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THE PROGRESSIVE REVIEW - October 19, 2009
Still a Long Way to Go Before Health Bill Becomes Law
by: David Lightman
McClatchy Newspapers
Washington - Now comes the hard part of crafting a new
health care system - hard not just because a lot of
corporate, consumer and political interests want to be
satisfied, but because the next steps will proceed in
secret.
White House Chief of Staff Rahm Emanuel, Health and
Human Services Secretary Kathleen Sebelius and other
top Obama administration officials huddled for about
an hour Wednesday afternoon with Senate Democratic
leaders, trying to fashion a plan that can get the
60 votes needed to overcome procedural hurdles in
the Senate.
Democratic leaders of the House of Representatives have
been meeting privately with their caucus members for
weeks, seeking enough common ground to bring legislation
to a vote.
The Senate aims to begin debate the week of Oct. 26, but
the House is unlikely to start floor consideration of
its bill before early November. If the two versions win
approval in each chamber, compromise negotiations will
combine them into a single measure that must again win
majorities in the House and Senate. Final votes are
unlikely before December.
Along the way, several political mazes must be navigated.
The Senate's two health bill-writing committees, Finance
and Health, differ sharply on whether to create a govern-
ment alternative to private insurers, or "public option."
(Finance said no; Health said yes.) The House and Senate
are at odds over how to pay for changes: The House wants
higher income taxes on the wealthy, while the Senate
prefers higher taxes on insurers.
Adding to the drama is the secrecy: The White House-Senate
session took place behind closed doors in Senate Majority
Leader Harry Reid's Capitol office, and few clues were
available about the talks' progress, let alone specifics.
Republicans have already started pounding away at the
secrecy.
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"The real bill is currently being written behind closed
doors in the dark corners of the Capitol," lamented Sen.
Orrin Hatch, R- Utah , usually one of the GOP senators to
whom Democrats turn when they want compromise.
The key to any bill's success are the centrists. In the
Senate, that means wooing eight to 10 moderate Democrats
and two Republicans, Maine's Susan Collins and Olympia
Snowe, who was the only Republican to back the Finance
Committee bill.
Collins signaled Wednesday that she's open to compromise,
but had concerns about the Finance Committee bill. She
was "disappointed" that it didn't trim costs further,
and "troubled" about its Medicare changes.
In addition, said Collins, the measure "falls short of
the goal of providing access to more affordable health
care to all Americans."
Centrist Democrats voiced other concerns.
Sen. Blanche Lincoln, D- Ark., insisted that the federal
budget deficit not be increased, as the House bill would
do. Sen. Ben Nelson, D- Neb., would like near-universal
coverage, and saw the Finance bill as not going far
enough. In the House, many lawmakers from rural areas
want assurance that small businesses won't be unduly
burdened by the cost of providing insurance.
Here are some key questions that lawmakers must answer
before they can be optimistic about legislative success:
- Can a public option win congressional approval? President
Barack Obama, Democratic congressional leaders and most
Democratic lawmakers want a government-run plan. So does
their party's base.
A group of 27 labor unions ran full-page newspaper ads
Wednesday calling the Finance Committee bill "deeply
flawed," and endorsing the public option.
Moderates, however, are unenthusiastic.
The Finance Committee endorsed co-ops, or member-run,
nonprofit companies that would negotiate with providers.
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Among the compromises being discussed: allowing states to
set up their own public plans or enabling a nationwide
government-run system to be created if private insurers
fail to meet certain standards.
While the House is expected to back the public option, the
Senate is more of a battleground. Asked what he'd support,
Senate Majority Whip Richard Durbin of Illinois said, "I'm
going to keep an open mind about all this."
- Who should pay higher taxes? The House Ways and Means
Committee would begin imposing higher tax rates on adjust-
ed gross incomes of more than $280,000 for singles and
$350,000 for couples.
Moderate Senate Democrats see such taxes as particularly
onerous to small business. They prefer a 40 percent excise
tax on most high-end insurance policies.
Any new tax has to come from the health care sector, and
it has to make health care less expensive, said Sen.
Thomas Carper, D- Del., a Finance Committee member. The
House's income-tax surcharge, he said, does neither.
House Democrats, though, are wary of an insurance tax.
Last week, with labor's backing, 157 Democrats signed a
letter opposing it.
The insurance industry's trade group also expressed concern
about the Finance Committee's tax provisions. The measure
"imposes hundreds of billions of dollars in new health care
taxes and provides an incentive for people to wait until
they are sick to purchase coverage," said Karen Ignagni,
the president of America's Health Insurance Plans, a health
insurance industry group.
- Are enough people covered? The Finance bill would cover
about 94 percent of all eligible Americans, the nonpartisan
Congressional Budget Office says. The House plans would
cover an estimated 97 percent, largely because it would
provide more financial help for lower-income people.
Currently, about 83 percent have insurance.
Liberals want near-universal coverage, and are willing to
spend whatever it takes to meet that goal.
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"I fundamentally believe that if we place a mandate on
families to purchase coverage, we have to ensure that that
coverage is truly affordable," said Sen. Robert Menendez,
D- N.J.
The CBO estimates that the Finance version would reduce
the federal deficit by $81 billion over 10 years, while
the House bill would increase deficits by $239 billion
over the same period.
Moderate Democrats have said that they're not going to
stand for that.
"It's not perfect. We all know that. But the (Finance
measure) is a great step in the right direction," said
Lincoln of Arkansas, emphasizing that it met her
"principle" of deficit reduction.
There are no easy choices, said Durbin of Illinois. Asked
if lawmakers agree on anything, he chuckled. "Prevention
and wellness," he said.
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