Sen Mike Johanns, R-NE, laid a challenge at the feet of the small handful of pro-life Democrats in the Senate, saying just one needs to come forward and vote against proceeding to the Senate Democratic leader's healthcare reform bill, one Johanns declared inadequate in ensuring that no federal funds can be spent on abortion.

"We don't need 40 Democrats to stand up for what's right. We need just one. if just one pro-life Democrat would say i will not vote to move this bill until it's fixed, until it's truly pro-life, that would happen. So those who say they are pro-life but refuse to take that stand, I worry are not standing up for life. "

Senate Majority Leader Harry Reid, D-NV, attempted to fence off federal money from covering abortion in his bill, but pro-life critics say the effort fails. The HHS Secretary is to ensure that each state has one private plan that covers abortion in the state-based healthcare exchanges. The public option is not permitted to cover the procedure.

But those who oppose abortion want to see the stricter language that passed in the House - where abortions are not permitted in plans on the new exchanges where federal subsidies might be used to buy abortion coverage.

A new Pew poll showed that only three percent of Americans who oppose the Democrats healthcare legislation do so because of abortion, still it was an issue that nearly brought the House healthcare bill down.

Johanns issued a challenge that surely had his senior colleague from his home state, Dem Sen Ben Nelson, in mind, saying that merely voting to proceed just to try to change the bill was unacceptable.

Nelson said as much in a statement Wednesday night, that merely voting to proceed was not a vote of support for the bill, rather it was a vote in favor of moving forward and trying to make changes.

Johanns said he believes there are not the necessary 60 votes to strip out what he sees as offensive abortion language.

"I ask for a pro-life senator to come down here and stand up on this bill. Pro-life Americans are waiting, and they aren't fooled."

When it was originally suggested many months back -- a tax on elective cosmetic surgery -- many positively laughed at the idea.  Most said - NO WAY.

Now -- if you turn to page 2,045 of Reid's healthcare bill, it's right there -- -here's the cut&paste:

Page 2045

SEC. 9017. EXCISE TAX ON ELECTIVE COSMETIC MEDICAL PROCEDURES.

(a) IN GENERAL.-Subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by adding at the end the following new chapter:

''CHAPTER 49-ELECTIVE COSMETIC MEDICAL PROCEDURES ''Sec. 5000B. Imposition of tax on elective cosmetic medical procedures.

''SEC. 5000B. IMPOSITION OF TAX ON ELECTIVE COSMETIC MEDICAL PROCEDURES.

''(a) IN GENERAL.-There is hereby imposed on any cosmetic surgery and medical procedure a tax equal to 5 percent of the amount paid for such procedure (determined without regard to this section), whether paid by insurance or otherwise.

''(b) COSMETIC SURGERY AND MEDICAL PROCEDURE.-For purposes of this section, the term 'cosmetic surgery and medical procedure' means any cosmetic surgery (as defined in section 213(d)(9)(B)) or other similar procedure which-

''(1) is performed by a licensed medical professional, and

''(2) is not necessary to ameliorate a deformity arising from, or directly related to, a congenital abnormality, a personal injury resulting from an accident or trauma, or disfiguring disease.

''(c) PAYMENT OF TAX.-

''(1) IN GENERAL.-The tax imposed by this section shall be paid by the individual on whom the procedure is performed.

''(2) COLLECTION.-Every person receiving a payment for procedures on which a tax is imposed under subsection (a) shall collect the amount of the

tax from the individual on whom the procedure is performed and remit such tax quarterly to the Secretary at such time and in such manner as provided

by the Secretary.

''(3) SECONDARY LIABILITY.-Where any tax imposed by subsection (a) is not paid at the time payments for cosmetic surgery and medical procedures are made, then to the extent that such tax is not collected, such tax shall be paid by the person who performs the procedure.''.

(b) CLERICAL AMENDMENT.-The table of chapters for subtitle D of the Internal Revenue Code of 1986, as amended by this Act, is amended by inserting after the item relating to chapter 48 the following new item:

''CHAPTER 49-ELECTIVE COSMETIC MEDICAL PROCEDURES''.

(c) EFFECTIVE DATE.-The amendments made by this section shall apply to procedures performed on or after January 1, 2010.

Yikes.

Definitely getting creative in paying for this bill.

