Given the arm-twisting and deal-making that characterized the Senates eventual Christmas Eve passage of its bill, Senate aides said much of the capitulation on a unified health care bill would need to come from the House.
For example, aides said House liberals would likely have to give up on having a public insurance option, which proved a nonstarter in the Senate.
But negotiations are expected to be intense over whether to tax high-cost, or Cadillac, insurance plans as well as over how much the federal government should subsidize lower-income people who are trying to meet the bills mandate for health insurance coverage. The Senate measure taxes those Cadillac plans, while the House plan does not, and the Senate included less generous subsidies than the House. One key area of wiggle room: about $30 billion in spending can be added to the Senate bill in conference without running afoul of Obamas goal of keeping the measure under $900 billion.
One key compromise could come on the Senate bills reliance on a network of federally sponsored, but state-based, insurance exchanges. The senior Senate Democratic aide said a national exchange included in the House bill is not necessarily off the table for Senate leaders. The insurance exchanges in the Senate bill were included as a mechanism to help bring health insurance costs down, just as House leaders had hoped their plan for a public option would do.