Health care reform debate

FARGO -- Senate debate on health care reform could begin as early as next week, and Minnesota and North Dakota's senators have similar but varied ideas about what should be included in the final legislation.

Although the House passed its health care reform bill last weekend, that action has minimal impact on senators' decisions since the Senate will debate its own bill, North Dakota Democrat Kent Conrad said.

But a unified Senate bill hasn't been released yet, as Senate leaders are waiting for the Congressional Budget Office to issue its analysis of a bill merged from two bills previously approved by separate Senate committees.

The CBO report, which will help reflect the affordability and feasibility of the bill, is expected to be released today to Senate Majority Leader Harry Reid, Conrad said.

Without a unified bill on the Senate floor, it's too early for Minnesota Sens. Al Franken and Amy Klobuchar and North Dakota Sens. Conrad and Byron Dorgan to say how they'd vote on the legislation.

But all four Democrats said this week that they'd consider a public option proposal as long as it didn't disadvantage the rural health care systems of their two states.

Each senator also said there are key issues they find important, namely improving affordability of insurance and access to care. But the preferred way to meet those goals differs among the senators.

As they gear up for the turn to debate, craft and eventually vote on health care reform, here's a look at where each Minnesota and North Dakota senator stands:

Kent Conrad, D-N.D.

"The most important thing is that we get this right, not that we meet an artificial timeline."

Priorities for reform:

* Increasing competition with insurance companies through an alternative insurance program, such as a nonprofit cooperative or a type of government-run insurance option.

Deal-breakers:

* Conrad said he would not vote for a public option that's tied to Medicare reimbursement levels since that option would destabilize rural health care systems because of disparities in Medicare reimbursement rates.

* Public funding for abortion.

Byron Dorgan, D-N.D.

"If at the end of the day, this legislation does not effectively put the brakes on escalating costs, it will be a failure. I'm not interested in voting for something that's a failure."

Priorities for reform:

* Containing health care costs, including prescription drug costs. Dorgan said he plans to offer an amendment to the forthcoming Senate bill so escalating prescription drug costs are addressed.

* Dorgan said he's "willing to consider any range of ideas to increase competition," including a public in-surance option.

Deal-breakers:

* Dorgan said he won't support coverage for illegal immigrants or public funding for abortion.

Al Franken, D-Minn.

"People have to see this as both health insurance reform and then reform of the health care system."

Priorities for reform:

* Offering incentives for low-cost, high-quality care by revamping the Medicare reimbursement system and using operations, such as the Mayo Clinic, as examples to achieve more patient-driven health care systems.

* Supports a public insurance option with rates that reflect the quality and value of health care systems. Franken said a public option tied to Medicare rates would be a "big mistake."

* Supports a compromise approach to public abortion funding. "I think you can separate out what money is going to the plan itself and what money would be going to providing the abortions."

Deal-breakers:

* Franken said he's "not drawing any lines in the sand."

Amy Klobuchar, D-Minn.

"I've been positive on the public option as long as it goes hand-in-hand with cost control. It would expand the problem if you didn't do both."

Priorities for reform:

* Rewarding quality health care systems and controlling costs to ensure affordability.

* Prefers a public insurance option tied to negotiated rates.

* Reducing the $38 billion tax on medical device manufacturers, such as Minnesota-based 3M and Medtronic, because of the negative economic impact it could have in the state.

* Creating incentives to attract quality physicians to rural health care systems.

Deal-breakers:

* "The cost control issue is just huge for me," Klobuchar said. "We need to be doing enough to bend the cost curve so you can ultimately make health care more affordable."

* Klobuchar said the Senate bill must "significantly reduce" the medical device tax because otherwise it could hurt jobs in Minnesota.

Kristen Daum is a reporter at The Forum of Fargo-Moorhead, which is owned by Forum Communications Co.