An Update on the Senate Health Reform Debate

The Senate health reform bill is in a procedural holding pattern right now. Even though the body will be in session over the weekend, Majority Leader Harry Reid has put off votes on the bill while he waits for the Congressional Budget Office to evaluate a new Democratic proposal that could strip the public option out of the bill. In my Time.com story today, I explore the ramifications of one part of that plan – expanding Medicare eligibility to include Americans 55-64.

But just because the Senate is stalled doesn’t mean time has stopped. On the contrary, there are a few important things happening right now on the health care reform front.

1. Democratic Senators Ron Wyden and Evan Bayh have teamed up with moderate Republican Senator Susan Collins to offer a package of meaningful amendments. (I emphasize meaningful here because, as I’ve been noting, many of the amendments to the Senate bill are “message amendments” or “sense of the Senate” amendments that have no actual effect.) The Wyden-Bayh-Collins package, on the other hand, is worthy of examination because it represents a genuine act of bipartisanship and could alter the bill in meaningful ways. The most notable amendment in the package is the so-called “Free Choice Amendment” that Wyden has been pushing all year. Ezra Klein, the Washington Post’s resident health policy wonk, has a description of the idea here. The quick explanation, though, is that the Free Choice Amendment would allow workers to opt out of their employer-sponsored health insurance and instead get a voucher from their employer to shop around for coverage. While a majority of Americans get health insurance through their jobs, the system as it exists is unsustainable and Wyden argues it’s unfair and unwise to prohibit workers from going outside that system.

2. The Associated Press dropped a bit of a policy bombshell today, reporting that Reid quietly inserted language into the Senate health reform bill that would allow insurers to limit the annual amount they spend on benefits. The bill from the Senate Health, Education, Labor and Pensions committee, according to the AP, did not have such a limit. This is important. Cancer patients, for example, can bump up against these kinds of caps and, in effect, end up without coverage long before their treatment is complete. One of the oft-touted insurance market reforms in the Democrats’ health plan is a rule to prohibit insurers from placing a lifetime limit on benefits. It’s not clear how an annual limit has less of an effect than a lifetime effect. Of course, the flip side is that allowing insurers to cap benefits ends up lowering premiums for everyone.

3. The chief actuary for the Centers for Medicare and Medicaid Services, an arm of the Department of Health and Human Services, released a report last night evaluating the Reid Senate bill. Republican Senators have been citing the CMS report as proof that the Democratic bill is a fiscal disaster, but that’s a mischaracterization. The CMS actuary did say the bill would make health expenditures go up, but that’s because more people are expected to have better insurance and therefore will be able to afford more care. The New Republic’s Jonathan Cohn has a good read on the CMS report here.

4. I wrote earlier this week about an amendment spearheaded by Democrat Byron Dorgan that would allow for the “reimportation” of pharmaceuticals from foreign countries. This proposal would go against a deal the White House made with the drug industry and so it’s caused no small amount of consternation. Democrats are divided over the plan. Things have gotten so dicey that Sen. Jay Rockefeller, who is a co-sponsor of the Dorgan amendment, has said he will vote against it. Read more here and here.

Related Topics: byron dorgan, cms, evan bayh, free choice amendment, Ron Wyden, susan collins, Budgets, Congress, Democratic Party, Harry Reid, Health Care, Republican Party, Senate, Uncategorized
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  • 53_3

    Got my eye on #2.
    .
    Why even bother with HCR? With that and no public option…

  • deconstructiva

    Thanks, Kate. Some of us asked about recent lack of HC red meat. With debates on hold does this mean you, Karen, Jay, and Amy get the weekend off? Or will other topics generate weekend posts? How do you decide who works when at the Senate (by turn, issue, rock-paper-scissors)? Is the 60-vote count dicey enough that reconciliation, flushing senate bill thru house as is, or other tactics being pondered again? thanks

  • destor23

    The proposal doesn’t really expand Medicaid eligibility. It just makes it so that some people who can’t get insurance by other means and who have $7,600 and who are 55 can buy into the program under different terms than are enjoyed by people over 65. This isn’t really an expansion of Medicare at all, it’s more like just using it to solve a different and very small problem.

    Sorry to be pedantic but it’s important because of the way this is being debated.

  • Kate Pickert

    I’ll be keeping an eye on the health care debate over the weekend and will post if something particularly noteworthy happens. Reconciliation is not being talked about at the moment, although there has been talk of bypassing the conference process. It’s very unlikely though. See here: http://prescriptions.blogs.nytimes.com/2009/12/08/the-democrats-longest-shot/

  • shepherdwong

    Thank you, Kate.
    .
    Any idea how AP has information that Senators, who are saying Harry Reid did this on his own, in secret, before sending the bill to CBO, claim not to have?

  • stuartzechman

    Kate Pickert:
    .
    Thanks so much for responding to commentary, it is greatly appreciated.
    .
    Also, you have our gratitude for your continued reporting on these important matters.

  • stuartzechman

    Kate Pickert:

    This proposal would go against a deal the White House made with the drug industry and so it’s caused no small amount of consternation.

