Sources: Talks 'Approaching the End'
Jonathan Cohn
Negotiations over health care reform continued into the wee hours of Friday morning, as President Obama presided over a White House meeting with his top advisers and congressional leaders.
The group met in the Cabinet room. Obama didn't leave until just before 1 a.m. The congressional delegation, which included House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid, didn't depart until 1:25.
No agreement was reached and talks will continue today. But several sources from the administration and Capitol Hill suggested that a deal was getting close. "I think we are approaching the end," one Democratic source said.
Multiple, sometimes contradictory stories about the details of negotiations were circulating throughout Washington world all night long. But those with direct knowledge of the talks said there was an emerging, if still fluctuating, consensus that insurance exchanges in the new system would be some sort of state-national hybrid--possibly a blending of the proposals that gives states more autonomy than the House proposal envisioned but gives the federal government more regulatory oversight than the Senate proposal initially sketched out.
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Whatever the net addition of new money, a key issue will be how to spend it. The biggest weaknesses of the Senate bill, relative to its House counterpart, are in so-called actuarial value and overall limits on out-of-pocket spending. The low actuarial value, in particular, would mean higher cost-sharing for a large number of people with moderate- to heavy medical expenses. (High out-of-pocket limits also mean higher cost-sharing, but they tend to affect only the very sickest people, since only the very sickest people spend enough to reach those limits.)
But improving actuarial value costs a lot of money--precisely because it affects so many people. It also raises more political opposition among even some moderate Senate Democrats. As such, discussions were apparently moving towards improving, instead, the subsidies for purchasing insurance--although sources cautioned again that, at least as of very early this morning, discussions remained extremely fluid.
The goal, all week long, has been to wrap up negotiations today, so that language could go to the Congressional Budget Office.
http://www.tnr.com/blog/the-treatment/sources-talks-approaching-the-end
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