November 2009 Archives

Debate begins today on the Senate's health care reform bill, with both Democrats and Republicans planning to offer amendments on divisive subjects such as abortion and taxes.    The one thing that all observers agree on is that the debate will be contentious.  As reported in Politico,

the reasons are clear: deep divides among Democrats on a public insurance plan, abortion, tax hikes and cost-cutting. Liberals want the plan to be generous enough. Moderates fear a budget-buster. And everyone is trying to avoid angering seniors...  [Senate Majority Leader Harry] Reid (D-Nev.) is far from having the votes to move his $848 billion package to final passage. At least four centrists have pledged to oppose it in its current form, largely over the public option. Reid is in a bind. Stay to the left, and moderates vote no. Move a tad to the right, and Reid faces insurrection from the left, as liberals in his own caucus and in the House vow not to compromise any further on their signature issue.

The Washington Post's coverage focuses on the overall cost of the proposed bill and the evidence surrounding costs and projected long term savings:

Kaiser Health News and NPR reported last week that the focus on the cost of health reform has focused almost entirely on the overall costs of the various proposals, while very little attention has been paid to how much an individual or family will have to pay. 

That could be a costly miscalculation, says health economist Jonathan Gruber of the Massachusetts Institute of Technology. "Let's put it this way: It is 10 times as important as the public option and has received one one-hundredth of the coverage," he says. That's because, in the end, whether or not people can afford health insurance may have a bigger impact on the bill's political popularity than whether the final price tag exceeds a trillion dollars.

The bills now before Congress do address affordability by providing government subsidies for insurance premiums for people who earn less than four times the poverty level.   But insurance premiums are just part of what people pay for their health care.  Deductibles and co-pays can be substantial additional costs.  Gruber notes that the House provides substantially more help with these additional costs than does the Senate bill:

For the full story, click here, 

The Hill posted an article on Sunday summarizing what it sees as the seven pivotal issues that stand  will be subject of debate and possible amendment as the Senate takes up its health care reform bill next week:

Public option: An issue that unites Republicans and divides Democrats on ideological grounds inevitably was bound to haunt the Senate Democratic leadership. The notion of creating a government-run health insurance plan to compete with private companies is seen as vital by liberal Democrats but centrists range from skeptical to deeply antagonistic, even though states could opt out. 
The best hope for a positive outcome for the Democrats could rest on the chances that liberal Sen. Chuck Schumer (D-N.Y.) along with centrist public option supporter Sen. Tom Carper (D-Del.) can forge yet another compromise version of the program to satisfy centrists such as Sens. Ben Nelson (D-Neb.) and Joe Lieberman (I-Conn.), who have threatened to filibuster the bill over the public option. Sen. Olympia Snowe (R-Maine) is waiting in the wings with her "trigger" compromise.

Abortion: It wouldn't be American politics if the forces on both sides of the abortion issue weren't at loggerheads. The healthcare bill already includes language that is supposed to keep federal dollars away from abortion funding but the Catholic bishops, and Nelson, don't think it goes far enough. Democratic Sens. Bob Casey Jr. (Pa.) and Kent Conrad (N.D.) each voted in committee to beef up the abortion restrictions so their actions on the floor will be key. Sen. Orrin Hatch (R-Utah) authored the failed committee amendments and is sure to raise objections to the bill on abortion.

A press release from the Government Printing Office announced that the Senate health care reform bill is available on their Federal Digital System. 

The U.S. Government Printing Office (GPO) has made available the U.S. Senate's health care reform bill in electronic and printed form.  The authentic, electronic version is available on GPO's Federal Digital System (FDsys), named by Government Computer News as one of the Government's best Web sites.  GPO authenticated the document by digital signature. This signature assures the public that the document has not been changed or altered. A digital signature, viewed through the GPO Seal of Authenticity, verifies the document's integrity and authenticity.

Link to FDsys:  www.fdsys.gov

Direct link to the Senate bill: 
http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590AS/pdf/BILLS-111hr3590AS.pdf

Direct link to the House bill:  
http://www.gpo.gov/fdsys/pkg/BILLS-111hr3962IH/pdf/BILLS-111hr3962IH.pdf

In a 60-39 vote, the Senate voted tonight to proceed with the debate on the Senate Finance Committee's health reform bill.  After days of indecision, the two final Democratic holdouts -- Sens. Blanche Lincoln (Ark.) and Mary Landrieu (La.) -- joined the rest of their caucus in supporting a procedural motion to begin debate.   No Republican voted for the measure.   

While Saturday's vote was a key victory for Senate Democrats and a necessary step in moving the health reform bill to a vote, it is just the beginning of what will likely be a struggle to get the bill passed.  As reported in The Washington Post,

[E]ven as Democrats heralded their victory, they conceded that it represents the end of the beginning -- and not the other way around.   Like Sen. Ben Nelson (D-Neb.), a holdout until Friday, Lincoln and Landrieu said they will press Reid for further changes to the bill before committing to its final passage. Above all, the Democratic caucus remains bitterly divided over a government insurance option.   Reid quelled an uprising by liberal senators weeks ago by adding a public option to the legislation. But although he included an opt-out clause for states, some moderates -- including Landrieu and Lincoln -- have told Reid they will oppose the Senate bill on final passage unless the provision is dropped.  For Democratic leaders, the weeks ahead are likely to bring costly concessions. Lawmakers are already requesting changes to the legislation, raising concerns related to Medicare, abortion and employer requirements.

For the complete story in the Washington Post, click here.  For coverage from The Wall Street Journal, The New York Times, and the Los Angeles Times click here, here, and here. 

For the text of the bill, click here.

As previously reported on this blog, House Republicans announced over the weekend that they would be releasing their own health care reform proposal.   The text of the bill was released and the New York Times summarized the major differences between this bill and the one that Democrats proposed last month:

The Republican bill differs from the Democratic measure in that it would not require people to obtain insurance or require employers to offer it. It is almost surely cheaper than the House Democrats' bill because, unlike that proposal, it would not expand Medicaid or offer federal subsidies to low- and middle-income people to help them buy insurance. Nor would the Republican bill impose new taxes.

On Saturday, the House approved a rule which should clear the way for debate, and ultimately a vote, on H.R. 3961, the "Medicare Physician Payment Reform Act of 2009." The vote on the rule was 242-192, with all but 15 Democrats voting in support and all Republicans voting against. While the rule sets parameters for debate on the bill, the upcoming congressional recess for the Veterans Day holiday, along with the historic vote on the House health care reform bill, prevented a floor vote on H.R. 3961 from taking place on Saturday. The House is expected to take up H.R. 3961 during the week of November 16.

As previously reported in this blog, HR 3961 would repeal the sustainable growth rate (SGR) physician payment formula and replace it with a new, more equitable payment system.

For the text of H.R. 3691, click here and for the text of the rule approved by Congress today for considering HR 3961, click here.   For our previous blog post on HR 3961, click here.