    Has the White House actually admitted on the record that a deal took place, and answered questions on the record as to the terms of that deal?
    .
    Has the White House answered questions on the record about any other industry deals?
    .
    In other words, anonymous sources aside, how do you know with certainty that there was any deal?

  • shepherdwong

    Karen and I went ’round and ’round about this “deal or no deal” question weeks ago. I argued, to little avail, that if it doesn’t end up in the final legislation then you really can’t characterize it (or get overly exercised about it) as a “deal”. What it looked and looks like to me is a very savvy move to check big pharma opposition for as long as possible.

  • stuartzechman

    shepherdwong:

    What it looked and looks like to me is a very savvy move to check big pharma opposition for as long as possible.

    I must respectfully disagree.
    .
    What it looked or looks like to me is a DLC centrist (Rahm) doing his Third Way “partnership between government and industry as the basis for good governance” thing.
    .
    What it looked or looks like to me is more emperor’s new clothes journalism.
    .
    What it looked or looks like to me is not change we can believe in.
    .
    It might be a completely “savvy” move on the part of the Obama Administration, but savviness isn’t very valuable if it’s not a means to a decent end, and this legislation isn’t a decent end…unless the only goal is a domestic “mission accomplished” for Obama.
    .
    Casting a standard ideological move by New Democrats –make backroom deals with industry– as “pragmatism” when the outcome is more compromise with Republican elites, and more partnership between corporate institutions and the state seems to miss the point, in my opinion.

  • shepherdwong

    At present, I find that a completely understandable viewpoint – I’m pretty much alone out here thinking that Obama is head-faking everyone (including liberals) as best he can, while trying to move the ball toward the correct goalposts, again, as best he can. In other words, I think he has a much better understanding of the forces of status quo and limitations of the office than anyone else, and is using all the tools he has to work against them. I’m not surprised at all that he’s decided not to go straight at the corporatist establishment, that way is political and policy suicide and everyone (especially liberals) should know that by now.
    .
    But check back with me this time next year.

  • vinniel20

    I agree. What’s the point if we’re going to incorporate one of the major weaknesses of the current health care insurance industry? Get a major illness and go bankrupt. This whole thing started out as a way to prevent that kind of thing.

  • rustyreturns

    Mr New Republic a Liberal blog site says:
    .

    “The key question, going forward, is whether we can somehow offset this increase–ideally, in a way that reduces medical spending across the board and that doesn’t lead to inferior medical care.”

    .
    Ideally, what will happen is cost will not be controlled because Democrats have made deals with big Pharma and Hospitals to keep their prices stable. Rather than focusing on real reform, the deals from the Democrats will keep us paying at levels exceeding OECD averages by double the amount. Average OECD countries spend on average 3,000 per person on health care. The US spends over 7,000 per person.
    .
    Such a great deal the Democrats are proposing. Now, their holy grail of health care, the “public option” is off the table. But, in it’s place we are going to allow those of us who are 55 to 64 to “buy into” Medicare. How does that help those who are uninsured? My guess is most of this group HAVE health care insurance. And, of that group, over 80% are completely satisfied.
    .
    All it does is to get Employers to quit paying for my insurance knowing I can go to Medicare. Cut out the insurance I like now, and force me into Medicare at a cost of $7500 per year. That is more than $5,000 dolalrs than I am paying now, for a more inferior policy. I truly do not get it.
    .
    Instead of simply focusing on those reforms such as life-time caps, recisision or pre-existing conditions, they focus on purely the so-called “mission accomplished” to say they passed Health Care Reform.
    .
    Bull-Crap!

  • rustyreturns

    stuart:
    .
    Is there anything in the legislation that allows us to buy drugs from Canada?
    .
    Is there anyting in the legislation that requires cuts in the cost of drugs overall? To decrease the patent time of brand named drugs so that generics can be made at a much cheaper cost?
    .
    Is there any legislation which looks at the charges hospitals make for patient care that caps or limits those costs? You know like rent control? Only in this case the rent of a hospital room when I am sick?
    .
    You know as well as I do that deals were made. Deals to keep big Pharma out of the negative advertising that this health care bill is nothing short of a sell out by the Democrats. Deals to garner hospital and Physician backing of the legislation, knowing full well that if they didn’t then health care reform as proposed would be dead out of the gate.

  • shakrai

    Why is it so unreasonable to expect that health insurance policies have an annual limit on how much they will pay out?
    .
    Most insurance policies have this sort of limit. Your homeowners insurance will only pay up to a certain point. Your automobile policy liability limits are capped at a certain level, based on how much you are willing to pay.
    .
    Economics 101 tells us that nothing is free. If you expect every single health insurance policy to have “infinity” as the limit for payouts then you are going to wind up pricing many people out of the insurance market altogether.
    .
    If someone wants a limitless policy then they should be prepared to ante up the money to pay for it. If someone wants to save the money and spend it on other things then why shouldn’t they be allowed to purchase a cheaper policy with lower limits, just as they can do with every other kind of insurance that’s out there?

  • carotexas1

    Thank you Kate for this update.

