WASHINGTON — The mounting Senate tension in these last days of the 2009 session is all about public options, Medicare and abortion policy, but step away from the rhetorical flames and it turns out that a lot of lawmakers from both parties agree on many proposals to change the nation's health care system.
The headlines will say that Senate Democrats struggled Monday to find common ground on the more contentious issues, and President Barack Obama planned to meet with them Tuesday afternoon.
At the same time, though, there's little discord over plans to require insurers to offer a minimum amount of coverage to nearly everyone, and the Democratic-authored House of Representatives and Senate bills bar insurers from denying coverage or raising rates because of pre-existing conditions.
Under both bills, lower-income people could get government help to buy insurance, and Medicare costs would be trimmed significantly.
There are differences on how these policies could be implemented, but "There are overarching ideas that almost everybody (from both parties) agrees with," said Drew Nannis, an AARP spokesman.
"It's a big deal," Elizabeth Carpenter, a health care analyst at the New America Foundation, a liberal public-policy research institute, said of the common ground. "I know there are a lot of questions about the public option, abortion and other issues, and these are all important conversations. "But they're not the be-all, end-all of reform."
The incendiary issues — such as whether to create a government-run health-care plan, or public option, which appears nearly dead in the Senate, and to expand Medicare, the government's insurance program for people older than 65 and others with some disabilities — have stalled progress on health-care legislation for weeks.
The struggle continued Monday, with Senate Democrats appearing to back off from the Medicare expansion plan after some Democrats expressed reservations about it.
The tentative deal that Senate Democrats have been considering would all but abandon the public option, but the plan to offer Medicare instead to 55- to 64-year-olds under certain circumstances is increasingly likely to be abandoned as Democrats seek to win enough votes to pass the health care legislation.
Democrats control 60 of 100 Senate seats, which means that they need to keep every Democrat in line in order to cut off extended debate, unless they pick up a Republican or two, which is a 50-50 proposition.
Sen. Ben Nelson, D-Neb., wants stricter limits on abortion coverage. Sen. Joe Lieberman, a Connecticut independent who caucuses with Democrats, said he opposed the Medicare extension and a public option, a concern shared by a handful of Democrats.
They all tend to embrace the other changes, however, and have some Republican support.
Among the areas of agreement:
_ Requiring most people to have a certain level of health care coverage. In the Senate bill, those who don't would pay a $750 penalty after 2016, up to a maximum of $2,250 per family. The House penalty is on a sliding scale, depending on income.
_ Helping those who have trouble paying for coverage. Both bills offer help to people who earn up to 400 percent of the poverty level, currently about $88,000 a year for a family of four.
_ Creating health insurance exchanges. Though the bills differ in how the exchanges would be set up, they agree that consumers would be able to shop for coverage and rates easily through the exchange, or marketplace. Exchanges would have to offer four kinds of plans, from basic to premium. Basic plans would cover 70 percent of the actuarial value of costs in the House version, 60 percent in the Senate bill.
_ Barring insurers from denying coverage or charging people more because of pre-existing conditions.
_ Ending separate rates because of gender, which now is allowed in most states. In addition, both bills would limit how much more an insurer could charge someone because of age.
One question that's looming throughout the Capitol is whether lawmakers will be willing to enact the provisions they agree on if they deadlock on the more controversial issues.
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