The New Health Dialogue

For months, Barack Obama let Congress hash out the details of health care. Pundits and critics wondering when and how he would weigh in sometimes made him sound like the  Miss Clairol of health reform -- does he or doesn't he back a public plan? A national exchange? A Cadillac tax? Only his OMB director knew for sure.

Now the president is showing his true colors. He held an unusual eight-hour meeting at the White House yesterday with Democratic leaders from the House and Senate. How those preferences shape the final legislation remains to be seen, as the de facto conference committee produced a predictably vague statement following the Wednesday’s negotiations:

Today we made significant progress in bridging the remaining gaps between the two health insurance reform bills. We’re encouraged and energized, and we’re resolved to deliver reform legislation that provides more stability and security for those with insurance, extends coverage to those who don’t have coverage, and lowers costs for families, businesses, and governments.

As negotiations continue, participants are doing their best to stay tightlipped on the details of discussions until a final deal is reached.

“I’m not going to go into specifics because it’s a whole package, and we have to reach agreement on the whole package,” House Majority Leader Steny Hoyer (D-Md.) told reporters.

Still here are the outlines of what’s being said on outstanding issues between the House and Senate Bills.

• Health Insurance Exchanges: The president expressed his support for a national health insurance exchange, similar to that laid in out in the House bill over the state based exchanges of the Senate bill. Our colleague Elizabeth Carpenter has more on this issue.
• Affordability: Obama and negotiators are looking for ways to expand the subsidies that will help Americans purchase health insurance. Of course the expanding the subsidies requires finding a way to pay them. In addition to new government revenues, the President may ask drugmakers and other industry stakeholders to up their commitments to help share the costs of reform.
• Financing Reform: The White House has made clear that it wants to see an excise tax on high-cost plans included in the final bill, but has been willing to negotiate the details in it’s discussions with the House and Labor. Potential compromises on the table include raising the threshold at which the excise tax would kick in and exempting policies that were negotiated through collective bargaining. Meanwhile increasing the Medicare payroll tax on high earners and expanding it to include investment income, has emerged as a potential alternative to the House’s surtax on high income individuals.

Discussions are resuming this afternoon. Senate Majority leader Harry Reid (D-NV) told reporters the goal was the have a compromise package ready by early next week to send to the CBO. Deadlines, like hairlines, have a way of receding. No one said health reform would be Nice N Easy, but the closer we get, the better it looks that Congress and the President will find a way to get to final passage.