Over the last week, tens of thousands of people have sent a letter to President Obama, Speaker Pelosi, and Majority Leader Reid telling them to finish health reform right. Joining them, hundreds of organizations who care about health reform - from huge international unions to small community groups - and health care and political experts like Jacob Hacker, Wendell Potter, and Mike Lux have also signed on to the letter.

With one voice, we're all fighting for some very important things as the House and Senate health care bills head into conference to be reconciled. Things like:

• Affordable health care for low and middle income people - a mixture of the House and Senate bills
• Affordable health care at work, with employers pitching in their fair share to cover employees, as is done in the House bill
• A financing plan for health reform that doesn't tax middle class health benefits, as is done in the House bill
• Strong insurance regulations like a national exchange and standard benefit plans, like those in the House bill
• And a national public health insurance option, like the House bill

These things are important. They will lower cost to government and to people. They will hold the insurance industry accountable and do away with their bad practices. They will increase competition. And they will make health care for you and me better.

These things are worth fighting for, and so we're sending an important message.

Next week, we'll be turning up the volume. We've got a television ad all set to go, sending a clear message to Congress and the White House that important things must be fixed in conference. The ad is set to run in all 50 states and Washington, DC, guaranteeing our politicians get the message.

Watch it:

Can you help us put this ad on the air? It's the end of the year, so can you chip in $10 to help us finish health reform right? Click here to donate securely online and help us turn up the volume.

This morning, the Senate passed their health care bill Here's our statement, from National Campaign Manager Richard Kirsch:

“With passage by the Senate, the nation has moved one big step closer to comprehensive health care reform. Health Care for America Now will work to get the strongest bill to the President’s desk, one that provides good, affordable coverage to all and holds insurance companies accountable. To realize the promise of reform, we need to be sure that employers are required to help pay for good coverage for their workers, that premiums are affordable to families, that we do not tax benefits, that we enact tough insurance regulations, and that we offer the choice of a public health insurance option. We will urge President Obama to work with leaders in both houses of Congress to agree on legislation that meets these goals, guaranteeing good health coverage we can count on.”

Yesterday, we discussed what needs to be fixed in terms of affordability before the final health care bill reaches the President's desk. Today, let's talk about insurance accountability.

Holding the insurance industry accountable has always been a key goal of health reform. In fact, one of the main promises of health reform - that you'll never be denied needed care - is based off the sad reality that insurance companies routinely deny health care to increase their profits.

The abuses of the Wall Street-driven insurance companies are legion, and have been thoroughly chronicled here and elsewhere, but here's a quick rundown [pdf]:

• Insurers deny medically necessary coverage for profit
• Insurers discriminate against women, children, older people, and sicker people
• Insurers drop coverage when you get sick
• Insurers reward employees for denying care
• Insurers collude with providers to drive up prices
• And insurers and Wall Street reward CEOs for increasing profits by using all the abuses listed above

These insurance company abuses must be stopped. And insurance companies need to be given an incentive to serve their customers as opposed to their Wall Street investors, perhaps a more important goal. This should be accomplished in two ways: Strong, enforceable insurance company regulations, and a national public health insurance option available on day one.

NEWS

Obama tries to distance himself from the public option - Politico

Now that the Senate has firmly rejected the public option, President Obama is trying his darnedest to distance himself from the controversial, and failed, proposal. But that may be harder than he thought.

Did Obama Campaign On The Public Option? Yes But Not Entirely - Huffington Post

President Barack Obama, in an interview with The Washington Post, said on Tuesday that in the two years leading up to his election he "didn't campaign on the public option" for insurance coverage.

House Dems: We won't roll over - Politico

House Democrats insisted Tuesday they have no plans to roll over for the Senate in upcoming negotiations on a health reform bill, even as they acknowledged it would be all but impossible to reinsert a public insurance option or force the so-called millionaire's tax on the Senate.