Looks like CBO is not going to deliver any cost analysis on a healthcare reform bill Senate Majority Leader Harry Reid, D-NE, is trying to bring to the floor this week.

He has been going back and forth with the nonpartisan Congressional Budget Office for some time now, massaging the numbers and policy to get a bill and total price tag that his Caucus can swallow.

He will need every one of his 60 Democrats to vote to move forward to debate on the bill.  A handful are still holding out, because no one has seen any details. Reid is keeping all of that close to the vest, but most believe Reid will be able to open formal debate.

The major questions remain unanswered, as yet:

What kind of public option will be in the bill?  It's almost impossible to see how anything could be in the bill but a triggered government insurance plan. But it's unclear if the more liberal members could stomach this.  The plan, authored by Sen. Olympia Snowe, R-ME, would trigger a public plan almost at the same time current reforms kick in -- IF the reform efforts don't bring costs down.  Reid would have a sales job to get it by a dug-in group who want a robust public option and want it right out of the gate.

Will Reid increase subsidies for the poor and lower middle class?

Will there be more options available to more people?

Abortion seems all but certain to be the Hyde amendment language already approved by the Senate Finance Committee.  Conservative, pro-life Dems like Ben Nelson, D-NE, seem ok with language that clearly fences off all federal funds from being used to fund abortion.   Nelson clearly would like the more restrictive language approved in the House, but he seems to know that won't fly with the vast majority of the Senate Dem Caucus.

Lots more questions remain unanswered.

Possibly Wednesday we see a Reid bill and a special Caucus of Dems to go over the bill.   Unclear if the CBO score would be made public.

That sets up a key test vote to start debate Saturday.  Several key senators have said they feel like Saturday is a near certainty.

After that, they all leave for the weeklong Thanksgiving recess.

Former President Bill Clinton traveled to Capitol Hill Tuesday to push his colleagues to do something he could not do in 1993-94 -- pass a healthcare overhaul bill.

It was clear that Clinton still has the power to mezmerize Dems.  Sen. Ben Cardin, D-MD, emerged positively bubbling over with effusive praise of the former president.

A number of participants afterward said Clinton urged them to complete a bill ASAP, because if they do not they will become defined by the defeat.

The former president, a student of politics, told his fellow Dems that 'not getting it done is not a good political option' -- and that if they do get it done, 'The public will see the sky didn't fall down.'  Cardin said the later was a "near quote."

It seems almost impossible for Congress to get a bill to President Obama's desk this year. Members will be off for the rest of the week in observance of Veteran's Day.  The Senate's number 2 Dem, Dick Durbin of Illinois, told reporters, "Our goal is to make sure it is out of the Senate this year...I wish we could complete it this year. But if we don't, we will get it done."

 Clinton, for his part, emerged and said he told Dems, "This is an economic imperative," remembering the days just after he left office when there was a surplus.

"I just urged them to resolve their differences and pass a bill," Clinton told reporters.

Sen. Chuck Schumer, D-NY, said Clinton told Dems they should get healthcare done and immediately follow that with work on jobs and the ballooning budget deficit, both topics of highest interest to voters at the polls Nov. 3.

Cardin said Clinton told the gathering that energy is where the job growth is.

Nearly all 60 Dems attended Tuesday's policy lunch in the Mansfield Room on the 2nd floor of the U.S. Capitol. Clinton was invited by Senate Democratic Leader Harry Reid, D-NV, and White House Chief of Staff Rahm Emanuel.

Senate Maj Ldr Reid appears to be gambling on this "opt out" public option that he announced earlier today - a national plan that somehow allows states to opt out.  He needs 60 votes on a procedural motion just to begin debate on the bill. I was told earlier today by a senior Dem aide that the rough count on "opt out" is about 58 votes (this appears to waiver, though, on any given day).  Sen. Ben Nelson, D-NE, is known to be one of the holdouts.  Unclear on the other(s).

When I asked a senior aide to Reid (post-Reid news conference) if the leader is 100% sure he has 60 votes (because Reid ignored that question at the event, the aide told Fox, Reid "hopes to have the 60 votes necessary" to move forward with debate on healthcare reform.  So he isn't sure.

His Whip/Deputy, Dick Durbin of Illinois, confirmed that he had not done a "hard Whip count" (where he meets with his deputy whips and they work in teams to ask all Dems how they'll vote or do a lot of persuading; hard tallies are put on paper, etc), that Reid was meeting one-on-one with moderates to win them over.  Durbin said that was the best way to start.

