Senate Clears Procedural Steps; Reform Bill Moves Closer to Thursday Vote
The Senate voted 60-39 on Tuesday morning to end debate on a package of amendments to the chamber's original health reform bill (HR 3590), thus overcoming the second of three procedural obstacles to final passage of the bill in an expected Christmas Eve vote, the New York Times reports (Herszenhorn, New York Times, 12/22).
The first procedural hurdle was a 1 a.m. Monday morning vote, in which the Senate voted 60-40 to suspend debate on Senate Majority Leader Harry Reid's (D-Nev.) manager's amendment (Murray, Washington Post, 12/22).
The final procedural hurdle will come Wednesday afternoon, when the Senate will vote on a substitute measure to the bill followed immediately by a vote to suspend debate. If it passes, the Senate is scheduled to hold a final vote at about 7 p.m. on Thursday. The final vote could take place earlier, but only if the Senate unanimously agrees to it (Alarkon, The Hill, 12/21).
The manager's amendment, which includes all the compromises reached since the bill was first introduced in late November, aims to bring the Democratic caucus together behind a single reform bill.
According to the Congressional Budget Office and the Joint Committee on Taxation, the manager's amendment would increase the cost of the chamber's health reform bill from $848 billion over 10 years to $871 billion over 10 years.
The manager's amendment was introduced after Reid reached an agreement over abortion coverage with Sen. Ben Nelson (D-Neb.), who threatened to withhold support from the legislation unless tighter restrictions were added. The abortion language change was only one of the many revisions made to the original Senate reform bill. Others include:
- Public option: The manager's amendment would remove the state "opt-out" public health insurance plan from the original bill and replace it with a system of national, private insurance plans that are negotiated by the Office of Personnel Management. OPM would be required to recruit at least two plans to participate in the new national health insurance exchange, and one would have to be not-for-profit.
- Medicare physician payment fix: The amendment would drop a provision in the health reform bill to enact a 21% reduction in Medicare physician reimbursement rates that was scheduled to take effect on Jan. 1, 2010. A defense spending bill (HR 3326) approved by the Senate on Saturday would postpone the cuts for two months. According to Reid, the Senate will pass a separate bill in January to avert reimbursement cuts for the entire year.
- Insurer financial regulations: The amendment includes requirements that starting in 2011, private insurers covering employees of large companies spend at least 85% of their premium revenue on medical claims. Under the requirements, insurers covering employees of small companies or individuals would have to spend 80% of their revenue on claims (Wayne, CQ Today, 12/19).
- Medicaid expansion: The Senate health reform bill would expand Medicaid eligibility to all U.S. residents below 133% of the federal poverty level (Murray/Montgomery, Washington Post, 12/20). Under the manager's amendment, Massachusetts, Nebraska and Vermont would receive additional federal Medicaid payments for new enrollees (CQ Today, 12/19). Starting in 2016, Nebraska would have 100% of the additional Medicaid costs sponsored by the federal government (Washington Post, 12/20).
- Penalties: The manager's amendment also would alter penalties for people who do not abide by the mandate that every individual have health insurance by instituting a formula based on how many months a person or a family is without coverage. In addition, the penalties for employers who do not offer coverage, or have coverage restrictions, were changed to allow employers to keep in place 30-day waiting periods before allowing workers to enroll in health plans (CQ Today, 12/19).
CBO Scores Legislation
The most recent version of the Senate's health reform legislation would cost $871 billion over 10 years and would result in 94% of non-elderly U.S. residents having health coverage, according to a preliminary score released on Saturday by CBO, The Hill reports.
The figures came in a letter from CBO Director Douglas Elmendorf (Young, The Hill, 12/19).
The changes in the manager's amendment that most heavily factored into the cost increases included:
- Replacing a public option with multi-state plans that would be run by the OPM;
- Expanding eligibility for a small-business tax credit; and
- Eliminating payment increases for physicians under Medicare (Simmons, HealthLeaders Media, 12/21).
The legislation also would expand coverage to 31 million more people by 2019. Of those people, 26 million would obtain coverage through the health insurance exchange included in the bill and 15 million would join Medicaid. CBO predicts that 23 million U.S. residents would still be uninsured in 2019 under the bill, about one-third of whom would be undocumented immigrants (The Hill, 12/19). The number of U.S. residents who obtain coverage through their employer would be reduced by about four million in 2019 under the legislation.
In a separate addendum to Elmendorf's letter released on Sunday, CBO found that Medicare spending under the Senate reform bill would increase on average by 6% annually over the next two decades, below the 8% average annual growth rates over the previous two decades (HealthLeaders Media, 12/21).
Prospects for Reconciling House, Senate Bills
The conference committee responsible for combining the House (HR 3962) and Senate reform bills is expected to start negotiations once Congress returns after the Christmas break in early January, the Wall Street Journal reports.
According to the Journal, Democratic leaders are planning "swift negotiations," during which the House is likely to be "under enormous pressure to compromise" because of the fragility of the 60 votes needed to support the legislation in the Senate (Hitt, Wall Street Journal, 12/22).
Among the issues that the two chambers will need to find compromise on are:
- Public option: The House bill includes a public health insurance option, while the state opt-out plan originally included in the Senate bill was removed during caucus negotiations.
- Financing: The House bill would rely primarily on a surtax on the wealthiest U.S. residents as a funding mechanism for reform, while the Senate bill would create an excise tax on high-cost "Cadillac" insurance plans.
- Abortion: While both bills have undergone revisions on how to address abortion language, the two bills differ on how they would restrict abortion coverage.
Other differences between the bills include how they would expand Medicaid eligibility, mandate coverage for employers, restrict coverage for undocumented immigrants and regulate health insurers (Hook/Levey, Los Angeles Times, 12/21).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.