Archive for the ‘Senate Finance Committee’ Category
SENATE: Chances Increase for Public Option in Final Bill
The chance that a public plan will be included in a final Senate health reform bill — “once on life support” in the chamber — is “making a recovery” among top Senate Democratic leaders and White House officials, who have been holding an ongoing series of discussions to merge the chamber’s two health reform bills, the Wall Street Journal reports (Hitt/Adamy, Wall Street Journal, 10/20).
After one such discussion on Monday, Sen. Christopher Dodd (D-Conn.), who helped guide reform legislation (S 1679) through the Senate Health, Education, Labor and Pensions Committee, said that no decisions have yet been made on the public option. However, the senators said they are working toward reaching an agreement by the end of this week (Budoff Brown, “Live Pulse,” Politico, 10/19).
The group, which is being led by Senate Majority Leader Harry Reid (D-Nev.), is working to merge the HELP Committee’s bill, which includes a public plan, with the Senate Finance Committee’s bill. The Finance panel approved its bill last week without a public plan, replacing it with a network of not-for-profit health cooperatives.
However, the Journal reports that although the Finance panel rejected a pair of amendments that would have included a public plan and ultimately decided on the co-ops, a public plan “wouldn’t die.” According to the Journal, that is partly because the Congressional Budget Office found that the co-ops “seem unlikely to establish a significant market presence in many areas of the county” and because private health insurers began attacking the committee’s bill, which led Democratic senators “to look less favorably on the industry.”
Still, the Journal notes that “no one is talking about a nationwide Medicare-like” public plan, which liberal Democrats favor. Instead, a number of variations — or a blend of them — are being considered for the final bill (Wall Street Journal, 10/20).
Instead of a national public option, senators are discussing other alternatives, including:
- A public option offered in insurance exchanges, which would pay rates that were negotiated between the HHS secretary and medical providers;
- A provision that would allow states to opt out from a national public plan and, instead, establish a network of co-ops;
- A “trigger” under which a public plan would be introduced only if private insurers fail to meet certain standards for coverage (American Health Line, 10/19); and
- A proposal allowing states to set up public plans on their own, along with a provision to create a federal public plan, in which states could choose to participate (American Health Line, 10/15).
According to Kaiser Health News, the “toughest version” of the public option would tie payment rates to medical providers to those paid by Medicare. CBO estimates this proposal would generate about $110 billion in overall savings over 10 years. Meanwhile, moderate Democrats are advocating for the proposal that would require the government to set payment rates with providers, which CBO projects would reduce spending by about $25 billion over 10 years.
On Monday, Senate Finance Committee Chair Max Baucus (D-Mont.) — who is involved in the meetings with Reid — said the goal is to deliver a bill that attracts the 60 votes needed to prevent a Republican-led filibuster in the chamber. Speaking to reporters during a media conference call organized by Families USA, Baucus noted, “I don’t know if there are 60 votes for the pure kind [of a national government-run version] of public option proponents are demanding.” But he added that various versions of the public option are being “bandied about” and “we’re trying to see what makes the most sense” (Pianin, Kaiser Health News, 10/19).
On Tuesday, Reid is expected to convene another meeting with Baucus, Dodd and key White House officials — including Chief of Staff Rahm Emanuel — to continue discussion of merging the HELP and Finance committee bills (Drucker, Roll Call, 10/19).
– 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.
THE BLOG LINE: Snowe Speaks, Bloggers Concur, Morris Opines
Ezra Klein of the Washington Post scores a lengthy interview with Sen. Olympia Snowe (R-Maine), who cast the lone Republican vote for the Senate Finance Committee’s health reform bill last week. Meanwhile, two bloggers take on a bill to resolve the annual Medicare payments issue, and former President Clinton confidante-turned-nemesis Dick Morris calculates the cost of “ObamaCare.”
