Health bill ready for the Senate

WASHINGTON — U.S. senators and the American people got their first peek Wednesday at Senate Democratic leader Harry Reid's sweeping proposal to reshape the nation's health care system.

The 10-year plan would cost $849 billion but, according to a preliminary analysis, would reduce the federal budget deficit by $127 billion over that decade. That's because the bill's costs would be offset by new taxes and reductions in spending, particularly on Medicare.

Those budget numbers stood out as a bright spot for Sen. Ben Nelson, D-Neb.

“Any time you add more to deficit reduction, you have to say it's a move in the right direction,” Nelson said.

The Nebraskan is one of several centrist Democrats in the Senate whom Reid must corral in order to have all 60 votes needed to break through a Republican filibuster and start debate on the bill. The initial vote to start debate could be Saturday.

The House already has approved its version of the health care bill on a near party-line vote of 220-215.

If Democrats succeed in pulling together all the needed votes, the Senate intends to devote most of December to an unpredictable debate that could determine the fate of legislation that President Barack Obama has declared to be his top domestic priority.

Republicans have vowed to fight the legislation, saying it represents a dangerous expansion in the role of government that would increase taxes and insurance costs for millions of people. They promised a raft of amendments.

“It's going to be a holy war,” said Sen. Orrin Hatch of Utah, who is one of the Republican Party's most respected voices on health policy but for the last several months has voiced fury over the Democrats' efforts.

Reid's bill would not go as far as the House-passed bill in limiting insurance coverage for abortions but still would bar federal funding for abortions. It would bar private industry from denying insurance because of pre-existing medical conditions.

Reid's Senate measure would require most Americans to carry health insurance, providing subsidies to help those with lower incomes afford it. It also would mandate that large companies provide coverage to workers.

Sen. John Kerry, D-Mass., said Reid had decided to require the side-by-side sale of insurance policies that cover abortion services and do not, an attempt to satisfy both sides. That is far less restrictive than a House-passed provision.

At its core, the Senate bill would set up new insurance marketplaces — called exchanges — primarily for those who now have a hard time getting or keeping coverage. States would be allowed to opt out. Beginning in 2014, consumers would have the choice of purchasing this government-sold insurance, an attempt to hold down prices charged by private insurers.

Reid, of Nevada, called for an increase of half a percentage point in the Medicare payroll tax for individuals with income over $200,000 a year, $250,000 for couples.

He also included a tax on high-value insurance policies, a measure designed to curb the appetite for expensive care.

About 94 percent of eligible Americans eventually would be covered under the proposal, compared with the 83 percent that currently have insurance.

Obama issued a statement saying that the bill meets his primary goals of getting more people covered while making insurance more affordable and reducing federal deficits. “We're closer than ever to enacting solutions to these problems.”

Sen. Tom Harkin, D-Iowa, chairman of the Senate Health Committee, agreed that the bill met the key goals. He flashed two fingers in a V-for-victory sign at a press conference with Senate leaders Wednesday night. “This is a great victory for the American people,” Harkin said.

Reid outlined his proposal in a closed-door session with Senate Democrats. Afterward, Nelson said he wants to study the specific language of the bill before deciding how he will vote.

“I trust Senator Reid; now we go verify,” Nelson said.

Nelson said he continues to have concerns about certain areas, including some tax provisions and the creation of a new government insurance plan.

Another point of concern, Nelson said, is a voluntary federal program to provide long-term care insurance and cash benefits to people with severe disabilities. The program, known as Community Living Assistance Services and Supports, would be financed with premiums.

“I don't know that that's a business the government should be in,” Nelson said. Though Reid made some improvements to the program, Nelson said he remained concerned that it would eventually run out of money.

Nelson met with Reid earlier in the day to discuss procedures for moving forward on the legislation. The discussion included the prospect of reconciliation, a parliamentary procedure that would require only 51 votes and render centrists such as Nelson irrelevant to the debate.

Nelson said Reid was not making threats. “But anybody can conclude that if you don't move something on to the floor, (reconciliation) is one of the possibilities.”

It appeared that Nelson was leaning toward voting to begin debate, stressing that such a vote would not be the final word.

“If you don't like the bill, then why would you block your own opportunity to amend it or to improve it?” Nelson asked. “Why would you stop other senators from doing the job they're elected to do — debate, consider amendments, take action on an issue affecting every American?”

Nelson said he was pleased that the proposal does not include a repeal of the insurance industry's antitrust exemption. Proponents say repealing that exemption would allow for greater federal regulation of the industry and more competition.

Nelson said it could hurt smaller insurance companies by limiting their ability to share data and ultimately harm competition. Nelson said he discussed the issue with Reid but disputed reports that he “demanded” the repeal be left out.

Sen. Mike Johanns, R-Neb., who has been critical of many of the proposals in Reid's legislation, said Wednesday that he looked forward to reading it.

“I hope my concerns are unfounded,” Johanns said. “However, Nebraskans should rest assured that I will not support legislation that has billions of dollars in cuts to Medicare, budget gimmicks that mask the true costs of the bill, unfunded mandates, tax increases and provisions that don't protect life.”

This report includes material from the Associated Press and the New York Times.

Contact the writer:

202-662-7270, joe.morton@owh.com