Health fight shifts to insurer shopping - Boston Globe

Extent of regulation on exchanges is pivotal; US plan could follow Massachusetts model

Republicans Relent; Final Senate Health Care Vote 8AM Christmas Eve - FDL News

Republicans, eager to get home for Christmas, have agreed to give back some of their debate time which delayed the inevitable, setting up a final vote on the Senate health care bill on December 24, this Thursday, at 8am ET. Previously, the Senate would have had to wait, if the Republicans stretched out the clock, to 8pm that night or even later. Now they can achieve the vote and be back in their states in time for the Christmas goose.

Ed Hanway, CEO of Cigna, one of the nation's largest health insurance companies, will step down at the end of this year, in just over a week. When he does, he'll get $73,200,000 as compensation for a job well done.

What makes Hanway worth $73.2 million? Well, for one example, he's presided as Cigna denied a liver transplant to 17-year-old Nataline Sarkisyan, causing her death and widespread outrage. Wendell Potter, Cigna's former spokesperson turned whistle-blower, was at the company during the Sarkisyan scandal, and he explains its effect on him personally, as well as how the company thinks about denying care:

In our system today, there is literally no repercussions for insurance companies when they deny care, jack up rates, or do all the other things they do to screw over their customers. Ed Hanway did all those things as much as he could, and for that, he's being rewarded.

Out there in America, people are losing their jobs. They're losing their homes. They're skimping on holiday gifts to put food on the table. And they're still going bankrupt due to skyrocketing medical costs.

Meanwhile, insurance company stocks are "on fire" in reaction to the Senate bill, which, though it has some regulations, leaves people at the mercy of private insurance because it lacks a public health insurance option.

People out there are suffering, insurance companies are winning, and Ed Hanway is walking away with $73.2 million.

We've managed to track down Hanway's personal email address. This isn't a spam box or an unattended address, this is Hanway's actual corporate email. It's H.Edward.Hanway@CIGNA.com.

Send him an email. Tell him what you think of his golden parachute. While you're at it, why don't you tell Hanway what you'd like for Christmas, and what you'd buy with his money. You can leave a message on Cigna's Facebook page as well, if you want.

As I noted yesterday, there are two crucial areas that need attention before a final health care bill is sent to President Obama for his signature: Affordability and insurance company accountability. Today, I'll focus on what specifically needs to be done to make good health care affordable.

The Senate health care bill slated to be passed by Christmas Eve falls short of affordability in three ways:

1. It lacks adequate subsidies to make health care affordable for those who don't get it through work and are buying it in the new health insurance exchange
2. It lacks any shared responsibility provision for employers, meaning employers don't have to give their employees good health benefits, increasing cost to workers
3. And it taxes health care benefits to pay for reform, again increasing costs

The House bill comes extremely close to taking care of all of those points in a way that reduces costs for you and me, although it needs improvement on subsidies for low and moderate income people, as discussed below.

NEWS

Democrats Face Challenge in Merging Health Bills - New York Times

Even as the Senate took a significant step toward passing its version of a sweeping overhaul of the health insurance system before Christmas, Democrats were grappling Monday with deep internal divisions over abortion, the issue that most complicates their drive to merge the Senate and House bills and send final legislation to President Obama.

Three big differences between House and Senate healthcare bills - CSM

Even if the Senate healthcare bill is approved, reconciling it to the House bill will take a concerted effort on three major points: who bears the cost, the public option, and abortion funding.

Seeing Public Subsidy (Not Public Option) Investors Flock to Health Insurers - Huffington Post

Investors are seeing the Senate's version of health care reform as a massive public subsidy for insurance companies — and as a result, are sending the sector's stock prices shooting up, up, up. Stripped of a government-run insurance plan, the bill would give tens of millions of Americans no option but to start paying hefty premiums to private companies.

Public option tensions linger - Politico

Just hours after a critical Monday morning vote in the Senate, Democrats were already talking about future changes to the health reform effort in hopes of calming a revolt among liberal activists.

