AHLAlerts: American Health Line’s Blog

A Congressional Budget Office analysis of the insurance exchanges included in the Senate’s health reform bill found that premiums in an exchange would be higher than under current law but that federal subsidies would offset the higher costs, CQ Today reports. Insurers participating in the exchange would be forced to offer more coverage than they currently provide, which would contribute to the higher premiums, according to the report.

The bill’s proposals would be fully implemented by 2016. The analysis found that by that time people who purchase insurance via the exchange would pay premiums between 10% and 13% higher on average than under current law. However, roughly 57% of exchange participants would receive federal subsidies in the form of tax credits, which would cause those people to pay 56% to 59% less than they currently pay for insurance. The average cost of premiums on the exchange would be $5,800 for an individual and $15,200 for families.

Coverage for businesses with fewer than 50 employees that participate in the “small group” market would cost between 1% more and 2% less than it does currently, CBO found. However, subsidies for small businesses would allow employers to pay between 8% and 11% less than they do now to cover employees. The effect on larger businesses would be negligible, according to the report (Armstrong, CQ Today, 11/30).

by Zach Swiss, staff writer

It’s all systems go in the Senate with the start of the debate on the chamber’s health reform bill today. In an effort to help us understand the bill and its proceedings, Kaiser Health News and The Hill provide primers with a similar theme.

• “Seven Things You Didn’t Know Were In the Senate Health Bill“: The bill “is chock full of interesting but little publicized provisions” that would affect “people from the cradle to old age,” according to KHN. Some would prefer to call it a congressional tradition of including “pet interests.” For example, the bill would try to provide nursing mothers a reprieve with breast pumps or make the transition into adulthood for teens a little easier (Carey et al., Kaiser Health News, 11/30).
• “Seven Issues To Watch as the Senate Begins Amending the Health Care Bill“: Senators will begin offering amendments to the bill, of which some may be designed to improve the bill. However, some of them may seek to “satisfy a special interest or pet peeve,” but others might be presented as “poison pills” to restrict progress on the measure, according to The Hill (Young, The Hill, 11/29).

Many would argue the Senate’s reform bill is far from perfect, so the debate in the coming weeks could be long and sometimes contentious. Two publications examine potential roadblocks in the form of Medicare Advantage and health insurance premiums.

• “Medicare Advantage Trims Could Affect Millions of Seniors“: Some experts would consider MA “a case of a good idea gone financially wild” because the government now spends nearly 15% more to provide health insurance coverage to MA plan beneficiaries. House and Senate Democrats insist that the proposed cuts in pending reform legislation — estimated at between $120 billion and $150 billion over 10 years, which would be used to help pay for the overhaul — are meant to improve the program. However, Republicans say the cuts would reduce health benefits for seniors in the program (Garber, U.S. News & World Report, 11/25).
• “Health Reform’s Impact on Premiums: Winners, Losers and, for Many, a Question Mark“: One of the many questions that Democrats will attempt to answer will be the effect of their proposed legislation on health insurance premiums for individuals and small-business owners. Republicans maintain the rates will rise as a result of proposed new taxes on insurance companies, while Democrats insist the rates will drop because of new health insurance regulations and billions of dollars in new subsidies for policyholders to purchase coverage. “Who’s right? Perhaps both,” according to KHN, which is why there appears to be a “heated debate over the long-term outlook” (Appleby, Kaiser Health News, 11/25).

by Santosh Rao, staff writer

Today the Senate is starting debate on its long-awaited health reform bill. Harry Reid is going to need a lot of luck as he attempts to cull the 60 votes necessary for cloture. The debate is expected to last several weeks — though there is still hope that something will get passed by Christmas. In anticipation of the momentous debate about to get under way, bloggers are doing what they do best — predicting the future and speculating how the debate will go.

Today the Senate is starting debate on its long-awaited health reform bill. Harry Reid is going to need a lot of luck as he attempts to cull the 60 votes necessary for cloture. The debate is expected to last several weeks — though there is still hope that something will get passed by Christmas. In anticipation of the momentous debate about to get under way, bloggers are doing what they do best — predicting the future and speculating how the debate will go.

Jonathan Cohn of The New Republic‘s “The Treatment” writes that “the next few weeks will be full of drama,” adding that by the time debate is over the “legislation might end up a lot worse than it is now.” He warns that “along the way to implementation” of a fully reformed health care system, “a lot of bad things can happen,” including to “the lawmakers who championed it.” Cohn writes that the “key for the next few weeks, as the Senate debate moves forward, is figuring out how to minimize that danger,” which “should create plenty of drama.”

Scott Hensley of NPR’s “Shots” says that the Senate reform bill will be “the subject of all kinds of amendments to spice it up,” but that Reid wants Democrats to “restrain themselves” and offer only their “single best idea” as an amendment in order to keep the process moving forward. “Good luck with that,” Hensley writes.

