On the eve of a big senate vote to open debate on health insurance reform, Washington Senator Patty Murray explains the stakes:

Listening to KUOW's Weekday just now, on which Governor Christine Gregoire is talking about the dramatic cuts that are going to be needed to deal with the state's $2.6 billion budget shortfall. Among the programs she says are on chopping block: Basic Health.

Host Steve Scher asked Gregoire if she was just talking about trimming the program's budget, or about cutting the entire program.

Her answer: cutting the entire program.

Vancouver Sun reports:

All British Columbians who need and want to be immunized against the H1N1 flu virus will now be eligible to receive the vaccine starting tomorrow, the B.C. government announced today.

As for us...

How much of the vaccine has been shipped to Washington state?

More than 790,000 doses either have been shipped to the state or are in the process of being shipped, Church said Monday, Nov. 16.

The federal government allocates the free vaccine based on population. The total allocated for Washington state, as of Monday, was 936,000 doses, although that number continues to climb each week.

"We continue to order it as fast as we're told it's available to order," Church said.

Who can get the vaccine now?

Supplies of the vaccine have increased, but it's still only available to:

• Pregnant women.

• Health-care providers and emergency responders.

• Those who live with or care for children younger than 6 months old. Children this young cannot be vaccinated.

• Everyone who is 6 months to 24 years old.

• People who are 25 to 64 years old with medical conditions that place them at high risk for complications from the flu. Those conditions include asthma, heart disease, immune disorders or neurological conditions.

Washington has about 2 million more people than British Columbia.

And it costs less than $900 billion. (Which, while politically helpful, is not necessarily reason to celebrate, reminds Ezra Klein.)

Now if Harry Reid can only get these three Democratic Senators to allow debate on the measure.

From a puff piece on the fat acceptance movement in the NYT last week:

Heavier Americans are pushing back now with newfound vigor in the policy debate, lobbying legislators and trying to move public opinion to recognize their point of view: that thin does not necessarily equal fit, and that people can be healthy at any size.... “I get so angry when I feel people pushing a weight-loss agenda,” said Linda Bacon, a nutrition professor at City College of San Francisco and author of “Health at Every Size,” a book published last year whose title has become the rallying cry of the fat pride community. “What we’re doing in public health care policy is harmful. We give a direct and clear message that there’s something wrong with being fat.”

And in today's NYT:

While Congress searches for ways to slow the growth of health care spending, a new study suggests that its efforts may be overwhelmed by the surging prevalence of obesity. The report, to be issued Tuesday, projects that if current trends continue 103 million American adults will be considered obese by 2018. That would be 43 percent of adults, compared to 31 percent in 2008, according to the research by Kenneth E. Thorpe of Emory University, an authority on the cost of treating chronic disease.

Mr. Thorpe concluded that the prevalence of obesity is growing faster than that of any other public health condition in the country’s history. Health care costs related to obesity—which is associated with conditions like hypertension and diabetes—would total $344 billion in 2018, or more than one in five dollars spent on health care, if the trends continue. If the obesity rate were held to its current level, the country would save nearly $200 billion a year by 2018, according to the study.

Mr. Thorpe said in an interview that the health care bills in Congress limit their attack on obesity to a few community-centered pilot programs with insufficient funding. Congress has steered clear of measures that might have a more direct impact, like taxing sugary sodas and fat-laden snacks.

Now that the House has passed its landmark health insurance reform bill, the big question is how long it will take for the Senate to act.

At the moment, it sounds like that chamber will get to work next Tuesday—provided the Senate Democrats can hold themselves together on procedural votes. If they can't, then it will be a sign that health insurance reform has basically gone to the Senate to die.

• E.S.

So said House Speaker Nancy Pelosi, talking this afternoon in Seattle about the controversial abortion amendment that was added at the last minute to the House health insurance reform bill.

Which is not to say she likes that the amendment had to be added.

"I myself do not really think this issue should be part of this legislation," Pelosi said, flanked by two Washington congressmen, Jim McDermott and Jay Inslee. "But others thought differently... I voted against it, as did all of the members of the leadership and the chairs of the committees of jurisdiction."

McDermott and Inslee also voted against the amendment, which passed 240 to 194.

The amendment vote had to be allowed, Pelosi said, because Republicans were determined to force the issue one way or another, and letting them do it via the amendment process was the best way to avoid derailing the entire health insurance reform effort:

The major parts of this bill do so much to provide quality health care, and bring many more people into the loop. And, by the way, under this legislation, being a woman is no longer a pre-existing medical condition... The provision that you're talking about would have been in the bill one way or another. The Republicans would have put it as a motion to recommit—not to get too much into this—we thought it was better to have it as an amendment that could be voted up or down, rather than a provision in the motion to recommit, which would take down the whole bill.

