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Senator Jay Rockefeller, a West Virginia Democrat and longtime champion of the public plan, said he intends to introduce an amendment to insert the federal alternative into the bill, though there was no word if Baucus would accept such an amendment. "The proposed co-op model is untested and unsubstantiated and should not be considered as a national model for health insurance," Rockefeller said. If Dems choose to go it alone without any Republican support, it's possible they could include such a plan in the final version of the bill. But many moderate Democrats, such as Landrieu and Nebraska's Ben Nelson, have said they will not vote for a public plan, complicating the prospect of getting the 60 votes they would need to prevent a Republican filibuster.
2. Affordability
This issue emerged in the final days of negotiations as a key flash point. To help keep costs down, Baucus provides comparatively less generous subsidies to help low- and middle-income people purchase insurance. "The House bill clearly does more to make coverage affordable for more Americans," said House Speaker Nancy Pelosi in welcoming Baucus' bill. "As this proposal evolves, we hope to see modifications that result in the Senate bill better reflecting the work of the House to make health care more affordable for all Americans."
Senator Wyden said he plans on offering amendments to increase the subsidies. "I continue to be concerned about affordability for hardworking middle-class families," Wyden told reporters just off the Senate floor. "A lot of them can't get by now, and the prospect of paying significantly more or getting an exemption [from the requirements that all individuals have health insurance] or being penalized, that is not going to meet their test of health-care security." The problem, of course, is paying for more subsidies. In its current version, the bill actually shrinks the deficit by about $50 billion over 10 years, according to the Congressional Budget Office. For many deficit hawks on Capitol Hill, unfunded liabilities are out of the question.
3. Immigration
Representative Joe Wilson may have gotten himself into trouble when he yelled "You lie!" at President Obama during the address to the joint session of Congress, but it certainly seems that Democrats took his outburst to heart. Senate Finance negotiators went back to the table and rewrote the bill to ensure not only that illegal immigrants would be prevented from receiving government subsidies to buy insurance, but that they wouldn't be able to purchase insurance on the so-called exchanges even if they could pay for it in full. The plan also tightens the rules for some legal immigrants to qualify for government subsidies on the exchange. Both points have angered Latino lawmakers, such as Representative Luis Gutierrez and Senator Bob Menendez, a New Jersey Democrat, who are seeking to modify the provisions. Health-policy experts say it makes absolutely no sense to prevent illegal immigrants from purchasing insurance, since taxpayers end up covering the costs anyway when the undocumented inevitably go to emergency rooms to get medical care. But with almost all politicians afraid of being painted as soft on illegal immigration, it's hard to see enough lawmakers supporting scaling back the provisions.