REFORM’S ‘ROUGH PATCH’…. As days of debate in the Senate over health care reform go, yesterday was not altogether pleasant.

Democratic leaders hit a rough patch Friday in their push for sweeping health care legislation, as they tried to fend off criticism of their proposals from a top Medicare official, Republicans and even members of their own party.

Let’s take a look at the three big developments, one at a time.

Medicare Actuary: The chief actuary of the federal Centers for Medicare and Medicaid Services issued a report yesterday afternoon concluding that health care spending would be slightly higher from 2010 to 2019 if the Senate bill becomes law, as opposed to doing nothing. Congressional Republicans were ecstatic and said the report should kill health care reform; the White House said the exact opposite. Who’s right? Jonathan Cohn reviewed the report and concluded, “The underlying trend is in the right direction. As more time passes, it’s more likely we’ll save money…. Saving more money and doing it more quickly is possible, but it requires a stronger bill. In the meantime, the bill as written would dramatically improve financial security for all Americans, reduce the medical and insurance bills for most, and do it for a price to society that even relatively conservative estimates suggest would be a pittance. That’s a pretty good deal.”

Annual Caps: One of the selling points of health care reform is the consumer protections extended to those who already have insurance, most notably a ban on annual caps. It was more than a little jarring, then, when the AP reported yesterday, “A loophole in the Senate health care bill would let insurers place annual dollar limits on medical care for people struggling with costly illnesses such as cancer.” Harry Reid’s office said the loophole was necessary to prevent much higher premiums for everyone. Ezra said, “[T]he American people are much more likely to hear that premiums are going up than they are to get a detailed explanation of what they’re getting in return for higher premiums, and so the Senate bill is watching its back.” Expect a lot more work on this measure.

Re-importation: Sen. Byron Dorgan (D-N.D.) is leading the way on a measure to let consumer purchase medication from other countries, where it’s cheaper. Democratic leaders have already worked out a cost-control deal with the pharmaceutical industry, and hope to defeat Dorgan’s measure to keep the deal intact. Kate Pickert added, “Things have gotten so dicey that Sen. Jay Rockefeller, who is a co-sponsor of the Dorgan amendment, has said he will vote against it.”

Meanwhile, the overall effort is in a holding pattern, waiting for a CBO score on the compromise framework crafted on Tuesday night. No one knows when that report will be available, what it’ll say, or how much work Dems will have to do in response to it.

The NYT‘s report added, “While Democrats appeared to be on the defensive Friday and Republicans were buoyant, the mood on Capitol Hill can shift quickly. Lawmakers said the health care debate would take many twists and turns before reaching a conclusion.”

Steve Benen

Follow Steve on Twitter @stevebenen. Steve Benen is a producer at MSNBC's The Rachel Maddow Show. He was the principal contributor to the Washington Monthly's Political Animal blog from August 2008 until January 2012.