Know the lead players in the political machinery

Sen. Max Baucus (D-Mont.) is chairman and appears more of a centrist, seeking a bill some Republicans would support.

Sen. Jeff Bingaman (D-N.M.), also on the Health Committee, wants a public-plan option-Democrats' main focus right now.

Sen. Michael Enzi (R-Wyo.) is also on the Health Committee and voted against the healthcare bill that contained a public plan.

Sen. Charles Grassley (R-Iowa) has taken a lead for Republicans on reforms and is known for keeping watch on spending. He favored private competition for Medicare Part D.

Sen. Olympia Snowe (R-Maine) could offer the pivotal vote. A small-business advocate, she opposes taxing employer-sponsored benefits.

There are influential players along the sidelines, too. Some will sway final votes, and others will have responsibilities in the implementation of policy changes (if any).

Nancy-Ann DeParle, the "health reform czar," has listened to the voices of industry groups.

Sen. Chris Dodd (D-Conn.), member of the Senate Health, Education, Labor and Pensions Committee, is leading negotiations in the absence of the committee's chairman, Sen. Edward Kennedy.

Ezekiel Emanuel, author, professor, oncologist and special advisor for health policy to the director of the White House Office of Management and Budget, helps the President craft his health policy strategy. His brother Rahm is chief of staff.

Sen. Orrin Hatch (R-Utah) co-sponsored the legislation that created the State Children's Health Insurance Program. He represents a potential vote on a bipartisan bill.

Peter Orszag, director, Office of Management and Budget, drives the administration's decisions around cost and is a supporter of comparative effectiveness.

Rep. Nancy Pelosi (D-Calif.), Speaker of the House, will have to coordinate House efforts. She's been outspoken about her distrust of private health insurance companies.

Sen. Harry Reid (D-Nev.), Senate Majority Leader, is working with the White House and the committees on strategy and the possibility of budget reconciliation.

Kathleen Sebelius, Secretary, Department of Health and Human Services (HHS), will manage changes to Medicare and Medicaid and drive policy implementation.

With partisan politics squarely at the center of the debate, some question whether these players will achieve reform policy at all.

Vince Ventimiglia, senior vice president of B&D Consulting and former HHS assistant secretary, tells me some type of legislation will pass toward the end of the year.

"There remains the political imperative in avoiding the 21% doctor pay cuts under the [Medicare sustainable growth rate] and in providing mechanisms to provide insurance coverage for at least a portion of the enormous number of uninsured persons," he says. "The real question is what can be afforded in today's economic and political environment."

While Congress might be working hard to craft a bill, it will be industry's job to complete the far more difficult task of carrying out the new policies.

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at julie.miller@advanstar.com