Senate braces for historic health bill debate
WASHINGTON (AP) – After months of maneuvering, the Senate stands at the brink of a historic battle over health care with President Barack Obama and his allies on one side and Republicans, outnumbered but unflinching, on the other.
“Now it’s America’s turn, and this will not be a short debate,” Sen. Mitch McConnell of Kentucky, the Republican leader, warned after Majority Leader Harry Reid unveiled long-awaited legislation Wednesday night to extend coverage to 30 million more Americans and force insurance companies to take all comers.
“Higher premiums, tax increases and Medicare cuts to pay for more government. The American people know that is not reform,” McConnell said.
Obama and Democrats hailed the 10-year, $849 billion measure that would remake the nation’s health care system, relying on cuts in future Medicare spending to cover costs, as well as on higher payroll taxes for the well-off and a new levy on patients undergoing elective cosmetic surgery.
Reid, D-Nev., wrote the legislation with White House aides during weeks of secretive negotiations, selecting elements from two committee-passed bills with the aim of securing the necessary 60 votes in a Senate debate that will be decisive for Obama’s health care agenda.
“From Day One, our goal has been to enact legislation that offers stability and security to those who have insurance and affordable coverage to those who don’t, and that lowers costs for families, businesses and governments across the country,” Obama said. Reid’s bill “meets those principles,” the president said.
Aides said the mammoth, 2,074-page bill would reduce deficits by $127 billion over a decade, citing estimates by the Congressional Budget Office. For the first time most Americans would be required to carry health insurance, and the bill would provide hundreds of billions of dollars in subsidies to help those with lower incomes afford coverage.
Employers would not be required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees’ insurance.
Reid released his legislation more than a week after the House approved its more expensive version of the health care bill on a near party-line vote of 220-215.
Reid pointedly declined to claim the 60 votes needed to clear a must-pass procedural hurdle before debate can begin. That vote could take place Saturday.
Democrats hold 58 seats in the Senate and two independents generally vote with them, but several moderate Democrats — Mary Landrieu of Louisiana, Ben Nelson of Nebraska and Blanche Lincoln of Arkansas — have yet to commit to allowing debate to begin. Reid met privately with the three before releasing his bill Wednesday, and Nelson later issued a statement strongly suggesting he would support fellow Democrats on the procedural vote.
Landrieu said she wanted more information about the bill before making a final decision, while Lincoln, the only one of the three who faces re-election next year, told reporters, “We’ll wait and see.”
If this weekend’s vote succeeds, it would be followed by weeks — if not more — of unpredictable maneuvering on the Senate floor, where Reid and his allies will seek to incorporate changes sought by Democrats and repel attempts by Republicans to defeat the legislation and inflict a significant political defeat on the president.
Beginning in 2014, Reid’s bill would set up new insurance marketplaces called exchanges, primarily for those who now have a hard time getting or keeping coverage. Consumers would have the choice of purchasing government-sold insurance, an attempt to hold down prices charged by private insurers.
The bill has many similarities to the House-passed measure, but with some important differences.
Reid called for increasing the Medicare payroll tax by half a percentage point to 1.95 percent on income over $200,000 a year for individuals, $250,000 for couples.
He also included a tax on high-value insurance policies, meant to curb the appetite for expensive care.
The House bill contains neither of those two provisions, relying on an income tax surcharge on the wealthy to finance an expansion of coverage.
On a controversial issue that threatened to derail the House legislation, Reid would allow the new government insurance plan to cover abortions and would let companies that receive federal funds offer insurance plans that include abortion coverage.
A provision in the House bill — passed at the insistence of anti-abortion Democrats over strenuous objections from liberals — banned both those things. Reid attempted to tighten up the abortion language to strictly segregate private from public funds, but that did not pass muster with the National Right to Life Committee, which issued a statement Wednesday night calling the language “completely unacceptable.”
A comparison of the Senate and House Democratic health bills
A comparison of the health care bills before Congress:
The Senate Democratic bill (Patient Protection and Affordable Care Act):
Who’s covered: About 94 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2014. Illegal immigrants would not receive assistance.
Cost: Coverage provisions cost $849 billion over 10 years.
Requirements for individuals: Almost everyone must get coverage through an employer, on their own or through a government plan. Exemptions for economic hardship. Those who are obligated to buy coverage and refuse to do so would pay a fine starting at $95 in 2014 and rising to $750
Requirements for employers: Not required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees’ coverage.
Changes to Medicaid: Income eligibility levels likely to be standardized to 133 percent of poverty, which is $29,327 a year for a family of four, for all parents, children and pregnant women. Federal government would pick up the full cost of the expansion during the first three years. States could negotiate with insurers to arrange coverage for people with incomes slightly higher than the cutoff for Medicaid.
Drugs: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson’s and other deadly diseases. Drug companies contribute $80 billion over 10 years with the majority of the money used to limit the prescription coverage gap in Medicare.
The House bill (Affordable Health Care for America Act):
Who’s covered: About 96 percent of legal residents under age 65 — compared with 83 percent now. Government subsidies to help buy coverage start in 2013. About one-third of the remaining 18 million people under age 65 left uninsured would be illegal immigrants.
Cost: The Congressional Budget Office says the bill’s cost of expanding insurance coverage over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties on individuals and employers who don’t comply with new requirements. That’s under President Barack Obama’s $900 billion goal. However, those figures leave out a variety of new costs in the bill, including increased prescription drug coverage for seniors under Medicare, so the measure may be around $1.2 trillion.
Requirements for individuals: Individuals must have insurance, enforced through a tax penalty of 2.5 percent of income. People can apply for hardship waivers if coverage is unaffordable.
Requirements for employers: Employers must provide insurance to their employees or pay a penalty of 8 percent of payroll. Companies with payrolls under $500,000 annually are exempt – a change from the original $250,000 level to accommodate concerns of moderate Democrats – and the penalty is phased in for companies with payrolls between $500,000 and $750,000.
Small businesses – those with 10 or fewer workers – get tax credits to help them provide coverage.
Changes to Medicaid: The federal-state insurance program for the poor would be expanded to cover all individuals under age 65 with incomes up to 150 percent of the federal poverty level, which is $33,075 per year for a family of four. The federal government would pick up the full cost of the expansion in 2013 and 2014; thereafter the federal government would pay 91 percent and states would pay 9 percent.
Drugs: Grants 12 years of market protection to high-tech drugs used to combat cancer, Parkinson’s and other deadly diseases. Phases out the gap in Medicare prescription drug coverage by 2019. Requires the HHS secretary to negotiate drug prices on behalf of Medicare beneficiaries.
