As House Democratic leaders celebrate passage of health care legislation, Senate Majority Leader Harry Reid, D-Nev., continues to await a Congressional Budget Office analysis as he tries to craft a compromise package between bills passed by the Senate Finance and the Senate Health, Education, Labor and Pensions committees. President Obama has said that he wants a health care bill to his desk by Christmas but it is unclear if that timetable will be met. View the HOTH video or listen to the audio version (mp3).
JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill, a conversation about efforts to pass health care reform legislation. Joining me, Mary Agnes Carey of Kaiser Health News and Eric Pianin, also of Kaiser Health News. Welcome as always to you both. Those efforts moved ahead quite a bit over the weekend as we know. The House passed a Bill to vote margin, $1.1 trillion over ten years. The expectation is 36 million people currently uninsured will have coverage. What are the other big points in that Bill?
MARY AGNES CAREY: Well, it has a public plan option based on negotiated rates versus tied to Medicare. It also would put an excise tax on high income wage earners here. We are talking about folks who make $500,000 a year as an individual or a couple who makes $1 million. It’s about a 5.4 percent surtax, not expected to be too popular in the Senate. It has an individual mandate, an employer mandate. Most individuals with some exceptions would have to have insurance or face a penalty, and for small employers, $500,000 or lower wouldn’t have to provide –
JACKIE JUDD: In payroll.
MARY AGNES CAREY: In payroll, thank you, would not have to provide health insurance but there is a penalty that begins to phase in up to a payroll of $750,000 and then beyond that they would be required to provide insurance or face the penalties. There are some Medicare changes in there. There is a big expansion for Medicaid, taking up to about 150 percent of the poverty level, so it’s quite a comprehensive –
JACKIE JUDD: Where are the cost controls?
MARY AGNES CAREY: Well, the cost controls include looking at how Medicare is paid for and trying to make some changes to that. One of these issues is how they pay private plans in Medicare, called the Medicare Advantage Plans. They want to bring those payment rates down to what they pay for beneficiaries in the private fee for service plans. Data now shows that in Medicare Advantage the government pays about 14 percent more per beneficiary. That is one of those it is pointed to. There are also steps taken over time to link payment in Medicare more to the quality of the care provided.
JACKIE JUDD: Eric, you were on the Hill Saturday before the vote. What happened in terms of the abortion language compromise, which helped the Democrats get over the 218 vote threshold that they needed?
ERIC PIANIN: That is right. For a long time, the public option seemed to be the hottest issue, most contentious, but in the last couple of days the whole question of whether there would be some restrictions on abortion spending as part of the health care reform package became the preeminent debate, really, and Congressman Bart Stupak from Michigan, a Democrat, representing as many as 40 Democrats, warned that they would oppose the Bill unless there was an extremely strict restriction placed in the legislation, concerning abortion spending.
What is interesting in the end is that Nancy Pelosi basically went along with their demands and gave them a vote on an amendment that passed that really takes restrictions on federal involvement in abortion programs to new levels. There is absolutely no way any of the subsidies could be spent in the new exchanges or outside of the new exchanges for abortion related services. No program could be offered as part of the exchange to provide abortion services. So, this really enraged a lot of the liberal Democrats who are pro-choice and at first a lot of them threatened to pull out their support.
In the end, though, Pelosi prevailed and they added a very tough abortion provision and the liberal Democrats in the end decided to go along with it because they felt that passing health care reform was more important than victory on abortion, but I just wanted to make one other
JACKIE JUDD: And with the expectation that in conference that language would change.
ERIC PIANIN: Well that’s the hope, but once it gets over the Senate, there is no telling what form that abortion provision will take. It is also interesting, too, that to me at least it showed that Pelosi was prepared to do almost anything to get that Bill passed in the House. I mean, there is this basic sense that we just have to move the process along. The final Bill is not going to look anything like the House Bill, but still she showed that she was prepared to do almost anything to get a victory that night.
JACKIE JUDD: And even by doing almost everything, there was only that two vote margin, which shows how hard this is and will continue to be. So, what are the next difficult steps? What are the big questions that the Senate will now have to face and then, presuming they pass something, the conferees?
MARY AGNES CAREY: Well, first of all, the Senate has to come up with a Bill. Harry Reid, who is the majority leader, has sent several options off to the Congressional Budget Office. He is awaiting their analysis. He has to try to reconcile differences between Bills passed by two different committees and find something that can get 60 votes in the Senate. Differences include the public plan, for example.
In the House, it is offered to everyone. In the Senate, it would allow states to opt out of the public plan. That is a big difference. Financing is a big difference. We talked earlier about this excise tax on the high wage, the high income earners.
That in the Senate would be, is not there, and instead they would place a tax on some of the highest cost health insurance plans, which they feel is a great way to get cost at containment, the other issue that we just discussed. The individual mandate is not expected to be as severe or rigorous, rather, as what is in the House Bill, and also there is not expected to be a strong mandate on employers to offer coverage. There is, in the Finance Bill for example, if one of your workers received the subsidy, you would have to help offset the cost of that, but it’s nowhere near as tough as the provisions in the House Bill.
JACKIE JUDD: So, as hard as it was for Democrats to cross the finish line in the House Saturday night, is the most difficult work still ahead?
ERIC PIANIN: I think that’s true. And I think there is a lot of concern that the Senate has lost some of its momentum. When the Senate Finance Committee finished up its work, there was a feeling that things would move apace. Since then, Harry Reid, the majority leader, has decided to take the responsibility upon himself and a small number of other leaders to try to cobble together a Bill that would attract 60 votes in the Senate.
Right now, they are still waiting a week later for the CBO to come back with some estimates of what their latest options, proposals would cost. They don’t even have a Bill yet. And Reid signaled recently, much to the consternation of the White House that he wasn’t going to be held to any deadlines, suggesting that this thing could spill over into next year.
Rahm Emanuel immediately was dispatched to the Hill the next day to say you know we are really thinking in terms more like Christmas rather than New Years to get something out of the Senate and the President gave a similar message for the Rose Garden on Sunday. Now that the House has acted, it’s time for the Senate to pull up its socks and get moving.
JACKIE JUDD: And now there is some hope that it actually could happen before Thanksgiving. Likely?
MARY AGNES CAREY: I don’t think so. I mean if Senate debate began before Thanksgiving, that would be amazing progress and we are not even sure that is going to happen, but this is Congress. Anything can happen at any time.
JACKIE JUDD: You know, beginning about five or six weeks ago there began to be a sense of inevitability that there would be a Health Care reform Bill passed by both Houses of Congress and signed by the President. Where are we at this moment?
ERIC PIANIN: I don’t think we are feeling that sense of inevitability right now. I think that it was a big victory for Pelosi and the Democrats to get this thing through the House. It was a great accomplishment. It was a very interesting debate and clearly incredible division between the Republicans and the Democrats. Only one Republican, Cao of Louisiana, finally voted for it.
But moving to the Senate, these things get more complicated because there aren’t the strict rules that the Democratic leadership imposed in the House to kind of march through it, set time limits for debate, schedule votes. This stuff is like the old saying, it’s like herding cats when you are trying to deal with the Senate, and Harry Reid does not have the same power that Nancy Pelosi does.
So there is no telling when they can pull together something that is likely to get 60 votes. And now this abortion issue, it’s very problematic, and it is going to play out in the Senate just as it did in the House and in the end it might be very hard for liberal Democrats, who are pro-choice, to go along with any Bill that is so restrictive in terms of abortion.
JACKIE JUDD: Okay, well thank you both very much, as always, Mary Agnes Carey and Eric Pianin. Thank you for joining us. I’m Jackie Judd.