    One of the oft-touted insurance market reforms in the Democrats’ health plan is a rule to prohibit insurers from placing a lifetime limit on benefits. It’s not clear how an annual limit has less of an effect than a lifetime effect. Of course, the flip side is that allowing insurers to cap benefits ends up lowering premiums for everyone.

    Will someone tell me the difference? If you cannot afford to pay the annual limit, do you not have the medical procedure done, or do you do it and then file bankruptcy?

    I thought that the compulsory requirement for everyone was supposed to give the insurance companies millions more healthy to compensate. If they open up medicare for 55 to 64, does that not take a lot of risk off of the Insurance Companies?

    I do not think anyone expected for premiums not to rise, but hoped that would be held to a minimum.

  • Paul-no not that one

    “I thought that the compulsory requirement for everyone was supposed to give the insurance companies millions more healthy to compensate”
    .
    That was exactly my thought.
    .
    Early on the Insurance Industry gets the benefit (everyone MUST buy their product) and then over time slowly negotiate (read:lobby) away as much cost/risk as possible.
    .
    They are so much better at this than the people with whom they are negotiating.

  • carotexas1

    Paul, Emptywheel has some good points on why the senate bill had to do this to make the Senate bill not cost so much.

    http://emptywheel.firedoglake.com/2009/12/11/the-truth-about-harry-reids-lifetime-cap-loophole/

  • Paul-no not that one

    Thanks carotexas1, that sort of supports my point about the negotiating skills.
    .
    “So what Ezra’s sources really mean is that the Senate bill–partly because it has traded off other means to keep premiums down–has had to eliminate a key promise of health care reform: that families experiencing a catastrophic health care event wouldn’t lose coverage at the time they needed it the most.”
    .
    One thing the long HCR process has illustrated is that private companies (insurance, pharma, etc.) have veto power over public legislation.
    .
    They couldn’t be more brazen.
    .
    And voters, including me, don’t blame them. It is Congress and the WH who are responsible.
    As they will likely find out next year.

  • diecash1

    Rusty –
    ..
    Real reform that controlled costs would have come in one of two flavors: Single-payer or a strong public option. Either one could have brought costs down by adding millions of new people (and dollars) into the mix and by paying reimbursement rates similar to or slightly above that of Medicare. The reduction in required claims and reimbursement paperwork and other assorted overhead would have lowered costs as well.
    ..
    The problem is that the Dems started the negotiations from a compromised position and it was further eroded by the Senate Reps and the variety of corporate interests aligned against reforming the system.
    ..
    Even though I am not enamored with the current House or Senate proposals I still hope to see some sort of health care reform passed. Though it will not be what I hoped it would be, some improvement (depending upon what shakes out it the conference committee) over the status quo would be appreciated. I believe that improving health care will be an iterative process as the problems that we face are not going away. I imagine that it will be similar to the passing of Medicare Part D; flawed and costly, but a step in the right direction. Hopefully this Congress will continue attempting to improve Medicare Part D and future sessions will do the same with this health care bill. Now we just need to do away with corporate “speech” and personhood!

  • freeinpa

    “The problem is that the Dems started the negotiations from a compromised position and it was further eroded by the Senate Reps and the variety of corporate interests aligned against reforming the system.”

    An interesting contention but absolutely wrong on the facts.. Harry Reid conducted a re-write of the Senate bill with DEMOCRATS only behind locked doors. If the corporate interests (Does that include AARP & SEIU?) were let in it was by Democrats. They have a 60 vote majority, so it is silly and false to blame anybody but the Democrats for whatever form if any this bill takes.

  • diecash1

    “They have a 60 vote majority, so it is silly and false to blame anybody but the Democrats for whatever form if any this bill takes.”
    ..
    Again, wrong on the facts. The Dems have 58 seats in the Senate, not 60. As such, they are forced to compromise with the Repubs, not to mention the conservaDem “Blue tick” Dems.
    ..
    It’s blatantly obvious that all or nearly all of the Repubs have no interest in achieving any reform of health care. Far too many of them are more interested in making this Obama’s Waterloo than in passing reforms that will actually help American’s achieve more comprehensive and affordable health care coverage. One needn’t look any further than the various strategies that a number of leading Repubs have proffered to slow or kill the process.

  • 53_3

    So then, what you are saying is that you are in favor of Death Panels?
    .
    I thought only liberal, America hating traitors wanted Death Panels?
    .
    Where is Sarah Palin when you need her…

  • 53_3

    FYI, I’m for single payer.

  • bacalove

    The problem with tReform is the Democratic Senate. House Democratis Did Vote for a strong public option and do vote for progressive reform. It is the small minority of the majority in the Senate that makes things so difficult to pass, espeically when the small – majority have a few Democratic Senators who act more like the minority party or Republicans than Democrats. No, the answer is more Democratic Senators who are true progressives and not ConservaDems!

    In regards to healtcare reform, while some Senators want to slow the process down or kill it all together, there are people all over America who are sick and dying or cannot afford their medicine, they can’t slow things down. There are people who are losing their health care insurance because employers just cannot afford it any more. They don’t want the processed slowed down. These Senators do not feel a sense of urgency because it is not happening to them. They are not really connected to the pain of people. They should not be representatives of the people!

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