Reid Maneuvers to Pass Reform Bill
Changes expected as offstage dealings take shape in Senate
by Jerry Geisel
WASHINGTON—Health care reform legislation has moved to the Senate floor, but the most significant activity is happening behind closed doors.
The Senate last week opened debate on a reform bill put together by Majority Leader Harry Reid, D-Nev., melded from differing measures previously approved by the Finance and Health, Education, Labor and Pensions committees.
The process moved slowly, with the Senate considering just a handful of amendments, rejecting one by Sen. John McCain, R-Ariz., to gut the package’s funding by stripping out Medicare spending reductions and approving another by Sen. Barbara Mikulski, D-Md., to improve access to mammograms by women younger than 50.
But the most significant action, Washington observers say, is happening behind the scenes, not on the Senate floor.
Sen. Reid, they say, is brokering deals with members to gain the 60 votes he needs to stop debate on the Senate floor.
Those deals will be incorporated in a new reform bill—called a manager’s amendment—which the Senate then would consider, probably next week.
“The real work in fashioning an acceptable compromise in the Senate is going on behind closed doors. They want to accommodate most senators in the modified bill” expected to be introduced later, said Frank McArdle, a consultant with Hewitt Associates Inc. in Washington.
Experts agree that Sen. Reid does not yet have the 60 votes he needs to halt debate and vote on a bill, but they also are certain that Sen. Reid will get the necessary support through back-room deals.
“Sen. Reid will do whatever he needs to do to lock in the votes necessary to win passage,” said Paul Dennett, senior-vp health care reform with the American Benefits Council in Washington.
Already, Sen. Reid has made deals to win the support of recalcitrant senators. For example, after Sen. Mary Landrieu, D-La., refused to commit to vote to bring the legislation to the floor, Sen. Reid agreed to support modifying the measure to give Louisiana an extra $300 million in Medicaid funding. Sen. Landrieu then said she would vote to move the bill, with her support giving Sen. Reid the crucial vote required to begin debate.
Much of the back-room maneuvering now involves a provision in the measure to create a public option, or government-run health insurance plan, offered by state health insurance exchanges that the legislation would establish. Under the bill, states would be permitted to opt out of government plan.
But several moderate Democrats, as well as Connecticut Independent Sen. Joe Lieberman, whose support Sen. Reid needs on a vote to stop debate, have said they will not vote for the legislation if it contains a public option.
Negotiations have started to modify the public option to win support of Sen. Lieberman and the Democrats opposed to it, without triggering a revolt by Senate Democrats strongly in favor of a public option.
Under one possible compromise floated previously, Washington observers say the public option would be triggered only if certain conditions were met, such as exceptionally high health insurance cost increases in a state.
On the other hand, experts do not expect much negotiating on issues of concern to employers. Those issues include a new 40% excise tax on health insurance plans whose annual costs exceed $8,500 for single coverage and $23,000 for family coverage starting in 2013 and a financial penalty on employers if their health care plans fail an employee affordability test.
Experts say those issues likely will be ironed out after the Senate passes the legislation and a House and Senate conference committee is set up to work out differences in the two bills.
Observers say it is likely that the Senate will complete action on the legislation by Christmas, which Sen. Reid pledged again last week.
“We’re going to do our very utmost to complete health care reform before the end of the year,” Sen. Reid said during a briefing with reporters last week.
“Democrats do not want a bill dangling over the holidays,” said Gretchen Young, vp-health policy for the ERISA Industry Committee in Washington.
But assuming conferees can work out differences, final passage of health care reform legislation is not likely until next year.
“I just don’t see—given the deep, fundamental differences in the two bills—how a final bill can be passed any sooner than February,” said Chantel Sheaks, a principal with Buck Consultants L.L.C. in Washington.
While there are significant differences, the House and Senate measures share many similar features. For example, the Senate version would raise revenue through the excise tax on costly health insurance plans, while the House bill would impose new taxes on higher-income individuals.
The heart of the two bills is identical: providing federal health insurance premiums to the lower-income uninsured and moving the United States much closer to universal health insurance coverage.
The measures also would penalize employers that don’t offer health insurance coverage as well as individuals who don’t enroll in a health insurance plan.
Additionally, the measures would reform the personal lines markets to eliminate practices such as insurers denying coverage for individuals’ pre-existing medical conditions.