The Republican strategy during the debate is “clear-cut,” according to Steve Benen of Washington Monthly‘s “Political Animal.” Benen writes that Republicans intend to “delay as long as possible, obstruct as much as possible, and bring up as many embarrassing amendments as possible.” According to Benen, they are also “strategizing about having amendments read word for word.”

Drama, spice and clear-cut obstructionism. Sounds like the Senate is in for a heck of a few weeks.

by Julia Moss, staff writer

The Senate on Monday will begin debate on its health reform bill, with opening statements from Majority Leader Harry Reid (D-Nev.) and Minority Leader Mitch McConnell (R-Ky.) at 2 p.m., the Wall Street Journal reports (Bendavid, Wall Street Journal, 11/29). According to Politico, the initial debate is expected to begin at 3 p.m. with a member from each party introducing one amendment to the bill (Budoff Brown, Politico, 11/29). The debate is set to start “in earnest” on Tuesday as Democrats and Republicans begin offering alternating amendments, the Journal reports (Wall Street Journal, 11/29).

Although all 60 members of the Democratic caucus voted for the procedural motion to begin the debate, CQ Weekly reports that it does not appear that those 60 votes will be there to end the debate for the test and final votes on the bill. As a result, it will be up to Reid and President Obama to devise a way “to break the gridlock” (Wayne/Armstrong, CQ Weekly, 11/30).

Some Democrats have indicated that they will withhold their support for the final bill if it includes a government-run health insurance plan, while others have said that they will refrain from supporting the bill if the abortion coverage language is not strengthened. The AP/Chicago Tribune reports that while “no compromise seems possible” on the abortion issue, there is the possibility for a deal on the public plan (Alonso-Zaldivar, AP/Chicago Tribune, 11/30).

Reid’s Private Game Plan

A large portion of Reid’s work on the legislation will come in the privacy of his office, as he attempts to develop a compromise on the public option that would garner the 60 votes necessary for reform passage, Politico reports. During the private meetings, Reid will seek to reach a compromise with at least four moderate members of his caucus — Sens. Mary Landrieu (D-La.), Joseph Lieberman (I-Conn.), Blanche Lincoln (Ark.) and Ben Nelson (Neb.). Lincoln and Lieberman are fully opposed to the public plan while Nelson has indicated that he is open to a public plan with an “opt-in” clause. Landrieu has shown a preference for a “trigger” that would enact a public plan in states where insurers fail to provide adequate and affordable coverage.

In addition, Reid is expected to reach out to Sen. Olympia Snowe (R-Maine), a longtime advocate for the trigger who could be encouraged to vote with the Democrats if a deal with the four moderate Democrats is reached. Meanwhile, a new alternative to the public plan that is under development could attract the support of moderates, according to Politico (Politico, 11/29). Earlier this month, Reid said that Landrieu had been working with Sens. Tom Carper (D-Del.) and Charles Schumer (D-N.Y.) to devise the alternative plan and noted that he is open to considering it (American Health Line, 11/23).

Reid’s Public Game Plan

Reid also has several other “tactical objectives” for the debate in the Senate, Politico reports. Reid is seeking to give Republicans adequate time to offer their concerns and revisions to the bill, while also making sure that they do not slow down the progress on the measure. Republicans reportedly have devised several strategies to delay further votes on the bill, such as introducing large and numerous amendments and demanding that they be read word for word. Reid also will attempt to ensure that certain contentious amendments are not passed by introducing more acceptable alternatives, and discouraging vulnerable members from casting votes that could threaten their seats in future elections, according to Politico.

Democrats, Republicans Devise Separate Team Approaches

Politico reports that Reid and other Senate Democratic leaders also have assigned certain members of their caucus to lead the messaging and amendment teams in several areas — the middle class; health insurance reform; children, senior citizens and Medicare; fiscal responsibility; business and small business; and “the truth squad.” Meanwhile, Republicans also plan to take a similar approach to highlight the more than $400 billion in proposed Medicare cuts, the more than $100 billion in new taxes on health industry players and the impact on health insurance premiums, according to Politico (Politico, 11/29).

– Santosh Rao

Note: This is an abridged version of the story that appeared in American Health Line this morning. For complete access to the full version, plus all of AHL’s other stories and content, subscribe to AHL.

AHLAlerts’ daily columns — “The Blog Line” and “Interesting Reads — are on hiatus and will return on Monday, Nov. 30. The weekly columns — “In Case You Missed It …” and “Editor’s Roundup” — will be back on Friday, Dec. 4.

To stay up-to-date with the most recent health policy news over the Thanksgiving holiday, check our Twitter feed (@AHLAlerts).

