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STEVE INSKEEP, host:

On a Wednesday morning, its MORNING EDITION from NPR News. Good morning. Im Steve Inskeep.

MADELEINE BRAND, host:

And Im Madeleine Brand, in for Renee Montagne.

Congress is still technically on its holiday break, but leaders are already back in Washington. Theyre working to reconcile the House and Senate versions of the health-care overhaul bill. Yesterday, House Speaker Nancy Pelosi insisted that lawmakers will waste no time settling on a compromise bill to accomplish three main goals.

Representative NANCY PELOSI (Democrat, California; Speaker of the House): Affordability for the middle class, accountability for the insurance companies, and accessibility to many more people in our country to quality, affordable health care.

BRAND: Getting there will not be easy. NPRs Julie Rovner looks back at the year in health policy, and the fights still to come.

JULIE ROVNER: For health policy watchers like Jonathan Oberlander, 2009 was a great year.

Professor JONATHAN OBERLANDER (University of North Carolina): It had everything in it - lots of attention to health care, high drama, very close votes, death panels, fights over abortion. If you were to write a soap opera on health- care reform, you probably couldnt do better than what you had last year.

ROVNER: And despite the fact that the bill is overdue according to the schedule originally laid out by President Obama, Oberlander, a health policy professor at the University of North Carolina, says in the long run, that probably wont make much difference.

Prof. OBERLANDER: If they are able to get legislation passed in the next month that looks like what the House and Senate have already passed, it will be a tremendous political victory. And nobody is going to remember that it was legislated and signed in February rather than in October. Its just not going to matter.

ROVNER: What will matter is whats in the bill, and thats still a big concern to people like Neil Trautwein of the National Retail Federation. His group is particularly concerned about provisions of the House bill that require employers to offer their workers health coverage.

Mr. NEIL TRAUTWEIN (National Retail Federation): Its a huge problem for retailers who have thin profit margins, and theyve ultimately produced a product that we dont care to buy - and judging from the polls, a lot of Americans also dont want to buy.

ROVNER: Whats really frustrating for Trautwein is that 2009 wasnt supposed to turn out this way. He and representatives from interest groups spanning the spectrum met for more than a year with the late Senator Ted Kennedy and his staff, in preparation for the anticipated push for a health overhaul bill.

Mr. TRAUTWEIN: There was great commonality between business, labor, medical, hospitals, pharmaceutical and others, but theres a warping process that goes through the political prism, and that really took health reform into a direction we dont think is ultimately good for America.

ROVNER: Trautwein says that might not have happened had Kennedy, who died last summer, remained part of the debate. Kennedy was legendary for his ability to bring opposing groups together. But Jonathan Oberlander says he thinks Democrats didnt get enough credit for what they did manage to accomplish, particularly after Republicans decided to oppose the entire effort.

Prof. OBERLANDER: If you look historically, Democrats are like cats. Theyre difficult to herd and theres actually an extraordinary amount of coordination from the committee chairs in the House to get, at the end of day, all 60 Democrats in the caucus to vote for this legislation. Its pretty remarkable, and something I think a lot of us would have bet against at the beginning of the year.

ROVNER: But Trautwein and Oberlander agree on one thing: Even if the bill does pass - and both assume a bill will - selling it to a skeptical public will be a big job.

Prof. OBERLANDER: You have an issue that the public is very divided over, that is accompanied by a lot of controversy, a lot of mythology and a lot of misunderstanding. And people arent actually going to experience most of the benefits for at least four years. So thats two election cycles - and thats a big risk.

ROVNER: In other words, as he puts it, even after a bill is signed by the president, the debate will be far from over. Democrats will want to start expanding right away, while Republicans are already talking about repeal efforts.

Julie Rovner, NPR News, Washington.

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