Snowe’s vote for the Finance Committee bill last week made her the only Republican in both chambers of Congress to support any of the Democratic health reform bills. Snowe defended her vote, but not before she weighed it: “Could be a philosophical difference or a policy difference,” Snowe said during the interview with Klein. She said that she continues to struggle with the “affordability” factor in reform legislation, as well as the “individual mandate” that some of the bills have proposed. Once again, she surmises, “It could be my libertarian streak. I understand the rationale and the need to bring everybody into the system, but until we’re sure the system will work, I’m reluctant to impose those [penalty] fees” that residents would incur if they fail to obtain coverage. Klein does not let her go without allowing her to make a case for the “trigger” option, which would create a public option if private insurers fail to provide affordable coverage to residents. “We need a lever to force industry to drive down prices. If the goal of the public option is to ensure the industry performs, then the same could be true of a trigger mechanism,” she said.
Meanwhile, David Herszenhorn at the New York Times‘ “Prescriptions” makes an interesting discovery that illustrates how the American Medical Association has evolved its stance on Medicare. Last week, AMA launched an ad to support the Medicare physician payment fix bill (S 1776), nearly 45 years after the group mounted an ad campaign to block legislation aimed at extending government health insurance to Americans older than age 65. Herszenhorn notes that the ad fails to inform viewers that the bill would not comply with President Obama’s pledge to sign reform legislation only if it does not add to the federal budget deficit. Congressional Democrats insist that the 10-year, $247 billion bill is independent from any health reform legislation, Herszenhorn writes, adding that they “have trouble explaining … how the flawed formula is different from any of the zillion other entrenched problems in the health care system that the proposed overhaul aims to fix.”
Over at the American Spectator‘s “AmspecBlog,” Philip Klein highlights this morning’s Post editorial that “exposes the absurdity” of the argument that the Medicare physician payment bill is separate from health reform legislation. Klein echoes Herszenhorn analysis, writing, “Were the so-called ‘doc fix’ combined with the larger bill, it would bring the total cost of health care legislation to well over $1 trillion, and add significantly to deficits, in clear violation of President Obama’s pledge.”
Finally, at The Hill‘s “Pundit Blog,” Morris and Eileen McGann have a warning for uninsured U.S. residents: “Obama’s health care bill will cost you dearly.” They write, “All during the campaign, Obama kept speaking about affordable coverage,” adding, “Now it appears that his definition of ‘affordable’ might be a bit elastic.” Morris and McGann present a few mathematical calculations, which show how “you will be socked with a mandate to buy coverage and pay a hefty proportion of your income to do it” if you are uninsured. In addition, they write that “if you have insurance, you will be hit with an excise tax on the coverage.”
by Santosh Rao, Staff Writer
American Health Line’s Editor’s Roundup
With deals from several health industry groups in hand, and with all observers trying to gauge whether Sen. Olympia Snowe (R-Maine) would vote for the Senate Finance Committee reform bill, perhaps entering this week there was an air of inevitability that clouded out opposition voices on health reform.
In fact, President Obama on Saturday in his weekly radio and Internet address said the recent calls for action on health care reform by prominent GOP members — mostly former members of Congress and White House officials — represent an “unprecedented consensus” on the need for a health system overhaul.
America’s Health Insurance Plans, the health insurance industry lobby, tore into the quiet on Sunday by sending its members a new study that said the Finance panel’s bill would increase premiums dramatically. Previously, there existed a sort-of détente between proponents of reform and AHIP.
The AHIP report found that the average cost of family coverage will rise from $12,300 to $18,400 in 2016 under current law but would increase to $21,300 by 2016 if the Finance Committee bill is adopted and the majority of its proposals take effect in 2013. According to the report, the cost of individual coverage will increase from $4,600 to $6,900 under current law but would increase to $7,900 under the Finance Committee bill.
Republicans hailed the report, saying that it confirmed their concerns about an overhaul. Meanwhile, Democrats responded vociferously, calling the report flawed and incorrect. Regardless of the report’s accuracy, many observers wondered if it could throw reform’s chances into question. With just one day between the report’s release and the Finance panel’s vote on its reform bill, and Snowe and Democratic Sens. Jay Rockefeller (D-W.Va.) and Ron Wyden (Ore.) waffling over their votes, it was enough to make one wonder whether the Finance Committee’s 13-10 Democratic majority would hold up. The stink of uncertainty fouled the previously sweet air of inevitability.
Come Tuesday morning, health policy observers sat on the edge of their seats, waiting and wondering whether Rockefeller and Wyden would stay true to their party and whether Snowe would give proponents of reform hope for bipartisanship. Despite all the drama, the bill breezed through the committee, 14-9, with all three voting yes.