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Both Democrats and Republicans have developed strategies for framing the health reform debate while they are away for the Thanksgiving recess, CongressDaily reports.

Democratic Strategy

Senate Democratic leaders in a memorandum to members said that the break is a prime opportunity to capitalize on momentum created by the passage of a procedural vote last Saturday that allows for floor debate on the chamber’s reform bill. The memo says that U.S. residents are “serious about reforming health insurance and for the first time in 60 years … Congress is primed to act.” It adds that the Senate bill “saves lives and saves money,” reduces the deficit and protects Medicare.

House Democrats also were urged by the chamber’s leaders to promote progress made on the Senate bill. Leaders told House members to do radio, television and newspaper interviews “to make the case for health reform and explain the principles of the House bill” (HR 3962) because “poll after poll shows that most Americans support our health care insurance reform when we clearly communicate with them what the legislation does.”

GOP Strategy

The Senate Republican Conference provided talking points to GOP members restating party claims that the Senate bill would cost $2.5 trillion when fully implemented and emphasizing the legislation’s length of 2,074 pages. The talking points say that the bill would cause higher premiums, higher taxes and Medicare cuts.

In addition, the guidance describes the Republican strategy for health reform as a “step-by-step” approach, countering Democratic claims that the GOP’s strategy is “to do nothing.” This approach, according to the points, includes medical malpractice reform, combating waste, allowing small businesses to form purchasing pools and facilitating the purchase of insurance across state lines (Friedman/House, CongressDaily, 11/24). In addition, the National Republican Senatorial Committee has made Senate Majority Leader Harry Reid (D-Nev.) a target for criticism until next year’s midterm elections (Stanton, Roll Call, 11/24).

Brown Says Congress Will Finish Reform by State of Union

Sen. Sherrod Brown (D-Ohio) recently said that Democrats will work overtime to finish a reform bill in the Senate by the end of the year and complete finalized legislation before President Obama gives the State of the Union address in late January 2010. Brown said, “[W]e’re going to be working weekends, we’re going to be working into the night.” He said that when lawmakers return from recess on Monday, they need to “stay in Washington … and do whatever it takes to get this bill past the Senate in December and to the president’s desk” in January, adding, “That’s absolutely our commitment.”

– compiled by Matthew Wayt

Note: This is an abridged version of the story that appeared in American Health Line this morning. For complete access to the full version, plus all of AHL’s other stories and content, subscribe to AHL.

As centrist Democrats and members of the GOP count the ways they are unhappy with the current Senate reform bill, some experts predict that Senate Majority Leader Harry Reid (D-Nev.) will have to use budget reconciliation to pass an overhaul that includes liberal proposals like the public plan option. Bloggers take stock of the conflict and measure how such a tactic could further damage the already unhappy relationship between Senate Democrats and Republicans, while others either try to think through the situation or simply choose sides.

Jay Newton-Small of Time‘s “Swampland” writes that as the “public option withers on the Senate vine,” there are “a few whispers on the Hill” that Reid might use budget reconciliation to hold onto the plan. However, he continues that Democrats know “for the most part” that “shoe-horning” a bill through reconciliation “not only burns all centrist good will” but that “such a plan has a lot of complications.” According to Newton-Small, the first hurdle is that Republicans would “invoke the Byrd rule,” which would “forc[e] Dems to pare down the bill and pass something much, much less ambitious.” He writes that the second problem is “the budget expires in five years — meaning Congress would have to go through this whole process all over again to either extend or make permanent the changes.”

Ezra Klein thinks that the most important relationship in Congress is not between Democrats and Republicans but between “cause (one party got elected) and effect (they passed bills).” He writes that strengthening “that crucial relationship … is not only better from the perspective of assuring action on problems. It’s also a road to a better informed citizenry that knows who to blame, and who to reward, for the condition of the country and the performance of the most recent Congress.”

The performance part could be a problem for Democrats, according to The Health Care Blog’s Robert Laszewski, who cites recent poll results that indicate “an unmitigated disaster” for Democratic reform efforts. He writes that the “dramatic slip in approval ratings for the Democrats on health care” largely reflects the public’s concern with the cost of overhaul packages in Congress. Laszewski asks, “How can the Democrats ram anything so big and complex through as these health care bills with approval ratings — now in the 35% to 40% range — so low?” He adds, “They seem intent on showing us.”

If Laszewski had his way, the Dems would be sleeping on the couch tonight.

– by Matthew Wayt, staff writer

Two high-profile figures in the health care debate — Sens. Harry Reid (D-Nev.) and Christopher Dodd (D-Conn.) — will be doing some campaigning in the coming weeks, both to save health reform and their political careers. Then the Associated Press looks at whether taxes on “Cadillac” plans are “fair,” and The Hill examines some of the crazy things lawmakers have said during the debate over health reform.

