Senator Reid's bill passed the Senate before Christmas (60-to-39 party-line vote)  now it must be reconciled with the House version   H.R. 3962, the Affordable Health Care for America Act (vote of 220-215). 

According to David Dayen at FireDogLake

"Discussions are beginning early on the health care bill, although the House is not returning to session until January 12, and the Senate not until a week later. This will not be a traditional conference committee, Waxman said, because the motions to select and instruct conferees in the Senate “would need 60 votes all over again.” Instead, whatever agreements made could be packaged in an amendment to the bills passed by the House and Senate."

David continued in his blog by explaining via Waxman that one of the progressives concerns in the House is the Pharma Deal;

"While many observers expect the Senate bill to remain largely intact following the conference negotiations, Waxman vowed to fight hard on at least one issue: prescription drugs. “The President and the Senate made very poor deals with PhRMA,” Waxman said, explaining the deal whereby the drug industry offered $80 billion dollars in givebacks in exchange for their support for the overall bill. “Rahm (Emanuel) said that’s OK,” Waxman said, but he noted that under the deal, the industry would get millions of new customers and Americans would still pay far more than the rest of the industrialized world for prescription drugs."

Waxman will have a hard time fighting against the Pharma deal since most member of both parties are beholden to Pharma for a lot of their campaign funding.  Not only that but some of the key players in the Senate including; Enzi, Baucus and Hatch are some of the highest recipients of Pharma money. 

The Pharma deal is not the only bone of contention.  There is also the debate over the public option and abortion funding.

Sens Liberman (I-Conn) and Nelson ( D-Neb) say they will not vote for a final bill that has a 'public option'  The Final Senate bill did not but the House bill does have one included.   Many member of the progressive caucus in the House say they will not vote for a final bill unless it has a 'public option'.   Jane Hamsher does the math when it comes to the the support in the House for a public option;

"There are 57 Democrats who signed the July 30 letter saying that they "simply cannot vote" for a bill that "at minimum" does not have a public plan (PDF).  There are 7 more not listed on the letter who have pledged to vote against any bill that does not have a robust public plan.   

Do the math:  257 – 64 = 193.  They need 218 to pass the bill."

So, it appears that they will be in stalemate when it comes to the 'public option' with the House voting for one or requiring one in the final bill in order to vote for it and the Senate not willing to vote for the final bill if it has the 'public option'.

The same is true when it comes to the abortion game in both the House and Senate.   In the Senate, Sen Nelson ( D-Neb) got language included in the final senate bill that restricts federal funding of abortions.  But, according to Rep. Stupak (D-Mich) who authored the more restrictive anti-abortion funding langauge in the House, it does not go far enough.  That's debate between pro-life advocates in the House and Senate will continue but it is complemented by the pro-choicers in both bodies who say they will not vote for any final bill that limits women's access to abortions.  Rep. Slaugher (D-NY) is a House member who has threated to withhold her support for the final bill if it includes either Nelson or Stupak's language.  Another house member who has done the same is Rep. Diana DeGette, (D-Colo).I have included her letter below to Speaker Pelosi on the subject of abortion;

November 7, 2009

The Honorable Nancy Pelosi
Speaker
U.S. House of Representatives
H-232 Capitol
Washington, DC  20515

Dear Madam Speaker:

As Members of Congress we believe that women should have access to a full range of reproductive health care.  Health care reform must not be misused as an opportunity to restrict women’s access to reproductive health services.

The Stupak-Pitts amendment to H.R. 3962, The Affordable Healthcare for America Act, represents an unprecedented and unacceptable restriction on women’s ability to access the full range of reproductive health services to which they are lawfully entitled.  We will not vote for a conference report that contains language that restricts women’s right to choose any further than current law.

Sincerely,

The Pharma issue, public option and abortion issue all are contentious issues that can lead to failure of consensus on a final bill.   Another issue which is not so divisive at least not to the public is the insurance mandates.   There is a transpartisan consensus that there should be no mandate in the final bill.  The consensus left and right can be seen by the cross spectrum of individuals who signed onto a coaition letter right before the Christmas Break;

12/19/09

Dear Senator,

On behalf of our organizations and the millions of people we represent, we strongly encourage you to oppose the “individual mandate” in the “Patient Protection and Affordable Care Act of 2009.”  Our groups and members may disagree on what are the best solutions to our health care problems, but this unprecedented coalition of organizations from across the political spectrum agrees that forcing individuals to buy insurance from private companies under the threat of fines is not the reform we need.