Health reform legislation has reached an unprecedented level. Never before has an overhaul passed through five committees on its way to the floor of both chambers.
So much for the AHIP report. In fact, AHIP’s report might only have resulted in raising the ire of lawmakers, who have been even more willing to demonstrate their potential power over the industry in recent days.
House Speaker Nancy Pelosi (D-Calif.) joined several senior Senate Democrats in a chorus against the health insurance industry. Pelosi on Thursday warned insurers that reform legislation could mean more fees, regulation and competition, suggesting that the House could adopt a Senate proposal to place a flat $40 billion fee on insurance companies over 10 years and adopt a windfall profits tax on the industry. She also pointed to rules in the House bill that would require health insurance companies to spend 85 cents of every dollar collected in premiums on benefits. Furthermore, Pelosi pointed to an effort by lawmakers to eliminate the industry’s antitrust exemption, which insurers have had since 1945.
The criticism of the industry went all the way to the top. During a town-hall meeting in New Orleans on Thursday, President Obama accused the industry of trying to block health care reform efforts in order to protect profits.
Lest you join in the vilification of insurers, a revelation from Thursday could explain organization’s intent in releasing the study. In a letter sent to Democratic Sens. Harry Reid (Nev.), Max Baucus (Mont.) and Tom Harkin (Iowa) on Tuesday, AHIP President Karen Ignagni proposed specific policy changes for health care legislation that would be more palatable to the insurance industry.
In the letter, Ignagni wrote that AHIP released the study “not to stop health reform, but to highlight that key changes were necessary to ensure a bill not only gains a majority of the Congress.” Ignagni also acknowledged that the “politics of monetary penalties is very challenging” and suggested alternatives to strengthen the penalties for those not obtaining health coverage.
Although it appears to have quieted, the AHIP situation is indicative of just how difficult it will be for lawmakers and the White House to continually satisfy a number of industry players. Meanwhile, as bills head toward the floor in both chambers, legislators must determine ways to tweak provisions — including the public option — in their proposals to garner just enough votes for passage while remaining true to their principles and keeping the price tag to a palatable number.
Tell us what you think: What’s your take on AHIP’s study? Were they trying to ruin reform and only backed off when it backfired? Or were they truly trying to help lawmakers develop a stronger bill?
by Anthony Wilson, Associate Editor
THE BLOG LINE: Baucus and Snowe — That’s Entertainment
If health reform had a marquee, it surely would boast the names of Senate Finance Committee Chair Max Baucus (D-Mont.) and Sen. Olympia Snowe (R-Maine). These government limelighters have been topics of interest for bloggers over the past few weeks, but with the recent passage of the bipartisan Finance Committee bill that Baucus wrote and Snowe broke ranks to support, these two finally are going places — even if those places are just more secret meeting rooms in the Capitol. Bloggers cannot get enough of the dynamic duo (let’s see Batman and Robin fight rising premiums), and they continue to forecast what each senator’s actions mean for the future of health reform.
Len Nichols of “The New Health Dialogue Blog” writes that Snowe’s vote to approve the Finance Committee bill helps to make it truly “bipartisan.” In addition, he writes, “It is in her willingness to find policy solutions that will actually solve our health care crisis that Snowe outshines her colleagues on her side of the aisle” on the Finance panel.
Brent Budowsky trumps even the highest praise for Snowe in The Hill‘s “Pundits Blog”: “Who is the boss of the Democratic White House? … Snowe. Who is the boss of the Democratic Senate? … Snowe.” According to Budowsky, “The weaker Democratic senators are using Snowe as their figurehead excuse to kill the public plan option, while they remain terrified to vote for it, because it offends their insurance company donors, and equally terrified to vote against it, because it offends the majority of their constituents, who support it.”
Now on to Baucus, whose star could use a little shining after being condemned by lawmakers and the media over the past several weeks for slowing the reform process and constructing what some considered a weaker overhaul bill. Those voices of dissention began to quiet when the Congressional Budget Office scored Baucus’ bill and found that, not only would it expand coverage and cost less than the House reform bill, but it would also decrease the federal deficit. Now that Baucus’ work has paid off with a bipartisan vote, Ezra Klein thinks the Finance Committee chair might have been “misjudged” this entire time.
