JACKIE JUDD: Good day. I am Jackie Judd with Health on the Hill. As always, we are going to be having an update on the debate over health care reform. Joining me, Mary Agnes Carey of Kaiser Health News, Julie Rovner of National Public Radio, and Eric Pianin, also of Kaiser Health News. Welcome as always to all of you. Eric, start with you, the focus continues to be on Senate finance, what is the time table? What should we expect this week?
ERIC PIANIN: Well, after months and months of behind closed door negotiations, Senator Max Baucus and his Gang of Six have reached a point where Baucus is ready to unveil a bill. It may not be all that the Republicans were pushing for, but Baucus is under enormous pressure to get the train moving so this week he will unveil his bill. The plans are to take it to mark-up in committee next week and Senate leaders hope to have something to move to the floor by early next month.
JACKIE JUDD: What is in the bill? Julie?
JULIE ROVNER: Well, we don’t know exactly what’s in the bill. We do know what it was that Senator Baucus put before his Gang of Six last week.
JACKIE JUDD: The frame work.
JULIE ROVNER: Yes the notorious frame work. It was a 17 page outline. We now know it costs around $880 billion over ten years. That is a good bit less than the other bills that have been floating around. It does have what we call exchanges, where people without insurance can go and buy insurance. It does not have a public option. It does have co-ops that would be member owned and member run instead. They are working even now as we speak on ways to ensure that illegal immigrants couldn’t get coverage. They are working on ways to make it so called abortion neutral, which is a real trick. They are trying to not have public funds pay for abortion as public funds do not now pay for abortions generally throughout the federal government but that is tricky because a lot of private insurance does pay for abortion so there are going to be subsidies for private insurance. And they want to do this without taking away coverage in the private sector but also without letting public money pay for abortions so it turns out that is very difficult to write. So those are two of really the last big sticking points in the bill and of course then this question of funding, there will not be a big tax as in the House bill. Instead, they are going to try and have really fees on a lot of providers, the insurance industry, medical device markers, the drug industry, that would be the way that this would be funded, at least according to the Bill that was presented to the Gang of Six. We don’t know exactly what kinds of changes the Senator will make in the mark that he is planning to present to the rest of the committee.
JACKIE JUDD: You started by saying no public option, but do we know if there would be a public option triggered if certain economic conditions prevail years down the road?
JULIE ROVNER: Well, that certainly is something that Olympia Snowe, the Republican from Maine, part of the Gang of Six has been a proponent of that. I think it’s unclear exactly if that would be in the bill at this point. It could be added if they decided to add it. They could certainly add it in committee. They could add it on the floor. They could add it at any point, but it is unclear at this point whether that would be in the finance bill, which we expect in the next few days.
JACKIE JUDD: And Eric, you are good at head counting, when Baucus does what he says he is going to do tomorrow, will he have any Republicans standing by his side?
ERIC PIANIN: I think that is an open question. Even at this 11th hour, the three Republicans on the committee are pressing him for more and more changes, some of which he will not be able to accommodate them on, so Olympia Snowe has been long viewed as perhaps the most gettable Republican and there are still high hopes of bringing her on. Chuck Grassley, Mike Enzi, the two other Republican negotiators, seem to be constantly coming up with more and more objections and concerns. I think they were both scarred and shaken up by the intensity of public resistance and opposition to the President’s plan during the August recess during these Town Meetings. And I think that while the President’s speech helped a little, I don’t think it has really changed public opinion all that much, so it is quite possible that the Democrats in the end are going to have to go it alone, embrace some of the Republican ideas, but essentially go with a Democratic plan.
JULIE ROVNER: Well, I think that what’s happened to Senator Baucus is that he is starting to feel a little bit of backlash from his Democrats on the committee who are worried that the Bill is not generous enough, particularly with these subsidies. Now, this is important. There is going to be an individual mandate in this Bill. People will be required to have insurance. Now, people who don’t earn a lot of money will get help from the government. That is actually what causes it to cost so much and small businesses will get help. There will be a business mandate, too. Small businesses will get help to help provide insurance for their employees, but certainly if you are going to be required to have insurance, there are going to have to be generous subsidies and there is concern that those subsidies are not generous enough. For example, in the proposal that we saw last week from Senator Baucus, people would have to pay up to 13 percent of their income on health insurance. That is a lot of money and there is a lot of concern about that. There is also concern about how generous the packages actually are. Spelled out in these packages, I think there is a gold, silver and bronze package, and they would be, there are these actuarial equivalences but some of them would be I think only about 50 or 60 percent of what the federal workers, Blue Cross standard option, Blue Cross Blue Shield plan, that is not such a generous package that you might end up spending 13 percent of your income on, so there is a bit of worry from some Democrats that people might be required to spend a lot of money and get not so generous a plan for it. So, when you bring down the overall cost of the package, there is a question of are you getting value for money in terms of what you are requiring people to buy?
