Three healthcare reform bills are on a collision course in Washington, with President Barack Obama urging lawmakers to stick to an aggressive timeline that could result in votes next month.
Dem leaders hash out reform ...
... as GOP lawmakers say they’re being left out
But before then, lawmakers have deliberately given themselves ample room for eleventh-hour changes.
In the Senate, partisan politics threatened to stall a health reform bill in the Senate Health, Education, Labor and Pensions Committee that is without its heart-and-soul leader, Sen. Edward Kennedy (D-Mass.). That happened as a consensus among Democrats and Republicans showed signs last week of building over some of the thornier parts of a Senate Finance health reform bill being written.
Meanwhile, on the other side of Capitol Hill, Democratic lawmakers in the House debuted a legislative outline for their own reform package, which at first blush looks to be much more liberaland costlythan whats being shaped in the Senate.
Early in the week, the Senate HELP Committee raised the curtain on a 615-page bill that takes aim at the insurance industry and almost every level of provider in an effort to make the delivery of care more streamlined, and thus drive down costs. Once the domain of Kennedy, a much-lauded dealmaker in the Senate, the committee is now being shepherded by Sen. Christopher Dodd (D-Conn.).
The bill, for now, sidestepped the more contentious issues that surround the creation of a public health plan that would compete alongside private payers. Weve left out some major sections in all of this, Dodd said at a news conference. So rather than writing something and then later provoking antagonism about trying to shove something down somebodys throat, we left it open for discussion.
But the move irked Republican lawmakers on the committee, who complained that they were shut out of the legislative process.
So far, the bill would require insurance companies to cover all Americans even if they are already sick or are genetically inclined to become so in the future. Other provisions include money to help defray the cost of uncompensated care, a program to help identify and tamp down hospital readmission rates, and measures aimed at making the everyday person a better healthcare consumer.
Called the Affordable Health Choices Act, the bill would extend Medicaid eligibility to 150% of the federal poverty level (or $33,075 for a family of four based on 2009 guidelines) and increase the federal governments share of the program to 100% for a period of time to help pay for the cost of the expansion.
While legislative text has yet to emerge from the Finance Committee, the process by most accounts has been a bipartisan one, with a senior aide to Chairman Max Baucus (D-Mont.) saying that they will report out a bill signed by both Democrats and Republicans.
Members of both the HELP and Finance committees spent days behind closed doors in an effort to craft a measure that would be palatable to both parties.
What emerged was a compromise plan by Senate Budget Chairman Kent Conrad (D-N.D.), which borrows from the co-op model that was first used by utility companies and has spread to many other sectors. The thing thats attractive about it is its an alternative delivery model that could compete with for-profit insurance companies because they are not-for-profit entities, Conrad said. On the other hand, its not government-controlled or government-run, so that appeals to those who dont like the public option because theyre concerned that its a backdoor approach to single payer.
In the House, three committeesWays and Means, Energy and Commerce and Education and Laborshowed a draft outline for a bill that would match the Senates on some provisions, but that would also create a government-backed health plan.
Additionally, the bill would gut the Medicare Advantage program by shaving federal overpayments and create a provider payment system focused on coordination of care.
The bill also allows for a replacement for the Sustainable Growth Rate system that currently sets physician payments.
Rep. Henry Waxman (D-Calif.), chairman of the Energy and Commerce Committee, told reporters that the outline is fluid and likely to change. I think we could have a lot of different ideas and a lot of differences, he said. Were going to have to recognize there will be compromises. Everyone cant get everything that everyone wants and get legislation.
That was on display late last week as a Senate panel met with healthcare stakeholders, including a representative from the American Medical Association. The AMA has been steadfast against a public health plan patterned after Medicare, but showed some flexibility on other option types. AMA board member Samantha Rosman, told a Senate panel that the AMA is open to consideration of a new health insurance option thats market-based and not run by government.
Send us a letter