|09-17-2009, 08:08 AM|
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What Democrats Want To Change In the Baucus Health Care Bill
After months of anticipation and blown deadlines, Senate Finance Committee Chairman Max Baucus Wednesday finally unveiled his bill to overhaul the nation's health-care system. The Montana Democrat did his best to sell the controversial proposal, stressing that it was largely in line with the principles laid out last week by President Barack Obama: it has a 10-year price tag of less than $900 billion, doesn't add to the deficit and includes a mechanism to ensure that those with pre-existing conditions can't be denied coverage. But Baucus' relentlessly positive spin couldn't change the fact that for all the wrangling and delays not a single Republican signed on to his much-touted bipartisan bill. Even more troubling for anyone hoping there might be some resolution any time soon, many of Baucus' fellow Democrats had lots of negative things to say about the controversial proposal, treating it as nothing more than a first offer to be bargained over.
"Everyone should understand that it is just the beginning," said Senate Majority Leader Harry Reid. "There'll be some changes before the markup starts and then there'll be some changes during the markup." (See 10 players in health-care reform.)
"There's much more work to be done," said Russ Feingold, a Wisconsin Democrat.
Asked if she could vote for the bill right now, Senator Blanche Lincoln, an Arkansas Democrat, smiled coyly. "There's always room for improvement," she said. "I've got an opportunity to make improvements so we all look forward to that."
"I'm going to do my best to fix the legislation," declared Oregon Senator Ron Wyden.
"It's a work in progress," hedged Louisiana Senator Mary Landrieu.
Still, senators shouldn't hold their breath that they will be radically changing the bill, at least in the formal markup expected in committee next week. It's unlikely that any amendments that basically change the framework will be accepted, Baucus told reporters before unveiling his bill. The Montana Democrat has not even given up on the hope of some Republican support. But despite his apparent confidence, Baucus may still need to work to win over enough wavering Democrats to get the bill through the finance committee. Here are their five biggest issues with the legislation, and what Baucus can - or in some cases cannot - do to assuage these fears.
1. The Public Option
All four other versions of health-care reform legislation that have emerged from the House and Senate include a government insurance option that would compete with private plans to help keep costs down. Republicans across the board have denounced the proposal, many calling it the first step to socialized medicine. In a nod to the concerns of his G.O.P. colleagues and some moderate Democrats, Baucus introduced an alternative to the public plan: non-profit state or regional cooperatives that, except for some seed money from Washington, would be exclusively financed by members' premiums. The hazy concept of co-ops has been pushed by North Dakota Democrat Kent Conrad, who was part of the bipartisan so-called Gang of Six that worked to draft the Baucus bill, but many health policy experts view it was as a poor substitute for a public plan; in fact the Congressional Budget Office, in its scoring of the deficit impact of the bill, stated that it didn't believe the co-ops as proposed by Baucus would attract many members. Liberals see the plan as letting insurers off the hook. "Senator Baucus' health care bill released today is like a dream come true for the insurance industry," screamed a statement by Justin Ruben, executive director of the progressive group MoveOn.org.
Senator Jay Rockefeller, a West Virginia Democrat and a longtime champion of the public plan, said he intends to introduce an amendment to insert the federal alternative into the bill, though there was no word if Baucus would accept such an amendment. "The proposed co-op model is untested and unsubstantiated and should not be considered as a national model for health insurance," Rockefeller said. If Dems choose to go it alone without any Republican support it's possible they could include such a plan in the final version of the bill. But many moderate Democrats such as Landrieu and Nebraska Ben Nelson have said they could not vote for a public plan, complicating the prospect of getting the 60 votes they would need to prevent a Republican filibuster. (Watch TIME's video "Uninsured Again.")
This issue emerged in the final days of negotiations as a key flashpoint. To help keep the costs down, Baucus provides comparatively less-generous subsidies to help low- and middle-income people purchase insurance. "The House bill clearly does more to make coverage affordable for more Americans," said House Speaker Nancy Pelosi in welcoming Baucus' bill. "As this proposal evolves, we hope to see modifications that result in the Senate bill better reflecting the work of the House to make health care more affordable for all Americans."
