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THE PROGRESSIVE REVIEW - October 12, 2009
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Health-Care Bill Wouldn't Raise Deficit, Report Says
Budget Office Assesses Finance Panel's Plan
By Lori Montgomery and Shailagh Murray
Washington Post
Congressional budget analysts gave an important political
boost Wednesday to a Senate panel's health-care overhaul,
projecting that the $829 billion measure would dramatically
shrink the ranks of the uninsured and keep President
Obama's pledge that doing so would not add "one dime" to
federal budget deficits.
With the report from the nonpartisan Congressional Budget
Office, the measure crafted by the Senate Finance Committee
has emerged as the only one of five bills by various panels
that achieves every important goal Obama has set for his
top domestic initiative.
White House budget director Peter Orszag applauded the
analysis, saying the bill "demonstrates that we can
expand coverage and improve quality while being fiscally
responsible," and Senate Majority Leader Harry M. Reid
(D-Nev.) called the CBO report "another important step
down the road toward enacting comprehensive health
insurance reform." But senior Republicans seemed only
to harden in their opposition to the measure.
The Finance Committee could vote as soon as Friday on the
bill. Passage by the Democrat-dominated panel is virtually
assured, but Democrats are eager to win the vote of Sen.
Olympia J. Snowe (Maine), the only Republican on the
committee who has expressed any support for the measure.
Snowe said Wednesday that she was relieved to see that
the cost of expanding coverage remained below Obama's
limit of $900 billion over the next decade. "But we have
a lot to review," she said.
She urged Chairman Max Baucus (D-Mont.) to wait until next
week for a final vote. "It's a critical vote.... I would
rather have the comfort level of having had sufficient time
to analyze it."
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Other Republicans pored over the 27-page report in a late-
afternoon huddle, then emerged with the warning that the
finance panel's measure would impose a stiff price on
people who already have health insurance. Sen. Charles E.
Grassley (Iowa), the ranking Republican on the committee,
said he is worried that insurers and other health-care
companies would pass on the cost of new fees and taxes to
consumers. And he said the bill's expansion of Medicaid
would leave a new set of "unfunded mandates" for states
already struggling with record budget deficits.
"There's a lot of things in there to be concerned about,"
Grassley said.
Reid said he hopes to combine the bill with a competing
measure approved by the Senate health committee and present
the result to the full Senate later this month. He will
begin to convene small meetings in his office next week
with Baucus, Sen. Christopher J. Dodd (D-Conn.) and senior
White House officials, including Orszag, Chief of Staff
Rahm Emanuel and senior health adviser Nancy-Ann DeParle.
Senate Minority Leader Mitch McConnell (R-Ky.) said the
legislation is likely to become more problematic as Reid
works "in a closed-to-the-public conference room, some-
where in the Capitol" to add provisions aimed at winning
the 60 votes needed to avert a GOP filibuster. "The real
bill will be another 1,000-page, trillion-dollar experi-
ment," McConnell said in a statement, "that slashes a
half-trillion dollars from seniors' Medicare, raises
taxes on American families by $400 billion, increases
health care premiums, and vastly expands the role of
the federal government in the personal health-care
decisions of every American."
According to the CBO, Congress's official arbiter of the
cost of legislation, the Finance Committee measure would
expand coverage to an additional 29 million Americans by
2019 by dramatically expanding Medicaid coverage for the
poor and by subsidizing private insurance for low- and
middle-income Americans.
The $829 billion cost would be more than offset by reduc-
ing spending on Medicare and other federal health programs
by about $400 billion over the next decade, and by impos-
ing a series of fees on insurance companies, drugmakers,
medical device manufacturers and other sectors of the
health industry that stand to gain millions of new
customers under the legislation.
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In addition, the package would raise $200 billion more by
levying a 40 percent excise tax on high-cost insurance
policies -- the "Cadillac" plans that cost more than
$8,000 for individuals or $21,000 for a family.
All told, the package would reduce federal budget deficits
by $81 billion over the next decade, the CBO forecast,
adding that the savings probably would continue to
accumulate well into the future.
"The added revenues and cost savings are projected to grow
more rapidly than the cost of the coverage expansion," the
report said. "Consequently, CBO expects that the proposal,
if enacted, would reduce federal budget deficits [beyond
2019] relative to those projected under current law" by
as much as one-half of 1 percent of the nation's gross
domestic product -- savings that could total hundreds of
billions of dollars.
The package is significantly more expensive than the $774
billion coverage plan Baucus initially presented, in part
because the committee agreed to offer more generous
subsidies to people buying private insurance through a
network of state-run exchanges.
But the CBO determined that the new measure would cut the
deficit by an even greater amount than did the original
version. One reason: An amendment offered by Sen. John D.
Rockefeller IV (D-W.Va.) would require states to maintain
coverage levels for children currently on Medicaid or the
Children's Health Insurance Program, rather than pushing
them into exchanges, where the government would have to
pay more to keep them insured.
The CBO said it was unable to tease out the effects of
other key amendments, such as a proposal by Sen. Maria
Cantwell (D-Wash.) that would authorize states to pool
federal subsidies to develop other forms of insurance.
Baucus said he hopes that the provision would generate
substantial savings.
Despite an amendment by Sen. Charles E. Schumer (D-N.Y.)
that would make it easier for people to dodge a mandate
to buy health insurance, the CBO estimated that the final
package would extend coverage to just as many people as
the original version, causing the share of non-elderly
residents with insurance coverage to grow from about 83
percent today to 94 percent in 2019. About 25 million
people would still lack insurance in that year, the CBO
said, about half of them illegal immigrants.
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Across Capitol Hill, House Democrats said they were close
to agreement on a pared-down package of health-care reforms
that takes a very different tack on a number of key issues,
particularly the method of financing.
"We are coming around the bend. Not in the homestretch yet,
but coming around the bend," House Speaker Nancy Pelosi
(Calif.) said after a closed-door meeting. "We are very
near to some of our final decisions needed for us to send
something to the CBO that will inform how we go forward."
The major remaining challenge for House leaders is how to
squeeze the cost of expanding coverage to Obama's prescrib-
ed $900 billion from an initial version that cost more than
$1.2 trillion. That could require shrinking the value of
government subsidies that the bill would provide to uninsur-
ed low- and middle-class families, or reducing the amount
of coverage that people would be required to buy.
Pelosi said the House bill would create a government-run
insurance option, something liberals are seeking but the
Senate Finance Committee rejected. Reid has not decided
whether to include a public option in the final Senate
bill, although several proposals are circulating that would
give individual states the leeway to create such a plan.
Meanwhile, a senior Democratic aide said House leaders plan
to stick with a surtax on income above $500,000 to finance
the package, rather than adopting the Finance Committee's
tax on Cadillac insurance policies. More than half of House
Democrats signed a letter sent to Pelosi, Senate leaders
and the White House on Wednesday saying they oppose a new
tax on health benefits in any form. The idea "is a non-
starter for the supermajority of the House Democratic
caucus," said Rep. Joe Courtney (D-Conn.), who drafted the
letter.
At a news conference outside the Capitol, Courtney and
others argued that the tax would strike not only "the
Paris Hiltons of the world," but also many middle-class
families.
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