A crucial part of the backstage maneuvering on the health bill involves the change to Medicare payments to doctors. President Obama’s budget uses a different method than Congress for measuring the cost of doing that, and House Democrats have agreed to accomodate Obama’s way of handling the books on that. In exchange for going along with that, the generally tight-fisted Democrats in the Blue dog Coalition won a promise to bring to the floor a measure that would enforce budget discipline by making “Pay as You Go,” or Pay Go,” the law.

When that bill (HR 2920) is considered in the next week, the house budget chairman will be allowed to change the budget rules so that the physician payment section of the health bill does not violate “Pay Go.”

Budget watchdogs have criticized that plan, saying it would add to the deficit.

Fine Print and Procedure

By speaking generally about health plans rather than specifically about the House bill, Obama has room to brush aside, for now, warnings about the long-term costs of the legislation while all the fine print is being worked out prior to Congress sending a bill to his desk.

Cost has been a major concern for many lawmakers and despite its caveats and limitations, the official CBO score undoubtedly will provide more fodder for those who argue that health care costs will not be contained under the legislation.

The CBO score raises the prospect that lawmakers could have tremendous difficulty if they try to use the fast-track budget reconciliation process to circumvent a Senate filibuster of the legislation.

The reconciliation process, designed originally to bring down deficits, provides procedural protection from filibuster to certain bills that affect spending or revenue. But under the so-called Byrd rule, all provisions of a reconciliation bill must produce changes to one side of the ledger or the other.

The CBO estimate identifies dozens of provisions that would have no net impact on the deficit, suggesting that it would be difficult to rewrite the legislation to avoid giving foes an easy target to shoot down on the Senate floor — as has happened before on big bills. In 2005, for instance, Sen. Kent Conrad , D-N.D., frustrated Republican attempts to pass a package of $40 billion in spending cuts by objecting to a series of studies required by the reconciliation bill that would have had no impact on the deficit.

Who’s Covered?

The CBO estimate says that by 2019, the bill would result in insurance coverage for 97 percent of the documented population. For many involved in the debate, that’s the only number that counts.

Obama on Saturday emphasized that point, saying: “This is what the debate in Congress is all about: Whether we’ll keep talking and tinkering and letting this problem fester as more families and businesses go under, and more Americans lose their coverage. Or whether we’ll seize this opportunity — one we might not have again for generations — and finally pass health insurance reform this year, in 2009.”

Worth noting is that enactment would not immediately bring widespread health coverage. The CBO estimated that the number of uninsured would continue to rise until 2013.

Democrats have crafted the House plan to delay coverage expansions until then in order to meet their own goals for limiting the projected cost during a specific 10-year window, 2009-2019.

Alex Wayne contributed to this story.