That's a pretty technical answer, but again, what Pelosi was saying is that the amendment process was the least bad way she could think of to contain this explosive issue.

Will the Senate be able to strip about the amendment and its limits on abortion funding, now that the bill is in its hands?

Pelosi dodged that question.

Here's the video:

This afternoon on the sidewalk outside Swedish Hospital on First Hill, just after House Speaker Nancy Pelosi finished her health insurance reform press conference, a remarkable collection of teabaggers displayed themselves. We begin with the man who's missing an apostrophe and so much more....

...and proceed to this mom-and-daughter team of camera baiters...

...and arrive, finally, inevitably, at the man wearing the NOPE hat:

What's the deal with that last-minute abortion amendment that was added to the House health insurance reform bill? Ezra Klein explains:

Rep. Bart Stupak's amendment did not make abortion illegal. And it did not block the federal government from subsidizing abortion. All it did was block it from subsidizing abortion for poorer women.

Stupak's amendment stated that the public option cannot provide abortion coverage, and that no insurer participating on the exchange can provide abortion coverage to anyone receiving subsidies.

Which is no small thing.

Nancy Pelosi allowed this amendment to go through—despite fury from pro-choice advocates in the Democratic caucus—in order to keep conservative Democrats happy and prevent the entire bill from collapsing. It was a wrenching decision, but it did lead to an historic achievement in the House.

What would you have done if you were Nancy Pelosi—or, say, a representative from Washington State?

Well? Would you have voted "yes" or "no" on the health insurance reform bill given its limits on abortion funding?

It's happening now, and when it's finished—probably later today—it's likely that the U.S. House of Representatives will have made history, passing* a huge health insurance reform bill that includes a public option.

Follow it here, here, and here.

*Without the help of Washington Democrat Brian Baird.

A reliable source sends over a copy of an e-mail that he says went out recently to employees of Premera, one of Washington State's largest insurance companies, telling those employees to call their representatives in Congress and urge them to vote no on the Democrats' health insurance reform bill:

Message from Jack C. McRae
Senior Vice President of Congressional and Legislative Affairs
Premera Blue Cross

We are reaching an extremely critical point in the healthcare reform debate. Later this week, possibly Friday or Saturday, the U.S. House of Representatives will vote on its healthcare reform bill.

Please contact your Representative immediately to share your comments and concerns, urging them to vote no on HR 3962. For contact information, please visit http://www.house.gov/. Simply put in your zip code to get your Congressional Representative’s contact information. We recommend that you call and e-mail your Representative.

If you have any questions, please do not hesitate to contact me at jack.mcrae@premera.com or Kelly Jones at kelly.jones@premera.com.

Thank you.

I have e-mails and calls in to Premera to confirm that this e-mail was, indeed, sent to employees. So far, no response.

UPDATE: Premera spokesman Eric Earling says the e-mail was sent to "brokers" (private contractors who sell Premera and other insurance plans), not to Premera employees. But the e-mail does reflect the company's position: supportive of health care reform in general, but concerned about reports that the Democrats' bill will lead to higher premiums.

...a provision, authored by Seattle Congressman Jim McDermott, to give domestic partners the same health-insurance-related tax benefits as married couples.

Section 571. Certain health related benefits applicable to spouses and dependents extended to eligible beneficiaries. This section promotes parity in health benefits by expanding the definition of “eligible beneficiary” so that domestic partners can enjoy the same tax benefits with regard to health insurance coverage, as married couples do.

It's all part of a reform package, McDermott says, that "has been my top priority since the day I entered Congress.”

The Democratic leadership wants the combined House health care bill, released earlier today by Nancy Pelosi, to be voted on before November 11.

This has been a long and eye-crossingly complicated debate. But if you've stopped paying attention, now might be a good time to tune back in. The finish line is (theoretically) in sight.

Something to bear in mind today during the debate about reforming the health insurance industry...

The woman who lost her coverage is a health insurance agent. Via HuffPo.

That's the cost of the House health insurance reform bill unveiled today by Nancy Pelosi—which, though it sounds like a big number, is relatively low in the world of comprehensive reform proposals. So that's good news.

The even better news:

In its size and scope, the House bill is very similar to a measure under development by the Senate majority leader, Harry Reid of Nevada.

The more similar the House and Senate bills are, the more likely we are to see quick passage through both houses of Congress.

But, of course, crucial differences remain on complicated, sticky issues like the public option, the millionaire's tax, and the employer mandate.

Get down in the weeds and read all about them here and here and here. But when you come back up out of the weeds, remember: in the big picture, we're closer to Congress passing meaningful health insurance reform than we've been in decades.