Insurers anxious over the health care debate may breathe easier as a mix of congressional gridlock and rapidly approaching deadlines may delay or derail reform efforts. Indeed, at 1,900 pages, H.R. 3962, the “Affordable Health Care for America Act,” may have given insurers plenty to contemplate, but may also be an indication that the reform efforts will drag on until next year.

Though House Democratic leader Steny Hoyer (D-Md.) has indicated he would like to have a final vote on the legislation as early as next week, the more than 500 amendments offered to the health reform legislation in the Senate may prove instructive. Further muddying the matter, Republicans intend to introduce their own 230-page take on health care reform later this week, according to published reports.

“I can’t imagine the discussion the House is going to have about the all the amendments that are going to be tacked on,” Paul Keckley, Ph.D., a health care economist and executive director of the Deloitte Center for Health Solutions, tells Insurance Networking News.

While Keckley believes one of the primary concessions the sponsors of H.R. 3962 made—not granting rate-setting authority to any public option or government funded co-op— may help it appeal to moderate Democrats, it doesn’t ensure final passage. “It keeps the moderates behind the bill but they still have to find another 20 votes, so it’s going to be challenging,” he says.

One factor all pieces of legislation must contend with is time. Legislators are hoping to get reform measures enacted before next year, Keckley notes. With a sizable majority, Speaker of the House Nancy Pelosi (D-Calif.) may well be able to bring a reform bill to a vote by Thanksgiving. Senate Majority Leader Harry Reid (D-Nev.), who has promised a vigorous floor debate on his bill, may have a tougher time shepherding his legislation to a vote given the rules of the Senate.

Reid’s task was made tougher when Sen. Joe Lieberman (I-Conn.) recently indicated that he would not vote to end a Republican filibuster if reform legislation included a public option. While Reid could conceivably pass some reform measures by a simple majority vote under the reconciliation process, which is normally confined to budget-related votes. Keckley says this option is unappealing for Reid because many of the most sought after reforms, such as banning rescission by health insurers, cannot be addresses using it. “Some of the things they can’t do under reconciliation are what they think are the most important,” he says. “To stick to insurance-related reforms, they have get 60 votes and that means keeping the moderates happy.”

If and when Reid and Pelosi manage to get a bill through their respective chambers, the two pieces of legislation would need to be combined and returned to each chamber for a final vote. The fact that 2010 is an election year, further compresses the amount of time available, Keckley notes.

Another primary political calculation for legislators is cost. Reid’s bill is currently at the Congressional Budget Office for scoring, but is expected to cost roughly $900 billion. Also impacting the legislation is the fate of the economy at large. “All of this has to work in an economy having a hard time,” Keckley says. “The longer the economy is down, the more incremental the bill is likely to be.”

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