Senator Ron Wyden said he plans on offering amendments to increase the subsidies. "I continue to be concerned about affordability for hard-working middle-class families," Wyden told reporters just off the Senate floor. "A lot of them can't get by now and the prospect of paying significantly more or getting an exemption [from the requirements that all individuals have health insurance] or being penalized, that is not going to meet their test of health-care security." The problem, of course, is paying for more subsidies. In its current version, the bill actually shrinks the deficit by around $50 billion over 10 years, according to the Congressional Budget Office. For many deficit hawks on Capitol Hill, unfunded liabilities are out of the question.
Rep. Joe Wilson may have gotten himself into trouble when he yelled "You lie!" at President Obama during the address to the Joint Session of Congress, but it certainly seems that Democrats took his outburst to heart. Senate Finance negotiators went back to the table and rewrote the bill to ensure that not only would illegal immigrants be prevented from receiving government subsidies to buy insurance, but that they couldn't purchase insurance on the so-called exchanges even if they could pay for it in full. The plan also tightens the rules for some legal immigrants to qualify for government subsidies on the exchange. Both points have angered Latino lawmakers such as Rep. Luis Gutierrez and Senator Bob Menendez, a New Jersey Democrat, who are seeking to modify the provisions. Health policy experts say it makes absolutely no sense to prevent illegal immigrants from purchasing insurance, since taxpayers end up covering the costs anyway when the undocumented inevitably go to the emergency rooms to get their medical care. But with almost all politicians afraid of being painted as soft on illegal immigration, it's hard to see enough lawmakers supporting scaling back the provisions.
Baucus has held down the fiscal impact of his legislation by proposing to cut a hefty $500 billion in Medicare costs. The bill claims to do this by trimming a lot of fat out of the system and setting up an independent, non-partisan panel that will take the power away from Congress to set Medicare payment policies and reimbursement rates. But, most controversially, the bill takes a big chunk of money from the Medicare Advantage program, which essentially subsidizes insurers. "We are committed to working with policymakers and stakeholders to find savings in the Medicare program, including Medicare Advantage, but it is important to ensure seniors' health care choices are protected," said a statement from America's Health Insurance Plans, the powerful lobbying group that represents private health insurance companies.
While proponents argue that today's seniors will feel little or no difference in their levels of coverage, many Medicare beneficiaries are still worried, as was evident during August's heated town halls. In response, several senators have introduced legislation to scale back those cuts. "I will offer an amendment to grandfather in all the senior citizens on Medicare so that they're not going to be cut from the Medicare Advantage," said Florida Senator Bill Nelson. He plans to offset that by asking the pharmaceutical firms to apply the same rebates they currently give to Medicaid patients to Medicare recipients. "That pays for a lot and more," he insists. (See how to prevent illness at any age.)
Baucus would expand Medicaid coverage currently topping out for people who make 100% of the poverty level to 133% of that level ($29,327 for a family of four), a shift that is expected to cover an additional 10 million Americans, including childless adults who have previously not been eligible for the program. Medicaid, however, has always been a partnership between the states and the federal government, and Baucus wasn't willing to absorb all of the costs of expanding the program. Under his proposal, the federal government would pay most of the new Medicaid costs: at least 80% in wealthy states like Connecticut and up to 95% in poorer ones like Mississippi.
The problem is that in the current economy, a number of already cash-strapped states can hardly afford Medicaid at current levels, let alone an expansion. Ohio, for example, would likely have had to cut back on its existing Medicaid benefits if it weren't for the stimulus funds the state received earlier this year. Many people on Medicaid also would be absorbed into the so-called exchanges where lower income people would purchase their insurance, a move that some Democrats don't like. "Everybody gets to keep the insurance they have except if you're poor, and that's the State Children's Health Insurance Plans, which is drawn into the exchange, and a lot of Medicaid," Rockefeller said, adding that he planned several amendments to fix the Medicaid provisions in the bill.