Klein writes that The Baucus Show “seems to have worked with conservative Democrats, who were the target audience. Unlike liberals, they wanted a leisurely, bipartisan process, and they got one.” He adds that moderates were so “sufficiently satisfied with the attempt that they’ve been generally supportive of the overall project ever since. The disagreements are confined to policies within health care reform, like the public plan option, rather than erupting over whether health care reform should be pursued in the first place.”
Philip Klein at The American Spectator analyzes the political relationship between Baucus and Snowe. He thinks that the “ability to attract one Republican might strengthen Baucus’ hand during negations with” Senate Majority Leader Harry Reid (D-Nev.) — who is combining the Finance panel’s bill with the Senate Health, Education, Labor and Pensions bill — “and embolden” fiscally conservative Democratic Blue Dogs “to oppose the inclusion of a government-run plan in the House.”
And the Health Reform Achievement Award goes to…
by Matthew Wayt, Staff Writer
THREE OF A KIND: Newspapers Provide In-Depth Looks at Each of the Health Reform Proposals
With three different reform bills being considered in Congress, it’s easy to confuse the details of each. Luckily, the AP/San Francisco Chronicle, the Chicago Tribune, the New York Times and the Washington Post have spelled out the specifics, so you never again will confuse state-based insurance pools (in the Senate Finance Committee bill) with a nationwide insurance exchange (in the House bill). There will be a test after this … in 2013, when you’ll wake up to find the insurance system has changed. Study up.
by Matthew Wayt, Staff Writer
THE BLOG LINE: The Day After Yesterday
Health reform advocates, White House officials, and Democratic operatives and senators all heaved a deafening sigh of relief at approximately this time yesterday when Sen. Olympia Snowe (R-Maine) confirmed her vote for the Senate Finance Committee’s health reform bill. Some bloggers cheered while other sneered, but everyone asked the same questions: What does it mean for the future of health reform legislation? Will she or won’t she vote for it again?
Ezra Klein paid special attention to Jim Manley, spokesperson for Senate Majority Leader Harry Reid (D-Nev.). Today, Reid begins merging the Finance Committee’s bill with the Senate Health, Education, Labor and Pensions Committee’s reform bill (S 1679), with input from Finance Committee Chair Max Baucus (D-Mont.), Sen. Christopher Dodd (D-Conn.) and other Democrats. Manley told the New York Times that Snowe will be invited to the merging committee’s future sessions and that Reid is prepared to go to great lengths to preserve Snowe’s support. According to Klein, “Democrats really want this bill to be bipartisan — to the point that they’re giving the Republican a space in the negotiations equivalent to the chairmen of the two relevant committees.” He adds, “Indeed, I wouldn’t be shocked if this perk had been negotiated in advance of Snowe’s vote yesterday.”
Over on “The Wonk Room,” Igor Volsky caught Snowe’s appearance on CNN’s “American Morning” today, where she said in the plainest words possible, “I oppose the individual mandate.” Volsky notes that prior to her vote yesterday, Snowe “indicated that she could support an individual requirement if coverage became more affordable.” He adds that her current status “as the only Republican to vote for health care reform will likely bolster her position at the bargaining table and give her greater influence in shaping the final legislation.” But he expresses concern that “if Snowe — who has called affordability her ‘first and foremost goal’ going forward — has decided that it’s easier to remove the mandate than fight for better affordability measures, some policymakers may be inclined to heed her concern in order to retain her vote and the bill’s ‘bipartisan’ flavor.” And that, “of course, could lead to disastrous policy consequences.”
However, it wasn’t all about Snowe. Health care policy expert Robert Laszewski on “The Health Care Blog” zeroed in on the “big issue” that will emerge as Reid begins to merge the bills and House Speaker Nancy Pelosi (D-Calif.) crafts her chamber’s final reform legislation. “The big issue is going to be money — just whose taxes are going to get raised to the tune of $500 billion to pay for it,” he writes. He believes the Finance Committee bill’s “$211 billion ‘Cadillac’ benefits tax” is “[d]ead on arrival” and its “$40 billion tax on medical device makers is also under pressure and likely to at least shrink.” While the “House solves that problem with a $500 billion tax on ‘millionaires,’ … lots of Democratic senators think that is really just a tax on small business and job creators,” according to Laszewski.