JACKIE JUDD: Let’s go back to the process for a moment. Once the Senate Finance Committee reports a Bill out, it then needs to be blended with what the HELP committee did on the Senate side. When that happens, do the doors open wide again to all of the controversy we have been reporting on in the past few months?
MARY AGNES CAREY: I think it continues throughout the floor debate. I mean, let’s not forget once it goes to the Senate floor and the same can be true of once the House Bill goes to the House floor, you could have an amendment process. You could have the Bill changed. I think opponents of the Bill, whether they have focused on immigration or abortion or as Julie is talking about, the affordability for people, the generous or non-generousness if you will of the benefits, all those things will continue to dominate the debate. That is how opponents will seize upon those during floor debate to try to stop the Bill.
JULIE ROVNER: I think that will be much more true in the Senate than in the House.
MARY AGNES CAREY: That is true.
JULIE ROVNER: Obviously where they will circumscribe the amendments that can be offered, I think it’s much easier to control the debate in the House because of the rules committee.
MARY AGNES CAREY: You are exactly right.
JULIE ROVNER: But in the Senate, certainly it is an interesting question, how they will merge these two Bills, how long they will let debate go on. Everyone seems to think that they will try to back it up to some kind of a break, probably the Columbus Day break, if they can get it to the floor that soon. Worst case scenario to the Thanksgiving recess, or the Veteran’s Day break, Christmas.
ERIC PIANIN: The timing will be very interesting and typically the House takes the lead on major measures like this, but there seems to be a desire to pull back a little in the House and just see what emerges from the Finance Committee and what eventually goes to the floor. A lot of members of the House, Democrats in particular, harken back to previous major votes on legislation where Democrats sort of went out on a limb, voted for something that the Senate immediately discarded and went in a different direction, and Democrats paid the price. I don’t think that they want to stick their necks out quite so much now. It is clear that the liberal Democrats in the House are very adamant in support of a public option approach to providing insurance, but there is just no support for that in the Senate and I think this time around the Senate may have to take the lead and then the House may come along.
JACKIE JUDD: You know what’s been so interesting about our conversation today is that we haven’t said much about President Obama’s speech in Congress last week. Did it move the needle? Did what he propose have a meaningful effect on Congress in the way that he wanted it? And on Americans?
ERIC PIANIN: Well I think that it had somewhat of a calming effect after the craziness if you will of August and all the outrageous claims.
JACKIE JUDD: The Town Hall meetings.
ERIC PIANIN: And angry statements made about the health care plan that got a lot of attention on cable TV and all that, and so I think it was useful for the President to sort of refocus the discussion and ask for perhaps a more civil tone to the conversation but the polling since then indicates that many Americans are still very skeptical of the President’s plan. The country is still very much divided on the question of whether or not congress should even go ahead and approve a major Bill this year and I think it’s true that people feel a little more comfortable with it if you drop the public option from the mix, but still there are many Americans who feel that this would make things worse, not better.
JULIE ROVNER: I think I’m a little more positive about what it did. I think it did what the President wanted. It stopped the bleeding from August. It made a lot of people a lot more comfortable. I think it made a lot of the moderates in Congress, both in the House and the Senate, a lot more comfortable. I think it really did put the debate back on track and that’s why I think we are talking about what the House is going to do and what the Senate is going to do. It put the legislative debate back, front and center and got us talking about these serious issues.
JACKIE JUDD: The substance.
JULIE ROVNER: The substance, the serious issues that need to be debated when you’re debating a Bill to change or fix the economy and I think it got us off sort of the tangential issues about death panels and maybe a little bit about illegal immigrants and to these issues, these big issues of affordability and how you structure it and the tradeoffs between how much you spend and how much you get.
JACKIE JUDD: And speaking of affordability, there was news just this morning before we spoke about the cost of health insurance for many Americans. Fill us in.
JULIE ROVNER: Yes the annual Kaiser Foundation Health Research and Educational Trust Survey of employers came out and once again we see the cost of employer provided insurance goes up this year. Family policy, the price of a family policy tripped the $13,000 a year threshold. It was a relatively small increase at about 5 percent but just this inexorable march upwards.
JACKIE JUDD: And much more that inflation.
JULIE ROVNER: Yes, absolutely. Every year, much more than inflation. I think under current trends, I think in the year 2019 the cost of a family policy would be about $30,000 so the numbers sort of boggle the mind. The President gets up and talks about why it’s almost impossible to do nothing, the idea of going out and having to buy your own family policy for $30,000 a year.
JACKIE JUDD: It is daunting.
JULIE ROVNER: Yes it is kind of daunting.
JACKIE JUDD: Okay thank you all, as always. See you next week. And thank you for joining us. I’m Jackie Judd.