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The Latest News On Healthcare Reform

Senate gets started

On Saturday night, the U.S. Senate cast the first of several important votes on health reform, paving the way for floor debate to begin the week after Thanksgiving. But speeches leading up to the vote and comments on the Sunday talk shows again exposed divisions within the Democratic Party that leave final passage in question.

As soon as the 60-39 vote was recorded, Senate Majority Leader Harry Reid of Nevada received congratulations from fellow Democrats and a phone call from the widow of the late Sen. Ted Kennedy.

“I will remember the call always, always,” said Reid. “We both said Ted would be happy.”

Many wondered whether Reid could muster the 60 votes needed to clear a procedural hurdle and begin consideration of the Senate reform bill, also known as H.R. 3590, the Patient Protection and Affordable Care Act. In the end, Reid was able to hold together all 58 Democrats and 2 Independents, including Sen. Blanche Lincoln, D-Ark., and Sen. Mary Landrieu, D-La., who were the last to declare their support for the motion to proceed.

The bill includes at least $100 million in Medicaid funds for Louisiana. Landrieu says it’s more like $300 million but contends that wasn’t why she voted with her party. “I’m proud to have asked for it,” she said of the funding. “I’m proud to have fought for it, and I will continue to. That’s not the reason I’m moving to debate.”

The Congressional Budget Office estimates the Senate health reform bill would cost $848 billion over ten years and extend health insurance to another 31 million Americans, covering 94 percent of the population. The bill has several provisions that were not contained in the House bill or in previous versions of Senate reform bills, including an increase in payroll taxes for couples earning more than $250,000 a year and individuals earning more than $200,000, and a tax on cosmetic surgery. It also pushes back the effective date, from 2013 to 2014.

Among the provisions in its 2,074 pages:

• It prevents insurers from denying coverage or charging more based on pre-existing conditions
• It mandates individuals buy insurance (although the annual penalty for not being insured is lower than in the House version – starting at $95 and eventually reaching $750 per person)
• Expands the Medicaid program
• Taxes high-cost “Cadillac” insurance plans
• Cuts Medicare Advantage by $118 billion

The measure would also create a government-run plan to compete with private insurers in a newly established health insurance exchange. States could opt-out of the government-run plan if they choose.

That government-run plan is one of the main issues dividing Democrats, and at least four middle-of-the-road senators have threatened to withhold their support if the public plan provision is not changed. “I’m opposed to the public option of where the states have to opt out,” said Sen. Ben Nelson, D-Neb., on ABC’s “This Week.” “I said I would look at the public option where states have to opt in. That if they opted in, it wouldn’t apply to every other state.”

Others cited concerns about the cost of the bill and its budget impact. “We have a health care system that has real troubles,” said Sen. Joe Lieberman, I-Conn., on NBC’s “Meet the Press.” “But we have an economic system that is in real crisis. I don't want to fix the problems in our health care system in a way that creates more of an economic crisis.”

However, more liberal Democrats asked party leaders to hold their ground. “In the end, I don’t want four Democratic senators dictating to the other 56 of us and to the country when the public option has this much support,” said Sen. Sherrod Brown, D-Ohio, on CNN’s “State of the Union.”

The Senate will remain adjourned until Monday, Nov. 30, when floor debate will begin and senators will discuss dozens – if not hundreds – of amendments that could substantially alter the bill. Senate Democratic leaders want to wrap up floor debate and pass a final bill by Christmas because if dissension and delays push the final vote into the new year, the chances of passage will drop as senators weigh potential political fallout in an election year with a third of the Senate’s seats up for grabs.

At least two more key Senate votes remain. First, it will take 60 votes to end floor debate and block any potential Republican filibuster – a delay tactic. Then, it will take 51 votes to pass the final bill itself. In addition, any amendment can be filibustered, requiring a separate 60-margin vote to keep the bill moving.

If and when the Senate bill passes, it would still need to be merged with the House version, which passed several weeks ago. Combining the bills is usually done by a conference committee of House and Senate leaders, but the tight timetable has Democrats considering fast-track alternatives, including an expedited conference process like that used to pass economic stimulus legislation earlier this year. Finally, the conference committee bill would go back to each chamber for a last, up-or-down vote.

All about the Senate bill: Download the Senate bill text and CBO analysis. How did your Senator vote? Get the official roll call tally.

What about the House? Here’s the roll call for the House vote on Nov. 7. Here is the House bill text, and here is the CBO analysis of the House bill.

Mail bag

Seems like everyone has an opinion about health care reform, and they’re making their case in letters and statements.

In a letter to President Barack Obama and congressional leadership, nearly 50 high-profile Republican members of Congress, governors and former administration officials, called on lawmakers to go back to the drawing board on health reform. “Ramming through a trillion-dollar bill without giving three hundred million Americans the chance to study the legislation raises legitimate questions of why some leaders are trying to avoid a careful review by the American people,” write the Republicans. Signers of the letter include: former House Speaker Newt Gingrich, former Governor of Utah and former HHS Secretary Mike Leavitt, and former Governor of Arkansas and one-time presidential candidate Mike Huckabee. Read the full letter.

AARP refuses to back down from its endorsement of health reform legislation, despite a different letter from 13 House Republicans asking the retiree organization to do so. The GOP cites a report from CMS – the agency that runs Medicare and Medicaid – which forecasts the House health reform bill would cut Medicare spending by $571 billion over ten years and warned that doctors and hospitals “might end their participation in the program” because of the cuts. AARP says it stands by its endorsement of the House bill “because it helps our members and all older Americans who struggle with skyrocketing Medicare costs and coverage gaps, as well as those who face discriminatory private insurance market practices.” Read the GOP’s letter.

Economists at some of the nation’s leading universities collaborated on a letter to President Obama, stressing that health reform legislation must include four key components:

• deficit neutrality in its first 10 years,
• an excise tax on high-cost insurance plans,
• an independent Medicare commission aimed at improving the program’s quality and value,
• and delivery system reforms that “reward health care professionals for providing better care, not just more care.”

Read the economists’ letter.

Although America’s Health Insurance Plans (AHIP) continues to support health reform in general, the industry trade group expressed concerns about the Senate legislation. “The promise of health care reform is that it will provide all Americans coverage, allow them to keep their coverage if they like it, and bends the cost curve to put the system on a sustainable path. These are the standards by which any reform bill should be judged, and the Senate bill falls short of meeting them.” Read AHIP’s full statement.

Lastly, the Dean of the Harvard Medical School writes in the Wall Street Journal that he would give health reform “a failing grade.” Dr. Jeffrey Flier argues that reform bills include “no provisions to substantively control the growth of costs or raise the quality of care. … In discussions with dozens of health-care leaders and economists, I find near unanimity of opinion that, whatever its shape, the final legislation that will emerge from Congress will markedly accelerate national health-care spending rather than restrain it.” Read his entire op-ed.

Get involved. Contact Congress about health reform at MyHealthReform.org.

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