Regardless - Durbin made it clear that more liberal members of the caucus would have rejected a "trigger", so this is the gamble Reid will take - in favor of a public option, something the vast majority of the caucus supports.  Durbin called is "unfortunately a zero-sum situation" -- a comment on losing their only Republican, Olympia Snowe of Maine, in favor of not losing a handful of more liberal senators.

When asked for details of HOW a state will opt out of this national plan, WHO opts out, and other mechanical questions ---- the aide said, "We don't have a lot of details. Final decisions wont be made until we hear back from CBO."

Reid made clear at his news conference earlier that he has NOT sent any other public option (ie, trigger & "opt in" for states) to CBO ----- so I asked if perhaps this is because someone already as a CBO score on these provisions, the aide said emphatically: NO.

And on Snowe --- as I've reported, she's NOT for this opt in approach.  Her office put out this statement in reaction to Reid's announcement:

“I am deeply disappointed with the Majority Leader’s decision to include a public option as the focus of the legislation. I still believe that a fallback, safety net plan, to be triggered and available immediately in states where insurance companies fail to offer plans that meet the standards of affordability, could have been the road toward achieving a broader bipartisan consensus in the Senate.”

I guess they can count her out.  So what now - if there is no Republican support?

So --- sometime as early as next week, when CBO finishes its analysis and cost estimation of the bill (this could take 2 weeks), we will see if Reid has effectively garnered the 60 votes he needs to start debate on this bill.

Just tried to get Sens Snowe & Ben Nelson to comment on Reid's 315pm presser, in which he's expected to announce a decision on public option --- that he's choosing the opt out approach --- and got the following responses:

*NOTE:  Snowe has said emphatically that the only public option she supports is one that is triggered down the road at some determined point if current reforms prove not to be bringing down healthcare costs (aka: "bending the cost curve"):

SNOWE SPOX:  

"Nothing’s changed. She’s made her position on this pretty well known. "

BEN NELSON SPOX:

"Nelson’s out of pocket this afternoon and early evening, so he’s not available and we won’t be sending a statement.

What he said on another cable station yesterday is operational for now:

'I can't decide about the procedural vote until I see the underlying bill. It would be reckless to say I'll support the procedure without knowing what the underlying bill consists of. And it's not put together yet.' "

It might not be considered robust enough by some more liberal members of the Democratic Party, but Senate Majority Leader Harry Reid, D-NV, appears set to announce (at 3:15pm) that he's chosen to put a national public option, giving states the chance to opt out, in his base bill that he will bring to the floor as early as next week.  This is a pretty big deal, as any kind of public option seemed dead on arrival for quite some time.

Sen. Chuck Schumer, D-NY, has been working hard to get something besides a "trigger" option touted by GOP Sen. Olympia Snowe of Maine, the lone Republican to vote for healthcare reform thus far.  She would have a government plan kick in at some determined point, if current reform efforts don't work.

The White House has been trying to keep her on board, but Dem sources  say that the Administration is not pressuring Reid.  (see White House blog for Dan Pfeiffer's weekend entry)

Keep Reading ...

As we've reported, a compromise is emerging in the Senate on a public option that give states the opportunity to either opt out of or opt in.  Democratic sources say the former, rather than the later, is preferred by Majority Leader Harry Reid, but some concerns still exists for moderate Dems, like Sens. Ben Nelson, D-NE, and Blanche Lincoln, D-AR, among others.

Regardless, the very idea of creating some sort of government-created insurance plan, that seemed a distant possibility in the Senate until this week, is now gaining steam.

One moderate Democrat, Sen. Mary Landrieu, D-LA, just met privately with Reid and emerged to say, "It really is a possibility," adding, "There is a way to complete this, I believe."

Landrieu has been inside meetings with her fellow moderates for months, bipartisan meetings that have ranged in size from about 5 or 6 to 15 members. "It's everyone from Ben Nelson to Mark Udall," Landrieu said, referring to the Democratic senator from Colorado.

Landrieu described a plan that would be modeled on the health plan for federal government employees, called Federal Employee Health Benefits Plan (FEHBP), that could be started with federal "seed money" and run not by the government, but by a private, independent board (though it is not clear yet who would appoint the board).  The program would be funded by an earnings pool created from premiums.