Senate still on track for final Christmas Eve vote on healthcare reform bill - The Hill

A final vote on the Senate healthcare bill is on track to happen Christmas Eve.

Now Democrats must sell health plan to voters - LA Times

With a healthcare overhaul inching closer to reality, Democrats looking to next year's midterm elections plan to market the bill as a way to help voters who are focused more on unemployment and the economy.

Dean faults White House for death of the public insurance option - The Hill

The administration is to blame for the public option's exclusion from healthcare legislation, former Democratic National Committee Chairman Howard Dean said Monday.

Senators overseeing health bill debate get dose of PAC money - USA Today

As the health care bill moves toward a critical vote in the Senate, the five senators charged with overseeing the floor debate count health interests among their biggest campaign contributors, records show.

Last month, history was made. The House of Representatives passed a health care bill that gave the American people what they want.

In poll after poll, people wanted most of all to have the choice of a public health insurance option, to keep their health care benefits untaxed, and to have affordable health care both at work and out of it. The House bill came incredibly close to those goals. It was truly history-making.

Early this morning, the Senate took its first step towards passing a health care bill. While the Senate bill includes significant reforms, it looks small in comparison with the House. And progressives are, as Richard Kirsch, our National Campaign Director said, "Very, very angry and disappointed."

Shortly, the two bills will head into conference. In the next few days, we'll elaborate on what exactly needs to be fixed in the Senate bill and how it's better in the House bill, but for now, the key differences can can be broken down into two areas:

1. Make health care affordable
Low and middle income families must be able to afford health insurance if they do not get it through work, and employers must be asked to provide good health coverage for their employees so health care is affordable at work.

The House bill asks employers to pitch in, and is much more affordable for lower-income people who don't get coverage through work. The Senate bill lets employers off the hook, increasing the cost to employees for health coverage, though it is more affordable for middle-income people who don't get coverage through work.

Also, the House bill finances reform with a surtax on the richest families - those making over $1 million per year. The Senate bill finances reform by taxing middle-class health care benefits, which will only increase cost or decrease coverage for millions.

The final bill should ask employers to pitch in and share responsibility for full and part-time workers, and should make health care affordable for all incomes. And t he final bill should get rid of this tax on health benefits, something President Obama ran against. Instead, the wealthiest in society who can afford to help should be asked to pitch in their fair share to pay for reform.

2. Hold insurance companies accountable
Insurance companies must be held accountable with strong regulations and consumer protections, and we must be given the choice of a national public health insurance option available on day one. The House bill gives us that choice.

One are we've seen the Senate bill improve upon since dropping the public option is improved insurance regulations such as the Patient's Bill of Rights. But the House bill is still stronger in many aspects. The final bill needs tough regulations and real choices, to give the American people what they want and need.

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In all of these areas (except some aspects of affordability, to be elaborated upon in the next few days), the House bill does a better job than the Senate bill of standing up for what the American people want and need. Speaker Pelosi has a document on the differences between the bills that's worth checking out, which lays things out along similar lines.

This process isn't over, not by a long shot. This what we'll be fighting for in conference. (And yes, there will be a conference.)

Over the last few weeks, progressives have been shocked and demoralized by the way the debate in Washington has played out. But we can't stop fighting, and we can't stop pressuring our leaders in Congress and the White House to do what's right.

A good bill, like the House bill, that does right by Americans can still be delivered to the Oval Office. Congress and the President have a choice: They can give us that good bill, or they can leave us disappointed and angry. A message to them: Choose wisely.

NEWS

Health Bill Passes Key Test in the Senate With 60 Votes - New York Times

After a long day of acid, partisan debate, Senate Democrats held ranks early Monday in a dead-of-night procedural vote that proved they had locked in the decisive margin needed to pass a far-reaching overhaul of the nation’s health care system.

