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Health On The Hill – November 19, 2009

Jackie Judd, Kaiser Family Foundation; Mary Agnes Carey, Kaiser Health News

Senate debate could begin later this week on an $849 billion health care bill Senate Majority Leader Harry Reid, D-Nev., unveiled Wednesday. The measure, once fully implemented, would extend health care coverage to 31 million uninsured Americans and reduce the deficit by 127 billion over the next decade, according to CBO estimates.

Listen to Audio interview (.mp3)


Jackie Judd: Good day, I’m Jackie Judd, and this is Health on the Hill. Last night, Senate Majority Leader Harry Reid finally unveiled a health care reform bill that he plans to shortly bring to the Senate floor. The price tag is about $850 billion dollars over 10 years, and an estimated 31 million Americans currently uninsured would get coverage. Mary Agnes Carey of Kaiser Health News has been pouring over some 2,000 pages of this bill. Mary Agnes, good morning. What are the major provisions that get Reid to those numbers I just described?

Mary Agnes Carey: Well he has an array of financing and coverage provisions to hit the targets you just mentioned. For example, on financing. The bill would place an excise tax of about 40 percent on some of these high-cost health insurance plans. But he raised that threshold to help appease unions, many of whom have members who have these plans and have taken these health insurance plans in lieu of salary increases. That threshold would be raised to about $8500 dollars for a plan for an individual and about $23,000 dollars for a plan that covers a family.

Jackie Judd: And raised from what the Senate Finance Committee bill had said.

Mary Agnes Carey: Exactly, the level originally was about $8,000, and then $21,000 with some exceptions put in committee for high-risk professions. There’s also a new tax on elective cosmetic surgery, a 5 percent tax that would be collected by providers but levied on the cost of that surgery. There’s also an increase in the Medicare payroll taxes for high income folks. And here we’re talking about individuals who make about $200,000 dollars a year and couples who make about $250,000 dollars a year. So we had to make some changes in financing to get the deficit reduction numbers and the price tag you talked about earlier. There’s a lot of market reforms that have been talked about on both sides of the Capitol. A ban on preexisting conditions, a ban on the practice of rescission, which is canceling the health insurance coverage when someone gets sick. No lifetime or annual caps. As far as mandates go, there would be an individual mandate, but it would be significantly weaker than what’s in the House package. For example, it would start in 2014, where most people would have to have coverage or pay a penalty of about 95 dollars.

Jackie Judd: And again, that’s a delay from 2013, which has been in other bills?

Mary Agnes Carey: Yes, there’s been several provisions, you mention in that example, the public option being delayed, the exchanges being delayed, the subsidies being delayed. That’s been pushed back a year as the individual mandate would be. There’s no employer mandate, but if you’re a company and have more than 50 workers, and they’re getting subsidies to help purchase coverage in an exchange, you could face a fine of $750 per employee. So they’re trying to take steps on the individual mandate to get folks in, to try to encourage employers to offer coverage without mandating it to help accomplish all the bill’s goals.

Jackie Judd: And regarding the public option, the plan is that states could opt out of it, correct?

Mary Agnes Carey: That is correct, but a state legislature would have to act for the state to opt out. But this is the language that Sen. Reid had said a few weeks ago, he wanted to include in the bill. And he in fact did include the opt out provision.

Jackie Judd: Now one of the trickiest issues, at this moment anyway, was what they were going to do with language regarding the funding of abortion.

Mary Agnes Carey: Exactly. They’re stipulating that no federal money could be used for abortion services in the health insurance exchanges. There would have to be a plan that covers abortion services, a plan that does not. If the secretary of Health and Human Services decided to cover abortion in the public option, the secretary would have to certify that no public money would be used. So this not as stringent as the language that’s used in the House. Abortion rights proponents, Barbara Boxer, for example, of California, feels this strikes the right balance. And they’re hoping that this is the abortion language that remains in the final deal.

Jackie Judd: Mary Agnes, does Sen. Reid currently have the votes to get this through the Senate?

Mary Agnes Carey: Well, that’s extremely unclear. The first time we’ll see on this could come as early as Saturday, on a motion to proceed, a motion for the Senate to begin to go to the bill. You could see Democrats who may have some discomfort with the package, Ben Nelson of Nebraska is one, may decide to go ahead and vote on the motion to proceed. Or Joe Lieberman, an independent from Connecticut, may decide to vote yes on the motion to proceed, to get the debate going. But it’s unclear whether or not they will be with Sen. Reid at the bill’s passage. But let’s remember there’s a long time between when they begin the debate, and the final passage. Republicans in the Senate have said they want an extremely lengthy debate for weeks if not more on the bill, so there’s plenty of time if a member is concerned about a provision to try to amend the bill or change it.

Jackie Judd: And what is the time table that Reid would like to see?

Mary Agnes Carey: Well they’re still hoping — they being Senate Democrats, House Democrats and the White House, are hoping to get a bill by President Obama’s desk by the end of the year. It is an extremely difficult hurdle to make because you have to have Senate passage of a bill, you have to have differences reconciled between the House and Senate, and that conference package passed again in both chambers and sent to the president. One possible scenario here is making modifications to the Senate bill that would get it more in line with the House bill, if you have support in the Senate, that was extremely unclear that was the case. But if you have a Senate package passed that’s pretty close, that could speed a conference and get things moving faster, but we’re just going to have to wait and see.

Jackie Judd: OK, thank you so very much, Mary Agnes Carey, of Kaiser Health News. I’m Jackie Judd.

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