"It's a private insurance model," Landrieu said, insisting that it neither be government-run, government-backed, nor government paid-for."

Landrieu has some criticism for the more liberal members of her caucus, saying that "this may not meet their requirements" for a "single payer, government-run, government-subsidized" insurance plan, but Landrieu said her group would not accept anything like that, something supporters call a "robust public option."

The senator said her group was trying to combine a proposal that emerged from the Senate Finance Committee, authored by Sen. Kent Conrad, D-ND, that would create a system of nonprofit cooperatives, and merge it with a states-based approach to a national plan authored by Sen. Tom Carper, D-DE.

"It's evolving. At this point...some solid compromise is possible," Landrieu said.

Pointing to about 5 or 6 Senate Republicans that she thought might be gettable, including both Maine moderates - Susan Collins and Olympia Snowe, as well as, George Voinovich of Ohio and Bob Corker of Tennessee.

These are definitely just guesses from Landrieu, it seems, in talking to these senators.  All of them have varying levels of concern about this and many other components of the bills passed by the Senate and now the subject of merger negotiations between Reid and Administration officials.

The issue of whether not states will have to opt in or can choose to opt out of a government-created insurance plan is not something Landrieu wanted to discuss, and this could certainly derail this compromise.  Sens. Nelson and Evan Bayh, D-IN, both former governors, along with Lincoln, have expressed a great deal of concern for the "opt out" option, the one favored by Reid and many other Democrats.  Nelson wants to know, for instance, how difficult it would be for states to opt out, fearing that those who want a more robust public option would virtually lock states into plans from which they could not opt out.

And there is certainly a long way to go before Senate Democrats can get a bill passed.  Leadership aides have told Fox that a bill will likely not be sent to the nonpartisan Congressional Budget Office (CBO) for a final analysis and determination of price tag until Monday or Tuesday of next week.

Moderates want to see more choices and greater affordability for all Americans in the bill that Reid is creating, a sentiment often expressed by more liberal members, as well.  Landrieu, alone, pointed to the variety of choices federal employees have, noting that in New York there are 34 insurance options, alone.

"We are not carrying water for the insurance companies," Landrieu said of herself and her moderate colleagues, but "We want to see more choice and more affordability not just for those who don't have insurance, but for those who can't afford what they have." 

Landrieu said that she and some of her fellow centrists want to see people come off of cash-strapped Medicaid programs and out of insurance plans they cannot afford to buy into a system like the one described, but she said that would not be part of current efforts to find a public option compromise.

"We're not trying to be Republicans...but we do believe in the free market," Landrieu said.

A handful of centrist Democrats with Sen. Olympia Snowe, R-ME, could pose a major problem for Senate Majority Leader Harry Reid, D-NV, as he tries to bring major healthcare reform legislation to the Senate floor.

Snowe, in concert with Sen. Ben Nelson, D-NE, has hosted a group of about five to six moderates, including Sens. Joe Lieberman, D-CT, Mary Landrieu, D-LA, Blanche Lincoln, D-AR, and, at times, Susan Collins, R-ME. 

Senate Majority Leader Harry Reid, D-NV, will need 60 votes to start debate on healthcare in the coming weeks, but centrist Democrats seem to be girding for a possible fight, should Reid put anything in the bill with which they do not agree.

  Keep Reading ...

Senate Majority Leader Harry Reid, D-NV, suffered his first defeat on healthcare reform today, but is it really a defeat?

No -- there will not be a 10-year $250 billion unpaid-for fix to avert the steep cuts Medicare doctors could receive in their federal reimbursement.

BUT -- this allows Harry Reid to get a $250 billion headache out of the way of broader healthcare reform, which, according to the budget and a White House mandate, must be deficit neutral.

AND -- it allows the leader to say he tried the $250 billion UNPAID-FOR route and it didnt work, so he can argue (possibly successfully) to keep it off the larger bill.

Not only that -- but imagine if this $250 billion UNpaid-for fix came to the floor during the healthcare reform debate. It's offered as an amendment.  If you're a Republican who wants to sink THIS healthcare reform bill (not healthcare in general -- Republicans have different wants in terms of reform, though they reiterate often that they DO want reform), would you not vote FOR the amendment, increase the price tag on the bill to well over $1 trillion? 

You've just voted to bust the budget, but the Democrats' healthcare reform effort would then be in serious jeopardy.