The “individual mandate” is a section of the bill that requires every single American to buy health insurance—whether or not they want it or feel they can afford it—or break the law and face penalties and fines.  Consequently, the bill does not actually “cover” 30 million more Americans—instead it makes them criminals if they do not buy insurance from private companies.  We hope you agree that it is unconscionable to force people to buy a product from a private insurer.  This would effectively be a tax—and a huge one—paid directly to a private industry.

Enacting this mandate would be a major victory for the insurance companies at the expense of the American people.  It should be no surprise they support the government forcing everyone to buy their product.  Imagine how the hamburger industry would respond if the government forced everyone to have hamburgers for lunch or pay fines?

According to the President’s Council of Economic Advisers, the average annual premium for single coverage is $4,321.  If the 46 million uninsured are forced to purchase private health insurance at that price, then the insurance industry stands to bring in up to $200 billion in new insurance premiums per year.  The Senate bill also includes an estimated $630 billion in corporate welfare for private insurance companies in the form of subsidies over the next 10 years, creating even less incentive than currently exists for private insurance premiums to be lowered.

To make matters worse, the Centers for Medicare and Medicaid Services estimates that 19 million Americans would not buy insurance and as a result would be forced to pay $29 billion in taxes/fines.

Given these fact, it is not surprising that a recent NBC News poll finds 57 percent of Americans do not want the government to create “a law that requires everyone to have health insurance coverage” and that only 38% of Americans favor the mandate, making it the least popular part of the bill.

The American people stand in firm opposition to the individual mandate.  We stand with them.  We hope you will, too.

Sincerely,

Americans for Tax Reform, Grover Norquist, President

Democrats.com, Bob Fertik, President

Healthcare-NOW!, Katie Robbins, National Organizer

Matt Kibbe, President and CEO, FreedomWorks

Progressive Democrats of America (PDA), Tim Carpenter, Director

Campaign for liberty, John Tate, President

60 Plus Association, Jim Martin, President

Liberty Tree Foundation, Ben Manski, Executive Director

National Taxpayers Union, Duane Parde, President,

National Coalition of Organized Women, Consuela Sylvester, Ohio Director

Citizens for Health, Jim Turner, Chairman,

Competitive Enterprise Institute, Gregory Conko, Senior Fellow

American Association of Small Property Owners, F. Patricia Callahan, President

U.S. Bill of Rights Foundation, Dane vonBreichenruchardt, President

Institute for Liberty, Andrew Langer, President

Santa Monicans for Safe Drinking Water Coalition, Gene Burke, Founder, Director

Alliance for Natural Health USA, Gretchen DuBeau, Executive Director

Association of American Physicians and Surgeons, Jane M Orient, MD, Executive Director,

Fairfax County Privacy Council, Mike Stollenwerk, Chairman

The Rutherford Institute, John W. Whitehead, President

Pain Relief Network, Siobhan Reynolds, Executive Director

American Policy Center, Tom DeWeese, President

Justice Through Music, Brett Kimberlin, Director

Velvet Revolution, Brad Friedman, Co-Founder

After Downing Street, David Swanson, Co-Founder

Project Vote Smart, Mark A. Adams, Founder,

Democracy in Action (DIA), Dorothy Reilly, Organizer

Squadron13.com, Gordon Sturrock, Founder

Democracy for America - Tucson chapter, Richard Kaiser, Co-chair

DownWithTyranny.com, Howie Klein, Publisher

Center for Financial Privacy and Human Rights, J. Bradley Jansen, Director

DownsizeDC.org, Inc., Jim Babka, President

Cyber Privacy Project, Richard Sobel, Director

Citizens For Legitimate Government, Lori R. Price, Managing Editor

Georgia Peace & Justice Coalition, Mike Hearington, Steering Committee

Doctor Patient Medical Association, Kathryn Serkes, Chair

It will definately be interesting to see what happens over the next month or so as the battle continues.  One thing for sure, no matter what comes out as the final bill from conference the American people will be the loosers.