Update – Health Care Reform – Senate Still Wrangling
Posted Under: Mitch Gurney,Tracking the Health Care Debate
By Mitch Gurney
December 9, 2009
I have taken a pause in posting more frequent health care reform updates while the Senate has been wrangling over their version of the Health Care Bill primarily because the dynamics change so much on a daily bases that it is extremely difficult to track. Plus it seems to make more sense to wait for more meaningful news.
The public option in the Senate version of the bill has been a very contentious issue and I suspect law makers are having quite a challenge placating those who want it in the bill versus industry lobbyist that are $$pressing$$ hard to have it removed. Today’s news is perhaps more directional as to where things could be headed but the bottom line is there is still a long way to go and who knows what our lofty legislators will bring us tomorrow.
Here are some of the latest updates that are available via OpenCongress.org:
December 9, 2009
A Breakthrough on Health Care — Drop the Public Option, Open Up Medicare:
Democrats in the Senate have negotiated a new deal to break the impasse on health care reform. It involves getting rid of the public option altogether, but, somehow, all the liberal Democrats seem to like it. The deal appears to have three parts:
- Medicare Buy-In — Starting in 2011, uninsured people between the ages of 55 and 64 would be allowed to “buy in” to Medicare. Until the Exchanges and affordability credits in the bill are set up in 2014, eligible people would have to pay for Medicare with entirely their own money at full price. It could be expensive. But in 2014, Medicare would become available to 55 to 64 year old on the Exchanges and people would be able to use their government-provided affordability credits. People in lower income brackets would get most of their Medicare coverage paid for by the government.
- Non-Profit Health Care Network — Starting in 2014, the Office Personnel Management (OPM) would run a program modeled on the Federal Employees Health Benefits Plan, which provides health care to members of Congress, that allows private insurance companies to set up national non-profit plans that would be offered to consumers on the Exchanges. The plans would be privately run, but the OPM would essentially be the regulator determining if they meet certain quality standards and should be allowed to sell on the Exchanges.
- Public Option Trigger — If the national non-profit network does not meet certain goals for making health care affordable to enough people, the creation of a national public option plan would automatically be created by the federal government and offered on the Exchanges.
More details, including a Congressional Budget Office score, should be coming along soon and we’ll post them to this blog as they are available.
Please see full article available at link provided above for additional info
December 8, 2009:
What Happens After the Senate Passes Their Health Care Bill?
Senate Democrats are reportedly close to a deal on the public option that they believe will get the 60 votes needed to break a Republican filibuster and pass. If the votes do in fact line up behind the deal, the Senate could vote on final passage of the bill early next week
At that point, Congress will be looking at two very different health care bills from the Senate and the House. The Senate could still change their bill in some major ways in an attempt to placate progressives, so we can’t pin down what all those differences will be quite yet. But on the most contentious issue in the bills — the public option — the difference between the bills will be huge. The House bill will include a public option plan and the Senate bill won’t.
Before President Obama can sign a final bill into law, both the Senate and the House need to pass the same exact version of the bill. So how do we get from two bills that are worlds apart on major issues to a single bill that both chambers can agree on? There are basically two options on the table.
The conventional method is to bring both bills to an ad hoc “conference committee” made up of members of both the Senate and the House to iron out the differences into a final version that the committee can agree to. The committee bill, known as a “report,” then goes back to both the Senate and the House for a final vote. No amendments can be considered to conference reports, but senators can filibuster it and require 60 votes for it to pass.
The conference committee method presents a few problems for the health care bill. First, the Democrats want to get the bill done quickly. With a deal imminent, there is some renewed hope among the Democrats that they can get a bill to Obama to sign into law according to his original timeline by the end of December. With the health care bill being so contentious and having so many moving parts, the conference committee process could be slow. Second, and more importantly, Democratic leaders worry that whatever deal the Senate has in place would be the best deal they can get, i.e. the most progressive bill they can possibly pass over the objections and dilatory tactics of the Republicans. If the conference committee drew up a compromise between the more progressive House bill and the more conservative Senate bill, it simply would not get the 60 votes it would need in the Senate.
That has Democrats considering a Plan B for reconciling the bills. “There is increased chatter on Capitol Hill about a possible “ping-ponging” of the Senate health care bill: that chamber would pass its health care bill, send it to the House and the House would be asked to pass it with no changes and send it directly to the president,” reports Ryan Grim at the Huffington Post. Ping-ponging bills from the Senate to the House is not that uncommon. The 111th Congress has already used this method several times to pass some substantial bill, including legislation allowing the FDA to regulate tobacco (H.R. 1256), reforming the credit card industry (H.R. 627), the GIVE Act (H.R. 1388) and expanding S-CHIP (H.R. 2).
