It’s crunch time for health insurance reform, and Senator Tom Harkin and the three Iowa Democrats in the House “announced a major breakthrough today on the issue of Medicare payment reform in the final health care reform bill,” according to a joint press release. Excerpt:

[Representatives Dave] Loebsack, [Senator Tom] Harkin, [Leonard] Boswell and [Bruce] Braley have been outspoken advocates for changing the way Medicare pays health care providers for services, from its current fee-for-service system into a quality and value-based system.

Loebsack, Harkin, Boswell and Braley helped negotiate a compromise adding language to the health care reform bill that provides an immediate $800 million to address geographic disparities for both doctors and hospitals, as well as written guarantees from Health and Human Services Secretary Kathleen Sebelius for further action to reform Medicare reimbursement rates that do not qualify for reconciliation under the Byrd Rule. The Senate bill previously only provided a Medicare reimbursement fix for doctors.

The House reconciliation package maintained automatic implementation of a value index as part of the reimbursement structures for doctors, beginning in 2015.  This language was secured in the Senate bill with the help of Harkin and is based on Braley’s Medicare Payment Improvement Act, introduced in June 2009. Under the fixes secured in the Senate bill and the House reconciliation package, Iowa doctors will see five percent increases in current Medicare reimbursement rates in both 2010 and 2011.

I posted the whole press release, containing more details, after the jump. This deal appears to have secured the vote of Peter DeFazio (OR-04) as well. Yesterday he threatened to vote no because of language on the Medicare payments disparity.

President Barack Obama gave House Democrats a pep-talk today, and his speech (which wasn’t pre-written) got rave reviews from many Democrats. If only the Senate bill were as good as Obama made it sound. (UPDATE: I posted the White House transcript of Obama’s speech after the jump.)

House Democratic leaders have decided to ditch the “deem and pass” method for passing health insurance reform with a single vote, even though the legislative procedure isn’t as rare or controversial as Republicans would have you believe. Instead, the House will hold an hour of flood debate tomorrow on “the rule to allow reconcilation to get to the floor,” then House members will vote on the rule, then they will debate the Senate health insurance reform bill and vote on it. I assume this means that House Speaker Nancy Pelosi is confident she has the 216 votes she needs.

Bart Stupak is now claiming only about half a dozen Democrats are willing to vote against the bill unless it contains major new restrictions on private insurance coverage of abortion. Stupak was supposed to hold a press conference this morning, but he cancelled it, so maybe that means he didn’t get the deal he was hoping for from Pelosi. David Dayen speculates on who is still in the Stupak bloc. David Waldman warns about the prospect that Stupak will use a “motion to recommit” to try to get his anti-abortion language into the reconciliation fix package.

Outside the Capitol, tea party protesters shouted racist insults and held signs threatening gun violence if health care reform passes. Congressional Republicans should disavow this reprehensible behavior, but of course they won’t.