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.

On Sunday, the House of Representatives will vote on the Senate’s health insurance reform bill and some “fixes” to that bill. The procedural details have not been fully worked out (David Waldman takes you through the weeds here and here), but it’s clear that the vote will be very close. House Speaker Nancy Pelosi needs to find 216 votes to pass the bill.

Various whip counts are floating around the internet. Take your pick from David Dayen’s version at FireDogLake, the Chris Bowers tally at Open Left, or the latest from The Hill staff. Several Democrats who voted against the House health care reform bill in November have announced plans to vote for this version. However, others who voted for the House bill remain undecided or have said they will vote no.

Today Peter DeFazio (OR-04) threatened to vote no on the bill because of changes in language on correcting geographical disparities in Medicare spending. DeFazio explained, “We spent months working this out. If we don’t get it in this bill, we will never get it.” The Huffington Post reported that other House Democrats share DeFazio’s concerns.

Because all three Iowa Democrats in the House strongly supported the changes to Medicare reimbursement rates that were included in the House bill, I contacted their offices today to find out whether they, like DeFazio, consider this issue a deal-breaker. I have not yet heard back from staffers for Representative Leonard Boswell (IA-03) or Dave Loebsack (IA-02), but a spokeswoman for Bruce Braley (IA-01) sent me this response:

Congressman Braley has spent hours in meetings with Speaker Pelosi and House Leadership this week, discussing the need to correct geographic disparities in Medicare reimbursement and how those corrections can be accomplished in this final bill.  Congressman Braley is still very much undecided on how he will vote on the reconciliation package and this is one of many factors that will play a role in his final decision.

I’ve never seen Braley on any list of wavering Democrats on the health insurance reform bill. If he and DeFazio do end up voting no, it will be much harder for Pelosi to find 216 votes. On the other hand, a compromise could be reached before Sunday:

At her press briefing Friday morning, House Speaker Nancy Pelosi (D-Calif.) was asked about Rep. Peter Defazio’s objections to the removal of the Medicare disparity fix from the final bill. “We’re working on that language,” said Pelosi. “I feel comfortable about where we are heading.” She said she supports the language that was in the House bill and is working toward restoring it as much as possible.

“We have reached agreement before,” she said of the dicey political issue.

I will update this post if and when I hear back from Loebsack’s and Boswell’s offices.

UPDATE: Loebsack’s spokeswoman confirmed that he will vote for the bill. Boswell seems like a firm yes as well, judging from an e-mail blast he sent yesterday, which I have posted after the jump.

SATURDAY UPDATE: Braley confirmed that he will vote for the bill because of the deal on Medicare reimbursement payments I discussed in more detail here.