Ping-ponging the bill would speed up the process and preserve the Senate’s carefully negotiated bill, but would the House go along with it? Many progressive Democrats in the House feel like they have been shut out of the health care process from the beginning. For them, the public option is a compromise from single payer, the plan to require the public option to use negotiated reimbursement rates is a compromise from their preference that the rates be tied to Medicare, and so on. The whole process has been moving away from them in favor of the conservatives. The Senate-House conference committee has long been seen as their last stand to defend some of the element of the bill they care about most, like the public option. There has even been some hope that they could win back some of their earlier concessions in the conference committee.
Please see full article available at link provided above for additional info
Senate Adds Online Consumer Reviews to Their Health Care Bill:
The Senate on Monday unanimously approved an elegant, two-page amendment to the health care bill that Sen. Mark Pryor [D, AR], the amendment’s sponsor, says will “both simplify a consumer’s search for the right health care company and make health insurance companies more responsive to patient needs.”
Under the Senate health care bill, by 2014 states would have to set up new health insurance marketplaces known in the bill as “American Health Benefit Exchanges.” These exchanges would have some regulatory qualities — they would only let in plans that meet certain minimum standards — but, essentially, they would be websites where people buying insurance on the individual market could comparison shop between different plans. The details of all the plans on the exchanges would be presented in a standardized manner so consumers could easily compare plans on things like price, deductibles and covered services.
Please see full article available at link provided above for additional info
December 7, 2009:
Senate: Public Option Wrangling
The big health care story this week will be the ongoing dealings among Senate Democrats to do something with the public option provision that will win enough votes for the bill to pass. As it stands, four conservative Democrats are threatening to filibuster the bill over the public option, but the Democrats can’t afford to lose a single Democratic vote if they are going to be able to break a Republican filibuster.
Please see full article available at link provided above for additional info
The following is my edited version of a recap from a MoveOn.org email update I received a couple of days ago which does a good job of summarizing some the details of the bills:
A recap of where we are:
The House of Representatives passed their bill last month. The Senate is still wrangling to pass its version before Christmas. Overall, both pieces of legislation would do four major things:
Create a “Health Insurance Exchange” The bills create a one-stop marketplace where people can choose from various insurance plans, including the public option. The details aren’t set yet, but initially the Exchange would likely be open to the self-employed, people without insurance at work, and small businesses.1 The key with the Exchange is that it brings “the bargaining power and scale that’s generally accessible only to large employers” to individuals—and with that, lower costs and better options.2
If the reforms are enacted an individual or an employer who offers employer provided coverage would be able to either purchase health care insurance in the open market — just as we do today — or through the government’s Health Care Exchange proposed in the bills. The Health Insurance Exchange would potentially be a vast market exchange created by the government pulling together the U.S. insurance companies that elect to participate in the exchange for both companies and individuals could shop for their insurance needs. The individuals or companies that purchase health care insurance through the exchange will be paying their premiums directly to the insurance company—just as we do today.
- Provide insurance to over 30 million more people. The House bill would expand coverage to 36 million people by 2019. The Senate bill extends coverage to 31 million 3
- Outlaw discrimination based on pre-existing conditions and gender. Insurance companies will have to stop denying coverage to people with “pre-existing conditions.” And they won’t be allowed to charge women more than men for the same coverage.4
- Eliminate coverage limits and price-gouging. The bills differ on some details, but in general would place limits on how much people have to pay for health care beyond their premiums. They both cap out-of-pocket costs and ban insurance companies from setting limits on how much health care they’ll cover for a person each year.5
Of course, the devil is in the details, and much in these bills still needs work.