Health plans on collision course - Politico

Despite a last-minute weekend deal that put the Senate on the brink of passing health care reform this week, liberal and moderate Democrats remain on a collision course over the bill, as both sides dug in Sunday for the next phase of negotiations.

Democrats Move To Regulate How Insurers’ Spend Customers’ Money - Kaiser Health News

Amid all their squabbling over health care legislation, Democrats staunchly agree on the need to regulate how insurers spend their customers’ money.

Hopes Dim, G.O.P. Still Vows to Fight Health Bill - New York Times

A day after Senate Democrats said that they had clinched an agreement on a far-reaching overhaul of the nation’s health care system, Republicans vowed on Sunday to continue their fight while acknowledging that their chances of stopping Senate passage had faded.

How health lobbyists influenced reform bill - Chicago Tribune

David Nexon had a big problem. An early version of national health care legislation contained a $40 billion tax aimed squarely at members of the medical device trade association he represents.

Democrats Pin 2010 Hopes on Bill - Wall Street Journal

Slumping in the polls and struggling to pass climate and financial legislation, President Barack Obama and Democratic leaders are counting on an historic health care victory to buoy their electoral prospects in 2010.

Senator Nelson has announced that he is on board for cloture on the Senate health care bill. Majority Leader Reid is expected unveil his Manager's Amendment and announce he has the 60 votes needed to move forward shortly. (It'll probably be broadcast on CSPAN for those who want to watch.)

Here is the full text of the Manager's Amendment [pdf]. And here's a bit of what's in it, courtesy of Reid's office:

• Stronger medical loss ratios. Health insurers will be required to spend more of their premium revenues on clinical services and quality activities, with less going to administrative costs and profits - or else pay rebates to policyholders. These stricter limits will continue even after the Exchanges begin in 2011, and apply to all plans, including grandfathered plans. (Ed note: Reportedly, these require group insurance plans to pay 85% of premiums to health care, and individual plans to pay 80%. These would go into effect in 2011. In 2012, the ratios would be based on the average medical loss ratio in the Exchange.)
• Accountability for excessive rate increases. A health insurer's participation in the Exchanges will depend on its performance. Insurers that jack up their premiums before the Exchanges begin will be excluded - a powerful incentive to keep premiums affordable.
• Immediate ban on pre-existing condition exclusions for children. Health insurers will be immediately prohibited from excluding coverage of pre-existing conditions for children.
• Patient protections. Health insurers will have to abide by a set of patient protections that, for example, protect choice of doctors and ensure access to emergency care.
• Ensuring access to needed care. The use of annual limits on benefits will be tightly restricted to ensure access to needed care immediately, and will be prohibited completely beginning in 2014.
• Guaranteed opportunity to appeal coverage denials. All health insurers will be required to implement an internal appeals process for coverage denials, and states will ensure the availability of an external appeals process that is independent and holds insurance companies accountable.
• Multi-state option. Health insurance carriers will offer plans under the supervision of the Office of Personnel Management, the same entity that oversees health plans for Members of Congress. At least one plan must be non-profit, and the plans will be available nationwide. This will promote competition and choice. (Ed note: At least two plans will have to be offered, one of which must be non-profit. OPM can negotiate medical loss ratio, profits, premiums and other terms.)
• Free choice vouchers. Workers who qualify for an affordability exemption to the individual responsibility policy but do not qualify for tax credits can take their employer contribution and join an exchange plan.
• Children's health. Support will be extended for the Children's Health Insurance Program and the adoption tax credit. Foster care children aging out of Medicaid will be able to retain its comprehensive coverage.
• Rural and underserved communities. Access will be expanded through funding for rural health care providers and training programs for physician and other types of health care providers.
• Revised abortion language, including state opt-out of abortion coverage (Ed note: details here)

The first cloture vote is expected to be filed shortly, putting the bill on track for passage in a few days.

Going forward, we'll be fighting as hard as possible to make sure we get the strongest bill to the President's desk.