Additions to House Reform Plan Spark Debate Over Higher Costs
The gross cost of the House health reform bill (HR 3962) would be $1.2 trillion or more over 10 years due to additional health care expenditures not included in the draft legislation initially submitted to the Congressional Budget Office, according to a new analysis and anonymous Democratic officials, the AP/San Diego Union-Tribune reports.
The new estimate is well above President Obama's desired price tag of $900 billion for health reform (Espo, AP/San Diego Union-Tribune, 11/2).
Preliminary CBO estimates found that the bill's gross cost would be $1.055 trillion between 2010 and 2019 and reduce the federal deficit by $104 billion (California Healthline, 10/30).
Since that analysis was conducted, House Democrats have added billions more in spending to improve benefits and expand access to government health programs. In addition, new spending has been added to address issues such as public health, retiree health care costs and preventive care.
Despite the additions to the bill, House Speaker Nancy Pelosi (D-Calif.) has continued to say that the overall net cost for coverage in the bill would be $894 billion over 10 years. When asked about the higher estimate, Pelosi spokesperson Brendan Daly reiterated that the health reform bill "will not add one dime to the deficit," adding that "CBO said last week that it will reduce the deficit both in the first 10 years and in the second 10 years" (AP/San Diego Union-Tribune, 11/2).
CBO Sees Premium Reductions
Under the House health reform bill, middle-income families could be required to pay 15% to 18% of their incomes on insurance premiums and copayments, according to the CBO report released Monday, the New York Times reports.
House Democrats have said the report offers evidence that the bill would reduce premiums for many U.S. residents who currently are without affordable coverage.
According to CBO, the House bill would provide $600 billion in subsidies to assist low- and middle-income families purchase coverage, primarily from private insurers, through a health insurance exchange.
CBO found that a family of four with an income of $78,000 in 2016 would pay an average annual premium of $8,800 and annual copays of $5,000, which would amount to about 18% of the family's income.
A family of four with an income of $66,000 in 2016 would pay premiums of $6,300 and copays of $3,700, which would amount to about 15% of its income, according to the report.
In the analysis, CBO did not assess the projected cost of insurance if Congress does not take action, but previous CBO analyses have estimated that premiums for families buying coverage on their own would average $11,000 in 2016.
The CBO report said that under the House legislation, people receiving subsidies would be granted $5,800 on average, $1,000 more than the average subsidy provided under the Senate Finance Committee's bill (S 1796) (Pear/Hulse, New York Times, 11/3).
Stimulus Assistance for Medicaid Included
The House bill includes a six-month expansion of a provision in the economic stimulus package that increases the share the federal government contributes to state Medicaid programs through federal medical assistance percentages.
The extension might help ease concerns about proposed Medicaid expansions in federal health reform legislation that would add additional pressure to states facing mounting budget deficits.
The stimulus package provided states with an additional $86.6 billion in Medicaid assistance through the end of 2010. The House bill extends the program through the end of June 2011 at a cost of about $23.5 billion.
The extension has sparked a partisan debate in the House, with many Democrats saying that it is necessary to fill in state budget gaps, while many Republicans are arguing that it would add to the deficit (Clarke, CQ Today, 11/2).
Many centrist House Democrats once considered "no" votes on health reform legislation are starting to move into the "leaning yes" or "yes" column, but House leaders still are shy of the 218 votes needed for final passage, The Hill reports (Soraghan, The Hill, 11/2).
Republican Alternative Bill To Address Costs
House Republican leaders on Monday did not release details of their alternative health reform bill but said that the legislation will focus on lowering costs, CQ Today reports (Epstein, CQ Today, 11/2).
House Minority Leader John Boehner (R-Ohio) said, "Our substitute aims at driving down costs," adding, "If you drive down costs, you can expand access."
Although full details of the GOP bill have not been released, the Republican plan is expected to:
- Limit medical malpractice lawsuits;
- Allow the purchase of health insurance across state lines; and
- Allow individuals and small businesses to band together to purchase coverage (O'Connor, Politico, 11/2).
The GOP bill would allow insurance companies to exclude people based on pre-existing conditions. In addition, under the GOP bill, there would be no public health insurance plan option, national insurance exchange, or individual and employer insurance mandates.
In crafting the legislation, Boehner did not include tax credits to help low- and middle-income U.S. residents purchase insurance. Boehner said on Monday that the tax credits are too costly (Dennis, Roll Call, 11/2).
Boehner said, "Our plan is over at (the Congressional Budget Office)," adding, "We expect to be ready here in the next several days." He called for "a real debate on our proposal, a real debate and a vote."
In response, Nadeam Elshami, a spokesperson Pelosi, said, "They're not even attempting to cover most Americans," adding, "House Republicans are now rushing to try to convert" their eight or nine ideas for health reform "into legislation, but without offering real reforms for Americans" (Politico, 11/2).
GOP Gets Aggressive
House Republicans are planning a series of events and initiatives this week that aim to undercut momentum in passing health reform legislation in the near future, Roll Call reports.
During a press conference Monday, Boehner and House Republican Conference Chair Mike Pence (Ind.) encouraged members of their caucus to take "every opportunity" to attack Democratic health care proposals in an effort to reignite the passion expressed during the August town-hall meetings and pressure centrist Democrats to reject the plan (Kucinich, Roll Call, 11/3).
Among the events scheduled to take place is a series of women-centered events organized by House Republican Conference Committee Vice Chair Cathy McMorris Rodgers (Wash.) (Bendery, Roll Call, 11/2).
House Republicans also will host an online town-hall meeting sponsored by the Republican National Committee from 1 p.m. ET on Thursday to 1 a.m. ET on Friday.
In addition, many members of the House Republican Caucus will participate in a health reform protest scheduled on Thursday outside the Capitol (Roll Call, 11/3).
Floor Debate Delayed Until at Least Friday
Floor action on the House health reform bill has been delayed until at least Friday because of discussion over abortion and immigrant coverage in the legislation, CQ Today reports.
A Democratic leadership aide said that an amendment expected to include compromise language on both topics will not be ready until Tuesday at the earliest. The aide added that because leaders have pledged to allow a 72-hour review period before debate begins, Friday is the earliest possible start date (Wayne , CQ Today, 11/2).
The aide said that members have been told to leave their schedules open on Nov. 7, Nov. 9, and Nov. 10 for a possible debate (Wayne , CQ Today, 11/2).CongressDaily reports that the House Rules Committee is likely to meet on Wednesday or Thursday to determine the structure of the floor debate (Hunt, CongressDaily, 11/2). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.