After passing a critical test last week, legislation reforming the U.S. health care delivery system is now dealing with its next hurdle, floor action in both the House and Senate.

The critical test for the legislation was support from the Senate Finance Committee with at least one Republican vote. On Oct. 14, the panel voted, 14-9, to report the bill to the full Senate with all 13 Democrats supporting it and Sen. Olympia Snowe, R-Me., also voting “yes.” All other Republicans voted against it.

The Senate Finance bill is estimated to cost $829 billion over 10 years. Most of the provisions would not go into effect until 2013.

Immediately after the vote, Sen. Harry Reid, D-Nev., Senate majority leader, said the leadership will “now move to the important work”, merging the proposals of the Senate Health, Education, Labor and Pension Committee with the bill passed by the Finance panel.

The chairmen of the two committees, working with the White House, will now work “to craft a bill that can garner 60 votes in the Senate,” Reid said.

The group includes Sen. Max Baucus, D-Mont., chairman of the Finance Committee; and Sen. Chris Dodd, D-Conn., who was acting chairman of the HELP committee when it passed its health care bill.

Snowe is also expected to take part in the talks, according to Reid’s staffers.

Reid faces a daunting task. According to Ira Loss, a healthcare analyst at Washington Analysis, even before the vote, key senators and the Obama Administration had already begun melding a bill behind closed doors.

And, just shortly before the Finance Committee was due to vote, America’s Health Insurance Plans issued a report warning that this latest health care reform measure, which lowers the individual penalties for lack of insurance, will significantly raise insurance premiums as it reduces the pool of healthy individuals.

AHIP also began airing ads in states with a large percentage of seniors decrying cuts in the Medicare Advantage program that the Finance panel bill uses to help finance the measure’s key objective, adding as many people to the health care rolls as possible.

Besides the Medicare Advantage issue, Loss said the health insurers are mounting a full-scale campaign against the bill because it doesn’t do enough to curb costs, imposes high excise taxes on insurers, and doesn’t mandate strong enough penalties to ensure more people don’t sign up for insurance.

Specifically, Karen Ignagni, AHIP president and CEO, issued a statement following the passage saying that, “While we agree with the objective of the current proposal, we are concerned about its workability and cost.”

She alleged that the bill imposes hundreds of billions of dollars in new health care taxes and provides an incentive for people to wait until they are sick to purchase coverage.

She cited a recent analysis by PricewaterhouseCoopers that “found that these provisions will cause health care costs to increase far faster and higher than they would under the current system.

“We believe these issues can and should be addressed,” she said.

The White House, however, derided the PWC report. A statement on the White House website said, “This is a self-serving analysis from the insurance industry, one of the major opponents of health insurance reform.”

The statement noted that “even the company hired to produce the report has issued a statement saying they produced a skewed report that analyzes only part of the bill because that is what the insurance industry paid them to do.”

The statement added that, “It comes on the eve of a vote that will reduce the industry’s profits. It is hard to take it seriously.”

Agents’ trade groups had their concerns about the legislation.

Officials of all insurance agent trade groups that have worked on the bill lauded a provision of the Senate Finance bill which says specifically that insurance agents would be allowed to sell insurance to individuals and businesses purchasing health insurance through the exchanges proposed in the legislation.

But they voiced misgivings with other provisions of the bill and said they would work to improve it through the rest of the process.

Thomas Currey, president of the National Association of Insurance and Financial Advisors, said, “Reforming the American health care system is no easy task. We are pleased that, at each step of the way, agent priorities have been included in the proposals.

“Paramount for NAIFA, of course, is recognition of the critical role agents play in servicing consumers,” he said.

So far, recognition of that role has been included in every version of reform,” he said. However, as the Senate Finance Committee reports out its plan, “NAIFA still has a number of concerns that need to be addressed before final passage.”

Peter Stein, vice president of Congressional Affairs for the National Association of Health Underwriters, said, “For comprehensive health reform to succeed, it must ensure that premiums are affordable for all consumers and that people are able to keep the private coverage they like.”

But a number of significant changes were made to the Finance Committee bill during markup that would run completely counter to these goals of reform, Stein said.

He specifically cited the weakening of the individual mandate, tens of billions of dollars in new insurer fees and taxes, tight limits on age rating and high minimum benefit levels will make private health insurance unaffordable for many Americans.

“By some estimates these provisions combined could double premiums for the youngest third of our population coming into a reforms insurance marketplace,” he added.

Another key issue is House action. There is strong support in the House for a public option, although such a provision is unlikely to pass Senate muster.

As Loss noted, “We are also awaiting the Congressional Budget Office’s cost analysis for the three versions of the public option,” requested by Speaker Nancy Pelosi, D-Calif.

Once that analysis is in, Loss said, “Pelosi and other key members of the House will incorporate one of the public options into the emerging House bill.”

But, “rather than send their bill to the chamber floor, however, the House leadership is likely to let the Senate move first so as to provide political cover,” Loss said.

Regarding specific concerns, NAIFA’s Currey worried about provisions that offered no teeth for mandates requiring everyone to purchase insurance.

According to Currey, “Weak mandates could devastate affordable insurance. If people can carry insurance only when they’re sick or injured, the price of insurance will skyrocket for everyone. This is a very difficult problem that Congress must resolve.”

Finding acceptable new tax revenue to pay for health reform will continue to be a difficult problem lawmakers must solve, Currey noted.

He said there is growing opposition in the House to the Senate’s proposed “luxury tax” on health insurance.

And, he said, opposition to the surcharge on high-income Americans contained in the House bill is also strengthening.

He also noted that the Congressional Budget Office found that medical malpractice reform, including caps on damages, could achieve some $41 billion in health care savings.

“If access to affordable coverage is the goal of reform, then medical malpractice reform should be addressed,” he said.

The Senate Finance Committee’s plan includes a cap on annual contributions to flexible spending arrangements (FSAs). According to Currey, NAIFA supports an effort to index (or eliminate) the cap on annual contributions to FSAs.