• “For Reid, Dodd, Clout on Big Issues Cuts Both Ways“: Reid and Dodd are players in “two of the most ambitious and hotly contested” legislative items in decades — health reform and an overhaul of financial regulation — but that’s not helping their re-election chances. Both are trailing Republican challengers in early polls (Babington, AP/Atlanta Journal-Constitution, 11/23).
• “Health Reform: Is Tax on ‘Cadillac’ Plans Fair?“: Though President Obama pledged not to raise taxes on the middle class, experts agree that the Senate’s tax on Cadillac, or high-cost, health care plans will affect more middle-class workers than wealthy ones. Is that fair? Who should pay the bill for health reform? The Associated Press explores the issue — and finds no easy answers (Johnson, AP/Atlanta Journal-Constitution, 11/23).
• “Side Deals Stack Up as Health Bills Move Along“: Sen. Mary Landrieu (D-La.) isn’t the only lawmaker who got a little extra incentive to vote for health reform. In fact, offering special legislative favors for votes on close bills “is a long tradition,” according to The Hill (Soraghan, The Hill, 11/23).
• “‘You Lie’ to ‘Die Quickly’: Lawmakers Not Short of Sound Bites in Debate“: In today’s political world, you don’t need the rhetorical skill of an MLK or JFK to make headlines — all it takes is a zinger like “half pregnant” or “garlic milkshake” to get attention (O’Brien, The Hill, 11/23).

by Ryan Holeywell, staff writer

The Senate health reform bill no longer contains a proposal to eliminate the antitrust exemption currently granted to health insurance companies, HealthLeaders Media reports (Masterson, HealthLeaders Media, 11/23). Democrats wanted to strip insurers of the exemption — which was granted in 1945 — in order to make health and malpractice insurers accountable under antitrust laws that ban price-fixing, bid-rigging and dividing markets between them (American Health Line, 9/21). Lawmakers renewed their push to repeal the exemption after America’s Health Insurance Plans released a report last month criticizing some aspects of Democratic health reform proposals (HealthLeaders Media, 11/23).

Schumer Says Bill Will Pass
Sen. Charles Schumer (D-N.Y.) on Monday said that Democrats are determined to pass a health reform bill, with or without Republican support. He said that the health system “is broken” and that Democrats prefer to overhaul it “with Republicans if we reach compromise in some areas.” He added, “But we’re not going to not pass a bill” (AP/Boston Globe, 11/24). Schumer added that both moderate and liberal Democrats likely will have to make concessions to ensure passage of a final reform bill (O’Brien, “Blog Briefing Room,” The Hill, 11/23).

– compiled by Matthew Wayt

Everyone’s a strategist. Now that the Senate has voted to begin debate on health reform, look to newspapers and magazines across the country to offer their advice on what it will take to make or break the legislation.

• “Five Things You Could Do in the Time It Would Take To Read the Senate’s Health Care Bill“: Sen. Tom Coburn (R-Okla.) has threatened to have the entire 2,074-page health bill read on the Senate floor as a delay tactic, which could take 48 hours. In that time, Senators could read the entire Bible — and then some (Chicago Tribune, 11/23).
• “Are There Enough Doctors To Make Reform Work?”: There’s a dire shortage of primary care physicians in the U.S., as medical students turn away from primary care and instead set their sights on more lucrative specialties. Who could blame them? Family care doctors earn, on average, a paltry $173,000 annually. Fortunately, Congress wants to bump up their salaries by 10% to make the field more attractive (Plautz, National Journal, 11/21).
• “Eight Key Hurdles for Health Care Overhaul”: Different constituencies have different goals for health reform. Enough groups will have to sign on for it to pass, but many of them have mutually exclusive interests. Senate and House leaders will need to carefully decide who they are willing to alienate and who they will have to appease as they craft the legislation (Werber Serafini/Vaida, National Journal, 11/21).
• “Filibusters Aren’t What They Used To Be“: If you’re hoping to see shades of Jimmy Stewart as the Republicans threaten to filibuster the health reform bill, don’t count it. A traditional old-school filibuster hasn’t occurred in more than 20 years, and less dramatic procedural techniques can be used to block the bill (Coller, Politico, 11/23).
• “How Health Care Reform Could Fall Apart“: The battle lines have been drawn, and the Democrats will have a nearly impossible time reaching consensus on health reform’s abortion restrictions, taxes and Medicare cuts. Still, it’s the public option that seems to be the biggest point of contention. Ironically, “a Democratic dream — expanding the government role in guaranteeing health care to the uninsured — might well be reform’s undoing,” Politico states (Budoff Brown/O’Connor, Politico, 11/22).

by Ryan Holeywell, staff writer