Health Care Reform

The latest on health reform for Humana brokers

What next? All eyes are on the Senate

By the slimmest of margins, the House passed its health care reform bill on Saturday. Of course, the fight over this issue is far from over. In fact, Saturday’s vote was just the first of several big votes on the journey to health reform.

The next step is for the Senate to pass a bill, but despite President Obama’s encouragement last weekend “to take the baton and bring this issue to the finish line,” the Senate is currently stalled. Majority Leader Harry Reid has merged the two different bills passed by the two Senate committees with jurisdiction over health care, but the Congressional Budget Office has not yet attached a cost estimate. That probably won’t be done until the end of the week.

Further, no date has been set for the start of debate. Debate in the Senate is expected to last several weeks. So the question now is whether to attempt to start debate before Thanksgiving, which would mean pausing while everyone goes home for the holiday. Some senators think it would be best to hold off even starting until after the break, but on Tuesday Reid said he would like to start debate next week.

And there’s another problem with trying to anticipate the Senate’s schedule: It takes 60 votes to approve the start of debate, and right now Reid doesn’t have those 60 votes. For example, Sen. Joe Lieberman, a Connecticut Independent who caucuses with the Democrats and whose vote Reid is likely to need, says he won’t vote to start debate until the public plan is removed from the bill.

Then, any bill the Senate passes is likely to be very different from the one the House just passed. For example, the House bill includes more generous subsidies for people to buy health insurance, and it pays for reforms in a different way than the Senate would. So merging the House and Senate bills will be a complicated exercise.

And if any of these negotiations drags too far into 2010 – an election year – some moderate Democrats are likely to lose some of the courage the President has been praising them for this week. Their votes on the final bill that emerges from the Senate-House conference committee could be far from a sure thing.
Saturday in the House: Democrats prevailed – but by a slim margin
Saturday was a long, long day in the House of Representatives, with almost 14 hours of health reform. Much of that time was filled with speeches – there was a constant parade of members to the microphones at the front of the chamber. In general, Democrats and Republicans took turns, arguing their points in the one to three minutes they were allotted. Republicans, focused on the new requirements for business and the bill’s high gross cost – $1.1 trillion for the first 10 years – referred to the House version of reform as a “jobs killing bill” that would increase debt and threaten the economy. Democrats, focused on bringing 36 million uninsured people into the system, described it as “the moral thing to do” and an opportunity to make history.

But away from the House floor, speeches and C-SPAN cameras, the last arm-twisting and vote-tallying was going on. In a Rules Committee meeting that had lasted half the night before, a compromise had been worked out with anti-abortion Democrats who had threatened to vote against the bill. Early Saturday afternoon, the President arrived in the Capitol to address the Democratic caucus. Still, the vote count was close.

Democrats needed 218 votes, and in the end they passed their bill 220-215 – the tightest of margins. One Louisiana Republican voted yes; 39 Democrats voted no.

Afterward, House Democratic leaders were jubilant, noting the historic moment and praising Speaker Nancy Pelosi. In the Rose Garden on Sunday, President Obama praised everyone who had voted for the bill. “For years,” he said, “we’ve been told that this couldn’t be done. After all, neither chamber of Congress has been able to pass a comprehensive health reform bill for generations. But last night, the House proved differently.”

On Fox TV on Sunday, Rep. Mike Pence, R-Ind., expressed his feelings about how this vote would fit into history. “I’ve got to tell you,” he said, “if Democrats keep ignoring the American people, their party is going to be history in about a year.”

Actually, both political parties seemed to come out of the weekend feeling as if they were well positioned for the next round of battle. As CNN’s John King wrote in his “State of the Union” blog, “Democrats saw the victory, as narrow as it was, as a major step forward and a momentum boost they say dramatically increases the odds of getting legislation to President Obama this year. Republicans took the 220-215 margin and the 39 Democrats who voted “No” as proof of jitters in the Democratic ranks, and proof that they will end up on the winning side of the politics of health care.”
Late nights in the Congressional Budget Office
Two new “scores” from the Congressional Budget Office were released last week: one on the cost of the reform bill that was offered by House Republicans, another on the cost of the House’s “doc fix” bill.

According to the CBO, if the Republicans’ alternative bill had passed, it would have cost about $60 billion over the next 10 years and would have resulted in about 3 million more people having insurance. This is in contrast to the House Democrats’ bill, which would have a gross cost of $1.1 trillion and result in 36 million more people having insurance.

What the Republicans’ approach would do, however, is reduce the average premium cost for those who do have insurance. The CBO says that in 2016, small group insurance premiums would cost 7 to 10 percent less than they would under current law, and individual insurance prices would cost 5 to 8 percent less. Prices in the large group market would be zero to 3 percent lower, but some people – including older, sicker people – could see higher premiums.

Minority Leader John Boehner has said the GOP favors a step-by-step approach to reform, and that their first step is to reduce health care costs. Expanding access would come later.

The CBO also released cost estimates on the “doc fix” – the AMA’s top priority, which is to repeal the law that automatically reduces Medicare payments to physicians when budget targets aren’t met. The CBO says the cost over 10 years would be $210 billion. House leaders have removed the doc fix from the big health reform legislation and turned it into a separate bill to keep the cost of reform lower.

The Senate voted down a similar bill in October because the legislation didn’t include a plan to pay for the fix.
About those AMA and AARP endorsements of the House bill
The AARP endorsed the House’s health reform bill on Thursday. President Obama responded, “They're endorsing this bill because they know it will strengthen Medicare, not jeopardize it. They know it will protect the benefits our seniors receive, not cut them. So I want everybody to remember that the next time you hear the same tired arguments to the contrary from the insurance companies and their lobbyists. And remember this endorsement the next time you see a bunch of misleading ads on television.”

The AMA also announced its “support” for the bill, although the organization stopped short of endorsing it. As the AMA president told reporters, "The way we use words, an endorsement of a bill means you completely accept it 100 percent and you leave the table," he said. "Support of a bill, in our way of viewing it, is that we agree with many of those components in it, but we still need to work to make it better. And that's where we are."

Meanwhile, several state medical societies broke with the AMA last week on the issue of health reform. For example, the Illinois State Medical Society distributed “An Open Letter to Patients” through the media. “Illinois physicians have grown frustrated as we watch the best opportunity for health reform in decades potentially slip away,” stated the group’s president. “Bad policy proposals and political partisanship must not be allowed to destroy this rare opportunity to guarantee access to health care for our patients.”

The Ohio State Medical Association also announced its opposition to the House Bill. The group's president said the association "supports many of the goals of this bill. However, the total proposal lacks many of the critical elements necessary for successfully reforming America’s health care delivery system and strengthening the physician-patient relationship.”

Twenty surgical organizations, led by the American College of Surgeons and including neurologists, urologists and oncologists, also broke with the AMA over its support of the House plan.