Rep. Bart Stupak (D-MI) is telling reporters that he’s optimistic that he can reach a deal with Democrats on abortion and that “he expects to resume talks with House leaders this week in a quest for wording that would impose no new limits on abortion rights but also would not allow use of federal money for the procedure.” “I’m more optimistic than I was a week ago,” Stupak told the Associated Press. “So is there some language that we can agree on that hits both points, we don’t restrict, we don’t expand abortion rights? I think we can get there.”

If Stupak is serious about strengthening the abortion provisions in the Senate bill — and so far, it’s not clear that he is — Democrats would have to pass a separate bill to change the Senate’s abortion provisions. Below is a comparison of the abortion language in the House and Senate reform bills and some options for how Democrats can persuade pro-life Democrats to vote for reform:

To be clear, most progressives would rightfully argue that the existing Senate measure already goes further than current law by regulating the abortion coverage of private insurers. As Jessica Arons points out, the Nelson amendment places “unprecedented restrictions on private insurance coverage for abortion care, making it much more cumbersome for insurers to offer coverage and for consumers to obtain it.”

Yesterday, Rush Limbaugh — who has been one of health care reform’s most vociferous opponents — warned his loyal troop of “ditto heads” that if health care passes, he’ll leave the country for Costa Rica. “I’ll just tell you this,” Limbaugh said to a concerned caller. “If this passes and it’s five years from now and all that stuff gets implemented — I am leaving the country. I’ll go to Costa Rica.”

Listen:

Limbaugh’s announcement could very well inspire liberals to pass reform, but his decision to re-locate to Costa Rica is also telling. Limbaugh probably chose Costa Rica because its tropical climate reminded him of his swanky New York City bachelor pad and he believed that this tiny Central American nation — population 4 million — couldn’t insure its citizens.

But unbeknownst Rush, Costa Rica’s hybrid government-private health care system provides comprehensive universal coverage to all residents — and even sells affordable policies to soon-to-be visitors like Limbaugh. The government owns several major public hospitals and operates small clinics in almost every community. Workers are required to contribute 15% of their salaries to health insurance and the unemployed “obtain public funding for all health services, including prescription drugs.” At least a third of all Costa Rican residents receive some care in the private sector and the government regularly purchases services from private providers. The system is not without its problems, but it boasts a higher ranking from the World Health Organization — Costa Rica is 36, United States 37 — and has higher life expectancy and lower infant mortality rates. Costa Rica also spends less per capita on health care than the United States and insures almost all of its residents.

In fact, there is literally nowhere in the developed world Limbaugh can travel to receive market-driven medicine or escape “government intervention in health care.” Thus, his accidental endorsement of universal health reform and Palin’s admission that she had traveled to single-payer Canada for care, make for several curious conservative endorsements of greater government involvement in the health care system.

Insurers have responded to the administration’s campaign against recent rate hikes by blaming increasing health care costs, provider cost increases and adverse selection (healthier Americans are dropping coverage) for their premium increases. To hear them tell it, the insurance industry is a low-profit industry that spends just one cent of every premium dollar on administration and strives to reduce costs by encouraging efficiencies. Insurers “do not deserve to be vilified for political purposes,” Robert Zirkelbach, a spokesman for America’s Health Insurance Plans (AHIP) told the AP:

For every dollar spent on health care in America, less than one penny goes toward health plan profits. The focus needs to be on the other 99 cents.

But the argument that insurers run a tight ship is misleading, on several counts, not least of which is the fact that insurers are planning to spend “more than $1 million” not on health care claims — as their justification for the premium hikes would suggest — but “to run television ads on cable stations nationwide beginning in the next few days to push back on the attacks on insurers.”

That $1 million ad fund will presumably come from the one penny that goes towards health care profits. But this too is misleading. Zirkelbach is clever enough to compare the private insurance industry’s administrative spending to national health care expenditures — 45 percent of which includes spending in Medicare, Medicaid and other public programs. In the context of total spending, insurers administrative costs may look small, but compared to the revenues of private insurers, administrative spending is seen as far more substantial. Insurers skim off 15-20 percent of premium dollars for administrative costs and profits which fund TV ad campaigns, Washington lobbyists, lavish company retreats and outlandish CEO salaries.

