As the health care bill debate gets heated up there are many lawmakers who are threatening not to support it unless some changes are made. This is a direct result of Senate Majority Leader Harry Reid working out a number of compromises just to get the votes needed to push the legislation forward.

While the bill has gone this far it could be stopped in its tracks very quickly if some key issues are not resolved. Here are some of the key points that may gum up the works:

  • Public Plan: The Senate bill will create a federally sponsored medical insurance plan for those who cannot get coverage through their work. As it stands now, each state will have the ability to opt out of such a plan. Several conservative Democrats have voiced concerns over this point and will not support the bill in this form as they feel it expands the government too much. Instead they want to see trigger points that will create these options only in areas of the country that do not meet affordability standards. However, any such move will weaken support from the more liberal Democrats who will not support such triggers and instead want a government sponsored plan to pass ASAP.
  • Abortion: The hot topic here is that the conservatives will not support a bill that allows for taxpayer dollars to pay for abortions. This will be the case if someone is receiving federal subsidies to pay for their medical insurance and the conservatives are calling for strict measures to take place to ensure this doesn’t happen. But the liberals say they will not tolerate any further restrictions on abortion services and this is ultimately going to lead to some gridlock on the floor.
  • Subsidies: The Senate bill will provide those who cannot get health insurance through work with a subsidy to help pay for insurance costs. This subsidy will only be made available to those who are making between 133 percent to 400 percent of the poverty level. The conservatives say this will not be enough as almost everyone will be required to buy insurance under the bill’s current form. This puts Reid between a rock and a hard place as he cannot lose any more liberal votes but if he caves in on more subsidies then he threatens to push the entire cost of the plan up and that will effectively eliminate its ability to lower the deficit.
  • ‘Cadillac’ Health Insurance: The Senate bill now imposes a 40 percent excise tax on high-end, or ‘Cadillac’ medical insurance policies that are worth more than $8,500 for individuals and $23,000 for family policies. This is not sitting well with many labor unions as they have negotiated better health care plans in the past instead of increased pay. These labor unions are pushing for higher thresholds to save middle income American money. However, if the bill gives in on this point then it will have to figure out another tax to impose in order to gain the $149 billion that the ‘Cadillac’ tax is expected to generate over the next decade.
  • Malpractice Lawsuits: The bill does not change medical malpractice laws and only encourages states to look at different alternatives to civil litigation. Republicans want a limit on the amount of money that can be won, which they say, will save $54 billion over the next decade. If the Democrats give in on this point they risk angering their long-standing allies in the trail attorneys.
  • Prescription Drugs: The current bill requires drug makers to provide a 50 percent discount to seniors for brand name drugs after they hit the Medicare Part D coverage gap. One proposal is to import drugs from other countries in an effort to make them more affordable.

Yes the debate will rage on and somehow it is almost certain that these issues will find a way of working themselves out. But if Reid can’t find a way to pacify his constituents on both sides of the table, he risks seeing the entire bill be stopped dead in its tracks.

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