Outside the Beltway

Senate Health Reform Bill Secured?

James Joyner · Sunday, December 20, 2009 · 1 comment

Senate Majority Leader Harry Reid (D-NV) (R) wipes his eyes as he and Senator Max Baucus (D-MT) (L) address senate health care legislation at the US Capitol in Washington December 19, 2009. U.S. Senate Democrats reached a compromise on Saturday with holdout Senator Ben Nelson that secured the 60 votes they need to pass the broad healthcare overhaul sought by President Barack Obama. (Reuters Pictures)

My late evening was going well. The struggling Dallas Cowboys had somehow overcome their annual December swoon and were leading the theretofore unbeaten New Orleans Saints by three touchdowns early in the fourth quarter. The Saints scored two quick touchdowns and the Cowboys’ basket case kicker Nick Folk missed a chip shot field goal but the Cowboys held on, keeping their playoff hopes alive. The underdog Senate Republicans, however, did not fare so well.

Majority Leader Harry M. Reid (D-Nev.) secured the pivotal 60th vote after acceding to the demands of Sen. Ben Nelson (D-Neb.) for tighter restrictions on insurance coverage for abortions, along with increased federal aid for his home state and breaks for favored health-care interests.

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GOP leaders, who have vowed to use every available tactic to keep the measure from advancing, invoked a rarely used Senate rule to require that the entire 383-page package of amendments introduced by Reid Saturday morning be read aloud on the floor, a process that consumed about seven hours. But Republicans were running out of options in their quest to derail the overhaul. Securing Nelson’s support allows Reid to maneuver the legislation through a complex parliamentary minefield without obstruction. A bloc of 60 votes is the exact number required to choke off the filibuster, the Senate minority’s primary source of power, and the GOP’s best hope of defeating the bill.

Unless the GOP yields and the vote comes sooner, the bill is expected to pass in a final Senate vote at 7 p.m. on Christmas Eve. Negotiations to merge the bill with the House version would begin early next month.

Many liberals, however, were bitterly disappointed with the bargains Reid struck to win support from moderates in his caucus, any member of which could demand alterations in exchange for his or her support. Democratic leaders dropped a government insurance option and the idea of expanding Medicare to younger Americans. Reid also omitted language that would have eliminated the federal antitrust exemption for health insurers — another nonstarter for Nelson.

Being the last vote has some great perks:

Nelson also secured full and permanent federal funding for his state to extend Medicaid eligibility to everyone below 133 percent of the federal poverty level. The bill would require all states to do so, but Nebraska alone would not be required to pay a portion of the additional cost after 2016. And he won concessions for some nonprofit insurers and for providers of supplemental Medicare coverage from a new insurance tax, and he was able to roll back cuts to health savings accounts.

Other Democrats also won important changes. Reid added $10 billion for community health centers to provide services to low-income people. That funding had been a top priority for Sen. Bernard Sanders (I-Vt.), a liberal champion of the public option.

The exact provisions of the bill are murky but these are the details WaPo is reporting:

The revised Senate bill would require every American for the first time to obtain insurance or face a financial penalty for failing to do so. Those without access to affordable coverage through an employer would be eligible to apply for federal subsidies and shop for coverage in the new state-based exchanges, starting in 2014.

The legislation would allow private firms for the first time to offer insurance policies to all Americans across state lines on the exchanges. Those plans would be negotiated through the Office of Personnel Management, which handles health coverage for federal workers and members of Congress.

Starting immediately, insurers would be barred from denying coverage to children with preexisting conditions. A total ban on the practice would take effect in 2014. Lifetime limits on coverage would be banned, and annual limits would be restricted until 2014, when they, too, would be banned entirely.

Insurers would be required to justify rate increases, and patients would have the right to appeal denials of claims to an independent state board. All insurance companies would be required to spend at least 80 cents of every dollar they collect in premiums on delivering care to customers.

All but the smallest employers would face fines of as much as $750 per worker if even one employee sought federal help to buy a policy. But at the behest of other Democratic skeptics, including Sens. Mary Landrieu (La.) and Blanche Lincoln (Ark.), Reid made changes to offer additional assistance to small businesses.

There’s still hope for a Republican comeback here, as reconciling the House and Senate versions will be arguably more difficult than what the Senate has already gone through.  The Post has a nifty interactive graphic you can play with to compare the House and Senate bills.   The House bill is projected to cost $1.052 trillion compared to a measly $871 billion for the Senate version over the next decade.   The former would cover 17 million and the latter 23 million additional uninsured out of the 54 million projected for 2019.  The mandates and funding provisions are radically different. Considering how much logrolling had to be done to get 60 votes, it’s going to be next to impossible to keep it all together.

The National Organization for Women (NOW) has already come out against passage, saying “The so-called health care reform bill now before the Senate, with the addition of Majority Leader Harry Reid’s Manager’s Amendment, amounts to a health insurance bill for half the population and a sweeping anti-abortion law for the rest of us.”  And Democratic Congressman Bart Stupak calls the Senate abortion language “unacceptable” — for the opposite reasons.  According to Brian Beutler, “Unlike the so-called Stupak language in the House, Nelson’s abortion language would not forbid people who receive subsidy assistance from the federal government from buying insurance policies that cover abortion. However, according to Nelson, the money that pays for each such policy will have to be separated into two pools–one that pays for the abortion coverage, and one for all other services.” And Nelson may still take his ball and go home.  He’s vowed, “If there are material changes in that conference report, different from this bill, that adversely affect the agreement, I reserve the right to vote against the next cloture vote–let me repeat it–I reserve the right to vote against the next cloture vote if there are material changes to this agreement in the conference report. And I will vote against it if that is the case.”

The bottom line, though, is that failure to put together a viable compromise bill would be a Democratic loss rather than a Republican victory.  The Senate has already demonstrated that it can pass the measure without a single Republican vote and that’s always the case for the majority in the House.   So the GOP can only hope the Democrats miss the equivalent of a 24-yard field goal with 2:16 to play.