KHN’s Mary Agnes Carey discusses the latest health reform proposal unveiled today by House Democratic leaders.
Jackie Judd: Good day, I’m Jackie Judd with Health On The Hill. Breaking News from Capitol Hill. House Democrats have unveiled their bill for health care reform. It’s the product of work of three House committees. Joining me today is Mary Agnes Carey from Capitol Hill. Mary Agnes, what’s the big picture?
Mary Agnes Carey: House Democratic leaders today unveiled their health reform package. They said it will come in at under $900 billion under the next decade. It will increase insurance for 36 million people who don’t have it now. It will have, as we’ve known from previous measures, it’ll have an individual mandate with some exemptions for hardship and so on, and also an employer mandate. But they’ve made some significant changes for small business. They said that small businesses , for example, whose payrolls are under $500,000 would be exempted from the mandate, and then that mandate penalty would come in on a gradual basis between $500,000 and $750,000 on payroll. That’s important because a lot of members with small business constituencies said requiring businesses to cover their employees would be a hardship. So that was a major concession. Of course, the public plan, which we’ve all heard so much about, is contained in the House bill. It would be paid for with negotiated rates for hospitals and physicians and for other providers. Again, that was an important change from the prior bill, which would have paid on Medicare rates. House moderates in the Democratic party, as well as those representing rural areas said that our providers need negotiated rates to stay in business, so that was a major change in this bill.
Jackie Judd: And so with all of those changes, do the House Democratic leaders believe that they have the sufficient number of votes to pass this?
Mary Agnes Carey: They’re feeling good about it. They’re feeling confident. They’ll have those 218 votes before they see a House vote, which they said tentatively could occur at the end of next week.
Jackie Judd: And what are the biggest differences – we understand at the moment – between the House version and the Senate?
Mary Agnes Carey: On the public plan, for example: In the House, it will be there and it will be part of the health insurance exchange. In the Senate, Democrats were talking about an opt-out provision for states that would allow governors and state legislatures to say “no, we’ve decided that we don’t want to participate in the public plan.” That’s one of the major differences. Another major difference between the bills is on how they finance it. In the House, they’ve decided to put an excise tax on high-income earners. That definition would be $500,000 for individual people and $3 million for couples. I don’t think you’ll see that excise tax in the final bill that’s in the works in the Senate, and if it is, part of the House package. And also, the House package is going to allow the Secretary of the Department of Health and Human Services to negotiate prescription drug prices for Medicare beneficiaries. In the Senate, Max Baucus, who is head of the Finance Committee, as well as the White House, have cut a deal with the drug industry to limit their exposure on financial issues in this bill and I don’t think you’re going to see allowing the HHS Secretary to negotiate Medicare drug prices, but the House Democratic leaders were not part of those negotiations, so that’s why that provision is in the House bill.
Jackie Judd: And a final question, Mary Agnes. In terms of the time table, does it still seem to be that if there is going to be legislation approved by Congress that it would happen before Christmas?
Mary Agnes Carey: That is absolutely the goal of Democratic leaders in the Senate and in the House. Their very strong feeling is they have momentum on their side; it’s an important issue. Next year, as we all know, we face a mid-term election. It would be very difficult to get legislation of this size done then, so they’re pushing their hardest to have it done this year before they leave for the year.
Jackie Judd: OK, thank you so much. Mary Agnes Carey outdoors on Captiol Hill – we can hear the background there. Thank you so much. I’m Jackie Judd with Health On The Hill.