Here’s what still needs to be fixed:
- Both bills leave millions uninsured. The House bill leaves 18 million without insurance in 2019; the Senate bill, 24 million.6
- The Senate public option is weak, [and as we know has been a very contentious issue in the Senate] and conservatives are pushing to make it weaker. The public option is a core piece of reform that will create real accountability and competition for private insurance—and that’s why it’s at the center of such a huge fight. While the House bill creates a national public option, the Senate lets states opt out, denying their residents access to it.7
- Many reforms don’t start quickly enough. While some pieces of reform go into effect right away, the larger structural changes are not scheduled to go into effect until 2013 (House bill) or 2014 (Senate bill). This includes the Exchange, the public option, and subsidies—the major ways coverage will be expanded.8
- Required insurance could still be too expensive for many. Both bills require virtually all Americans to have insurance. But the caps on how much we’re expected to pay are way too high, and the subsidies are way too low. 9
- Reproductive rights are severely restricted in the House bill. An egregious anti-choice amendment in the bill virtually prohibits anyone purchasing insurance in the Exchange from buying a plan that covers abortion—even if paid for with their own money.10
- The Senate bill could discriminate against lower income workers. The current Senate legislation retains a version of what’s called the “free rider” provision, which essentially penalizes employers for hiring lower income workers.11
Sources:
1. “A Health Insurance Exchange: The Fine Print,” The New York Times, August 20, 2009
http://www.moveon.org/r?r=85241&id=18172-2324985-ztdPDhx&t=3“Health Reform at a Glance: The Health Insurance Exchange,” House Committees on Ways and Means, Energy and Commerce, and Education and Labor, July 14, 2009
http://www.moveon.org/r?r=85665&id=18172-2324985-ztdPDhx&t=42. “Health Insurance Exchanges: The Most Important, Undernoticed Part of Health Reform,” The Washington Post, June 16, 2009
http://www.moveon.org/r?r=85664&id=18172-2324985-ztdPDhx&t=53. “H.R. 3962, Affordable Health Care for America Act,” Congressional Budget Office, November 20, 2009
http://cbo.gov/doc.cfm?index=10741“Patient Protection and Affordable Care Act,” Congressional Budget Office, November 18, 2009
http://cbo.gov/doc.cfm?index=107314. “Top 10 Ways Health Insurance Reform Works for You,” The Speaker of the House, October 29, 2009
http://www.moveon.org/r?r=85669&id=18172-2324985-ztdPDhx&t=6“How Health Insurance Reform Will Help Your Family,” Senate Democratic Policy Committee
http://dpc.senate.gov/dpcdoc-responsiblereform.cfm“Meeting Women’s Health Care Needs,” The Speaker of the House
http://www.speaker.gov/newsroom/legislation?id=0327“Reports on Health Insurance Reform—Women,” Senate Democratic Policy Committee http://dpc.senate.gov/dpcdoc-responsiblereform.cfm
5. “Top 10 Ways Health Insurance Reform Works for You,” The Speaker of the House, October 29, 2009
http://www.moveon.org/r?r=85669&id=18172-2324985-ztdPDhx&t=7“How Health Insurance Reform Will Help Your Family,” Senate Democratic Policy Committee
http://dpc.senate.gov/dpcdoc-responsiblereform.cfm6. “H.R. 3962, Affordable Health Care for America Act,” Congressional Budget Office, November 20, 2009
http://cbo.gov/doc.cfm?index=10741“Patient Protection and Affordable Care Act,” Congressional Budget Office, November 18, 2009
http://cbo.gov/doc.cfm?index=10731“REPORT: How the Senate Bill Compares to Other Reform Legislation,” Think Progress, November 19, 2009
http://www.moveon.org/r?r=85670&id=18172-2324985-ztdPDhx&t=87. “Sen. Reid Announces ‘Opt Out’ Public Plan,” The New York Times, October 26, 2009
http://www.moveon.org/r?r=85673&id=18172-2324985-ztdPDhx&t=9“Carper: Conservative Democrats Not Likely To Support Senate Public Option,” Talking Points Memo, November 17, 2009
http://www.moveon.org/r?r=85675&id=18172-2324985-ztdPDhx&t=108. “Top 14 Provisions That Take Effect Immediately,” The Speaker of the House
http://www.moveon.org/r?r=85676&id=18172-2324985-ztdPDhx&t=11“What happens before 2014?” The Washington Post, November 19, 2009
http://www.moveon.org/r?r=85677&id=18172-2324985-ztdPDhx&t=12“Senate, House Democratic health bills compared,” The Associated Press, November 18, 2009
http://www.moveon.org/r?r=85667&id=18172-2324985-ztdPDhx&t=139. “The Details of The New Merged Senate Bill,” Think Progress, November 18, 2009
http://www.moveon.org/r?r=85668&id=18172-2324985-ztdPDhx&t=14“REPORT: How the Senate Bill Compares to Other Reform Legislation,” Think Progress, November 19, 2009
http://www.moveon.org/r?r=85670&id=18172-2324985-ztdPDhx&t=15“Analysis: How the Senate health care bill stacks up with the House health care bill,” Think Progress, November 19, 2009
http://thinkprogress.org/2009/11/19/senate-house-comparison/10. “The Ban on Abortion Coverage,” The New York Times, November 9, 2009
http://www.nytimes.com/2009/11/10/opinion/10tue1.html11. “The noxious ‘free rider’ provision,” The Washington Post, November 25, 2009
http://www.moveon.org/r?r=85671&id=18172-2324985-ztdPDhx&t=16“Senate Health Bill Improves Employer Responsibility Provision,” Center on Budget and Policy Priorities, November 19, 2009
http://www.cbpp.org/cms/index.cfm?fa=view&id=3003“The Baucus Bill: The Worst Policy in the Bill, and Possibly in the World,” The Washington Post, September 16, 2009
http://www.moveon.org/r?r=85672&id=18172-2324985-ztdPDhx&t=17
Please see previous KAW Health Care updates:
Tracking the Health care Debate
Reader Comments