2009-11-19
Senate
Democratic leaders released their version of health reform legislation and set
the stage for what is likely to be a dramatic debate in the Senate over health-care.
The
new bill (HR 3590) reflects Senate Majority Leader Harry Reid’s (D-NV) melding
of Senate Committee-passed measures as well as a series of concessions Senator
Reid made to different groups of Senate centrists - some worried about the role
government would play in a retooled health marketplace, others concerned about
the bill’s cost - in an effort to gain their support.
The
result is a measure that would cover fewer people than the House bill (it is
estimated that 6 percent vs. 4 percent in the House bill would be left
uninsured) and would cost more than $200 billion less than the House health
reform measure.
Of
importance to the physician community, the Senate bill includes a provision
that would avert the planned 21 percent Medicare payment cut next year through
a one-year fix of the Medicare physician payment formula that would increase
payment rates by 0.5 percent. This
measure was separated out of the House bill although a similar proposal that
also includes long-term changes to increase physician payment is being voted on in the House on November 19.
Other
major provisions in the Senate measure include:
- Public
Option - The bill would create a government-run insurance program, but would
give states the right to opt out. Health-care providers would negotiate payment rates with the government.
- Individual
Mandates - The bill would require most people to obtain health insurance or pay
a penalty.
- Employer
Mandates - The bill would not require employers to provide health
insurance. The bill would charge
companies with over 50 employees a penalty if they have workers who receive
government subsidies to purchase coverage through the exchange.
- Insurance
Exchange - The bill would set up health insurance exchanges to help those newly
required to get insurance shop around. Exchanges would open in 2014, a year after the House plan. Plans offered in the exchange would have to
meet minimum requirements set by the government.
- Financial
Assistance - The bill includes subsides to help cover those earning up to 400
percent of the federal poverty level - currently $88,000 per year for a family
of four - and expands the Medicaid program to include those making 133 percent
of the federal poverty level.
- New
Taxes - The bill would impose a 40 percent tax on high-cost health insurance
plans, charge a 5 percent tax on elective cosmetic surgery, and would
increase Medicare payroll taxes on individuals earning $200,000 a year and
couples earning $250,000.
- Abortion - The bill includes a provision to prevent any federal funds to be used for
abortion in the public option.
- Medicare
Changes - The bill would reduce Medicare spending by approximately $323 billion
over 10 years, reduce payment to private insurance plans, and provide
$500 to Medicare beneficiaries to pay for prescription drugs not currently
covered because of cost.
Next Steps
A
key procedural vote on the Senate bill is expected to occur Saturday, November
21. The Democratic leadership needs 60
votes to allow consideration and votes on the bill, which would require support
by all members of the Democratic Caucus.
Some Democrat senators continue be classified as “fence sitters.” Senators Mary Landrieu (D-LA), Ben Nelson
(D-NE), and Blanche Lincoln (D-AK), for example, have expressed opposition to a
central feature in the Senate bill, the creation of a government-run plan or “public
option” to compete against private insurers.
In addition, Senate Finance Chairman Max Baucus (D-MT) has had to attend
to his sick mother, which raises the question of whether the vote could be held
as planned or would instead be postponed. Senators have
also been instructed to plan to remain in session until December 24.
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