Health Care Issues: Public Option, Abortion, Medicare Cuts

As the Democrats' self-imposed deadline to pass health care legislation by the end of this year approaches, lawmakers continue to trudge along slowly on the bill amid internal strife.

Publicly, the sparring and finger-pointing between Republicans and Democrats continues to dominate Senate debates. But even among Democrats, deep divisions remain, guaranteeing a rocky road as the debate approaches its final phases, with a vote expected by month's end. Moderate and liberal Democrats and a few moderate Republicans are negotiating behind closed doors on a health care bill that would get the 60 votes it needs to pass on the floor.

Video of ABC News Top Line.
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On Thursday, senators voted on four amendments in the 2,000-plus-page legislation, mostly on party lines. Nearly 72 amendments have been proposed for the bill, crafted chiefly by Majority Leader Sen. Harry Reid, D-Nev.

Today, Sens. Joe Lieberman, I-Conn., Arlen Specter, D-Pa., and Susan Collins, R-Maine, introduced what they hailed as a "tri-partisan" amendment expanding measures in the Reid bill and introducing more cost containments. But even as the three promoted health care overhaul and their joint proposal, they publicly sparred over provisions, mainly the option of a government-sponsored health care plan, more popularly called the "public option."

Lawmakers are planning to work through this weekend -- in what could be one of many firsts -- to push through a health care bill.

Press Secretary Robert Gibbs said today the White House is still aiming for the end of the year timeline for a health care bill, and even though President Obama will be in Hawaii for the holidays, lawmakers shouldn't rule out having him sign a bill, if need be.

"If the bill is passed the president would be happy to sign it in Hawaii. I can think of any number of picturesque locations," Gibbs told reporters.

Here is a look at some of the key points of debate in the Senate bill, and where things stand:

Public Option

"Abortion and public option are really the major obstacles at this point," Sen. Dick Durbin, D-Ill., told reporters on a conference call today. "We feel like we're moving to the point where soon we can talk about an endgame where we have an agreement that can bring together 60 votes but we're not there yet."

The internal disagreements over how a public option might be framed reflects the wide gap in the Democratic party. Some, such as Specter, support a more robust public option plan.

"It isn't a single payer [system] and it is not going to add to the deficit. It's going to be a level playing field," the former Republican said at the joint press conference with Collins and Lieberman. "I would invite everyone to read the fine print."

Asked whether his final vote will be determined on the public option, Specter responded: "I'm not going to make any concessions... on a strong public option."

On Thursday, Sen. Ron Wyden, D- Ore., said on ABC's "Top Line" that the public option as structured in the Senate health care bill would result in a pool insuring only the unhealthiest, unless it's available to all Americans.

"My concern is you can't let the public option be something of a health care ghetto," Wyden said. "Right now it looks like the folks that are going to be getting into it are people that haven't had insurance. The evidence shows that those are folks who didn't get check-ups, didn't get prevention, didn't get chronic care or maintenance."

On the opposite side of the spectrum, some of Wyden and Specter's own party members want to nix the option altogether.

Reid is walking a fine line with the public option. He has attempted to appease all sides by offering a public option plan in an insurance exchange, yet it would be one that's only open to the uninsured and which states would have the option to opt out of. Nevertheless, he could lose votes of his own party members and that of the lone Republican who sided with the Democrats, Sen. Olympia Snowe of Maine, who has repeatedly said she does not want to see a public option in the final bill.

Lieberman has said he would filibuster with the GOP if a public option was included, and today he said it was a "foot in the door" to a single payer, government-run health care system.

"I think it would be wrong and terrible for our country," Lieberman told reporters today. "I think it would result in worse health care, more expensive health care. ... I think the better political compromise is to get the public option out."

The House bill, passed in early November, offers a public option, although the Congressional Budget Office forecasted that premiums for it would be more expensive than for policies sold by private firms.

"This is a philosophical difference so it is not easily compromised," Collins, a moderate Republican, told reporters today.

Abortion

Abortion continues as a hot topic as Sen. Ben Nelson, D-Neb., prepares to offer an amendment next week with strict abortion restrictions, similar to the Stupak amendment that passed in the House health care bill. The current language in the Reid bill restricts the use of public funds for abortion services but Nelson wants to take the restrictions beyond that.

Despite the liberal outrage over his abortion proposals, the moderate Democrat has threatened to reject the final bill if it is not included, putting an all-important 60-vote count in jeopardy.

"At the end of the day we need Senator Nelson's vote. We still don't have a promise of a vote from the Republican side, so we would need his vote," Durbin told reporters today.

The House bill includes an amendment by Rep. Bart Stupak, D-Mich., that would not only cut federal funding for abortion-related services, but limit access to abortions for people who would receive federal subsidies and would have to buy insurance through a health insurance exchange.

Medicare Costs

One of the ways to pay for the Senate legislation, which would cost $849 billion over 10 years, according to the nonpartisan Congressional Budget Office, would be through cuts in Medicare and cost savings.

Senators on Friday continued to debate the proposed cuts to Medicare.

Democrats defeated on Thursday a proposal by Sen. John McCain, R-Ariz., to shelve the legislation until lawmakers find a way to fund it other than by cuts in Medicare. But lawmakers unanimously approved a proposal by Sen. Michael Bennett, D-Colo., that the bill cannot restrict current Medicare benefits in the future, while at the same time leaving more than $400 billion in Medicare cost savings.

Republicans assailed the measure, calling it a sham.

"Seniors do not want senators fooling with Medicare. They want us to fix it, to strengthen it, to preserve it for future generations, not raid it like a giant piggy bank in order to create some entirely new government program," Minority Leader Sen. Mitch McConnell, R-Ky., said today. "Yesterday's vote was particularly distressing for the nearly 11 million seniors on Medicare Advantage."

The House bill also pays for the $1.2 trillion costs over 10 years with more than $400 billion in cuts in Medicare spending over the same period.

Women's Health Coverage

Democrats on Thursday passed, by a vote of 61-39 and some bipartisan support, a proposal by Sen. Barbara Mikulski, D-Md., that would require insurers to cover and provide women access to preventive screenings like mammograms in the basic health care overhaul plans. It also mandates that all health plans cover women's preventive care and screenings with no copayments. The proposal is expected to add nearly $1 billion to the overall cost and was rejected by two Democrats.

Reid today hailed Mikulski's measure.

"Senator Mikulski of Maryland -- who for decades has been a champion for women's health -- made it better by making sure women can get the mammograms, check-ups and other preventive tests they need to stay healthy, and get them at no cost," Reid said on the floor of the Senate today.

Sen. Lisa Murkowski, R-Alaska, offered an alternative saying the government should not determine health guidelines based on the recommendations of the government-appointed U.S. Preventive Services Task Force -- which last month made the controversial recommendation that women didn't require mammograms that frequently and women between 50 to 74 years of age should have it every other year instead of annually. The amendment, which would also have barred abortion from being considered as a preventive service, was rejected.

ABC News' Z. Byron Wolf contributed to this report.

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