The top five earning insurance companies averaged profits of $12.2 billion, an increase of $4.4 billion, or 56 percent, from 2008. And in 2008 (the last year for which data was available), CEO compensation for these companies ranged from $3 million to $24 million.” Below is a partial list of insurer/CEO profits:

Insurer profits increased even in the midst of the current recession. Last week, during a hearing before the House Energy and Commerce Health Subcommittee, WellPoint admitted that it increased premiums to keep up with medical costs and maintain a 2% profit. The company’s 2009 fourth quarter net income “was more than $2.7 billion, a 727 percent increase from the fourth quarter of last year” — even as membership declined by some 4 percent.

Insurer profits are of course just one culprit for increasing premiums, but considering that insurers have been able to increase their returns by purging sicker Americans from the rolls and pulling out of competitive markets, the President’s strong rhetoric is more than justified. The Senate bill will start forcing insurers to earn profit by figuring out ways to deliver quality care more efficiently and they’re not very interested in accepting these changes.

Speaking at the CQ HealthBeat Conference this morning, Sen. Tom Harkin (D-IA) characterized the Republican push to treat the midterm elections as a referendum on health care reform as a “gift” and said he expected voters to embrace the bill once it passes. Harkin also predicted that the House would pass the Senate bill by March 18 and the final legislation would arrive on President Obama’s desk by March 27th.

“I think Mitch McConnell may have given us a big gift the other day,” Harkin said, referring to McConnell’s appearance on ABC’s This Week. “He’s on tape, when he said, ‘they pass this bill and I know what our campaign will be this November, it will be that we’re going to repeal it,’ — on tape. Just think of the dynamics of that. It’s okay to say that now because people don’t know what’s in the bill. Once it’s passed, signed into law, then they know”:

HARKIN: You see politically, before you pass legislation, especially meaningful legislation, there is always this back and forth and people are confused, I understand that…once a bill is passed and signed into law, then the American people have something. They have it. It’s theirs. It’s much harder, I think, for the opposition of that legislation to then come out, and say ‘that was wrong and I’m going to repeal it.’

Watch it:

Republicans are hoping to use the bill’s prolonged implementation period to turn public opinion against the Democrats in the short term. On Sunday, McConnell also stressed that “the benefits don’t kick in for four years.” “Just looking at the politics of it there’s nothing but pain here for the next four years. Why in the world would they conclude that would be popular?” Under the Senate bill, most of the health insurance reforms and the exchanges don’t begin until 2014, but Democrats believe that the bill’s early deliverables will win-over reluctant voters.

“Sometimes I wish I kind of wish I was running for re-election this year, I know that sounds odd” Harkin admitted. “But I would like to hear my opponent come out and say, ‘I want to repeal those lifetime caps.’” “I think once the American people know what they’ve got and they say, we’re going to take it away, that won’t wash,” Harkin said and listed several other provisions that begin in year one. They include:

1) Health insurers cannot exclude coverage of pre-existing conditions for children.

2) Prohibits insurers from imposing lifetime limits on benefits and tightly restricts insurance companies’ use of annual limits to ensure access to needed care

3) Will stop insurers from rescinding insurance when claims are filed, except in cases of fraud or intentional misrepresentation of material fact.

4) $5 million in federal support for a new program to provide affordable coverage to uninsured Americans with pre-existing conditions.

5) $10 million investment in Community Health Centers.

6) Immediate access to re-insurance for employer health plans providing coverage for early retirees,

7) Will reduce the size of the donut hole in year 1 and close it completely by 2020.

8) Will offer tax credits to small businesses beginning in 2010 to make employee coverage more affordable.

9) Plans in the individual and small group market must spend 80 percent of premium dollars on clinical services and quality activities, and 85 percent for plans in the large group market.

10) Will require insurers to permit children to stay on family policies until age 26.

11) Coverage of prevention and wellness benefits will be exempt from deductibles and other cost-sharing requirements in public and private insurance coverage.

12) Insurers will have to justify premium increases and a new federal agency will have the authority to deny significant and unnecessary hikes.

The Plum Line’s Greg Sargent pointed out that Obama stressed the bill’s immediate benefits at his health care rally in Pennsylvania, telling wavering Democrats, “[i]f you vote for health reform, some of your own constituents will — this year — suddenly find themselves with insurance where they had none. Your own consistuents will not be dropped arbitrarily from coverage, even if they get sick. Some of your own constituents will suddenly enjoy free preventive care they didn’t have before. And you will be able to take credit for it.”

Harkin also said that the bill is not perfect and will have to be amended over time. “One of the things that I want to disabuse people of is this idea that somehow once we pass health care reform that’s it. This health care bill is not the 10 Commandments written by the finger of God forever and ever. It’s a bill passed by humans and as such, we’re going to change it. It’s going to be amended.”