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Health On The Hill – After the Senate Vote

KHN’s Mary Agnes Carey calls in from Capitol Hill to discuss next steps, now that Senators have passed a health care bill.

Listen to the interview

 (.mp3) or read the transcript below.

Simone Vozzolo: Good day, I’m Simone Vozzolo and this is Health On The Hill, a conversation about health care policy and politics. With me today is Mary Agnes Carey of Kaiser Health News. And there is breaking news on Capitol Hill – Senate passage of health care legislation. Mary Agnes, the Senate has passed sweeping health reform legislation. Can you give us a picture of what went on this morning?

Mary Agnes Carey: It was a very dramatic moment. There was a debate that took place in the Senate chamber about 7 in the morning on Christmas Eve. Very, very rare circumstance for the Senate to be in on Christmas Eve. There were closing speeches given by both Majority Leader Harry Reid and Mitch McConnell, who is the Minority Leader from Kentucky. And they’ve pretty much followed the same pattern we’ve had during the 25 days of Senate debate. Sen. Reid said, this is a bill about people not about politics. It will provide relief to people who struggle with their insurance companies, who can’t afford health insurance, and it’s basically a very good deal for America.

Sen. McConnell, the Republican leader, talked about how the bill, in his view, does not control costs, will hurt the Medicare program, will make things worse for Americans, and he predicted that, as Democrats head home for their holiday break, they’re going to get an earful of criticism. Of course, Sen. Reid suggested that will be an earful of praise and not criticism because he believes, as many of the Democrats believe, that the bill is a good deal. So, it was a very majestic moment for the Senate.

Democrats talked about Sen. Edward Kennedy, who died this year of brain cancer, about how they evoked his memory. Robert Byrd, who is a Democrat from West Virginia, as he cast his vote said, “this is for my friend Ted Kennedy,” and he voted for the bill. And many members talked about how they could hear the voice of Ted Kennedy, Sen. Reid talked about booming in their ears. And so health care legislation was a top priority for Sen. Kennedy, and so I think this day a lot of people were talking about him. His widow was here. She talked about how when she heard Sen. Byrd mention her late husband’s name, it brought tears to her eyes. The galleries were full of observers.

Vice President Joe Biden was there in the chair overseeing the Senate – he was formerly a senator. And so it was a very dramatic moment. It went past pretty quickly and by about 7:15, 7:20 the vote was done. There were a lot of handshakes on the floor. But I think it is certainly a day that will go down in history in the Senate.

Simone Vozzolo: Now that the bill is passed, what’s next?

Mary Agnes Carey: House and Senate Democratic leaders have to resolve differences between those two bills. Typically, there’s a formal conference committee that does this, but time is of the essence here. There had been hopes earlier in the week that maybe a bill could be sent to the president’s desk by the State of the Union, which is typically the end of January or possibly early February. That seems in doubt now. I think members are tired, staff’s tired. Sen. Max Baucus, head of the Finance Committee, just told several reporters that there will be calls next week back and forth with members. But I think you can expect staff negotiations to begin in earnest probably early in January the 4th, on that Monday when the holidays are behind us. And I think members will continue to negotiate and they will try to move a package as fast as possible. But we have to see whether it’s a full conference or most of this negotiation is done at the leadership level between the House and Senate.

Simone Vozzolo: What are some of the key differences between the House and Senate versions of health care?

Mary Agnes Carey: There are a lot of major differences here. Financing, for one. For example, in the Senate bill, they would increase the Medicare payroll tax on high-wage earners; they would place a tax on some of the highest cost health insurance plans.

In the House, they would put an excise tax on individuals who make over $500,000 dollars a year and couples who make over a million dollars a year, so that is a significant difference. On abortion, the chambers take different approaches. In the Senate, a state legislature, as they can in current law, could pass a law saying we will not allow abortion services to be covered in the exchange. And if abortion services were covered in an exchange plan, the beneficiary of that policy would have to write two separate checks, one for the health insurance policy and one for the abortion coverage. In the House, the language is more onerous. It would not allow health insurance plans in the exchanges to cover abortion services or allow the public plan option to cover abortion services.

Moving to the public plan, that’s a key difference between the chambers. The Senate does not have a public plan, instead they would have the Office of Personnel Management, known as OPM. They oversee health insurance benefits for the members of Congress and federal employees. They would negotiate national plans to be offered in the exchanges. There is a government-run public plan in the House bill. That’s going to be a key dividing line between the chambers.

Simone Vozzolo: You’ve mentioned there might be a House-Senate conference. When might those discussions produce a bill?

Mary Agnes Carey: It’s unclear at this point, because a lot will depend on where they can find common ground. Of course, there have been discussions ongoing; everyone knows the differences between the two bills. And so it depends, I think, how quickly they want to strike a deal.

John Dingell, Democrat of Michigan, head of the Energy and Commerce Committee for years – he’s the dean of the House Democrats – was on the Senate side this morning. After the vote, he was saying that he predicted his folks would come together. People know this is a critical moment, Democrats in the House, and that they will resolve their differences. The conventional wisdom now is that the House bill, many of the House elements will have to go by the wayside, because they won’t fly in the Senate.

For example, the public plan. Not popular in the Senate by enough members to have it pass. The tax on the higher wage folks, that is not popular in the House. And so, if House members decide that they will swallow hard and move this bill along, things could happen quickly. But I think you can expect House members to want to weigh in, exercise their prerogative and do everything they can to have that final package resemble a lot of what they’ve pushed for in their chamber’s bills.

Simone Vozzolo: Thanks for the update, Mary Agnes. I’m Simone Vozzolo and this has been Health On The Hill.

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