Under the $905 billion version favored by liberals, compensation rates for medical providers in the government-run insurance plan would be based on Medicare rates, which are significantly lower than private rates. That idea, which Senate liberals also support, would hold down costs for the government, according to the CBO, but it would create a problem for providers in rural areas where Medicare rates tend to run much lower than the national average.

Under the $859 billion version, administrators would negotiate rates directly with doctors and hospitals, the option preferred by moderate Democrats from rural areas.