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The Latest News On Healthcare Reform

November 4, 2009

Big vote coming

Last Thursday, on the Capitol lawn, House Speaker Nancy Pelosi, D-Calif., unveiled the long-awaited health reform bill that House leaders have been compiling from three separate committee bills. The plan is for debate on that bill to begin late this week, with a vote on final passage as early as this weekend. Only a few amendments will be allowed – a Manager's Amendment released late Tuesday evening, and one or two others.

Democrats admit they don’t have firm commitments from enough lawmakers to guarantee passage of their bill. But their aggressive schedule suggests they feel fairly confident they’ll be able to get the votes they need.

After the bill was unveiled, the mood in Washington became festive – “like the excitement that precedes a great battle,” as one Capitol Hill staffer put it. Democrats were feeling confident their bill would pass; Republicans were feeling hopeful that they would be able to block it.

A lot to absorb: 1,990 pages of health reform

When Pelosi presented the House bill, she invoked the memory of the late Sen. Ted Kennedy. “This is about the character of our country,” she said. “The bill is fiscally sound, will not add one dime to the deficit as it expands coverage, implements key insurance reforms and promotes prevention and wellness across the health system.” Read the Healtcare bill here or Read a “Short Summary” here.

The bill contains a public plan option, but not the one Pelosi had tried to get Democratic members of Congress to support. Instead of a plan that would tie payments to doctors, hospitals and other providers to Medicare rates, the public plan in the merged bill requires the government to negotiate rates with providers – an approach favored by moderate Democrats in the House.

A few of the other provisions in the 1,990-page bill include:

  • Expansion of the Medicaid program
  • Lower subsidies for people between 150 and 400 percent of the federal poverty level than in earlier proposals
  • $170 billion reduction in Medicare Advantage payments over 10 years
  • A surtax on high-income people – but the threshold is higher than in previous versions of the bill (surtax starts at adjusted gross incomes of $500,000 for individuals, $1 million for couples)
  • Exempts 86 percent of small businesses from the requirement to offer or contribute to insurance coverage by setting thresholds for exemption at payrolls of $500,000
  • Provides start-up loans to establish not-for-profit or cooperative health plans
  • Creates a national exchange for people to shop for health plans
  • Health Benefits Advisory Committee to recommend covered treatments, items, services and cost-sharing for insurance plans
  • Prohibits insurance companies from putting lifetime caps on coverage and phases out the practice of turning down people with pre-existing medical conditions
  • Price difference between age groups can’t vary more than 2:1
  • Allows children to stay on their parents’ health insurance until age 26
  • Includes pilot projects and studies to try to reduce delivery system costs

According to the New York Times, Rep. John Dingell, D-Mich., “stole the show with a combative speech in which he assailed insurance companies and Republicans.” He said the bill would meet “the greatest humanitarian need this country confronts, and the greatest economic problem” and that “the only citizens who will have to worry about their participation in Medicare being cut are the insurance companies.”

Pelosi said the cost of the House bill would be $894 billion over 10 years, but the Congressional Budget Office put the number at $1.055 trillion. One way Pelosi got to the lower number was by removing provisions to increase Medicare payments to doctors – the so-called “doc fix.” Those provisions, which would cost $200- to $250 billion over 10 years, were included in a separate bill, which was also introduced on Thursday.

America’s Health Insurance Plans CEO Karen Ignagni released a statement saying that “the lack of system-wide cost containment is a missed opportunity. Without a greater focus on health care costs, families and employers will not be able to afford coverage and health care costs will rise at a rate much faster than the overall economy is able to sustain.”

The U.S. Chamber of Commerce also released a statement, saying the group was “very disappointed to see that the latest House bill includes many provisions that are not consistent with our shared goals of reducing costs and increasing access to health care without negatively affecting businesses.

“First and foremost, employer mandates, including requirements to pay or play, are not the answers to our nation's health care challenges. Employers will be required to either provide a government-mandated level of health care coverage regardless of the employer's ability to pay or face a penalty of 8 percent of payroll. This will result in job loss and lower wages, reduce flexibility and choice, and raise the cost of providing benefits,” their statement said. Read it in its entirety here.