Meanwhile, Jonathan Cohn of The New Republic offers his solutions for two fundamental questions in the reform debate: “What elements of reform are most important at this point? What needs fixing — and saving?” He writes that each of the 10 priorities he outlines “is somewhere within the universe of political possibility, at least according to the administration and Capitol Hill sources” he consulted. However, Cohn acknowledges, “Getting Congress to embrace many of them, let alone all, seems highly unlikely.”
by Santosh Rao, Staff Writer
SENATE: Reid Will Merge Finance, HELP Committee Bills With Input From Baucus, Dodd, Other Democrats
Senate Majority Leader Harry Reid (D-Nev.) will begin merging the chamber’s two health reform bills on Wednesday, a process that is expected to take at least one week, CQ Today reports. This stage of the overhaul process follows the Senate Finance Committee’s 14-9 vote to approve its reform bill on Tuesday. That legislation will be joined with the bill (S 1679) passed in the summer by the Senate Health, Education, Labor and Pensions Committee. The merged bill is expected to come to the Senate floor the week of Oct. 26, after it is scored by the Congressional Budget Office, according to a senior aide to Democratic leadership (Armstrong, CQ Today, 10/13).
When combining the bills, Reid will be joined by Finance Committee Chair Max Baucus (D-Mont.) and Sen. Christopher Dodd (D-Conn.), who helped shepherd the HELP panel’s bill through committee. Also slated to attend meetings are White House Chief of Staff Rahm Emanuel and Director of the White House Office of Health Reform Nancy-Ann DeParle (Wayne, CQ Today, 10/13). According to Time, White House Legislative Director Phil Schiliro, Deputy White House Chief of Staff Jim Messina and White House Office of Management and Budget Director Peter Orszag also are expected to give input during the process (Newton-Small, Time, 10/14). No members of the GOP have been invited to contribute to the merging of the bills (Wayne, CQ Today, 10/13).
Key Issues
Reid and the Democratic leadership will face several difficult issues when merging the two bills, including whether to include a government-run public plan option in the legislation. The HELP Committee bill features the option, while the Finance Committee bill would use not-for-profit health insurance cooperatives. Liberal Democrats want a public option, but Reid risks losing the support of centrist Democrats and any hope of attracting Republican votes if he includes the provision.
Another issue is the difference between how the bills treat employers. The HELP Committee bill would require most employers to provide insurance to their workers and pay 60% of premiums or face a penalty of up to $750 per employee. The Finance Committee bill would not require employers to provide insurance but would mandate employers that do not offer coverage pay for a portion of any subsidy their employees receive to buy insurance. Business groups do not support either approach, while liberal Democrats worry that the proposal in the Finance Committee bill would cause employers to avoid hiring low-income people who would qualify for insurance subsidies.
Liberal Democrats also have a problem with a provision in the HELP Committee bill that would give FDA authority to approve generic competitors to advanced protein-based drugs known as biologics. Although the measure has bipartisan support, liberals want to give biologic manufacturers less protection against competitors. Also, the HELP Committee bill includes a proposal to create a new government insurance program for long-term care, which Democrats say would be funded from its own premiums. Republicans argue that the program eventually would become unaffordable and provide only a modest benefit.
An additional point of contention could be how much insurers should be permitted to charge older customers. The HELP Committee bill would allow insurers to charge older people only twice as much as they charge their youngest beneficiaries, while the Finance bill would limit insurers to four times what they charge young people (Wayne, CQ Today, 10/13).
According to CQ Today, floor action could last several weeks. Democrats and Republicans are expected to debate numerous issues, and some believe the GOP will mount several filibusters — possibly delaying final passage of the bill into November (Armstrong, CQ Today, 10/13).
– 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.
SENATE FINANCE: More Details on Panel’s 14-9 Vote To Approve Reform Bill
The Senate Finance Committee voted to approve its health reform bill just before 3 p.m. today, making it the last of five committees to approve reform legislation, Roll Call reports. The 14-9 vote fell along party lines, save for Sen. Olympia Snowe (R-Maine), who cast the lone Republican vote in favor of the bill.
