Last night a group of Senate Democrats reached some kind of compromise on the health care reform bill. Senator Tom Harkin “told reporters he didn’t like the agreement but would support it to the hilt” in order to get a bill through the Senate. Reports on the nature of the compromise varied, but Talking Points Memo seems to have the most details:

If this trade-off carries the day, the opt out public option is gone. […]

As has been widely reported, one of the trade-offs will be to extend a version of the Federal Employees Health Benefits Plan to consumers in the exchanges. Insurance companies will have the option of creating nationally-based non-profit insurance plans that would offered on the exchanges in every state. However, according to the aide, if insurance companies don’t step up to the plate to offer such plans, that will trigger a national public option.

Beyond that, the group agreed–contingent upon CBO analysis–to a Medicare buy in.

That buy-in option would initially be made available to uninsured people aged 55-64 in 2011, three years before the exchanges open. For the period between 2011 and 2014, when the exchanges do open, the Medicare option will not be subsidized–people will have to pay in without federal premium assistance–and so will likely be quite expensive, the aide noted. However, after the exchanges launch, the Medicare option would be offered in the exchanges, where people could pay into it with their subsidies.

It appears as if liberals lost out on a Medicaid expansion that would have opened the program up to everybody under 150 percent of the poverty line. That ceiling will likely remain at 133 percent, as is called for in the current bill.

In addition to the new insurance options, the group has tentatively agreed to new, and strengthened, insurance regulations, which the aide could not divulge at this time.

Those unspecified insurance regulations might refer to this:

Additionally, there was consensus support for a requirement long backed by Sen. Jay Rockefeller, D-W.Va., and other liberals for insurance companies to spend at least 90 percent of their premium income providing benefits, a step that supporters argue effectively limits their spending on advertising, salaries, promotional efforts and profits.

The health care bill approved by the House would require insurers to spend 85 percent of premium income on providing benefits. Upping that to 90 percent is even better; my concern is that if enforcement is left to state insurance commissioners, evasion will be widespread.

Chris Bowers is excited about three “meaningful concessions” Senate progressives received in exchange for dropping the (already weak) public option.

I’m off the bus, however, unless further details come to light about very good provisions buried in this compromise. This bill creates millions more customers for private insurers but doesn’t give Americans enough choices, doesn’t create a government plan to keep private insurers honest, and therefore is unlikely to reduce costs or solve the various problems of our current health care delivery system.

In the good news column, last night the Senate tabled (killed) Ben Nelson’s abortion amendment modeled on the Stupak language in the House health care bill. The vote was 54-45, with seven Democrats from conservative states voting with all but two Republicans (roll call here). Harkin voted to table this amendment, like most Democrats, while Chuck Grassley was on the other side.

UPDATE: Can any Obama fans defend this kind of action from his administration?

A proposal to enable the importation of cheaper prescription drugs could endanger the U.S. medicine supply and would be difficult to implement, the Food and Drug Administration said Tuesday. […]

But the Obama administration’s declaration on the eve of the vote could derail the amendment despite the fact that Obama co-sponsored Dorgan’s drug imports bill while a member of the Senate and that White House Chief of Staff Rahm Emanuel was a vocal proponent of the House version of the bill when he served as a member of the lower chamber.

Feel the hope and change!

SECOND UDPATE: The compromise still may not be enough for Joe Lieberman. They shouldn’t have given up on using the budget reconciliation process to pass a better bill with 51 votes.

Health Care for America NOW and the American Federation of State, County and Municipal Employees are running television ads this week thanking 20 Democrats in relatively tough districts who voted for the House health care reform bill last Saturday. If you live in the Des Moines viewing area, you may have seen this commercial about Congressman Leonard Boswell:

Corporate-funded conservative groups have targeted Boswell in negative ads this year because of his vote for the climate-change bill in June. Ads attacking the health care reform project (many funded by insurance industry fronts or the Chamber of Commerce) have been plentiful this summer and fall too. It makes sense for reform advocates to thank Boswell, as Iowa Republicans are gearing up to challenge him with State Senator Brad Zaun or some other well-known figure.  

In other health care reform news, Tom Harkin is among the Senate Democrats trying to keep the "Stupak amendment" language on abortion out of the Senate's version of health care reform. He's absolutely right that some people pushing amendments are trying to kill the bill rather than make it better. A lot of questions have been raised about whether defeating the bill was Representative Bart Stupak's main goal. Since 1992, Stupak has been involved with the fundamentalist Christian "Family" group and has lived in their house on C Street in Washington.  

Stupak claims that as many as 40 House Democrats would reject health care reform without his amendment, but yesterday House Whip James Clyburn said the Stupak amendment only gained 10 votes for the bill. Meanwhile, more than 40 House liberals are threatening to vote down the final bill out of conference if it contains the Stupak language.  

Final note: MyDD user Bruce Webb wrote an interesting piece about what he views as "the most important and overlooked sentence" in the House health care reform bill:  

Most of the criticism of HR3962 coming from the left revolves around the belief that the House bill has no premium and so no profit controls, that it in effect delivers millions of Americans into the hands of insurance companies who can continue to raise premiums at will while denying care by managing the risk pool in favor of those unlikely to make claims. This just is not true, not if the provision in this one sentence is properly implemented. In a stroke it guts the entire current business model of the insurance companies, based as it is on predation and selective coverage, and replaces it with a model where you can only make money by extending coverage to the widest range of customers and or delivering that coverage in a more efficient way.

 Like they say, go read the whole thing.