GOP introduces a plan, too

Meanwhile, House Republicans have offered an alternative vision for health reform.

“What we do is we try to make the current system work better,” said House Minority Leader John Boehner of Ohio. “We take a step-by-step approach, by allowing people to buy insurance across state lines, allowing small businesses and other groups of individuals to group together for the purpose of buying health insurance at lower costs, like big businesses and unions can.

“We need to do something about junk lawsuits….And 34 states today have high-risk pools for those with pre-existing conditions. We want to encourage all states to have these. And we put more money into these high-risk pools so that we can bring down the cost of health insurance. And at the end of the day, what we're doing with our proposal is lowering health care insurance premiums, lowering cost and expanding access.”

The bill, officially released Tuesday evening, also:

  • Removes lifetime spending caps on health insurance.
  • Prohibits unjustified cancellation of insurance coverage.
  • Addresses the need for administrative simplification.
  • Strengthens provisions for health savings accounts and high deductible health plans.
  • Allows for greater incentives for people to live healthy.

Boehner said the GOP measure would cover “millions more Americans,” but doesn’t try to cover as many of the uninsured as the House Democratic bill would. The House bill would cover about 30 million of the 46 million uninsured.

Boehner says the Congressional Budget Office is “scoring” – that is, attaching a price to – the Republican proposal right now. Read a summary of the proposal here, or download full text here.

A spokesman for Pelosi said Republicans would be allowed to introduce their proposal during debate on the Democratic bill.

G.O.P. takes two

The Republican Party swept two pivotal and hotly contested governor’s races Tuesday – in New Jersey and Virginia, and the outcomes could affect the health reform debate.

In New Jersey, former federal prosecutor Chris Christie defeated incumbent Democrat Jon Corzine. Christie took 49 percent of the vote to Corzine’s 45 percent and became the first Republican to win a statewide race in New Jersey in 12 years. Christie was able to emerge victorious despite being outspent more than two to one and despite the state’s heavily Democratic leanings.

Meantime, Bob McDonnell becomes Virginia’s first Republican Governor in 12 years. The former state attorney general beat Democratic nominee Creigh Deeds, a long-time state senator from the western part of the state. McDonnell won 59 percent of the vote, to Deeds’ 41 percent, with most precincts reporting. Republicans also emerged victorious in races for lieutenant governor and attorney general.

In the evening’s other major story, Democrat Bill Owens defeated Conservative Party candidate Douglas Hoffman in New York’s 23rd Congressional District, after the Republican Party’s candidate dropped from the race and endorsed Owens. Hoffman had received backing from conservative talk show host Rush Limbaugh and former Alaska Governor Sarah Palin, and the campaign split the Republican Party, dividing conservatives and moderates.

The three races were the most-watched contests in the first major election of Barack Obama’s presidency. The president campaigned for both Democratic gubernatorial candidates, and many were waiting to see whether his involvement would make a difference. The election also played out in the midst of the worst economic recession in recent decades.

On Wednesday, the airwaves were alive with discussion about the extent to which voters had Obama in mind when they cast their ballot. Republicans claimed their gubernatorial victories were a referendum on the president, while Democrats downplayed any connection, pointing out that in the last 20 years, the president’s party has lost the gubernatorial races in each state the following year.

Exit polls showed independent voters strongly backed the Republican candidate in both New Jersey and Virginia. But, most voters also said Obama’s job performance was not a factor in their decision. Exit polls also confirmed that the economy, jobs and pocketbook issues were top concerns of many voters.

Still, the election outcomes may give moderate Democrats pause as they consider health care reform. Conventional wisdom says they may be less likely to back aggressive health reform legislation, fearing reprisal from middle-of-the-road voters in the 2010 election.

Dueling editorials

On Friday, the New York Times ran an editorial in support of the House reform bill, saying “the Senate should pay attention” and “should try to do as well.”

On Monday, the Wall Street Journal weighed in on its editorial page, calling the House bill “the worst bill ever” – perhaps “the worst piece of post-New Deal legislation ever introduced.”

Read the New York Times editorial here.

Read the Wall Street Journal’s here.

Get involved. Contact Congress about health reform at

Past articles on Healthcare Reform

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Article from 07/08/10

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Article from 11/04/09

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