Senate Majority Leader Harry Reid (D-Nev.) will continue working with Finance Committee Chair Max Baucus (D-Mont.) and Sen. Chris Dodd (D-Conn.), who led reform legislation through the Health, Education, Labor and Pensions Committee, on combining the two pieces of legislation (Drucker, Roll Call, 10/13).
It was unclear how two Democrats on the Finance Committee — Sens. Ron Wyden (Ore.) and Jay Rockefeller (W.Va.) — were going to vote heading into the hearing, since both had previously maintained that the bill did not go far enough to provide affordable health coverage. Rockefeller said, “I’m going to vote for this bill coming out of Finance because I think, in spite of a lot of problems I have with it, the dialogue is now for real” (Roll Call, 10/13).
Reaction
Republicans have expressed concern that the parts of the legislation they favor will be eliminated in the merger of the Finance and HELP Committee bills. “I wish I felt better about the substance of the bill,” ranking member Sen. Chuck Grassley (R-Iowa) said.
Meanwhile, Democrats say they hope to fix problems with the Finance legislation, viewed as the most conservative of the reform bills.
Floor debate on a joint Senate bill could begin by the last week of October, and House action should follow a similar timeline (Young, The Hill, 10/13).
– Ryan Holeywell
OUR TAKE: The Insignificance of Snowe
Sen. Olympia Snowe (R-Maine) set herself apart from the rest of her party today by becoming the first Republican to vote in favor of one of five health reform bills in Congress. By voting for the Senate Finance Committee’s reform bill, Snowe gave committee Chair Max Baucus (D-Mont.) the ability to declare his legislation a bipartisan victory — even though he hasn’t yet and even though the bill isn’t truly bipartisan.
Baucus set out to write a bipartisan health bill — working up until the end with his “Gang of Six” Republican and Democratic negotiators to craft a bill that was so full of compromises on Democratic priorities, such as a public health insurance option, that members of his own party, like Sens. Jay Rockefeller (D-W.Va.) and Ron Wyden (D-Ore.), threatened to vote against it. In addition to angering members of his own party, Baucus failed to get the support of any Republicans besides Snowe.
Snowe’s vote does not mean that the bill is bipartisan. It means that the bill was conservative enough for a moderate Republican from a relatively liberal state to vote for it. And at the end of the day, was Snowe’s single vote necessary? The Finance Committee has 13 Democrats and only 10 Republicans — a Democratic health reform bill should be able to pass easily through the committee. Also, now that there is once again 60 senators who vote with the Democrats, the party leadership doesn’t really need to craft final legislation to the liking of moderate Republicans. A lot of Snowe’s power went out the window once Massachusetts Gov. Deval Patrick (D) named Paul Kirk to Sen. Edward Kennedy’s Senate seat.
After announcing that she was going to vote in favor of the Senate Finance Committee bill, Snowe made it clear that that she reserves the right to change her mind when it comes to the final Senate bill. If Senate Majority Leader Harry Reid (D-Nev.) decides to appease members of his own party and make the final bill a little more liberal, it may not be palatable for the Maine Republican. However, if Reid essentially keeps the Senate Finance Committee bill intact, there is a chance Snowe could be joined by her fellow Maine Republican Sen. Susan Collins in voting in favor of the final legislation on the Senate floor.
In the end, the long-term significance of Snowe’s vote today might have more to do with the progress of her own career than the progress of reform. Because of her willingness to break ranks with her fellow Republicans on health reform, The Hill reports that Republican members of the Senate Committee on Commerce, Science and Transportation might overlook her in deciding who becomes the ranking Republican on the panel.
Although Snowe might have handed the Democrats a “bipartisan” victory, chances are they could have and would have passed a bill without her.
– by Julia Moss, Staff Writer
SENATE FINANCE: Approves Health Reform Legislation, 14-9
The Senate Finance Committee approved its health reform bill moments ago with a 14-9 vote. Sen. Olympia Snowe (R-Maine) was the lone Republican to vote for the bill. Finance Committee Chair Max Baucus (D-Mont.) said the bill will ensure that “no person will go broke just because he or she gets sick.”
