenue raisers, they're going to tweak things. But they do have the money there and they do have the will, and those seem to be the two things that are important.
ROVNER: Perhaps the most difficult issue to reconcile will be abortion. Everyone says they want the bill to reflect the status quo - no federal funding of abortion. But finding language that does that and no more has proved difficult. The House bill includes an amendment offered by pro-life Democrat Bart Stupak of Michigan and supported by anti-abortion groups. It would bar federal abortion funding and prevent plans that receive federal subsidies from paying for abortions. The Senate bill's abortion language was negotiated primarily by pro-life Democrat Ben Nelson of Nebraska.
Like the House bill, it would also bar direct federal abortion funding. It would, however, let private plans in the new insurance exchanges offer abortion coverage as long as people write separate checks each month, one for the abortion coverage and one for all other benefits. That doesn't work for abortion rights groups. Laurie Rubiner is Planned Parenthood's vice president for public policy.
Ms. LAURIE RUBINER (Planned Parenthood Federation of America): Who in the right mind would ask somebody to write two checks for their health insurance? You wouldn't ask, you know, anybody to do that for any other aspect of their health care. Can you imagine asking somebody to write a separate check for their coverage for diabetes or, you know, heart transplant or, you know, any other medical procedure? You never would do that.
ROVNER: But unlike the House bill, the Senate abortion language has also drawn opposition from anti-abortion groups. Tom McClusky is vice president of Family Research Council Action.
Mr. TOM MCCLUSKY (Family Research Council Action): When you're writing two different checks that are drawing from the same bank, it's not really a very good accounting system and you're - the government is still funding abortions.
ROVNER: So groups on both sides of the debate are worried about what might happen in a House/Senate conference. McClusky of the Family Research Council says he's worried about something else too, the fact that the leadership in both the House and Senate support abortion rights.
Mr. MCCLUSKY: I'm sure that what they're thinking is that since you have two different versions of abortion language, they would feel free to do a third version themselves, possibly reverting back to either the House or the Senate's original language, which did fund abortions.
ROVNER: But while abortion may be the hardest issue, there are other policy differences too. Among them is the fact that the House bill includes a government sponsored public option and the Senate bill doesn't, but House negotiators will need to remember one important thing: the Senate's margin for error is zero, so any single senator who says no can stop the entire effort in its tracks.
Julie Rovner, NPR News, Washington.
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